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Bao Y, Chen X, Li Y, Yuan S, Han L, Deng X, Ran J. Chronic Low-Grade Inflammation and Brain Structure in the Middle-Aged and Elderly Adults. Nutrients 2024; 16:2313. [PMID: 39064755 PMCID: PMC11280392 DOI: 10.3390/nu16142313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Low-grade inflammation (LGI) mainly acted as the mediator of the association of obesity and inflammatory diet with numerous chronic diseases, including neuropsychiatric diseases. However, the evidence about the effect of LGI on brain structure is limited but important, especially in the context of accelerating aging. This study was then designed to close the gap, and we leveraged a total of 37,699 participants from the UK Biobank and utilized inflammation score (INFLA-score) to measure LGI. We built the longitudinal relationships of INFLA-score with brain imaging phenotypes using multiple linear regression models. We further analyzed the interactive effects of specific covariates. The results showed high level inflammation reduced the volumes of the subcortex and cortex, especially the globus pallidus (β [95% confidence interval] = -0.062 [-0.083, -0.041]), thalamus (-0.053 [-0.073, -0.033]), insula (-0.052 [-0.072, -0.032]), superior temporal gyrus (-0.049 [-0.069, -0.028]), lateral orbitofrontal cortex (-0.047 [-0.068, -0.027]), and others. Most significant effects were observed among urban residents. Furthermore, males and individuals with physical frailty were susceptive to the associations. The study provided potential insights into pathological changes during disease progression and might aid in the development of preventive and control targets in an age-friendly city to promote great health and well-being for sustainable development goals.
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Affiliation(s)
- Yujia Bao
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (Y.B.); (X.C.); (Y.L.); (S.Y.)
| | - Xixi Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (Y.B.); (X.C.); (Y.L.); (S.Y.)
| | - Yongxuan Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (Y.B.); (X.C.); (Y.L.); (S.Y.)
| | - Shenghao Yuan
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (Y.B.); (X.C.); (Y.L.); (S.Y.)
| | - Lefei Han
- School of Global Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
| | - Xiaobei Deng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (Y.B.); (X.C.); (Y.L.); (S.Y.)
| | - Jinjun Ran
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
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Amaral R, Jacinto T, Malinovschi A, Janson C, Price D, Fonseca JA, Alving K. The influence of individual characteristics and non-respiratory diseases on blood eosinophil count. Clin Transl Allergy 2021; 11:e12036. [PMID: 34123365 PMCID: PMC8175041 DOI: 10.1002/clt2.12036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 11/07/2022] Open
Abstract
Background Blood eosinophil (B-Eos) count is an emerging biomarker in the management of respiratory disease but determinants of B-Eos count besides respiratory disease are poorly described. Therefore, we aimed to evaluate the influence of non-respiratory diseases on B-Eos count, in comparison to the effect on two other biomarkers: fraction of exhaled nitric oxide (FeNO) and C-reactive protein (CRP), and to identify individual characteristics associated with B-Eos count in healthy controls. Methods Children/adolescents (<18 years) and adults with complete B-Eos data from the US National Health and Nutritional Examination Surveys 2005-2016 were included, and they were divided into having respiratory diseases (n = 3333 and n = 7,894, respectively) or not having respiratory disease (n = 8944 and n = 15,010, respectively). After excluding any respiratory disease, the association between B-Eos count, FeNO or CRP, and non-respiratory diseases was analyzed in multivariate models and multicollinearity was tested. After excluding also non-respiratory diseases independently associated with B-Eos count (giving healthy controls; 8944 children/adolescents and 5667 adults), the independent association between individual characteristics and B-Eos count was analyzed. Results In adults, metabolic syndrome, heart disease or stroke was independently associated with higher B-Eos count (12%, 13%, and 15%, respectively), whereas no associations were found with FeNO or CRP. In healthy controls, male sex or being obese was associated with higher B-Eos counts, both in children/adolescents (15% and 3% higher, respectively) and adults (14% and 19% higher, respectively) (p < 0.01 all). A significant influence of race/ethnicity was also noted, and current smokers had 17% higher B-Eos count than never smokers (p < 0.001). Conclusions Non-respiratory diseases influence B-Eos count but not FeNO or CRP. Male sex, obesity, certain races/ethnicities, and current smoking are individual characteristics or exposures that are associated with higher B-Eos counts. All these factors should be considered when using B-Eos count in the management of respiratory disease.
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Affiliation(s)
- Rita Amaral
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine University of Porto Porto Portugal.,Department of Cardiovascular and Respiratory Sciences Porto Health School Polytechnic Institute of Porto Porto Portugal.,Department of Women's and Children's Health Paediatric Research Uppsala University Uppsala Sweden.,MEDCIDS- Department of Community Medicine, Information, and Health Sciences Faculty of Medicine University of Porto Porto Portugal
| | - Tiago Jacinto
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine University of Porto Porto Portugal.,Department of Cardiovascular and Respiratory Sciences Porto Health School Polytechnic Institute of Porto Porto Portugal
| | - Andrei Malinovschi
- Department of Medical Sciences Clinical Physiology Uppsala University Uppsala Sweden
| | - Christer Janson
- Department of Medical Sciences Respiratory, Allergy and Sleep Research Uppsala University Uppsala Sweden
| | - David Price
- Observational and Pragmatic Research Institute Singapore Singapore.,Division of Applied Health Sciences Centre of Academic Primary Care University of Aberdeen Aberdeen UK
| | - João A Fonseca
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine University of Porto Porto Portugal.,MEDCIDS- Department of Community Medicine, Information, and Health Sciences Faculty of Medicine University of Porto Porto Portugal
| | - Kjell Alving
- Department of Women's and Children's Health Paediatric Research Uppsala University Uppsala Sweden
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Cecoro G, Annunziata M, Iuorio MT, Nastri L, Guida L. Periodontitis, Low-Grade Inflammation and Systemic Health: A Scoping Review. ACTA ACUST UNITED AC 2020; 56:medicina56060272. [PMID: 32486269 PMCID: PMC7353850 DOI: 10.3390/medicina56060272] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
Background and objectives: Periodontitis is a multifactorial chronic inflammatory infectious disease in which an infection is necessary, but not sufficient, for development of the condition. Individual susceptibility strictly linked to the immune and inflammatory response of the organism must also be present. Low-grade inflammation (LGI) is a systemic status of chronic sub-clinical production of inflammatory factors. This condition represents a risk factor for many chronic diseases including diabetes, cardiovascular disease, cerebrovascular disease, neurodegenerative disease and cancer. This scoping review aims to clarify, summarize and disseminate current knowledge on the possible link between periodontitis, LGI and systemic health. Materials and Methods: PRISMA Extension for Scoping Reviews guidelines were followed. An ad-hoc created keyword string was used to search the electronic databases of PubMed/Medline, Embase, The Cochrane Library and ClinicalTrials.gov. A hand search of specialized journals and their reference lists was also performed. Results: 14 studies that respected eligibility criteria were selected and analyzed. There is emerging evidence of strong links between periodontitis, LGI and systemic health. On the one hand, periodontitis influences the systemic status of LGI and on the other hand, the systemic production of inflammatory factors affects periodontitis with a bidirectional connection. Conclusions: LGI and the subsequent onset of a systemic inflammatory phenotype can be considered the common substrate of many chronic inflammatory diseases including periodontitis, with multiple mutual connections between them. Understanding of the biological principles and mechanisms underlying such a complex interrelationship could lead to significant improvements in the field of personalized diagnostics and therapeutic protocols.
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Norde MM, Fisberg RM, Marchioni DML, Rogero MM. Systemic low-grade inflammation-associated lifestyle, diet, and genetic factors: A population-based cross-sectional study. Nutrition 2019; 70:110596. [PMID: 31743813 DOI: 10.1016/j.nut.2019.110596] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/24/2019] [Accepted: 08/25/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Systemic low-grade inflammation (SLGI) is an intermediary common condition to the physiopathology of chronic noncommunicable diseases and targeting its determinants could lead to more efficient public health strategies. We aimed to investigate SLGI-independent associations with lifestyle, diet, and genetic factors in a population-based sample of adults using a systemic low-grade inflammation score (SIS). METHODS The study sample is composed of 269 participants from the cross-sectional population-based Health Survey of Sao Paulo (2008-2010), ages 20 to 59 y, whose data on socioeconomic variables, lifestyle, health parameters, and blood samples were available. Diet was assessed by two 24-h recalls, and the Brazilian Health Eating Index-Revised (BHEI-R) was scored. From blood samples, 30 single nucleotide polymorphisms on inflammatory genes were genotyped, and plasma eleven inflammatory biomarkers levels that composed the SIS were determined. A multiple, stepwise, linear regression was used to investigate SIS-independent associated factors. RESULTS Factors independently associated with SIS were BHEI-R score (partial R² = 5.1; β = -0.13; P = 0.003), body mass index (partial R² = 3.4; β = 0.19; P = 0.001), TLR4 rs5030728 GA + AA genotype (partial R² = 3.1; β = -1.37; P = 0.008), age 50 to 59 y (partial R² = 2.5; β = 1.93; P = 0.029) in comparison with the reference category (20 to 29 y), and commuting physical activity >150 min/wk (partial R² = 2.2; β = -1.29; P = 0.043) after adjustment for current smoking status, medication use, and dietary misreporting. CONCLUSIONS Eating a lower quality diet, having a higher body mass index score and age, being GG homozygous for TLR4 rs5030728, and spending <150 min/wk in transportation physical activity are independent determinants of SLGI.
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Affiliation(s)
- Marina M Norde
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo City, SP, Brazil
| | - Regina M Fisberg
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo City, SP, Brazil
| | - Dirce M L Marchioni
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo City, SP, Brazil
| | - Marcelo Macedo Rogero
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo City, SP, Brazil.
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Li ZH, Zhong WF, Lv YB, Kraus VB, Gao X, Chen PL, Huang QM, Ni JD, Shi XM, Mao C, Wu XB. Associations of plasma high-sensitivity C-reactive protein concentrations with all-cause and cause-specific mortality among middle-aged and elderly individuals. IMMUNITY & AGEING 2019; 16:28. [PMID: 31708993 PMCID: PMC6833146 DOI: 10.1186/s12979-019-0168-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/16/2019] [Indexed: 01/28/2023]
Abstract
Background The association of high-sensitivity C-reactive protein (hsCRP) with mortality is controversial. We aimed to investigate the associations of hsCRP concentrations with the risks of all-cause and cause-specific mortality and identify potential modifying factors affecting these associations among middle-aged and elderly individuals. Methods This community-based prospective cohort study included 14,220 participants aged 50+ years (mean age: 64.9 years) from the Health and Retirement Study. Cox proportional hazard models were employed to estimate the associations between the hsCRP concentrations and the risk of all-cause and cause-specific mortality with adjustment for sociodemographic and lifestyle factors, self-reported medical history, and other potential confounders. Results In total, 1730 all-cause deaths were recorded, including 725 cardiovascular- and 417 cancer-related deaths, after an 80,572 person-year follow-up (median: 6.4 years; range: 3.6–8.1 years). The comparisons of the groups with the highest (quartile 4) and lowest (quartile 1) hsCRP concentrations revealed that the adjusted hazard ratios and 95% confidence intervals were 1.50 (1.31–1.72) for all-cause mortality, 1.44 (1.13–1.82) for cardiovascular mortality, and 1.67 (1.23–2.26) for cancer mortality. The associations between high hsCRP concentrations and the risks of all-cause, cardiovascular, and cancer mortality were similar in the men and women (P for interaction > 0.05). Conclusions Among middle-aged and older individuals, elevated hsCRP concentration could increase the risk of all-cause, cardiovascular, and cancer mortality in men and women.
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Affiliation(s)
- Zhi-Hao Li
- 1Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Wen-Fang Zhong
- 1Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Yue-Bin Lv
- 2National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Virginia Byers Kraus
- 3Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina USA
| | - Xiang Gao
- 4Department of Nutritional Sciences, Pennsylvania State University, University Park, PA USA
| | - Pei-Liang Chen
- 1Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Qing-Mei Huang
- 1Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Jin-Dong Ni
- 5Department of Epidemiology and Biostatistics, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Dongguan, Guangdong China
| | - Xiao-Ming Shi
- 2National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Mao
- 1Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515 Guangdong China
| | - Xian-Bo Wu
- 1Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515 Guangdong China
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Crotti G, Gianfagna F, Bonaccio M, Di Castelnuovo A, Costanzo S, Persichillo M, De Curtis A, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Body Mass Index and Mortality in Elderly Subjects from the Moli-Sani Study: A Possible Mediation by Low-Grade Inflammation? Immunol Invest 2018; 47:774-789. [PMID: 30422032 DOI: 10.1080/08820139.2018.1538237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The association between obesity and mortality in the elderly remains controversial. To test the association between BMI and mortality, with the hypothesis of a mediation by low-grade inflammation (LGI), a prospective study design (median follow-up 7.8 years) was used on a sample of 4,970 elderly subjects (age ≥ 65 years) from the Moli-sani Study cohort. The association between BMI categories and overall or cause-specific mortality (hazard ratio, HR) was calculated by multivariable Cox regression. Dose-response relationship was tested using restricted cubic splines. Interaction between BMI and LGI, assessed through high-sensitivity C-reactive protein (hs-CRP) and INFLA-score, was also tested. In comparison with normal-weight, overweight was significantly associated with a 20% (adjusted HR = 0.80; 95%CI 0.67-0.95) reduced risk of total mortality, while severe obesity (BMI > 40) with an increased risk (HR = 1.81; 95%CI 1.13-2.93). Cubic spline curves showed a U-shaped relationship between BMI and total mortality (p value for nonlinear relationship = 0.001). Similar results were found for cardio-cerebrovascular and other causes mortality. Hs-CRP and INFLA-score were associated with an increased risk of total mortality in adjusted analyses. Mediation analysis did not show any effect of LGI on the association between BMI and mortality. However, after stratification for LGI under or below the population median, greater LGI increased the risk of mortality in obese elderly more than expected (p for interaction = 0.04). A U-shaped association between BMI and mortality was observed in Italian elderly subjects. While the association was independent of LGI levels, there was a significant interaction between BMI and LGI in increasing mortality risk in obese elderly individuals.
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Affiliation(s)
- Giacomo Crotti
- a Research Center on Public Health, Department of Medicine and Surgery , University of Milano-Bicocca , Monza , Italy
| | - Francesco Gianfagna
- b Department of Epidemiology and Prevention , IRCCS Neuromed , Pozzilli (IS) , Italy.,c Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery , University of Insubria , Varese , Italy
| | - Marialaura Bonaccio
- b Department of Epidemiology and Prevention , IRCCS Neuromed , Pozzilli (IS) , Italy
| | | | - Simona Costanzo
- b Department of Epidemiology and Prevention , IRCCS Neuromed , Pozzilli (IS) , Italy
| | | | - Amalia De Curtis
- b Department of Epidemiology and Prevention , IRCCS Neuromed , Pozzilli (IS) , Italy
| | - Chiara Cerletti
- b Department of Epidemiology and Prevention , IRCCS Neuromed , Pozzilli (IS) , Italy
| | | | - Giovanni de Gaetano
- b Department of Epidemiology and Prevention , IRCCS Neuromed , Pozzilli (IS) , Italy
| | - Licia Iacoviello
- b Department of Epidemiology and Prevention , IRCCS Neuromed , Pozzilli (IS) , Italy.,c Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery , University of Insubria , Varese , Italy
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Lipid accumulation product in relation to 10-year cardiovascular disease incidence in Caucasian adults: The ATTICA study. Atherosclerosis 2018; 279:10-16. [PMID: 30366186 DOI: 10.1016/j.atherosclerosis.2018.10.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 10/06/2018] [Accepted: 10/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The lipid accumulation product (LAP) is an index describing lipid over-accumulation based on waist circumference (WC) and fasting triglycerides, and can outperform the body mass index (BMI) in recognizing cardiovascular disease (CVD) risk. We aimed to explore the association of LAP with long-term CVD risk and compare its CVD-predictive value against common anthropometric indices/ratios of obesity. METHODS ATTICA is a prospective, population-based cohort that recruited 3042 adults without pre-existing CVD from the Greek general population (age 18-89 years; 1514 men). The 10-year study follow-up (2011-2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). Baseline LAP (cm·mmol/L) was calculated and analyzed in relation to the 10-year CVD incidence. RESULTS In total, 317 CVD cases (15.7%) were documented during the follow-up. Baseline LAP showed a significant positive association with the 10-year CVD incidence, even after adjusting for hypertension, diabetes, hypercholesterolemia, smoking, physical activity, Mediterranean diet adherence, and key pro-inflammatory biomarkers (Hazard Ratios per 10 cm·mmol/L of LAP ranging from 1.1 to 1.21, p = 0.04). Moreover, LAP predicted the 10-year CVD study incidence better than common obesity indices (BMI, WC, waist-to-hip, waist-to-height ratio). CONCLUSIONS These findings support a positive association between LAP and long-term CVD incidence in CVD-free Caucasian adults from the general population.
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Bonaccio M, Pounis G, Cerletti C, Donati MB, Iacoviello L, de Gaetano G. Mediterranean diet, dietary polyphenols and low grade inflammation: results from the MOLI-SANI study. Br J Clin Pharmacol 2017; 83:107-113. [PMID: 26935858 PMCID: PMC5338145 DOI: 10.1111/bcp.12924] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/29/2016] [Indexed: 12/25/2022] Open
Abstract
Low grade inflammation is characterized by raised concentrations of inflammatory markers in the absence of any overt symptoms and is recognized as a risk factor for a number of chronic diseases including cancer, cardiovascular, cerebrovascular and neurodegenerative diseases. Many studies suggest that low grade inflammation is mitigated by health promoting behaviours such as healthy eating patterns, physical activity, body weight maintenance and tobacco cessation. To date, large scale studies were mainly focused on circulating markers and little evidence is available on cellular biomarkers. The MOLI-SANI study is a prospective cohort study that has recruited 24 325 men and women aged ≥35 years from the general population of the Molise Region, a Southern Italian area, with the purpose of investigating genetic and environmental risk/protection factors for cardiovascular and cerebrovascular disease and cancer. Within this cohort, a composite score of low grade inflammation based on the use of plasmatic (C-reactive protein) and cellular (leukocyte and platelet counts and granulocyte : lymphocyte ratio) biomarkers has been proposed and validated. This score accounts for all possible synergistic effects of such inflammatory markers, thus overcoming any potential bias linked to the multi-collinearity of these variables. Of notice, the MOLI-SANI study was the first to address the relationship between the traditional Mediterranean diet and platelet and leucocyte counts as emerging cellular biomarkers of low grade inflammation. The present review paper will discuss the main findings derived from the MOLI-SANI study on the association of low grade inflammation with a Mediterranean eating pattern, with a particular emphasis on the associated dietary polyphenols.
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Affiliation(s)
- Marialaura Bonaccio
- Department of Epidemiology and PreventionIRCCS Istituto Neurologico Mediterraneo NEUROMED86077Pozzilli (IS)Italy
| | - George Pounis
- Department of Epidemiology and PreventionIRCCS Istituto Neurologico Mediterraneo NEUROMED86077Pozzilli (IS)Italy
| | - Chiara Cerletti
- Department of Epidemiology and PreventionIRCCS Istituto Neurologico Mediterraneo NEUROMED86077Pozzilli (IS)Italy
| | - Maria Benedetta Donati
- Department of Epidemiology and PreventionIRCCS Istituto Neurologico Mediterraneo NEUROMED86077Pozzilli (IS)Italy
| | - Licia Iacoviello
- Department of Epidemiology and PreventionIRCCS Istituto Neurologico Mediterraneo NEUROMED86077Pozzilli (IS)Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and PreventionIRCCS Istituto Neurologico Mediterraneo NEUROMED86077Pozzilli (IS)Italy
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Bonaccio M, Di Castelnuovo A, Pounis G, De Curtis A, Costanzo S, Persichillo M, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. A score of low-grade inflammation and risk of mortality: prospective findings from the Moli-sani study. Haematologica 2016; 101:1434-1441. [PMID: 27742767 PMCID: PMC5394885 DOI: 10.3324/haematol.2016.144055] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/26/2016] [Indexed: 01/06/2023] Open
Abstract
Low-grade inflammation is associated with an increased risk of chronic degenerative disease, but its relationship with mortality is less well explored. We aimed at evaluating, at a large epidemiological level, the possible association of low-grade inflammation, as measured by a composite score, with overall mortality risk. We conducted a population-based prospective investigation on 20,337 adult subjects free from major hematological disease and acute inflammatory status, randomly recruited from the general population of the Moli-sani study. A low-grade inflammation score was obtained from the sum of 10-tiles of plasmatic (C-reactive protein) and cellular (leukocyte and platelet counts, granulocyte/lymphocyte ratio) biomarkers of low-grade inflammation; higher levels indicated increased low-grade inflammation. Hazard ratios were calculated using multivariable Cox proportional hazard models with 95% confidence intervals. At the end of follow-up (median 7.6 years), 837 all-cause deaths were recorded. As compared to subjects in the lowest quartile of the low-grade inflammation score, those in the highest category had a significantly increased risk in overall mortality (HR=1.44; 1.17-1.77), independently of possible confounders, including the presence of chronic diseases and a number of health-related behaviors. The magnitude of the association of low-grade inflammation with mortality was relatively higher in type 2 diabetic patients (HR=2.90; 1.74-4.84) and in individuals with a history of cardiovascular disease (HR=2.48; 1.50-4.11) as compared to their counterparts who were free from the disease. In conclusion, an elevated degree of low-grade inflammation, as measured by a composite score of inflammatory biomarkers, is an independent risk factor for total mortality in an apparently healthy adult general population.
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Affiliation(s)
- Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Augusto Di Castelnuovo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - George Pounis
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Mariarosaria Persichillo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Maria Benedetta Donati
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli (IS), Italy
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Davis E, Gorog DA, Rihal C, Prasad A, Srinivasan M. "Mind the gap" acute coronary syndrome in women: A contemporary review of current clinical evidence. Int J Cardiol 2016; 227:840-849. [PMID: 27829528 DOI: 10.1016/j.ijcard.2016.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/05/2016] [Accepted: 10/07/2016] [Indexed: 01/22/2023]
Abstract
The incidence and prevalence of coronary artery disease in women has exceeded that in men over the past four decades, and although a significant decline in mortality has occurred in the past two decades, there is a growing body of evidence suggesting that there are gender differences between the clinical manifestations and course of coronary artery disease, as well as differences in treatment and treatment response. This review article considers the current literature regarding the gender-specific manifestation of acute coronary syndromes. Through the review of basic science articles, subsets of trial data, and meta-analyses, the gender-specific differences in within acute coronary syndromes are considered in terms of diagnostic dilemmas, pathophysiology, and treatment options (including pharmacological, percutaneous and surgical methods). Finally, acute coronary syndromes and their management in the special circumstance of pregnancy are also reviewed.
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Affiliation(s)
- Elizabeth Davis
- Department of Cardiology, Papworth Hospital, Papworth Everard, UK.
| | - Diana A Gorog
- Hertfordshire Cardiology Centre, Lister Hospital, Stevenage, UK; Imperial College, London, UK; University of Hertfordshire, Herts, UK
| | - Charanjit Rihal
- The Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, United States
| | - Abhiram Prasad
- The Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, United States
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Ahmadi-Abhari S, Kaptoge S, Luben RN, Wareham NJ, Khaw KT. Longitudinal association of C-reactive protein and Haemoglobin A1c over 13 years: the European Prospective Investigation into Cancer--Norfolk study. Cardiovasc Diabetol 2015; 14:61. [PMID: 25994228 PMCID: PMC4445808 DOI: 10.1186/s12933-015-0224-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/06/2015] [Indexed: 01/21/2023] Open
Abstract
Background Type-2 diabetes is associated with systemic inflammation and higher C-reactive protein (CRP) levels. However, the longitudinal association of CRP and haemoglobin-A1c (HbA1c) has not been described in large prospective studies. Understanding such associations may shed light on the role of inflammation in development of type-2 diabetes and its complications such as cardiovascular diseases. Methods EPIC-Norfolk is a cohort study of men and women aged 40–79 years at time of recruitment (1993–1997). Serum CRP (mg/l) was measured using a high-sensitivity assay at baseline and 13-years follow-up. HbA1c (%) was measured at baseline, 4, and 13 years. Participants were excluded if they were diagnosed with diabetes or were taking diabetes medication. Data on at least one measurement of CRP and HbA1c was available for 14228 participants (55 % of the cohort). Results In the cross-sectional analysis of baseline data, a 1-SD higher loge-CRP (about three-fold higher CRP) was associated with 0.06 (95 % CI 0.04, 0.08) higher HbA1c (%) adjusted for potential confounders. In longitudinal analysis using multivariable linear mixed models, change in CRP over 13 years was to a similar extent positively associated with increase in HbA1c, such that 1-SD higher longitudinal change in loge-CRP was associated with 0.04 (95 % CI 0.02, 0.05) increase in HbA1c. Conclusion In this study we found longitudinal observational evidence suggesting that increase in systemic inflammation is associated with an increase in HbA1c and thus systemic inflammation may have a role in development of type-2 diabetes and its complications.
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Affiliation(s)
- Sara Ahmadi-Abhari
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. .,Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK.
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Nicholas J Wareham
- Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Sciences, Cambridge, UK.
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Hall TS, Herrscher TE, Jarolim P, Fagerland MW, Jensen T, Agewall S, Atar D, Hallén J. Myeloid-related protein-8/14 and C-reactive protein in individuals evaluated for obstructive sleep apnea. Sleep Med 2014; 15:762-8. [PMID: 24841106 DOI: 10.1016/j.sleep.2014.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/02/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and obesity are often present concomitantly. Their potential contribution to inflammation remains an ongoing debate. The objectives of this study were to investigate whether variables of sleep-disordered breathing are associated with levels of myeloid-related protein-8/14 (MRP-8/14) or C-reactive protein (CRP), and to characterize how adiposity interacts with these associations in individuals evaluated for possible OSA. METHODS Consecutive individuals referred to Lovisenberg Diakonale Hospital's sleep laboratory between 1st October 2009 and 1st March 2010 were included. We characterized the biomarker distribution sampled the morning after sleep and related these to clinical characteristics and variables recorded during polygraphy or polysomnography. RESULTS Of the total study population of 222 individuals, 161 (72.5%) were diagnosed with OSA (apnea-hypopnea index (AHI) > or = 5/h). In baseline models (multiple median regression adjusted for age and sex), AHI was independently associated with MRP-8/14 (P=0.025) and CRP (P<0.001). The associations were attenuated after the addition of body mass index (BMI), but remained statistically significant for CRP (P=0.025). However, in final models adjusted for additional factors (systolic blood pressure, cholesterol:high-density lipoprotein ratio, glycosylated haemoglobin, smoking, and cardiovascular disease), only average oxygen saturation for MRP-8/14 (P=0.028) and oxygen desaturation index (ODI) for CRP (P=0.037) remained independent predictors of inflammation, whereas AHI lost its predictive value (MRP-8/14; P=0.30 and CRP; P=0.092). The association between several variables of sleep-disordered breathing and inflammation were stronger in individuals with a higher BMI (P for interaction <0.05 for AHI, nadir oxygen saturation, and time <90% oxygen saturation). CONCLUSIONS No definitive indication of independent immunological activity resulting from apneas and hypopneas was found in final models adjusted for other factors associated with inflammation, whereas average oxygen saturation for MRP-8/14 and ODI for CRP remained statistically significant predictors. Interactions were observed between BMI and several variables of sleep-disordered breathing on MRP-8/14 and CRP levels.
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Affiliation(s)
- Trygve Sørdahl Hall
- Department of Cardiology, Lovisenberg Diakonale Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Tobias Erik Herrscher
- Department of Cardiology, Lovisenberg Diakonale Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Torstein Jensen
- Department of Cardiology, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Stefan Agewall
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jonas Hallén
- Medical Affairs, Boehringer Ingelheim Norway KS, Asker, Norway
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De Liso F, Bonara P, Vigna L, Novembrino C, De Giuseppe R, Bamonti F, Carbonelli V, Frugoni C, Tirelli A, Maiavacca R, Riboldi L. Oxidative Stress and Low-Grade Inflammatory Status as Cardiometabolic Risk Factors in Italian Occupational Overweight/Obese Subjects. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Obesity is associated with increased risk of cardiometabolic diseases. Adipocytokines (e.g. leptin), produced by the endocrine function of adipose tissue, can contribute to cardiometabolic risk in overweight and obese people. Oxidative stress, imbalance between oxidants and antioxidants, is considered a cardiovascular risk factor. High serum oxidized LDL (oxLDL) levels, marker of lipid peroxidation, a primary cause of atherosclerosis, can contribute to its progression. The aims of this study are to assess markers of oxidative status and cytokine profile and evaluate their role as cardiometabolic risk factors and possible correlations. In this cross-sectional study, we enrolled 76 occupational overweight-obese adults (46 females, 30 males; aged 46.8±9.5; BMI 33.7±4.8 kg/m2) without any previous cardiovascular disease. Oxidative status was measured by evaluating serum Reactive Oxygen Species (ROS) levels, Total Antioxidant Capacity (TAC) and oxLDL concentrations. All subjects' soluble cytokine and adhesion molecule levels were evaluated by cytofluorimetric method and compared with 35 controls matched for sex and age. ROS and oxLDL levels were high in 84% and 92% of the study population, respectively, despite adequate TAC (68%). Female ROS levels were significantly higher than those of males (414±99.3 vs 318±48.2 UCarr, p<0.0001), while their oxLDL levels were lower (95.3±22 vs 105.2±19.4 U/L, p=0.1). Leptin and sICAM-1 (intracellular adhesion molecule involved in leukocyte migration to inflamed area) levels of the study population were significantly higher than those of controls (93.8±89.1 vs 25.3±23 ng/mL, p=0.0002 and 505.8±236.7 vs 339.2±119.6 ng/mL, p=0.0009, respectively). Overweight/obese occupational subjects showed oxidative stress conditions accompanied by low chronic inflammatory status, possibly contributing to increased cardiometabolic risk.
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Affiliation(s)
- F. De Liso
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, UOC Ematologia e CTMO, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P. Bonara
- UO Mediana Interna 1b, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L. Vigna
- Dipartimento Area della Medicina Preventiva, U.O. Medicina del Lavoro 1, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C. Novembrino
- Laboratorio Centrale di Analisi Chimico Cliniche e Microbiologia, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - R. De Giuseppe
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, UOC Ematologia e CTMO, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F. Bamonti
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, UOC Ematologia e CTMO, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V. Carbonelli
- Dipartimento di Fisiopatologia Medico-Chirurgica e del Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C. Frugoni
- UO Medicina Trasfusionale, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A.S. Tirelli
- Laboratorio Centrale di Analisi Chimico Cliniche e Microbiologia, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - R. Maiavacca
- Laboratorio Centrale di Analisi Chimico Cliniche e Microbiologia, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L. Riboldi
- Dipartimento Area della Medicina Preventiva, U.O. Medicina del Lavoro 1, Fondazione IRCCS Ca‘ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Ahmadi-Abhari S, Luben RN, Wareham NJ, Khaw KT. Distribution and determinants of C-reactive protein in the older adult population: European Prospective Investigation into Cancer-Norfolk study. Eur J Clin Invest 2013; 43:899-911. [PMID: 23786220 DOI: 10.1111/eci.12116] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 05/02/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND C-reactive protein (CRP) is a well-documented predictor of cardiovascular diseases and mortality. We aimed to better understand the distribution and determinants of CRP in the population. MATERIALS AND METHODS Study participants were men and women aged 40-79 in the UK-based EPIC-Norfolk population-based cohort study. CRP was measured in 18 586 available serum samples (8334 men and 10 252 women) and remeasured in 6087 individuals on average 13 years later using a high-sensitivity assay. RESULTS In cross-sectional analyses, the range of serum CRP was 0.1-188.3 mg/L and the median 1.6 mg/L. A third of the population had serum CRP levels above 3 mg/L. Serum CRP levels were comparable in men and women who were not taking postmenopausal hormone replacement therapy (HRT). Women who were taking HRT had double CRP levels compared with HRT nonusers. Smoking was also strongly related to CRP in men and women. Serum CRP was positively and independently associated with age, body mass index and waist circumference and inversely with height. A stronger association with serum CRP measured concurrently than on average 13 years later indicated a short-term rather than long-term association with smoking and HRT use. Social class and alcohol intake were not independently related to CRP, but there was a strong inverse association with educational status. CONCLUSION The distribution of serum CRP in the population is similar in men and women after taking into account smoking and HRT use. Anthropometric factors as well as educational status are strongly related to serum CRP.
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Affiliation(s)
- Sara Ahmadi-Abhari
- Department of Public Health and Primary Care, University of Cambridge, UK.
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Seventeen year risk of all-cause and cause-specific mortality associated with C-reactive protein, fibrinogen and leukocyte count in men and women: the EPIC-Norfolk study. Eur J Epidemiol 2013; 28:541-50. [PMID: 23821244 DOI: 10.1007/s10654-013-9819-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 06/20/2013] [Indexed: 12/25/2022]
Abstract
There is strong evidence from observational studies suggesting serum C-reactive protein (CRP) is associated with cardiovascular and all-cause mortality. However, less is known about whether there are differences in the association of CRP with all-cause or cause specific mortality by sex, smoking, body mass index (BMI), or physical activity. We aimed to investigate these interactions and also investigate and compare the association of CRP and other inflammation markers (i.e., fibrinogen and leukocyte count) with all-cause and cause-specific mortality. Men and women aged 40-79 were recruited in 1993-1997 in the EPIC-Norfolk cohort study. A total of 16,850 participants with high-sensitivity assayed CRP data who had no known cancer, myocardial infarction and stroke at baseline were entered in the analysis to test the association of CRP, fibrinogen and leukocyte count with risk of all-cause and cause specific mortality. A total of, 2,603 all-cause deaths (1,452 in men) including 823 cardiovascular and 1,035 cancer deaths, were observed after 231,000 person-years of follow-up (median 14.3 years). CRP was positively associated with risk of all-cause, cardiovascular, and non-cancer non-cardiovascular mortality independent of established risk factors. The hazard ratio of all-cause mortality (95 % CI) for participants with CRP in the range of 3-10 and >10 mg/l (vs. <0.5 mg/l) was 1.56 (1.26-1.93) and 1.87 (1.43-2.43) respectively in men and 1.34 (1.07-1.68) and 1.98 (1.50-2.63) in women. The association was less positively graded in women with the increased risk being significant only at higher levels of the CRP distribution. The association persisted in never smokers and did not vary by levels of BMI or physical activity. Although fibrinogen and leukocyte count were also positively associated with mortality risk, only CRP remained a significant predictor of mortality when the inflammation markers were adjusted for one another in multivariable models. Serum CRP levels were a long-term predictor of risk of cardiovascular and non-cardiovascular mortality independent of known risk factors, fibrinogen, and leukocyte count.
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Casula M, Tragni E, Zambon A, Filippi A, Brignoli O, Cricelli C, Poli A, Catapano AL. C-reactive protein distribution and correlation with traditional cardiovascular risk factors in the Italian population. Eur J Intern Med 2013; 24:161-6. [PMID: 23040261 DOI: 10.1016/j.ejim.2012.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 09/04/2012] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND C-reactive protein (CRP) increases during an inflammatory response; its plasma levels are believed to be an independent predictor of future atherosclerotic disease. We report the distribution of plasma levels of CRP and its possible relationship with other cardiovascular risk factors in an Italian cohort. METHODS CRP was assessed in frozen plasma samples of 1949 participants in the CHECK study (2001-2005), which collected clinical and biochemical data from randomly selected subjects (40-79 years) in the setting of Italian general practice. RESULTS Median CRP (interquartile range) was higher in women (1.42 [0.58-2.86] vs 1.28 [0.58-2.50]; p=.163), in people aged ≥ 65 years (1.74 [0.89-3.34] vs 1.11 [0.52-2.45]; p<.001), in patients with obesity (2.37 [1.27-4.15] vs 1.16 [0.52-2.41]; p<.001), metabolic syndrome (2.12 [1.16-3.72] vs 1.10 [0.50-2.38]; p<.001), or higher cardiovascular risk (2.03 [1.01-3.42] vs 1.19 [0.53-2.50]; p<.001). Stepwise regression analysis showed significant associations (R(2)=.264) of circulating log(e)CRP with body mass index, fibrinogen, apoB, age, gender, smoking habits, physical inactivity, creatinine levels, and systolic blood pressure. CONCLUSION This study provides epidemiological data of CRP in the Italian population and reinforces the existing evidences about the close correlation between CRP and markers of inflammation and adiposity.
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Affiliation(s)
- Manuela Casula
- Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological Sciences, University of Milan, Via Balzaretti 9, 20133 Milano, Italy
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T-wave axis deviation, metabolic syndrome and estimated cardiovascular risk – In men and women of the MOLI-SANI study. Atherosclerosis 2013; 226:412-8. [DOI: 10.1016/j.atherosclerosis.2012.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 09/22/2012] [Accepted: 11/10/2012] [Indexed: 01/10/2023]
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Stranges S, Guallar E. Cardiovascular disease prevention in women: a rapidly evolving scenario. Nutr Metab Cardiovasc Dis 2012; 22:1013-1018. [PMID: 23123148 DOI: 10.1016/j.numecd.2012.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 09/27/2012] [Accepted: 10/04/2012] [Indexed: 11/23/2022]
Abstract
The past decade has witnessed a long overdue recognition of the importance of CVD in women, accompanied by an increasing awareness of gender differences in risk factors, natural history, preventive strategies, treatment, and prognosis of CVD. Reflecting the disease burden and the specific aspects of CVD in women, the American Heart Association has developed women-specific evidence-based guidelines and consensus documents for CVD prevention. The most recent update of these guidelines, published in 2011, is a milestone in the field and shows the rapidly evolving scenario of CVD prevention in women. We discuss some novel aspects of the 2011 update. The new guidelines change the focus from evidence-based to effectiveness-based, with consideration of both benefits and harms/costs of preventive interventions. The guidelines also introduce "ideal cardiovascular health" as the lowest category of risk, which implies the need of communitywide preventive, educational and policy initiatives to promote healthy lifestyles in the general population. Furthermore, the guidelines emphasize long-term overall CVD risk rather than short-term coronary risk. We also address several barriers and open questions in the evaluation and implementation of these guidelines, including how to increase the small proportion of women with ideal cardiovascular health; how to increase implementation and compliance with the recommendations; how to provide effectiveness-based recommendations for lifetime prevention goals based on short-term trials; how to obtain the best possible evidence in women; how to identify subgroups of women with different cardiovascular risk profiles or who may require tailored preventive strategies; and how to adapt current guidelines to international settings, particularly to low- and middle-income countries.
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Affiliation(s)
- S Stranges
- Division of Health Sciences, University of Warwick Medical School, Medical School Building, Gibbet Hill Campus, Coventry CV4 7AL, United Kingdom.
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Hsu BG, Hsieh JC, Chen YC, Wang JH. C-reactive protein positively correlates with metabolic syndrome in coronary artery disease patients. Tzu Chi Med J 2011. [DOI: 10.1016/j.tcmj.2011.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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di Giuseppe R, de Lorgeril M, Salen P, Laporte F, Di Castelnuovo A, Krogh V, Siani A, Arnout J, Cappuccio FP, van Dongen M, Donati MB, de Gaetano G, Iacoviello L. Alcohol consumption and n-3 polyunsaturated fatty acids in healthy men and women from 3 European populations. Am J Clin Nutr 2009; 89:354-62. [PMID: 19056552 DOI: 10.3945/ajcn.2008.26661] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Because high dietary and blood n-3 (omega-3) fatty acids (FAs) are protective against coronary heart disease and sudden cardiac death, the alcohol-associated increase in blood n-3 FAs could be considered an original mechanism of alcohol's cardioprotective effect. OBJECTIVE Our objective was to assess whether alcohol consumption is associated with concentrations of very-long-chain "marine" (eg, fish oil) n-3 FAs both in plasma and in red blood cell membranes. DESIGN In the framework of the IMMIDIET (Dietary Habit Profile in European Communities with Different Risk of Myocardial Infarction: the Impact of Migration as a Model of Gene-Environment Interaction) Project, 1604 subjects (802 women-men pairs), aged 26-65 y, were enrolled in Italy, Belgium, and England. A 1-y-recall food-frequency questionnaire was used to evaluate dietary intake. RESULTS In fully adjusted multivariate analyses, alcohol intake was positively associated with plasma eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and EPA + DHA concentrations (P < 0.0001, P = 0.036, and P = 0.002, respectively) in women and with EPA and the EPA + DHA index in red blood cells (P < 0.0001 and P = 0.037, respectively). In men, only plasma and red blood cell EPA concentrations were associated with alcohol intake (P = 0.003 and P = 0.004, respectively). Stratified analyses showed an association between alcohol and both plasma and red cell EPA (P = 0.008 and P = 0.002, respectively), DHA (P = 0.014 and P = 0.008, respectively), and the EPA + DHA index (P = 0.010 and P = 0.006, respectively) in wine drinkers, whereas no association was found in those who drink beer and spirits. CONCLUSIONS Alcohol intake was associated with higher plasma and red blood cell concentrations of marine n-3 FAs. Components of wine other than alcohol (polyphenols) might exert these effects. Part of the alcohol-induced cardioprotection may be mediated through increased marine n-3 FAs.
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Affiliation(s)
- Romina di Giuseppe
- Laboratory of Genetic and Environmental Epidemiology, Research Laboratories, John Paul II Centre for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy
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