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Disabato G, Andrea A, Guida G, Aboyans V, Piepoli M. Editorial comments. Aiming to reduce cardiovascular burden by targeting novel disease markers. Eur J Prev Cardiol 2024; 31:1055-1057. [PMID: 39042112 DOI: 10.1093/eurjpc/zwae214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Affiliation(s)
- Giandomenico Disabato
- Multimodality Cardiac Imaging Unit, IRCCS Policlinico San Donato, Via Morandi 30, Milan 20097, Italy
- Cardiology University Department, IRCCS Policlinico San Donato, Piazza Edmondo Malan, Milan 20097, Italy
| | - Attanasio Andrea
- Multimodality Cardiac Imaging Unit, IRCCS Policlinico San Donato, Via Morandi 30, Milan 20097, Italy
- Cardiology University Department, IRCCS Policlinico San Donato, Piazza Edmondo Malan, Milan 20097, Italy
| | - Gianluigi Guida
- Multimodality Cardiac Imaging Unit, IRCCS Policlinico San Donato, Via Morandi 30, Milan 20097, Italy
- Cardiology University Department, IRCCS Policlinico San Donato, Piazza Edmondo Malan, Milan 20097, Italy
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France
| | - Massimo Piepoli
- Cardiology University Department, IRCCS Policlinico San Donato, Piazza Edmondo Malan, Milan 20097, Italy
- Department of Preventive Cardiology, Wroclaw Medical University, Wroclaw, Poland
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Zhang N, Liu X, Wang L, Zhang Y, Xiang Y, Cai J, Xu H, Xiao X, Zhao X. Lifestyle factors and their relative contributions to longitudinal progression of cardio-renal-metabolic multimorbidity: a prospective cohort study. Cardiovasc Diabetol 2024; 23:265. [PMID: 39026309 PMCID: PMC11264843 DOI: 10.1186/s12933-024-02347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND The role of lifestyle factors and their relative contributions to the development and mortality of cardio-renal-metabolic multimorbidity (CRMM) remains unclear. METHODS A study was conducted with 357,554 UK Biobank participants. CRMM was defined as the coexistence of two or three cardio-renal-metabolic diseases (CRMDs), including cardiovascular disease (CVD), type 2 diabetes (T2D) and chronic kidney disease (CKD). The prospective study examined the associations of individual and combined lifestyle scores (diet, alcohol consumption, smoking, physical activity, sedentary behavior, sleep duration and social connection) with longitudinal progression from healthy to first cardio-renal-metabolic disease (FCRMD), then to CRMM, and ultimately to death, using a multistate model. Subsequently, quantile G-computation was employed to assess the relative contribution of each lifestyle factor. RESULTS During a median follow-up of 13.62 years, lifestyle played crucial role in all transitions from healthy to FCRMD, then to CRMM, and ultimately to death. The hazard ratios (95% CIs) per score increase were 0.91 (0.90, 0.91) and 0.90 (0.89, 0.91) for healthy to FCRMD, and for FCRMD to CRMM, and 0.84 (0.83, 0.86), 0.87 (0.86, 0.89), and 0.90 (0.88, 0.93) for mortality risk from healthy, FCRMD, and CRMM, respectively. Among the seven factors, smoking status contributed to high proportions for the whole disease progression, accounting for 19.88-38.10%. High-risk diet contributed the largest proportion to the risk of transition from FCRMD to CRMM, with 22.53%. Less-frequent social connection contributed the largest proportion to the risk of transition from FCRMD to death, with 28.81%. When we further consider the disease-specific transitions, we find that lifestyle scores had slightly stronger associations with development to T2D than to CVD or CKD. CONCLUSIONS Our study indicates that a healthy lifestyle may have a protective effect throughout the longitudinal progression of CRMM, informing more effective management and treatment. Smoking status, diet, and social connection played pivotal roles in specific disease transitions.
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Affiliation(s)
- Ning Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiang Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Lele Wang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuan Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Yi Xiang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiajie Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Hao Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Chinese Academy of Medical Sciences , Sichuan University, Chengdu, 610041, China
| | - Xiong Xiao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China.
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
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Hersi M, Beck A, Hamel C, Esmaeilisaraji L, Pussegoda K, Austin B, Ahmadzai N, Pratt M, Thuku M, Yazdi F, Bennett A, Shaver N, Vyas N, Skidmore B, Hutton B, Manuel D, Morrow M, Pakhale S, Presseau J, Shea BJ, Little J, Moher D, Stevens A. Effectiveness of smoking cessation interventions among adults: an overview of systematic reviews. Syst Rev 2024; 13:179. [PMID: 38997788 PMCID: PMC11242003 DOI: 10.1186/s13643-024-02570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/23/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND This overview of reviews aims to identify evidence on the benefits (i.e. tobacco use abstinence and reduction in smoking frequency) and harms (i.e. possible adverse events/outcomes) of smoking cessation interventions among adults aged 18 years and older. METHODS We searched Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the CADTH Health Technology Assessment Database and several other websites for grey literature. Searches were conducted on November 12, 2018, updated on September 24, 2020, with publication years 2008 to 2020. Two reviewers independently performed title-abstract and full-text screening considering pre-determined inclusion criteria. Data extraction and quality assessments were initially completed by two reviewers independently (i.e. 73% of included studies (n = 22)) using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR 2), and the remainder done by one reviewer and verified by another due to resources and feasibility. The application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) was performed by one independent reviewer and verified by another. RESULTS A total of 22 Cochrane systematic reviews evaluating the impact of smoking cessation interventions on outcomes such as tobacco use abstinence, reduction in smoking frequency, quality of life and possible adverse events were included. Pharmaceutical (i.e. varenicline, cytisine, nicotine replacement therapy (NRT), bupropion) and behavioural interventions (i.e. physician advice, non-tailored print-based self-help materials, stage-based individual counselling, etc.) showed to have increased smoking cessation; whereas, data for mobile phone-based interventions including text messaging, hypnotherapy, acupuncture, continuous auricular stimulation, laser therapy, electrostimulation, acupressure, St John's wort, S-adenosyl-L-methionine (SAMe), interactive voice response systems and other combination treatments were unclear. Considering harms related to smoking cessation interventions, small/mild harms (i.e. increased palpitations, chest pain, nausea, insomnia, headache) were observed following NRT, varenicline and cytisine use. There were no data on harms related to behavioural therapies (i.e. individual or group counselling self-help materials, internet interventions), combination therapies or other therapies (i.e. laser therapy, electrostimulation, acupressure, St John's wort, SAMe). CONCLUSION Results suggest that pharmacological and behavioural interventions may help the general smoking population quit smoking with observed small/mild harms following NRT or varenicline. Consequently, evidence regarding ideal intervention strategies and the long-term impact of these interventions for preventing smoking was unclear. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018099691.
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Affiliation(s)
- Mona Hersi
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Andrew Beck
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Candyce Hamel
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Leila Esmaeilisaraji
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Kusala Pussegoda
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Bradley Austin
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nadera Ahmadzai
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Misty Pratt
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Micere Thuku
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Fatemeh Yazdi
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
| | - Alexandria Bennett
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Nicole Shaver
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Niyati Vyas
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Brian Hutton
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Otolaryngology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Matt Morrow
- Patient Representative, British Columbia, Vancouver, Canada
| | - Smita Pakhale
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Beverley J Shea
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - David Moher
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Adrienne Stevens
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada
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De Silva R, Silva D, Piumika L, Abeysekera I, Jayathilaka R, Rajamanthri L, Wickramaarachchi C. Impact of global smoking prevalence on mortality: a study across income groups. BMC Public Health 2024; 24:1786. [PMID: 38965521 PMCID: PMC11225136 DOI: 10.1186/s12889-024-19336-6] [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: 04/10/2024] [Accepted: 07/02/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Smoking significantly contributes to the mortality rates worldwide, particularly in non-communicable and preventable diseases such as cardiovascular ailments, respiratory conditions, stroke, and lung cancer. This study aims to analyse the impact of smoking on global deaths, and its association with mortality across the main income groups. METHODS The comprehensive analysis spans 199 countries and territories from 1990 to 2019. The study categorises countries into four income groups: high income, upper middle income, lower middle income, and low income. RESULTS The findings underscore the profound impact of global tobacco smoking on mortality. Notably, cardiovascular disease mortality is notably affected in both upper-middle-income and high-income groups. Chronic respiratory disease mortality rates show a significant impact across all income groups. Moreover, stroke-related mortality is observed in the lower-middle, upper-middle, and high-income groups. These results highlight the pervasive influence of smoking prevalence on global mortality, affecting individuals across various socioeconomic levels. CONCLUSION The study underscores the critical implications of smoking on mortality rates, particularly in high-income countries. It emphasises the urgency of targeted interventions in these regions to address the specific challenges posed by tobacco smoking on public health. Policy recommendations include implementing prohibitive measures extending to indoor public areas such as workplaces and public transportation services. Furthermore, allocating funds for research on tobacco and health, is imperative to ensure policymakers are consistently informed about emerging facts and trends in this complex domain.
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Affiliation(s)
- Roshinie De Silva
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Disuri Silva
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Lakindu Piumika
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Isuri Abeysekera
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Ruwan Jayathilaka
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka.
| | - Lochana Rajamanthri
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Colinie Wickramaarachchi
- SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
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Chaisai C, Patikorn C, Thavorn K, Lee SWH, Chaiyakunapruk N, Veettil SK. Incremental net monetary benefit of using varenicline for smoking cessation: A systematic review and meta-analysis of economic evaluation studies. Addiction 2024; 119:1188-1202. [PMID: 38520121 DOI: 10.1111/add.16464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 01/25/2024] [Indexed: 03/25/2024]
Abstract
AIMS To conduct a systematic review and meta-analysis and pool the incremental net benefits (INBs) of varenicline compared with behaviour support with bupropion or nicotine replacement therapy (NRT), behaviour support alone and unaided cessation in adult smokers making a first-time attempt to quit. METHODS A search for economic evaluation studies was conducted from inception to 30 September 2022, on PubMed, Embase, Cost-Effectiveness Analysis (CEA) Registry by Tufts Medical Centre, EconLit and the NHS Economic Evaluation Database (NHS EED). Eligible studies were included if they were (1) conducted among adults ages 18 years old and older who were smokers attempting to quit for the first time; (2) compared varenicline to behaviour support with bupropion or NRT, behaviour support alone and unaided cessation; and (3) performed a CEA or cost-utility analysis. The INBs were calculated and pooled across studies stratified by country income level and study perspective using the random-effects model. Statistical heterogeneity between studies was assessed using the I2 statistic and Cochrane Q statistic. RESULTS Of the 1433 identified studies, 18 studies were included in our review. Our findings from healthcare system/payer perspective suggested that the use of varenicline is statistically significantly cost-effective compared with bupropion (pooled INB, $830.75 [95% confidence interval, $208.23, $1453.28]), NRTs ($636.16 [$192.48, $1079.84]) and unaided cessation ($4212.35 [$1755.79, $6668.92]) in high-income countries. Similarly, varenicline is also found to be cost-effective compared to bupropion ($2706.27 [$1284.44, $4128.11]), NRTs ($3310.01 [$1781.53, $4838.50]) and behavioural support alone ($5438.22 [$4105.99, $6770.46]) in low- and middle-income countries. CONCLUSION Varenicline is cost-effective as a smoking cessation aid when compared with behavioural support with bupropion or nicotine replacement therapies and behavioural support alone in both high-income countries and low- and middle-income countries, from the healthcare system/payer perspective in adult smokers who attempt to quit for the first time.
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Affiliation(s)
- Chayutthaphong Chaisai
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chanthawat Patikorn
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- School of Medicine, Taylor's University, Selangor, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- IDEAS Centre, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Sajesh K Veettil
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- School of Medicine, Taylor's University, Selangor, Malaysia
- School of Pharmacy, Department of Pharmacy Practice, International Medical University, Kuala Lumpur, Malaysia
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Noh S, Choo J. Gender-Specific Clustering of Lifestyle Behaviors and Its Impacts on Cardiovascular Health. J Cardiovasc Nurs 2024; 39:E115-E125. [PMID: 37249529 DOI: 10.1097/jcn.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Unhealthy lifestyle behaviors associated with cardiovascular risk manifest a clustering pattern. OBJECTIVE Our aim was to identify behavioral clusters by using 5 unhealthy lifestyle behaviors among the Korean population and examine the impacts of identified behavioral clusters on cardiovascular health (CVH). METHODS A cross-sectional study was conducted using data from the sixth Korea National Health and Nutrition Examination Survey. The participants were 7898, aged 19 to 64 years. The cluster analysis was performed using the behaviors of current smoking, binge drinking, physical inactivity, insufficient fruit intake, and sugar-sweetened beverage drinking. Cardiovascular health was defined as a composite modified z score calculated using biophysical factors. RESULTS Men manifested 4 clusters (ie, risky binge drinkers, dominant smokers, dominant sugar-sweetened beverage drinkers, and nonsubstance/low-fruit eaters) characterized predominantly by substance use; women had 4 clusters (ie, substance users, physically inactive/low-fruit eaters, physically inactive/fruit eaters, and active adherers) characterized predominantly by physical inactivity. Among men, the clusters of dominant smokers and risky binge drinkers had significantly lower CVH scores than those with poor eating behaviors. Among women, the clusters of substance users and physically inactive/low-fruit eaters had significantly lower CVH scores than the active adherers. All the clusters in men had lower CVH scores than the worst cluster in women. CONCLUSIONS There was a gender difference in the clustering pattern. The clusters with smoking and binge drinking in men and women were associated with negative impacts on CVH. Healthcare professionals should pay attention to the clustering pattern to design an efficient lifestyle intervention for cardiovascular disease prevention.
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Song WB, Soffer DE, Gelfand JM. Using Guidelines of Care to Lower Cardiovascular Risk in Patients with Psoriasis. Dermatol Clin 2024; 42:417-428. [PMID: 38796273 PMCID: PMC11128720 DOI: 10.1016/j.det.2024.02.008] [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] [Indexed: 05/28/2024]
Abstract
National guidelines define psoriasis as a risk enhancer for cardiovascular disease and recommend increased monitoring and more intense management of cardiovascular risk factors in these patients, who face an increased burden of cardiovascular disease morbidity and mortality. Screening for modifiable cardiovascular risk factors, including blood pressure, weight, cholesterol, glucose, and smoking, can be efficiently incorporated into routine dermatology clinical practice. Partnerships with primary care providers and preventive cardiologists are essential to improving management of cardiovascular risk in patients with psoriasis.
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Affiliation(s)
- William B Song
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Daniel E Soffer
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:2497-2604. [PMID: 38752899 DOI: 10.1016/j.jacc.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1313-e1410. [PMID: 38743805 DOI: 10.1161/cir.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Bartholomew K, Aye PS, Aitken C, Chambers E, Neville C, Maxwell A, Sandiford P, Puloka A, Crengle S, Poppe K, Doughty RN, Hill A. Smoking data quality of primary care practices in comparison with smoking data from the New Zealand Māori and Pacific abdominal aortic aneurysm screening programme: an observational study. BMC Public Health 2024; 24:1513. [PMID: 38840063 PMCID: PMC11154981 DOI: 10.1186/s12889-024-19021-8] [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: 09/18/2023] [Accepted: 05/31/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Quality smoking data is crucial for assessing smoking-related health risk and eligibility for interventions related to that risk. Smoking information collected in primary care practices (PCPs) is a major data source; however, little is known about the PCP smoking data quality. This project compared PCP smoking data to that collected in the Māori and Pacific Abdominal Aortic Aneurysm (AAA) screening programme. METHODS A two stage review was conducted. In Stage 1, data quality was assessed by comparing the PCP smoking data recorded close to AAA screening episodes with the data collected from participants at the AAA screening session. Inter-rater reliability was analysed using Cohen's kappa scores. In Stage 2, an audit of longitudinal smoking status was conducted, of a subset of participants potentially misclassified in Stage 1. Data were compared in three groups: current smoker (smoke at least monthly), ex-smoker (stopped > 1 month ago) and never smoker (smoked < 100 cigarettes in lifetime). RESULTS Of the 1841 people who underwent AAA screening, 1716 (93%) had PCP smoking information. Stage 1 PCP smoking data showed 82% concordance with the AAA data (adjusted kappa 0.76). Fewer current or ex-smokers were recorded in PCP data. In the Stage 2 analysis of discordant and missing data (N = 313), 212 were enrolled in the 29 participating PCPs, and of these 13% were deceased and 41% had changed PCP. Of the 93 participants still enrolled in the participating PCPs, smoking status had been updated for 43%. Data on quantity, duration, or quit date of smoking were largely missing in PCP records. The AAA data of ex-smokers who were classified as never smokers in the Stage 2 PCP data (N = 27) showed a median smoking cessation duration of 32 years (range 0-50 years), with 85% (N = 23) having quit more than 15 years ago. CONCLUSIONS PCP smoking data quality compared with the AAA data is consistent with international findings. PCP data captured fewer current and ex-smokers, suggesting ongoing improvement is important. Intervention programmes based on smoking status should consider complementary mechanisms to ensure eligible individuals are not missed from programme invitation.
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Affiliation(s)
- Karen Bartholomew
- Service Improvement and Innovation, Health New Zealand Te Whatu Ora, Auckland, New Zealand
| | - Phyu Sin Aye
- Service Improvement and Innovation, Health New Zealand Te Whatu Ora, Auckland, New Zealand.
- University of Auckland, Auckland, New Zealand.
| | - Charlotte Aitken
- Service Improvement and Innovation, Health New Zealand Te Whatu Ora, Auckland, New Zealand
| | - Erin Chambers
- Service Improvement and Innovation, Health New Zealand Te Whatu Ora, Auckland, New Zealand
| | - Cleo Neville
- Service Improvement and Innovation, Health New Zealand Te Whatu Ora, Auckland, New Zealand
| | - Anna Maxwell
- Service Improvement and Innovation, Health New Zealand Te Whatu Ora, Auckland, New Zealand
| | - Peter Sandiford
- Service Improvement and Innovation, Health New Zealand Te Whatu Ora, Auckland, New Zealand
| | - Aivi Puloka
- Service Improvement and Innovation, Health New Zealand Te Whatu Ora, Auckland, New Zealand
| | | | | | | | - Andrew Hill
- Service Improvement and Innovation, Health New Zealand Te Whatu Ora, Auckland, New Zealand
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11
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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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12
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Visscher J, Hiwase M, Bonevski B, O'Callaghan M. The association of smoking with urinary and sexual function recovery following radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024; 27:222-229. [PMID: 37500786 DOI: 10.1038/s41391-023-00701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Urinary and sexual dysfunction after radical prostatectomy remains a major cause of morbidity, despite widespread availability of pharmacological and rehabilitative treatments. Smoking is a modifiable risk factor known to correlate with erectile and urinary dysfunction and we hypothesise that smoking cessation may improve post-prostatectomy urinary and sexual function recovery. Our objective is to systematically evaluate literature describing the association of smoking status with urinary and sexual function in men following radical prostatectomy. METHODS In total, 310 unique records were identified through a systematic search of the MEDLINE, EMBASE, Scopus, Web of Science, CINAHL and CENTRAL databases up to February 2023. Nine studies reported smoking status and post radical prostatectomy urinary and sexual function outcomes in men with localized prostate cancer. Risk of bias was assessed and meta-analysis included six studies. RESULTS Smokers had inferior erectile function after prostatectomy compared to non-smokers (OR 0.73, [95% CI 0.56-0.95]) during follow-up, while urinary incontinence was not statistically different between groups (OR 1.20, [95% CI 0.75-1.91]). Smoking cessation improved the EPIC-26 sexual domain score with 6.6 points on average [p = 0.03] to a clinically significant maximum of 12.5 points at 18-24 months. CONCLUSIONS Smoking is associated with impaired sexual function recovery after radical prostatectomy and quitting may improve sexual function >18 months. Current evidence shows no such association for urinary outcomes. Further studies are needed to corroborate findings.
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Affiliation(s)
- Jordi Visscher
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Mrunal Hiwase
- Department of Surgery, Central Adelaide Health Network, Adelaide, SA, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michael O'Callaghan
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Medical Centre, Urology Unit, Adelaide, SA, Australia
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13
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Archbold J, Clohessy S, Herath D, Griffiths N, Oyebode O. An agent-based model of the spread of behavioural risk-factors for cardiovascular disease in city-scale populations. PLoS One 2024; 19:e0303051. [PMID: 38805418 PMCID: PMC11132484 DOI: 10.1371/journal.pone.0303051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/18/2024] [Indexed: 05/30/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality globally, and is the second main cause of mortality in the UK. Four key modifiable behaviours are known to increase CVD risk, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. Behaviours that increase the risk of CVD can spread through social networks because individuals consciously and unconsciously mimic the behaviour of others they relate to and admire. Exploiting these social influences may lead to effective and efficient public health interventions to prevent CVD. This project aimed to construct and validate an agent-based model (ABM) of how the four major behavioural risk-factors for CVD spread through social networks in a population, and examine whether the model could be used to identify targets for public health intervention and to test intervention strategies. Previous ABMs have typically focused on a single risk factor or considered very small populations. We created a city-scale ABM to model the behavioural risk-factors of individuals, their social networks (spousal, household, friendship and workplace), the spread of behaviours through these social networks, and the subsequent impact on the development of CVD. We compared the model output (predicted CVD events over a ten year period) to observed data, demonstrating that the model output is realistic. The model output is stable up to at least a population size of 1.2M agents (the maximum tested). We found that there is scope for the modelled interventions targeting the spread of these behaviours to change the number of CVD events experienced by the agents over ten years. Specifically, we modelled the impact of workplace interventions to show that the ABM could be useful for identifying targets for public health intervention. The model itself is Open Source and is available for use or extension by other researchers.
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Affiliation(s)
- James Archbold
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Sophie Clohessy
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Deshani Herath
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Nathan Griffiths
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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14
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Kong X, Wang W. Estimated glucose disposal rate and risk of cardiovascular disease and mortality in U.S. adults with prediabetes: a nationwide cross-sectional and prospective cohort study. Acta Diabetol 2024:10.1007/s00592-024-02305-1. [PMID: 38805079 DOI: 10.1007/s00592-024-02305-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
AIMS Estimated glucose disposal rate (eGDR), a noninvasive and convenient measure of insulin resistance, has been demonstrated to be associated with mortality in both type 1 and type 2 diabetes. We aimed to explore whether eGDR is associated with cardiovascular disease (CVD) risk and mortality in prediabetic adults. METHODS A nationwide population-based cohort of prediabetic individuals from the National Health and Nutrition Examination Survey 1999-2018 with available data on eGDR was included and categorized into eGDR ≥ 8 (reference), 6-7.99, 4-5.99, and < 4 mg/kg/min groups. Cox proportional hazards model was used to estimate the associations of eGDR with mortality. RESULTS A total of 4725 prediabetic adults, 60.12% men, mean age 48 years were included. The odds ratio and 95% confidence interval (CI) for CVD risk were 1.74 (1.08-2.78), 2.90 (1.79-4.67), and 4.58 (2.15-9.76) for the eGDR 6-7.99, 4-5.99, and < 4 mg/kg/min groups, respectively, compared with the reference group. There were 410 deaths (116 CVD-related) during a median follow-up of 107 months in 4,332 participants without baseline CVD. The hazard ratios and 95%CI for the eGDR 6-7.99, 4-5.99, and < 4 mg/kg/min groups were 1.70 (1.23-2.35), 2.01 (1.45-2.77), and 1.84 (1.11-3.04), respectively, for all-cause mortality (P for trend < 0.0001), and 3.84 (2.04-7.21), 4.01 (2.01-8.00), and 2.88 (1.03-8.06), respectively, for CVD mortality (P for trend = 0.01). Smoking status significantly modified the associations between eGDR and all-cause or CVD mortality. CONCLUSIONS Increased insulin resistance, as indicated by a lower eGDR, is associated with increased risks of all-cause and CVD mortality in U.S. prediabetic adults.
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Affiliation(s)
- Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Wang
- Department of Nephrology, Shanghai Tenth People's Hospital, Shanghai, 200032, China.
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15
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Hageman SHJ, Kaptoge S, de Vries TI, Lu W, Kist JM, van Os HJA, Numans ME, Läll K, Bobak M, Pikhart H, Kubinova R, Malyutina S, Pająk A, Tamosiunas A, Erbel R, Stang A, Schmidt B, Schramm S, Bolton TR, Spackman S, Bakker SJL, Blaha M, Boer JMA, Bonnefond A, Brenner H, Brunner EJ, Cook NR, Davidson K, Dennison E, Donfrancesco C, Dörr M, Floyd JS, Ford I, Fu M, Gansevoort RT, Giampaoli S, Gillum RF, Gómez-de-la-Cámara A, Håheim LL, Hansson PO, Harms P, Humphries SE, Ikram MK, Jukema JW, Kavousi M, Kiechl S, Kucharska-Newton A, Pablos DL, Matsushita K, Meyer HE, Moons KGM, Mortensen MB, Muilwijk M, Nordestgaard BG, Packard C, Pamieri L, Panagiotakos D, Peters A, Potier L, Providencia R, Psaty BM, Ridker PM, Rodriguez B, Rosengren A, Sattar N, Schöttker B, Schwartz JE, Shea S, Shipley MJ, Sofat R, Thorand B, Verschuren WMM, Völzke H, Wareham NJ, Westbury L, Willeit P, Zhou B, Danesh J, Visseren FLJ, Di Angelantonio E, Pennells L, Dorresteijn JAN. Prediction of individual lifetime cardiovascular risk and potential treatment benefit: development and recalibration of the LIFE-CVD2 model to four European risk regions. Eur J Prev Cardiol 2024:zwae174. [PMID: 38752762 DOI: 10.1093/eurjpc/zwae174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 08/28/2024]
Abstract
AIM The 2021 European Society of Cardiology prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding initiation of prevention. We aimed to update and systematically recalibrate the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model to four European risk regions for the estimation of lifetime CVD risk for apparently healthy individuals. METHODS AND RESULTS The updated LIFE-CVD (i.e., LIFE-CVD2) models were derived using individual-participant data from 44 cohorts in 13 countries (687,135 individuals without established CVD, 30,939 CVD events in median 10.7 years of follow-up). LIFE-CVD2 uses sex-specific functions to estimate the lifetime risk of fatal and non-fatal CVD events with adjustment for the competing risk of non-CVD death, and is systematically recalibrated to four distinct European risk regions. The updated models showed good discrimination in external validation among 1,657,707 individuals (61,311 CVD events) from eight additional European cohorts in seven countries, with a pooled C-index of 0.795 (95%CI 0.767-0.822). Predicted and observed CVD event risks were well calibrated in population-wide electronic health records data in the UK (CPRD) and Netherlands (ELAN). When using LIFE-CVD2 to estimate potential gain in CVD-free life expectancy from preventive therapy, projections varied by risk region reflecting important regional differences in absolute lifetime risk. For example a 50-year-old smoking woman with a SBP of 140 mm Hg was estimated to gain 0.9 years in the low risk region versus 1.6 years in the very high risk region from lifelong 10 mm Hg SBP reduction. The benefit of smoking cessation for this individual ranged from 3.6 years in the low risk region to 4.8 years in the very high risk region. INTERPRETATION By taking into account geographical differences in CVD incidence using contemporary representative data sources, the recalibrated LIFE-CVD2 model provides a more accurate tool for the prediction of lifetime risk and CVD-free life expectancy for individuals without previous CVD, facilitating shared decision-making for cardiovascular prevention as recommended by 2021 European guidelines.
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Affiliation(s)
- Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge , Cambridge UK
| | - Tamar I de Vries
- Department of Vascular Medicine, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Wentian Lu
- Department of Epidemiology and Public Health, University College London , London , UK
| | - Janet M Kist
- Health Campus The Hague, Leiden University Medical Center , The Hague , the Netherlands
- National eHealth Living Lab, Leiden University Medical Center , The Hague , the Netherlands
| | - Hendrikus J A van Os
- Health Campus The Hague, Leiden University Medical Center , The Hague , the Netherlands
| | - Mattijs E Numans
- Health Campus The Hague, Leiden University Medical Center , The Hague , the Netherlands
| | - Kristi Läll
- Estonian Genome Centre, Institute of Genomics, University of Tartu , Tartu , Estonia
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London , London , UK
- RECETOX, Masaryk University , Brno , Czech Republic
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London , London , UK
- RECETOX, Masaryk University , Brno , Czech Republic
| | - Ruzena Kubinova
- National Institute of Public Health , Prague , Czech Republic
| | | | - Andrzej Pająk
- Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College , Kraków , Poland
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences , Kaunas , Lithuania
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen , Essen , Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen , Essen , Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen , Essen , Germany
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen , Essen , Germany
| | - Thomas R Bolton
- British Heart Foundation Data Science Centre, Health Data Research UK , London , UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge , Cambridge , UK
| | - Sarah Spackman
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge , Cambridge , UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge , Cambridge UK
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen , Groningen , Netherlands
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital , Baltimore, MD , USA
| | - Jolanda M A Boer
- Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment , Bilthoven , The Netherlands
| | - Amélie Bonnefond
- Inserm/CNRS UMR 1283/8199, Pasteur Institute of Lille , EGID, Lille , France
- University of Lille , Lille , France
- Department of Metabolism, Digestion and Reproduction, Imperial College London , London , UK
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center , Heidelberg , Germany
- Network Aging Research, University of Heidelberg , Heidelberg , Germany
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London , London , UK
| | - Nancy R Cook
- Brigham & Women’s Hospital, Harvard Medical School Harvard University , Boston, MA , USA
| | - Karina Davidson
- Feinstein Institutes for Medical Research , Northwell Health, New York, NY , USA
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton , Southampton , UK
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanita’ , Rome , Italy
| | - Marcus Dörr
- Institute for Community Medicine, University Medicine Greifswald, University of Greifswald , Greifswald , Germany
- German Centre for Cardiovascular Disease (DZHK) , Partner Site Greifswald
- German Centre for Cardiovascular Disease (DZD) , Site Greifswald, Greifswald , Germany
| | - James S Floyd
- Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington , Seattle, WA , USA
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow , Glasgow , UK
| | - Michael Fu
- Department of Medicine, Sahlgrenska University Hospital/Östra Hospital , Gothenburg , Sweden
| | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen , Groningen , Netherlands
| | | | | | | | - Lise Lund Håheim
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo , Oslo , Norway
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy , Gothenburg , Sweden
| | - Peter Harms
- Department of General Practice, Amsterdam University Medical Center , Amsterdam , Netherlands
| | - Steve E Humphries
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London , London , UK
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam , Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center , The Netherlands
- Netherlands Heart Institute , Leiden , the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam , Netherlands
| | - Stefan Kiechl
- Department of Neurology, Innsbruck Medical University and VASCage, Research Centre on Vascular Ageing and Stroke , Innsbruck , Austria
| | - Anna Kucharska-Newton
- College of Public Health, Department of Epidemiology, University of Kentucky , KY , USA
| | - David Lora Pablos
- Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense de Madrid (UCM) , Madrid , Spain
| | - Kunihiro Matsushita
- Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD , USA
| | | | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University , Utrecht , The Netherlands
| | - Martin Bødtker Mortensen
- Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev Gentofte , Copenhagen , Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Mirthe Muilwijk
- Department of Epidemiology and Data Science, Amsterdam University Medical Center , Amsterdam , Netherlands
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev Gentofte , Copenhagen , Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Chris Packard
- School of Cardiovascular & Metabolic Health, University of Glasgow , Glasgow , UK
| | - Luigi Pamieri
- Department of Cardiovascular, Dysmetabolic and Aging-associated Diseases, Istituto Superiore di Sanità , Rome , Italy
| | | | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health , Neuherberg , Germany
- IBE, Pettenkofer School of Public Health, Medical Faculty, Ludwig-Maximilians-Universität , Munich , Germany
- German Centre for Cardiovascular Research (DZHK e.V.), partner site Munich Heart Alliance , Munich , Germany
| | - Louis Potier
- Université Paris City , Paris , France
- Department of Diabetology, Endocrinology and Nutrition, Assistance Publique - Hôpitaux de Paris, Bichat Hospital , Paris , France
| | - Rui Providencia
- Institute of Health Informatics Research, University College London , London , UK
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, University of Washington , Seattle, WA , USA
| | - Paul M Ridker
- Brigham & Women’s Hospital, Harvard Medical School Harvard University , Boston, MA , USA
| | - Beatriz Rodriguez
- University of Hawaii and Tecnologico de Monterrey , Honolulu, HI , USA
| | - Annika Rosengren
- Sahlgrenska University Hospital and Östra Hospital , Göteborg , Sweden
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow , Glasgow , UK
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center , Heidelberg , Germany
- Network Aging Research, University of Heidelberg , Heidelberg , Germany
| | | | - Steven Shea
- College of Physicians & Surgeons and Mailman School of Public Health, Columbia University , NY , USA
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London , London , UK
| | - Reecha Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool , Liverpool , UK
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health , Neuherberg , Germany
- IBE, Pettenkofer School of Public Health, Medical Faculty, Ludwig-Maximilians-Universität , Munich , Germany
| | - W M Monique Verschuren
- Centre for Prevention, Lifestyle and Health, National Institute for Public Health and the Environment , Bilthoven , The Netherlands
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University , Utrecht , The Netherlands
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, University of Greifswald , Greifswald , Germany
- German Centre for Cardiovascular Disease (DZHK) , Partner Site Greifswald
- German Centre for Cardiovascular Disease (DZD) , Site Greifswald, Greifswald , Germany
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, University of Cambridge , Cambridge , UK
| | - Leo Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton , Southampton , UK
| | - Peter Willeit
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge , Cambridge , UK
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck , Innsbruck , Austria
| | - Bin Zhou
- Faculty of Medicine, School of Public Health, Imperial College London , London , UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge , Cambridge , UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge , Cambridge UK
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht , Utrecht , The Netherlands
| | | | - Lisa Pennells
- Department of Public Health and Primary Care, University of Cambridge , Cambridge UK
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht , Utrecht , The Netherlands
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16
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Kim HL. Differences in Risk Factors for Coronary Atherosclerosis According to Sex. J Lipid Atheroscler 2024; 13:97-110. [PMID: 38826179 PMCID: PMC11140242 DOI: 10.12997/jla.2024.13.2.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 06/04/2024] Open
Abstract
Interest in sex differences related to coronary artery disease (CAD) has steadily increased, and the risk factors for CAD show distinct sex differences. For women, cardiovascular risk increases significantly after menopause due to a decrease in estrogen levels. In older individuals, increased arterial stiffness results in a higher pulse pressure, leading to a more common occurrence of isolated systolic hypertension; these changes are more noticeable in women. While the incidence of diabetes is similar in both sexes, women with diabetes face a 50% higher relative risk of fatal coronary heart disease compared to men. Smoking significantly increases the risk of ischemic heart disease in women, particularly those who are younger. The decrease in estrogen in women leads to a redistribution of fat, resulting in increased abdominal obesity and, consequently, an elevated cardiovascular risk. Pregnancy and reproductive factors also have a significant impact on CAD risks in women. Additionally, disparities exist in medical practice. Women are less likely to be prescribed cardioprotective drugs, referred for interventional or surgical treatments, or included in clinical research than men. By increasing awareness of these sex differences and addressing the disparities, we can progress toward more personalized treatment strategies, ultimately improving patient outcomes.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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17
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Holtrop J, Bhatt DL, Ray KK, Mach F, Smulders YM, Carballo D, Steg PG, Visseren FLJ, Dorresteijn JAN. Impact of the 2021 European Society for Cardiology prevention guideline's stepwise approach for cardiovascular risk factor treatment in patients with established atherosclerotic cardiovascular disease. Eur J Prev Cardiol 2024; 31:754-762. [PMID: 38324720 DOI: 10.1093/eurjpc/zwae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 02/09/2024]
Abstract
AIMS This study aimed to evaluate the stepwise approach for cardiovascular (CV) risk factor treatment as outlined by the European Society for Cardiology 2021 guidelines on CV disease (CVD) prevention in patients with established atherosclerotic CVD (ASCVD). METHODS AND RESULTS In patients with ASCVD, included in UCC-SMART (n = 8730) and European parts of the REACH registry (n = 18 364), the 10-year CV risk was estimated using SMART2. Treatment effects were derived from meta-analyses and trials. Step 1 recommendations were LDL cholesterol (LDLc) < 1.8 mmol/L, systolic blood pressure (SBP) < 140 mmHg, using any antithrombotic medication, sodium-glucose co-transporter 2 (SGLT2) inhibition, and smoking cessation. Step 2 recommendations were LDLc < 1.4 mmol/L, SBP < 130 mmHg, dual-pathway inhibition (DPI, aspirin plus low-dose rivaroxaban), colchicine, glucagon-like peptide (GLP)-1 receptor agonists, and eicosapentaenoic acid. Step 2 was modelled accounting for Step 1 non-attainment. With current treatment, residual CV risk was 22%, 32%, and 60% in the low, moderate, and pooled (very) high European risk regions, respectively. Step 2 could prevent up to 198, 223 and 245 events per 1000 patients treated, respectively. Intensified LDLc reduction, colchicine, and DPI could be applied to most patients, preventing up to 57, 74, and 59 events per 1000 patients treated, respectively. Following Step 2, the number of patients with a CV risk of <10% could increase from 20%, 6.4%, and 0.5%, following Step 1, to 63%, 48%, and 12%, in the respective risk regions. CONCLUSION With current treatment, residual CV risk in patients with ASCVD remains high across all European risk regions. The intensified Step 2 treatment options result in marked further reduction of residual CV risk in patients with established ASCVD. KEY FINDINGS Guideline-recommended intensive treatment of patients with cardiovascular disease could prevent additional 198-245 new cardiovascular events for every 1000 patients treated.
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Affiliation(s)
- Joris Holtrop
- Department of Vascular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, ICTU-Global, Imperial College London, London, UK
| | - François Mach
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Yvo M Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - David Carballo
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Gabriel Steg
- Department of Cardiology, Université Paris-Cité, FACT (French Alliance for Cardiovascular Trials) NSERM1148/LVTS, AP-HP, Hôpital Bichat, Paris, France
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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18
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Wu J, Meng W, Ma Y, Zhao Z, Xiong R, Wang J, Zhao R, Zeng H, Chen Y. Early smoking lead to worse prognosis of COPD patients: a real world study. Respir Res 2024; 25:140. [PMID: 38528530 DOI: 10.1186/s12931-024-02760-y] [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: 11/22/2023] [Accepted: 03/07/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Smoking remains a major risk factor for the development and progression of chronic obstructive pulmonary disease (COPD). Due to the adolescent smoking associated with worse health state, the age, at which an individual started smoking, might play a key role in shaping the trajectory of COPD development and the severity. METHODS We conducted an observational study from September 2016 through January 2023 of eligible patients hospitalized with COPD. Patients who started smoking during the alveolar development stage (ADS, smoking initiation ≤ 24 years old) were defined as early smoking patients, and patients who started smoking after ADS (smoking initiation > 24 years old) were defined as late smoking patients. We collected demographic and clinical data characterizing the patients and documented their condition from hospital discharge to follow-up. The primary endpoints were short-term (within one year), 3-year, and long-term (beyond 3 years) all-cause mortality after discharge. RESULTS Among 697 COPD patients, early smoking patients had a lower smoking cessation rate (P < 0.001) and a higher smoking index (P < 0.001) than late smoking patients. Although adjusted smoking index, early smoking patients still had poorer lung function (P = 0.023), thicker left ventricular diameters (P = 0.003), higher frequency of triple therapy use during stable stage (P = 0.049), and more acute exacerbations in the past year before enrollment (P < 0.05). Survival analysis showed that they had a higher risk of death after discharge within three years (P = 0.004) and beyond three years (P < 0.001). Furthermore, even in early smoking COPD patients who quit smoking after adjusting the smoking index had poorer lung function (P < 0.05) and thicker left ventricular diameters (P = 0.003), and survival analysis also showed that they had a higher long-term mortality rate (P = 0.010) and shorter survival time (P = 0.0128). CONCLUSION Early smoking COPD patients exhibited multiple adverse clinical outcomes, including heavy cigarette addiction, compromised pulmonary function, augmented left ventricular diameter, and elevated mortality risk. Additional, smoking cessation could not bring enough improvement of health state in early smoking COPD patients as late smoking COPD patients. Consequently, early intervention and specialized cessation approaches for younger smokers are of paramount importance in this context.
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Affiliation(s)
- Jiankang Wu
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, 410011, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Weiwei Meng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, 410011, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, 410011, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Zhiqi Zhao
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, 410011, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Ruoyan Xiong
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, 410011, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Jiayu Wang
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, 410011, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Rui Zhao
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, 410011, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Huihui Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, 410011, China.
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
- Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, Changsha, 410011, China.
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
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19
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Musonda E, Mumba P, Malungo JRS. Mortality from non-communicable diseases and associated risk factors in Zambia; analysis of the sample vital registration with verbal autopsy 2015/2016. BMC Public Health 2024; 24:666. [PMID: 38429671 PMCID: PMC10908156 DOI: 10.1186/s12889-024-18150-4] [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: 09/17/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the world's growing cause of preventable illness, disability, morbidity, and mortality which account for 71% of deaths. The aim of this study was to determine the factors associated with mortality from NCDs among persons aged 15 years and above in Zambia. METHODOLOGY The study used data from Sample Vital Registration with Verbal Autopsy (SAVVY) 2015/16 (Zambia). A total of 3529 Verbal Autopsy were completed in the study, with only 2599 of death where among people aged 15 years and above. Three-level data analysis was applied; univariate analysis, bivariate analysis, and multivariate analysis (binary logistic regression). FINDINGS The overall number of deaths from NCDs was 28.81%. Stratified analysis by gender showed that deaths from NCDs were higher among women (32.60%) as compared to men (26.25%). Among all persons, dying from NCDs was associated with tobacco use, age, and education. Tobacco use was negatively associated with mortality from NCDs (adjusted odds ratio [aOR] = 0.68; 95% confidence interval [CI]: 0.48-0.98). Age was positively associated with the odds of dying from NCDs among persons aged 45-59 years (aOR = 3.87, 95% CI: 2.13-7.01), 60-74 years (aOR = 12.05, 95% CI: 6.44-22.55), and 75 + years (aOR = 15.16, 95% CI: 7.93-28.97). The likelihood of dying from NCDs was higher among persons with secondary education as compared to those with no education (aOR = 1.93, 95% CI: 1.11-3.33). CONCLUSION The findings from this study suggest that public health interventions targeting NCDs need to consider behavioural factors, especially tobacco use which exposes people to second-hand smoke. We also recommend large-scale national-level studies to further examine the contribution of each factor leading to mortality from NCDs.
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Affiliation(s)
- Emmanuel Musonda
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.
| | - Peter Mumba
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Jacob R S Malungo
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
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20
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Wahbeh F, Restifo D, Laws S, Pawar A, Parikh NS. Impact of tobacco smoking on disease-specific outcomes in common neurological disorders: A scoping review. J Clin Neurosci 2024; 122:10-18. [PMID: 38428126 DOI: 10.1016/j.jocn.2024.02.013] [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: 11/06/2023] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
Although the association of smoking with the risk of incident neurological disorders is well established, less is known about the impact of smoking and smoking cessation on outcomes of these conditions. The objective of this scoping review was to synthesize what is known about the impact of smoking and smoking cessation on disease-specific outcomes for seven common neurological disorders. We included 67 studies on the association of smoking and smoking cessation on disease-specific outcomes. For multiple sclerosis, smoking was associated with greater clinical and radiological disease progression, relapses, risk for disease-related death, cognitive decline, and mood symptoms, in addition to reduced treatment effectiveness. For stroke and transient ischemic attack, smoking was associated with greater rates of stroke recurrence, post-stroke cardiovascular outcomes, post-stroke mortality, post-stroke cognitive impairment, and functional impairment. In patients with cognitive impairment and dementia, smoking was associated with faster cognitive decline, and smoking was also associated with greater cognitive decline in Parkinson's disease, but not motor symptom worsening. Patients with amyotrophic lateral sclerosis who smoked faced increased mortality. Last, in patients with cluster headache, smoking was associated with more frequent and longer cluster attack periods. Conversely, for multiple sclerosis and stroke, smoking cessation was associated with improved disease-specific outcomes. In summary, whereas smoking is detrimentally associated with disease-specific outcomes in common neurological conditions, there is growing evidence that smoking cessation may improve outcomes. Effective smoking cessation interventions should be leveraged in the management of common neurological disorders to improve patient outcomes.
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Affiliation(s)
- Farah Wahbeh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Restifo
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Sa'ad Laws
- Education and Research, Health Sciences Library, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Anokhi Pawar
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
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21
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Onyeaka HK, Chido-Amajuoyi OG, Daskalakis E, Deary EC, Boardman AC, Basiru T, Muoghalu C, Uwandu Q, Baiden P, Nkemjika S, Aneni K, Amonoo HL. Associations between Health-Related Use of Social Media and Positive Lifestyle Behaviors: Findings from a Representative Sample of US Adult Smokers. Subst Use Misuse 2024; 59:527-535. [PMID: 38037958 PMCID: PMC10922700 DOI: 10.1080/10826084.2023.2287199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Background: Cigarette smokers have elevated cardiovascular risk factors, which contributes significantly to mortality. Although social media is a potential avenue to deliver smoking interventions, its role in health promotion among smokers remains relatively unexplored.Objective: To examine the uptake and impact of health-related social media use in cigarette smokers.Methods: Using data from the 2017-2020 Health Information National Trends Survey, we evaluated differences in health-related social media use between smokers and nonsmokers. Multivariable logistic regression was performed to examine the association between social media use and positive health behaviors.Results: We included 1863 current smokers and 13,560 nonsmokers; Most participants were women (51.0%), White (64.6%), and 49.2% were aged ≥50 years. Smokers who used ≥1 social media site for health-related purposes in the past year were significantly more likely to meet the guideline recommendations for: (i) weekly physical activity (AOR 2.00, 95% CI 1.23-3.24), (ii) daily vegetable intake (AOR 2.48, 95% CI 1.10-5.59), and (iii) weekly strength training (AOR 1.80, 95% CI 1.10-2.94). However, the odds of reporting intentions to quit smoking (AOR 1.81, 95% CI 0.98-3.34) and attempts at smoking cessation (AOR 1.68, 95% CI 0.90-3.12) did not differ by health-related social media use.Conclusion: Smokers use social media for health-related purposes at comparable rates to nonsmokers. While our findings indicate that these platforms present a novel opportunity for health promotion among smokers, future research exploring the utility of social media in smoking cessation is crucial.
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Affiliation(s)
- Henry K Onyeaka
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Onyema G Chido-Amajuoyi
- Department of Epidemiology, The University of Texas Maryland Anderson Cancer Center, Houston, TX, USA
| | | | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Tajudeen Basiru
- Department of Psychiatry, Community Health South Florida, Miami, FL, USA
| | - Chioma Muoghalu
- Department of Pediatrics, Plains Regional Medical Center, Clovis, NM, USA
| | - Queeneth Uwandu
- Department of Internal Medicine, Geisinger Health System, Danville, PA, USA
| | - Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, TX, USA
| | - Stanley Nkemjika
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Kammarauche Aneni
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Hermioni L Amonoo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
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23
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Guo L, Xiao X. Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). Aging Med (Milton) 2024; 7:5-51. [PMID: 38571669 PMCID: PMC10985780 DOI: 10.1002/agm2.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024] Open
Abstract
With the deepening of aging in China, the prevalence of diabetes in older people has increased noticeably, and standardized diabetes management is critical for improving clinical outcomes of diabetes in older people. In 2021, the National Center of Gerontology, Chinese Society of Geriatrics, and Diabetes Professional Committee of Chinese Aging Well Association organized experts to write the first guideline for diabetes diagnosis and treatment in older people in China, the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2021 Edition). The guideline emphasizes that older patients with diabetes are a highly heterogeneous group requiring comprehensive assessment and stratified and individualized management strategies. The guideline proposes simple treatments and de-intensified treatment strategies for older patients with diabetes. This edition of the guideline provides clinicians with practical and operable clinical guidance, thus greatly contributing to the comprehensive and full-cycle standardized management of older patients with diabetes in China and promoting the extensive development of clinical and basic research on diabetes in older people and related fields. In the past 3 years, evidence-based medicine for older patients with diabetes and related fields has further advanced, and new treatment concepts, drugs, and technologies have been developed. The guideline editorial committee promptly updated the first edition of the guideline and compiled the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). More precise management paths for older patients with diabetes are proposed, for achieving continued standardization of the management of older Chinese patients with diabetes and improving their clinical outcomes.
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Affiliation(s)
- Lixin Guo
- National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well AssociationBeijingChina
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xinhua Xiao
- National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well AssociationBeijingChina
- Department of EndocrinologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
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24
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Bonekamp NE, Visseren FLJ, Cramer MJ, Dorresteijn JAN, van der Meer MG, Ruigrok YM, van Sloten TT, Teraa M, Geleijnse JM, Koopal C. Long-term lifestyle change and risk of mortality and Type 2 diabetes in patients with cardiovascular disease. Eur J Prev Cardiol 2024; 31:205-213. [PMID: 37774501 DOI: 10.1093/eurjpc/zwad316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
AIMS To quantify the relationship between self-reported, long-term lifestyle changes (smoking, waist circumference, physical activity, and alcohol consumption) and clinical outcomes in patients with established cardiovascular disease (CVD). METHODS AND RESULTS Data were used from 2011 participants (78% male, age 57 ± 9 years) from the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease cohort who returned for a re-assessment visit (SMART2) after ∼10 years. Self-reported lifestyle change was classified as persistently healthy, improved, worsened, or persistently unhealthy. Cox proportional hazard models were used to quantify the relationship between lifestyle changes and the risk of (cardiovascular) mortality and incident Type 2 diabetes (T2D). Fifty-seven per cent of participants was persistently healthy, 17% improved their lifestyle, 8% worsened, and 17% was persistently unhealthy. During a median follow-up time of 6.1 (inter-quartile range 3.6-9.6) years after the SMART2 visit, 285 deaths occurred, and 99 new T2D diagnoses were made. Compared with a persistently unhealthy lifestyle, individuals who maintained a healthy lifestyle had a lower risk of all-cause mortality [hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.36-0.63], cardiovascular mortality (HR 0.57, 95% CI 0.38-0.87), and incident T2D (HR 0.46, 95% CI 0.28-0.73). Similarly, those who improved their lifestyle had a lower risk of all-cause mortality (HR 0.52, 95% CI 0.37-0.74), cardiovascular mortality (HR 0.46, 95% CI 0.26-0.81), and incident T2D (HR 0.50, 95% CI 0.27-0.92). CONCLUSION These findings suggest that maintaining or adopting a healthy lifestyle can significantly lower mortality and incident T2D risk in CVD patients. This study emphasizes the importance of ongoing lifestyle optimization in CVD patients, highlighting the potential for positive change regardless of previous lifestyle habits.
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Affiliation(s)
- Nadia E Bonekamp
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
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Zaręba W, Krawiec P, Banaszkiewicz M, Batko K, Gołąb A, Plicner D, Żuber Z, Batko B. Newly developed cardiovascular risk factors in rheumatoid arthritis patients initiating biologic treatment. Reumatologia 2024; 61:424-431. [PMID: 38322099 PMCID: PMC10839918 DOI: 10.5114/reum/176554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a risk factor (RF) for cardiovascular (CV) disease, a leading cause of mortality in RA patients. Material and methods Consecutive records of RA patients with high disease activity screened upon biologic therapy initiation were reviewed between January 2001 and 2018. Patients with at least 6-month follow-up and baseline disease activity scores were enrolled (n = 353) and stratified into manifest CV disorder ("overt CVD"), any traditional CV risk factor ("atCVrisk") and no CV risk factor ("vlCVrisk") groups. Results Overall, mean (SD) patient age was 51.4 (±12.2) years, and 291 (82.4%) subjects were female. Median follow-up was 41.9 (IQR 18.6, 80) months. Overall, 89 (25.2%) individuals developed at least one new CV RF, of which 65 (18.4%) acquired one and 24 (6.8%) two or more. Incident lipid disorders (42, 11.9%), followed by hypertension (14, 4%), atrial fibrillation (17, 4.8%) and venous thromboembolism (VTE) (16, 4.5%), were common. Incident major adverse cardiac events (MACE) were not reported in the vlCVrisk group, in contrast to atCVrisk (n = 8, 4.2%) or overt CVD (n = 4, 18.2%). Age was a significant predictor of incident CV risk factor (HR 1.04, 95% CI: 1.02-1.07; p < 0.01). In age-adjusted analyses, only baseline body mass index (BMI) (HR 1.11, 95% CI: 1.04-1.18; p < 0.01), but not ever smoking (p = 0.93), male sex (p = 0.26), positive RF (p = 0.24), positive ACPA (p = 0.90), or baseline disease activity (p = 0.19), were independent predictor of incident CV risk factors. Conclusions Patients with RA initiating biologics should be screened for cardiometabolic risk factors, especially at an older age. The presence of at least one risk factor may be linked to a worse long-term prognosis.
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Affiliation(s)
- Wojciech Zaręba
- Department of Cardiology, Jozef Dietl Specialist Hospital, Krakow, Poland
| | - Piotr Krawiec
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
- Department of Research and Development, Medicine Economy Law Science Foundation (MELS), Krakow, Poland
| | - Małgorzata Banaszkiewicz
- Department of Nephrology and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Batko
- Department of Research and Development, Medicine Economy Law Science Foundation (MELS), Krakow, Poland
- Department of Nephrology and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Aleksandra Gołąb
- Faculty of Medicine and Dentistry, Pomeranian Medical University in Szczecin, Poland
| | - Dariusz Plicner
- Unit of Experimental Cardiology and Cardiac Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
- Department of Cardiovascular Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
| | - Zbigniew Żuber
- Department of Research and Development, Medicine Economy Law Science Foundation (MELS), Krakow, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
- Department of Research and Development, Medicine Economy Law Science Foundation (MELS), Krakow, Poland
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Kondo KK, Rahman B, Ayers CK, Relevo R, Griffin JC, Halpern MT. Lung cancer diagnosis and mortality beyond 15 years since quit in individuals with a 20+ pack-year history: A systematic review. CA Cancer J Clin 2024; 74:84-114. [PMID: 37909870 DOI: 10.3322/caac.21808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 11/03/2023] Open
Abstract
Current US lung cancer screening recommendations limit eligibility to adults with a pack-year (PY) history of ≥20 years and the first 15 years since quit (YSQ). The authors conducted a systematic review to better understand lung cancer incidence, risk and mortality among otherwise eligible individuals in this population beyond 15 YSQ. The PubMed and Scopus databases were searched through February 14, 2023, and relevant articles were searched by hand. Included studies examined the relationship between adults with both a ≥20-PY history and ≥15 YSQ and lung cancer diagnosis, mortality, and screening ineligibility. One investigator abstracted data and a second confirmed. Two investigators independently assessed study quality and certainty of evidence (COE) and resolved discordance through consensus. From 2636 titles, 22 studies in 26 articles were included. Three studies provided low COE of elevated lung cancer incidence beyond 15 YSQ, as compared with people who never smoked, and six studies provided moderate COE that the risk of a lung cancer diagnosis after 15 YSQ declines gradually, but with no clinically significant difference just before and after 15 YSQ. Studies examining lung cancer-related disparities suggest that outcomes after 15 YSQ were similar between African American/Black and White participants; increasing YSQ would expand eligibility for African American/Black individuals, but for a significantly larger proportion of White individuals. The authors observed that the risk of lung cancer not only persists beyond 15 YSQ but that, compared with individuals who never smoked, the risk may remain significantly elevated for 2 or 3 decades. Future research of nationally representative samples with consistent reporting across studies is needed, as are better data from which to examine the effects on health disparities across different populations.
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Affiliation(s)
- Karli K Kondo
- Early Cancer Detection Science, American Cancer Society, Kennesaw, Georgia, USA
- Research Integrity, Oregon Health & Science University, Portland, Oregon, USA
| | - Basmah Rahman
- Early Cancer Detection Science, American Cancer Society, Kennesaw, Georgia, USA
| | - Chelsea K Ayers
- Center to Improve Veteran Involvement in Care, Portland Veterans Affairs Health Care System, Portland, Oregon, USA
| | - Rose Relevo
- Early Cancer Detection Science, American Cancer Society, Kennesaw, Georgia, USA
| | - Jessica C Griffin
- Early Cancer Detection Science, American Cancer Society, Kennesaw, Georgia, USA
| | - Michael T Halpern
- Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
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Jung E, Park JH, Ro YS, Ryu HH, Cha KC, Do Shin S, Hwang SO. Family history, socioeconomic factors, comorbidities, health behaviors, and the risk of sudden cardiac arrest. Sci Rep 2023; 13:21341. [PMID: 38049526 PMCID: PMC10696087 DOI: 10.1038/s41598-023-48357-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/25/2023] [Indexed: 12/06/2023] Open
Abstract
Genetic, environment, and behaviour factors have a role in causing sudden cardiac arrest (SCA). We aimed to determine the strength of the association between various risk factors and SCA incidence. We conducted a multicentre case-control study at 17 hospitals in Korea from September 2017 to December 2020. The cases included out-of-hospital cardiac arrest aged 19-79 years with presumed cardiac aetiology. Community-based controls were recruited at a 1:1 ratio after matching for age, sex, and urban residence level. Multivariable conditional logistic regression analysis was conducted. Among the 1016 cases and 1731 controls, 948 cases and 948 controls were analysed. A parental history of SCA, low educational level, own heart disease, current smoking, and non-regular exercise were associated with SCA incidence (Adjusted odds ratio [95% confidence interval]: 2.51 [1.48-4.28] for parental history of SCA, 1.37 [1.38-2.25] for low edication level, 3.77 [2.38-5.90] for non-coronary artery heart disease, 4.47 [2.84-7.03] for coronary artery disease, 1.39 [1.08-1.79] for current smoking, and 4.06 [3.29-5.02] for non-regular exercise). Various risk factors related to genetics, environment, and behaviour were independently associated with the incidence of SCA. Establishing individualised SCA prevention strategies in addition to general prevention strategies is warranted.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea.
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
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Antonello G, Blostein F, Bhaumik D, Davis E, Gögele M, Melotti R, Pramstaller P, Pattaro C, Segata N, Foxman B, Fuchsberger C. Smoking and salivary microbiota: a cross-sectional analysis of an Italian alpine population. Sci Rep 2023; 13:18904. [PMID: 37919319 PMCID: PMC10622503 DOI: 10.1038/s41598-023-42474-7] [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: 05/23/2023] [Accepted: 09/11/2023] [Indexed: 11/04/2023] Open
Abstract
The oral microbiota plays an important role in the exogenous nitrate reduction pathway and is associated with heart and periodontal disease and cigarette smoking. We describe smoking-related changes in oral microbiota composition and resulting potential metabolic pathway changes that may explain smoking-related changes in disease risk. We analyzed health information and salivary microbiota composition among 1601 Cooperative Health Research in South Tyrol participants collected 2017-2018. Salivary microbiota taxa were assigned from amplicon sequences of the 16S-V4 rRNA and used to describe microbiota composition and predict metabolic pathways. Aerobic taxa relative abundance decreased with daily smoking intensity and increased with years since cessation, as did inferred nitrate reduction. Former smokers tended to be more similar to Never smokers than to Current smokers, especially those who had quit for longer than 5 years. Cigarette smoking has a consistent, generalizable association on oral microbiota composition and predicted metabolic pathways, some of which associate in a dose-dependent fashion. Smokers who quit for longer than 5 years tend to have salivary microbiota profiles comparable to never smokers.
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Affiliation(s)
- Giacomo Antonello
- Institute for Biomedicine, Eurac Research - Affiliated Institute of the University of Lübeck, Bolzano, Italy.
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy.
| | - Freida Blostein
- School of Public Health - Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Deesha Bhaumik
- School of Public Health - Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Elyse Davis
- School of Public Health - Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Martin Gögele
- Institute for Biomedicine, Eurac Research - Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Roberto Melotti
- Institute for Biomedicine, Eurac Research - Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Peter Pramstaller
- Institute for Biomedicine, Eurac Research - Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Cristian Pattaro
- Institute for Biomedicine, Eurac Research - Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Nicola Segata
- Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy
| | - Betsy Foxman
- School of Public Health - Epidemiology, University of Michigan, Ann Arbor, MI, USA.
| | - Christian Fuchsberger
- Institute for Biomedicine, Eurac Research - Affiliated Institute of the University of Lübeck, Bolzano, Italy.
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Blaauw MJT, Berrevoets MAH, Vos WAJW, Groenendijk AL, van Eekeren LE, Vadaq N, Weijers G, van der Ven AJAM, Rutten JHW, Riksen NP. Traditional Cardiovascular Risk Factors Are Stronger Related to Carotid Intima-Media Thickness Than to Presence of Carotid Plaques in People Living With HIV. J Am Heart Assoc 2023; 12:e030606. [PMID: 37804189 PMCID: PMC10757550 DOI: 10.1161/jaha.123.030606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/08/2023] [Indexed: 10/09/2023]
Abstract
Background Cardiovascular disease is a major cause of morbidity and mortality in people living with HIV, who are at higher risk than the general population. We assessed, in a large cohort of people living with HIV, which cardiovascular, HIV-specific, and lipoproteomic markers were associated with carotid intima-media thickness (cIMT) and carotid plaque presence. We also studied guideline adherence on lipid-lowering medication in individuals with high and very high risk for cardiovascular disease. Methods and Results In 1814 individuals with a median (interquartile range) age of 53 (44-60) years, we found a carotid plaque in 909 (50.1%) and a median (interquartile range) intima-media thickness of 0.66 (0.57-0.76) mm. Ultrasonography was used for the assessment of cIMT and plaque presence. Univariable and multivariable regression models were used for associations with cIMT and presence of plaques. Age, Black race, body mass index, type 2 diabetes, and smoking (pack years) were all positively associated with higher cIMT. Levels of high-density lipoprotein cholesterol, specifically medium and large high-density lipoprotein subclasses, were negatively associated with higher cIMT. Only age and prior myocardial infarction were positively related to the presence of a carotid plaque. Lipid-lowering treatment was prescribed in one-third of people living with HIV, who are at high and very high risk for cardiovascular disease. Conclusions Traditional cardiovascular risk factors were significantly associated with higher cIMT but not with carotid plaques, except for age. HIV-specific factors were not associated with both ultrasound measurements. Future studies are needed to elucidate which factors contribute to plaque formation. Improvement of guideline adherence on prescription of lipid-lowering treatment in high- and very high-risk patients for cardiovascular disease is recommended. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03994835.
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Affiliation(s)
- Marc J. T. Blaauw
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
- Department of Internal MedicineElisabeth‐Tweesteden HospitalTilburgthe Netherlands
| | | | - Wilhelm A. J. W. Vos
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
- Department of Internal MedicineOLVGAmsterdamthe Netherlands
| | - Albert L. Groenendijk
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
- Department of Medical Microbiology and Infectious DiseasesErasmus Medical Center (MC)Rotterdamthe Netherlands
| | - Louise E. van Eekeren
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
| | - Nadira Vadaq
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
- Center for Tropical and Infectious Diseases, Faculty of MedicineDiponegoro University, Dr. Kariadi HospitalSemarangIndonesia
| | - Gert Weijers
- Medical UltraSound Imaging Center, Division of Medical ImagingRadboud University Medical CenterNijmegenthe Netherlands
| | - Andre J. A. M. van der Ven
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenthe Netherlands
| | - Joost H. W. Rutten
- Division of Vascular Medicine, Department of Internal MedicineRadboud University Medical CentreNijmegenthe Netherlands
| | - Niels P. Riksen
- Division of Vascular Medicine, Department of Internal MedicineRadboud University Medical CentreNijmegenthe Netherlands
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30
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Georgiou AN, Zagkos L, Markozannes G, Chalitsios CV, Asimakopoulos AG, Xu W, Wang L, Mesa‐Eguiagaray I, Zhou X, Loizidou EM, Kretsavos N, Theodoratou E, Gill D, Burgess S, Evangelou E, Tsilidis KK, Tzoulaki I. Appraising the Causal Role of Risk Factors in Coronary Artery Disease and Stroke: A Systematic Review of Mendelian Randomization Studies. J Am Heart Assoc 2023; 12:e029040. [PMID: 37804188 PMCID: PMC7615320 DOI: 10.1161/jaha.122.029040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/27/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Mendelian randomization (MR) offers a powerful approach to study potential causal associations between exposures and health outcomes by using genetic variants associated with an exposure as instrumental variables. In this systematic review, we aimed to summarize previous MR studies and to evaluate the evidence for causality for a broad range of exposures in relation to coronary artery disease and stroke. METHODS AND RESULTS MR studies investigating the association of any genetically predicted exposure with coronary artery disease or stroke were identified. Studies were classified into 4 categories built on the significance of the main MR analysis results and its concordance with sensitivity analyses, namely, robust, probable, suggestive, and insufficient. Studies reporting associations that did not perform any sensitivity analysis were classified as nonevaluable. We identified 2725 associations eligible for evaluation, examining 535 distinct exposures. Of them, 141 were classified as robust, 353 as probable, 110 as suggestive, and 926 had insufficient evidence. The most robust associations were observed for anthropometric traits, lipids, and lipoproteins and type 2 diabetes with coronary artery; disease and clinical measurements with coronary artery disease and stroke; and thrombotic factors with stroke. CONCLUSIONS Despite the large number of studies that have been conducted, only a limited number of associations were supported by robust evidence. Approximately half of the studies reporting associations presented an MR sensitivity analysis along with the main analysis that further supported the causality of associations. Future research should focus on more thorough assessments of sensitivity MR analyses and further assessments of mediation effects or nonlinearity of associations.
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Affiliation(s)
- Andrea N. Georgiou
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Loukas Zagkos
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Georgios Markozannes
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Christos V. Chalitsios
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | | | - Wei Xu
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
| | - Lijuan Wang
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
| | | | - Xuan Zhou
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
| | - Eleni M. Loizidou
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Biobank Cyprus Center of Excellence in Biobanking and Biomedical ResearchUniversity of CyprusNicosiaCyprus
| | - Nikolaos Kretsavos
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Evropi Theodoratou
- Centre for Global Health, Usher InstituteThe University of EdinburghEdinburghUK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and CancerThe University of EdinburghEdinburghUK
| | - Dipender Gill
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUK
| | - Stephen Burgess
- Medical Research Council Biostatistics UnitUniversity of CambridgeCambridgeUK
- Cardiovascular Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Evangelos Evangelou
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Biomedical Research, Institute of Molecular Biology and BiotechnologyFoundation for Research and Technology‐HellasIoanninaGreece
| | - Konstantinos K. Tsilidis
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Ioanna Tzoulaki
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Centre for Systems Biology, Biomedical Research FoundationAcademy of AthensAthensGreece
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31
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Zhu Z, Liu Q, Li M, Yao Y, Qi F, Xu Y, Lu S, Yang Z, Guan Y, Li MD, Yao J. Determination of genetic correlation between tobacco smoking and coronary artery disease. Front Psychiatry 2023; 14:1279962. [PMID: 37822793 PMCID: PMC10562694 DOI: 10.3389/fpsyt.2023.1279962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
Backgrounds Tobacco smoking is an important risk factor for coronary artery disease (CAD), but the genetic mechanisms linking smoking to CAD remain largely unknown. Methods We analyzed summary data from the genome-wide association study (GWAS) of the UK Biobank for CAD, plasma lipid concentrations (n = 184,305), and smoking (n = 337,030) using different biostatistical methods, which included LD score regression and Mendelian randomization (MR). Results We identified SNPs shared by CAD and at least one smoking behavior, the genes where these SNPs are located were found to be significantly enriched in the processes related to lipoprotein metabolic, chylomicron-mediated lipid transport, lipid digestion, mobilization, and transport. The MR analysis revealed a positive correlation between smoking cessation and decreased risk for CAD when smoking cessation was considered as exposure (p = 0.001), and a negative correlation between the increased risk for CAD and smoking cessation when CAD was considered as exposure (p = 2.95E-08). This analysis further indicated that genetic liability for smoking cessation increased the risk of CAD. Conclusion These findings inform the concomitant conditions of CAD and smoking and support the idea that genetic liabilities for smoking behaviors are strongly associated with the risk of CAD.
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Affiliation(s)
- Zhouhai Zhu
- Joint Institute of Tobacco and Health, Kunming, Yunnan, China
| | - Qiang Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Meng Li
- Joint Institute of Tobacco and Health, Kunming, Yunnan, China
| | - Yinghao Yao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Feiyan Qi
- Joint Institute of Tobacco and Health, Kunming, Yunnan, China
| | - Yi Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Sheming Lu
- Joint Institute of Tobacco and Health, Kunming, Yunnan, China
| | - Zhongli Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ying Guan
- Joint Institute of Tobacco and Health, Kunming, Yunnan, China
| | - Ming D. Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianhua Yao
- Joint Institute of Tobacco and Health, Kunming, Yunnan, China
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Lee PN, Coombs KJ, Hamling JS. Evidence relating cigarettes, cigars and pipes to cardiovascular disease and stroke: Meta-analysis of recent data from three regions. World J Meta-Anal 2023; 11:290-312. [DOI: 10.13105/wjma.v11.i6.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND More recent data are required relating to disease risk for use of various smoked products and of other products containing nicotine. Earlier we published meta-analyses of recent results for chronic obstructive pulmonary disease and lung cancer on the relative risk (RR) of current compared to never product use for cigarettes, cigars and pipes based on evidence from North America, Europe and Japan. We now report corresponding up-to-date evidence for acute myocardial infarction (AMI), ischaemic heart disease (IHD) and stroke.
AIM To estimate, using recent data, AMI, IHD and stroke RRs by region for current smoking of cigarettes, cigars and pipes.
METHODS Publications in English from 2015 to 2020 were considered that, based on epidemiological studies in the three regions, estimated the current smoking RR of AMI, IHD or stroke for one or more of the three products. The studies should involve at least 100 cases of stroke or cardiovascular disease (CVD), not be restricted to populations with specific medical conditions, and should be of cohort or nested case-control study design or randomized controlled trials. A literature search was conducted on MEDLINE, examining titles and abstracts initially, and then full texts. Additional papers were sought from reference lists of selected papers, reviews and meta-analyses. For each study identified, we entered the most recent available data on current smoking of each product, as well as the characteristics of the study and the RR estimates. Combined RR estimates were derived using random-effects meta-analysis for stroke and, in the case of CVD, separately for IHD and AMI. For cigarette smoking, where far more data were available, heterogeneity was studied by a wide range of factors. For cigar and pipe smoking, a more limited heterogeneity analysis was carried out. A more limited assessment of variation in risk by daily number of cigarettes smoked was also conducted. Results were compared with those from previous meta-analyses published since 2000.
RESULTS Current cigarette smoking: Ten studies gave a random-effects RR for AMI of 2.72 [95% confidence interval (CI): 2.40-3.08], derived from 13 estimates between 1.47 and 4.72. Twenty-three studies gave an IHD RR of 2.01 (95%CI: 1.84-2.21), using 28 estimates between 0.81 and 4.30. Thirty-one studies gave a stroke RR of 1.62 (95%CI: 1.48-1.77), using 37 estimates from 0.66 to 2.91. Though heterogeneous, only two of the overall 78 RRs were below 1.0, 71 significantly (P < 0.05) exceeding 1.0. The heterogeneity was only partly explicable by the factors studied. Estimates were generally higher for females and for later-starting studies. They were significantly higher for North America than Europe for AMI, but not the other diseases. For stroke, the only endpoint with multiple Japanese studies, RRs were lower there than for Western studies. Adjustment for multiple factors tended to increase RRs. Our RR estimates and the variations by sex and region are consistent with earlier meta-analyses. RRs generally increased with amount smoked. Current cigar and pipe smoking: No AMI data were available. One North American study reported reduced IHD risk for non-exclusive cigar or pipe smoking, but considered few cases. Two North American studies found no increased stroke risk with exclusive cigar smoking, one reporting reduced risk for exclusive pipe smoking (RR 0.24, 95%CI: 0.06-0.91). The cigar results agree with an earlier review showing no clear risk increase for IHD or stroke.
CONCLUSION Current cigarette smoking increases risk of AMI, IHD and stroke, RRs being 2.72, 2.01 and 1.62. The stroke risk is lower in Japan, no increase was seen for cigars/pipes.
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Affiliation(s)
- Peter Nicholas Lee
- Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
| | - Katharine J Coombs
- Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
| | - Jan S Hamling
- Medical Statistics and Epidemiology, P.N.Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
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Akyea RK, Ntaios G, Kontopantelis E, Georgiopoulos G, Soria D, Asselbergs FW, Kai J, Weng SF, Qureshi N. A population-based study exploring phenotypic clusters and clinical outcomes in stroke using unsupervised machine learning approach. PLOS DIGITAL HEALTH 2023; 2:e0000334. [PMID: 37703231 PMCID: PMC10499205 DOI: 10.1371/journal.pdig.0000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/19/2023] [Indexed: 09/15/2023]
Abstract
Individuals developing stroke have varying clinical characteristics, demographic, and biochemical profiles. This heterogeneity in phenotypic characteristics can impact on cardiovascular disease (CVD) morbidity and mortality outcomes. This study uses a novel clustering approach to stratify individuals with incident stroke into phenotypic clusters and evaluates the differential burden of recurrent stroke and other cardiovascular outcomes. We used linked clinical data from primary care, hospitalisations, and death records in the UK. A data-driven clustering analysis (kamila algorithm) was used in 48,114 patients aged ≥ 18 years with incident stroke, from 1-Jan-1998 to 31-Dec-2017 and no prior history of serious vascular events. Cox proportional hazards regression was used to estimate hazard ratios (HRs) for subsequent adverse outcomes, for each of the generated clusters. Adverse outcomes included coronary heart disease (CHD), recurrent stroke, peripheral vascular disease (PVD), heart failure, CVD-related and all-cause mortality. Four distinct phenotypes with varying underlying clinical characteristics were identified in patients with incident stroke. Compared with cluster 1 (n = 5,201, 10.8%), the risk of composite recurrent stroke and CVD-related mortality was higher in the other 3 clusters (cluster 2 [n = 18,655, 38.8%]: hazard ratio [HR], 1.07; 95% CI, 1.02-1.12; cluster 3 [n = 10,244, 21.3%]: HR, 1.20; 95% CI, 1.14-1.26; and cluster 4 [n = 14,014, 29.1%]: HR, 1.44; 95% CI: 1.37-1.50). Similar trends in risk were observed for composite recurrent stroke and all-cause mortality outcome, and subsequent recurrent stroke outcome. However, results were not consistent for subsequent risk in CHD, PVD, heart failure, CVD-related mortality, and all-cause mortality. In this proof of principle study, we demonstrated how a heterogenous population of patients with incident stroke can be stratified into four relatively homogenous phenotypes with differential risk of recurrent and major cardiovascular outcomes. This offers an opportunity to revisit the stratification of care for patients with incident stroke to improve patient outcomes.
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Affiliation(s)
- Ralph K. Akyea
- PRISM Research Group, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, St Thomas Hospital, King’s College London, London, United Kingdom
| | - Daniele Soria
- School of Computing, University of Kent, Canterbury, United Kingdom
| | - Folkert W. Asselbergs
- Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
| | - Joe Kai
- PRISM Research Group, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Stephen F. Weng
- PRISM Research Group, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nadeem Qureshi
- PRISM Research Group, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Kumar M, Orkaby A, Tighe C, Villareal DT, Billingsley H, Nanna MG, Kwak MJ, Rohant N, Patel S, Goyal P, Hummel S, Al-Malouf C, Kolimas A, Krishnaswami A, Rich MW, Kirkpatrick J, Damluji AA, Kuchel GA, Forman DE, Alexander KP. Life's Essential 8: Optimizing Health in Older Adults. JACC. ADVANCES 2023; 2:100560. [PMID: 37664644 PMCID: PMC10470487 DOI: 10.1016/j.jacadv.2023.100560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 09/05/2023]
Abstract
The population worldwide is getting older as a result of advances in public health, medicine, and technology. Older individuals are living longer with a higher prevalence of subclinical and clinical cardiovascular disease (CVD). In 2010, the American Heart Association introduced a list of key prevention targets, known as "Life's Simple 7" to increase CVD-free survival, longevity, and quality of life. In 2022, sleep health was added to expand the recommendations to "Life's Essential 8" (eat better, be more active, stop smoking, get adequate sleep, manage weight, manage cholesterol, manage blood pressure, and manage diabetes). These prevention targets are intended to apply regardless of chronologic age. During this same time, the understanding of aging biology and goals of care for older adults further enhanced the relevance of prevention across the range of functions. From a biological perspective, aging is a complex cellular process characterized by genomic instability, telomere attrition, loss of proteostasis, inflammation, deregulated nutrient-sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. These aging hallmarks are triggered by and enhanced by traditional CVD risk factors leading to geriatric syndromes (eg, frailty, sarcopenia, functional limitation, and cognitive impairment) which complicate efforts toward prevention. Therefore, we review Life's Essential 8 through the lens of aging biology, geroscience, and geriatric precepts to guide clinicians taking care of older adults.
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Affiliation(s)
- Manish Kumar
- Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Ariela Orkaby
- New England GRECC (Geriatric Research Education and Clinical Center), VA Boston HealthCare System, Boston, Massachusetts, USA
- Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caitlan Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Dennis T. Villareal
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, Texas, USA
| | - Hayley Billingsley
- Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Min Ji Kwak
- Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA
| | - Namit Rohant
- Department of Cardiology, University of Arizona, Tucson, Arizona, USA
| | - Shreya Patel
- Department of Pharmacy Practice, School of Pharmacy and Health Sciences, Fairleigh Dickinson University, Florham Park, New Jersey, USA
| | - Parag Goyal
- Program for the Care and Study of Aging Heart, Department of Medicine, Weill Cornell of Medicine, New York, New York, USA
| | - Scott Hummel
- Division of Cardiovascular Medicine, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
| | - Christina Al-Malouf
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amie Kolimas
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | | | - Michael W. Rich
- Department of Medicine, Washington University, St Louise, Missouri, USA
| | - James Kirkpatrick
- Department of Cardiology, University of Washington, Seattle, Washington, USA
| | - Abdulla A. Damluji
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - George A. Kuchel
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Daniel E. Forman
- Divisions of Cardiology and Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh GRECC, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Karen P. Alexander
- Division of Cardiology, Duke Medicine, Duke Clinical Research Institute, Durham, North Carolina, USA
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Li L, Yao H, Zhang L, Garcia‐Argibay M, Du Rietz E, Brikell I, Solmi M, Cortese S, Ramos‐Quiroga JA, Ribasés M, Chang Z, Larsson H. Attention-deficit/hyperactivity disorder is associated with increased risk of cardiovascular diseases: A systematic review and meta-analysis. JCPP ADVANCES 2023; 3:e12158. [PMID: 37720588 PMCID: PMC10501695 DOI: 10.1002/jcv2.12158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/16/2023] [Indexed: 09/19/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with other psychiatric and physical diseases. However, available evidence on associations between ADHD and cardiovascular diseases (CVDs) is mixed. To systematically review, quantitatively synthesize, and appraise available evidence on the link between ADHD with CVDs, we searched relevant articles in PubMed, Embase, PsycINFO, and Web of Science from inception to May 1, 2022. Study quality was assessed by using the Newcastle-Ottawa Scale, and random-effects model meta-analyses were performed. A total of 18,391,169 (ADHD: n = 421,224) individuals from 11 studies were included in our systematic review and 8,196,648 (ADHD = 332,619) individuals from five studies were included in the main meta-analysis of adjusted estimates. Pooled estimates showed that ADHD was significantly associated with an increased risk of CVDs in analyses based on adjusted effect size (odds ratio (OR) = 1.96; 95% confidence interval (CI) = 1.19-2.23, Q = 140.74, P Q < 0.001, I 2 = 97.2%). When restricted among adults, the heterogeneity declined to null (OR = 1.73; 95% CI = 1.14-2.62, Q = 6.28, P Q = 0.10, I 2 = 6.28%), suggesting age might be the main source of heterogeneity. In subgroup analyses, we found increased risk of CVDs associated with ADHD across age groups, type of CVDs, and data sources. This systematic review and meta-analyses indicate that ADHD is associated with increased risk for CVDs, but further studies with various study designs are warranted to advance the understanding of the underlying mechanisms for the observed association between ADHD and CVDs. Additional research is also needed to resolve the role of ADHD medications which remains unclear due to the limited number of primary studies exploring this issue.
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Affiliation(s)
- Lin Li
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Honghui Yao
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Le Zhang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | | | - Ebba Du Rietz
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Isabell Brikell
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of BiomedicineAarhus UniversityAarhusDenmark
| | - Marco Solmi
- Department of PsychiatryUniversity of OttawaOttawaOntarioCanada
- Department of Mental HealthThe Ottawa HospitalOttawaOntarioCanada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of OttawaOttawaOntarioCanada
- Department of Child and Adolescent PsychiatryCharité UniversitätsmedizinBerlinGermany
- Centre for Innovation in Mental Health‐Developmental LabSchool of PsychologyUniversity of SouthamptonSouthamptonUK
| | - Samuele Cortese
- Centre for Innovation in Mental Health‐Developmental LabSchool of PsychologyUniversity of SouthamptonSouthamptonUK
- Solent NHS TrustSouthamptonUK
- Hassenfeld Children's Hospital at NYU LangoneNew York University Child Study CenterNew YorkHampshireUSA
- Division of Psychiatry and Applied PsychologySchool of MedicineUniversity of NottinghamNottinghamUK
| | - J. Antoni Ramos‐Quiroga
- Department of Psychiatry and Forensic MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- Biomedical Network Research Centre on Mental Health (CIBERSAM)MadridSpain
- Department of Mental HealthHospital Universitari Vall d'HebronBarcelonaSpain
- Psychiatric Genetics UnitGroup of PsychiatryMental Health and AddictionVall d’Hebron Research Institute (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Marta Ribasés
- Biomedical Network Research Centre on Mental Health (CIBERSAM)MadridSpain
- Department of Mental HealthHospital Universitari Vall d'HebronBarcelonaSpain
- Psychiatric Genetics UnitGroup of PsychiatryMental Health and AddictionVall d’Hebron Research Institute (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
- Department of Genetics, Microbiology, and StatisticsFaculty of BiologyUniversitat de BarcelonaBarcelonaSpain
| | - Zheng Chang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Henrik Larsson
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
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Katahira M, Imai S, Ono S, Moriura S. Estimating Triglyceride Levels Using Total Cholesterol, Low-Density Lipoprotein Cholesterol, and High-Density Lipoprotein Cholesterol Levels: A Cross-Sectional Study. Metab Syndr Relat Disord 2023; 21:327-334. [PMID: 37405724 DOI: 10.1089/met.2023.0045] [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] [Indexed: 07/06/2023] Open
Abstract
Objective: Triglyceride (TG) levels are affected by food intake, and the cutoff values for nonfasting TG levels vary. This study aimed to calculate fasting TG levels based on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels. Methods: Multiple regression analysis was performed to determine estimated triglyceride (eTG) levels using data from 39,971 participants divided into six groups based on non-high-density lipoprotein cholesterol (nHDL-C) levels (<100, <130, <160, <190, <220, and ≥220 mg/dL). Results: Provided that fasting TG and eTG levels ≥150 mg/dL were positive and those <150 mg/dL were negative, the three groups (nHDL-C levels <100, <130, and <160 mg/dL) consisting of 28,616 participants had a false-positive rate of <5%. The coefficient and constant terms in the formula for the eTG in groups with nHDL-C levels <100, <130, and <160 mg/dL were as follows: constant terms, 12.193, 0.741, and -7.157; coefficients of LDL-C, -3.999, -4.409, and -5.145; coefficients of HDL-C, -3.869, -4.555, and -5.215; and coefficients of TC, 3.984, 4.547, and 5.231, respectively. The adjusted coefficients of determination were 0.547, 0.593, and 0.678, respectively (P < 0.001, P < 0.001, and P < 0.001, respectively). Conclusion: Fasting TG levels can be calculated from TC, LDL-C, and HDL-C levels when nHDL-C levels are <160 mg/dL. Using nonfasting TG and eTG levels as indicators of hypertriglyceridemia might eliminate the need for venous sampling after overnight fasting.
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Affiliation(s)
- Masahito Katahira
- Aichi Prefectural University School of Nursing and Health, Nagoya, Japan
- Checkup Center, Daiyukai Daiichi Hospital, Ichinomiya, Japan
| | - Shu Imai
- Checkup Center, Daiyukai Daiichi Hospital, Ichinomiya, Japan
| | - Satoko Ono
- Checkup Center, Daiyukai Daiichi Hospital, Ichinomiya, Japan
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Azzolina D, Consonni D, Ferrante D, Mirabelli D, Silvestri S, Luberto F, Angelini A, Cuccaro F, Nannavecchia AM, Oddone E, Vicentini M, Barone-Adesi F, Cena T, Mangone L, Roncaglia F, Sala O, Menegozzo S, Pirastu R, Tunesi S, Chellini E, Miligi L, Perticaroli P, Pettinari A, Bressan V, Merler E, Girardi P, Bisceglia L, Marinaccio A, Massari S, Magnani C. Rate advancement measurement for lung cancer and pleural mesothelioma in asbestos-exposed workers. Thorax 2023; 78:808-815. [PMID: 36357176 DOI: 10.1136/thorax-2021-217862] [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: 06/26/2021] [Accepted: 10/13/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Exposure to asbestos increases the risk of lung cancer and mesothelioma. Few studies quantified the premature occurrence of these diseases in asbestos-exposed workers. Focus on premature disease onset (rate advancement or acceleration) can be useful in risk communication and for the evaluation of exposure impact. We estimated rate advancement for total mortality, lung cancer and pleural mesothelioma deaths, by classes of cumulative asbestos exposure in a pooled cohort of asbestos cement (AC) workers in Italy. METHOD The cohort study included 12 578 workers from 21 cohorts, with 6626 deaths in total, 858 deaths from lung cancer and 394 from pleural malignant neoplasm (MN). Rate advancement was estimated by fitting a competitive mortality Weibull model to the hazard of death over time since first exposure (TSFE). RESULT Acceleration time (AT) was estimated at different TSFE values. The highest level of cumulative exposure compared with the lowest, for pleural MN AT was 16.9 (95% CI 14.9 to 19.2) and 33.8 (95% CI 29.8 to 38.4) years at TSFE of 20 and 40 years, respectively. For lung cancer, it was 13.3 (95% CI 12.0 to 14.7) and 26.6 (95% CI 23.9 to 29.4) years, respectively. As for total mortality, AT was 3.35 (95% CI 2.98 to 3.71) years at 20 years TSFE, and 6.70 (95% CI 5.95 to 7.41) at 40 years TSFE. CONCLUSION The current study observed marked rate advancement after asbestos exposure for lung cancer and pleural mesothelioma, as well as for total mortality.
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Affiliation(s)
| | - Dario Consonni
- Unit of Epidemiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Dario Mirabelli
- Unit of Cancer Epidemiology, CPO Piedmont and University of Turin, Turin, Italy
| | - Stefano Silvestri
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Ferdinando Luberto
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessia Angelini
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Francesco Cuccaro
- Unit of Epidemiology and Statistics, Local Health Unit of Barletta-Andria-Trani, Barletta, Italy
| | - Anna Maria Nannavecchia
- Unit of Epidemiology and Statistics, Local Health Unit of Barletta-Andria-Trani, Barletta, Italy
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, and ICS Maugeri IRCCS, Pavia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Barone-Adesi
- Unit of Public Health, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Tiziana Cena
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Roncaglia
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Orietta Sala
- Regional Agency for Protection, Environment and Energy Emilia-Romagna, Reggio Emilia, Italy
| | - Simona Menegozzo
- National Cancer Institute IRCCS Fondazione Pascale, Napoli, Italy
| | - Roberta Pirastu
- Department of Biology and Biotechnologies 'Charles Darwin', Sapienza University, Rome, Italy
| | - Sara Tunesi
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Elisabetta Chellini
- Occupational & Environmental Epidemiology Unit-Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Firenze, Italy
| | - Lucia Miligi
- Occupational & Environmental Epidemiology Unit-Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Firenze, Italy
| | | | | | | | - Enzo Merler
- Mesothelioma Register of the Veneto Region, Regional Epidemiologic System, Local Health Unit 6, Padua, Italy
| | - Paolo Girardi
- Mesothelioma Register of the Veneto Region, Regional Epidemiologic System, Local Health Unit 6, Padua, Italy
- Department of Developmental and Social Psychology Department of Statistical Sciences University of Padova, Padua, Italy
| | - Lucia Bisceglia
- Apulia Regional Agency for Health and Social Policies-ARESS Puglia, Bari, Italy
| | - Alessandro Marinaccio
- Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Roma, Italy
| | - Stefania Massari
- Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Roma, Italy
| | - Corrado Magnani
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Novara, Italy
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Liu X, Sun J, Zhao M, Bovet P, Xi B. Cigarette smoking in childhood and risk of all-cause and cause-specific mortality in adulthood. Front Public Health 2023; 11:1051597. [PMID: 37483954 PMCID: PMC10359425 DOI: 10.3389/fpubh.2023.1051597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Background This study was aimed to examine the association between cigarette smoking in childhood and mortality in adulthood, and the impact of non-smoking duration among smokers who subsequently quit smoking. Methods We used data from 472,887 adults aged 18-85 years examined once in the US National Health Interview Survey in 1997-2014, which was linked to mortality data from the National Death Index up to 31 December 2015. Cigarette smoking status in childhood (age 6 to 17 years) and adulthood (age 18 to 85 years) was self-reported using a standard questionnaire at the time of participation in the survey. The vital status of participants due all-causes, cardiovascular disease (CVD), cancer and chronic lower respiratory diseases was obtained using mortality data from the National Death Index. Results During the mean follow-up of 8.75 years, compared with never smoking in childhood and adulthood, the risk of all-cause mortality among current adult smokers decreased slightly according to increasing age at smoking initiation: hazard ratios (HRs; 95% confidence intervals, CIs) were 2.54 (2.24-2.88) at age of 6-9 years, 2.44 (2.31-2.57) at age of 10-14 years, and 2.21 (2.12-2.31) at age of 15-17 years. Smoking cessation before the age of 30 years was not associated with increased risk of all-cause and cause-specific mortality (all p > 0.05) compared to never smoking. Conclusion Mortality risk was higher in individuals who started smoking at an earlier age in childhood. Inversely, smoking cessation before the age of 30 years was not associated with an increased risk of mortality compared to never smoking.
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Affiliation(s)
- Xue Liu
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiahong Sun
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Zhao
- Department of Toxicology and Nutrition, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Pascal Bovet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Gaalema DE, Khadanga S, Pack QR. Clinical challenges facing patient participation in cardiac rehabilitation: cigarette smoking. Expert Rev Cardiovasc Ther 2023; 21:733-745. [PMID: 37938825 DOI: 10.1080/14779072.2023.2282026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is highly effective at reducing morbidity and mortality. However, CR is underutilized, and adherence remains challenging. In no group is CR attendance more challenging than among patients who smoke. Despite being more likely to be referred to CR, they are less likely to enroll, and much more likely to drop out. CR programs generally do not optimally engage and treat those who smoke, but this population is critical to engage given the high-risk nature of continued smoking in those with cardiovascular disease. AREAS COVERED This review covers four areas relating to CR in those who smoke. First, we review the evidence of the association between smoking and lack of participation in CR. Second, we examine how smoking has historically been identified in this population and propose objective screening measures for all patients. Third, we discuss the optimal treatment of smoking within CR. Fourth, we review select populations within those who smoke (those with lower-socioeconomic status, females) that require additional research and attention. EXPERT OPINION Smoking poses a challenge on multiple fronts, being a significant predictor of future morbidity and mortality, as well as being strongly associated with not completing the secondary prevention program (CR) that could benefit those who smoke the most.
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Affiliation(s)
- Diann E Gaalema
- Department of Psychiatry, University of Vermont, Burlington, VT, United States of America
| | - Sherrie Khadanga
- Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, South Burlington, VT, United States of America
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, United States of America
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Song S, Lee HA, Kim Y, Jeon BK, Moon CM, Park J. Dynamic changing smoking habits and cardiovascular events in patients newly diagnosed with hypertension, diabetes, or dyslipidemia: a national cohort study. Front Cardiovasc Med 2023; 10:1190227. [PMID: 37448792 PMCID: PMC10336696 DOI: 10.3389/fcvm.2023.1190227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Background and aims This study aimed to examine the association between dynamic smoking habit change and cardiovascular risk in a population newly diagnosed with hypertension, diabetes, and dyslipidemia. Methods This study included 49,320 individuals who had received health examinations provided by the Korea National Health Insurance Service. To determine the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident major adverse cardiac events (MACE) and all-cause mortality based on dynamic smoking habit changes for 2 years, multivariable Cox proportional hazard models were utilized. Results During the follow-up, there were 1,004 (2.2%), 3,483 (7.6%), and 334 (0.7%) cases of myocardial infarction, stroke events, and cardiovascular death, respectively. The group with worsening smoking habits had an increased risk of cardiovascular events and death (HR: 1.33, 95% CI: 1.26-1.40) compared to improved smoking habits. The robustness of the results determined by a series of sensitivity analyses further strengthened the main findings. Conclusions Our findings suggest that worsening of smoking habits, even for a short period of time, may increase the risk of myocardial infarction, stroke, and cardiovascular death in patients diagnosed with hypertension, diabetes, and dyslipidemia. For the primary prevention of cardiovascular events in patients with underlying diseases, dynamic modification of smoking habits should be actively considered.
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Affiliation(s)
- Shinjeong Song
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Yeji Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Bo Kyung Jeon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chang Mo Moon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Vlasceanu AM, Gradinaru D, Stan M, Nitescu VG, Baconi DL. Relationships between Serum Biomarkers of Oxidative Stress and Tobacco Smoke Exposure in Patients with Mental Disorders. Antioxidants (Basel) 2023; 12:1299. [PMID: 37372029 DOI: 10.3390/antiox12061299] [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: 05/02/2023] [Revised: 06/11/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
The role of cigarette smoking as an aggravating factor of systemic oxidative stress in patients with mental disorders has not been extensively investigated, although significantly higher rates of smoking are recorded in these subjects in comparison with the general population. In the present study, we tested the hypothesis that smoking might be an exacerbator of systemic oxidative stress, being directly correlated with the degree of exposure to tobacco smoke. We analyzed, in 76 adult subjects from a public health care unit, the relationships between serum cotinine levels as a marker of tobacco smoke exposure, and three biomarkers of oxidative stress: the serum glutathione (GSH), the advanced oxidation protein products (AOPPs), and the total serum antioxidant status (FRAP). The results indicate that the degree of tobacco smoke exposure was inversely associated with GSH levels in both passive and active smokers, suggesting that smoke particulate components' toxicity is associated with a systemic GSH depletion. Paradoxically, the lowest AOPP levels which were positively associated with GSH, were recorded in active smoking patients whereas in passive smokers individual values of AOPPs decreased along with the increase in GSH levels. Our data suggest that an enhanced inhalation of particulate constituents of cigarette smoke could induce critical changes in systemic redox homeostasis and GSH can no longer exert its antioxidant role.
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Affiliation(s)
- Ana-Maria Vlasceanu
- Department of Toxicology, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Sector 2, 20021 Bucharest, Romania
| | - Daniela Gradinaru
- Department of Biochemistry, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Sector 2, 20021 Bucharest, Romania
| | - Miriana Stan
- Department of Toxicology, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Sector 2, 20021 Bucharest, Romania
| | - Viorela G Nitescu
- Emergency Clinical Hospital for Children Grigore Alexandrescu, Pediatric Clinic 2, Ward ATI -Toxicology, 30-32 Iancu de Hunedoara Street, 20021 Bucharest, Romania
| | - Daniela Luiza Baconi
- Department of Toxicology, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu Street, Sector 2, 20021 Bucharest, Romania
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Han B, Einstein EB, Compton WM. Patterns and Characteristics of Nicotine Dependence Among Adults With Cigarette Use in the US, 2006-2019. JAMA Netw Open 2023; 6:e2319602. [PMID: 37351884 PMCID: PMC10290248 DOI: 10.1001/jamanetworkopen.2023.19602] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/07/2023] [Indexed: 06/24/2023] Open
Abstract
Importance Nicotine dependence increases the risk of persistent smoking, which is the leading preventable cause of morbidity and death. However, evidence regarding the associations of nicotine dependence with age, psychiatric conditions, and sociodemographic characteristics is limited. Objective To assess whether and how nicotine dependence among US adults with cigarette use varies by year, age, psychiatric comorbidities, and sociodemographic characteristics. Design, Setting, and Participants This exploratory serial cross-sectional study used data from 152 354 US community-dwelling individuals 18 years or older who participated in the 2006-2019 National Surveys on Drug Use and Health. Data analyses were conducted from January 15 to February 15, 2023. Exposure Past-month cigarette use. Past-year major depressive episode (MDE) and/or substance use disorder (SUD) based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), Text Revision. Main Outcomes and Measures Past-month nicotine dependence based on criteria from the Nicotine Dependence Syndrome Scale or the Fagerström Test of Nicotine Dependence. Results Among 152 354 adults with past-month cigarette use (54.1% male; 40.2% aged 18-34 years; 29.0% aged 35-49 years; 69.8% non-Hispanic White), the adjusted prevalence of nicotine dependence decreased from 59.52% (95% CI, 57.93%-61.10%) in 2006 to 56.00% (95% CI, 54.38%-57.60%) in 2019 (average annual percentage change [AAPC], -0.4%; 95% CI, -0.5% to -0.4%; P < .001) and among each examined age group, except for stability among those aged 18 to 25 years (AAPC, -0.5%; 95% CI, -1.4% to 0.4%; P = .27). Compared with those 50 years and older with past-month cigarette smoking, the adjusted prevalence of nicotine dependence among those aged 18 to 49 years was 32% lower for those aged 18 to 25 years (adjusted risk ratio [ARR], 0.68; 95% CI, 0.66-0.70), 18% lower for those aged 26 to 34 years (ARR, 0.82; 95% CI, 0.80-0.84), and 6% lower for those aged 35 to 49 years (ARR, 0.94; 95% CI, 0.92-0.96). The adjusted prevalence of nicotine dependence varied by age, MDE and/or SUD status, and sociodemographic characteristics. For example, by 2019, prevalence was 41.27% (95% CI, 39.21%-43.37%) among those aged 18 to 25 years and 64.43% (95% CI, 60.98%-67.74%) among those 50 years and older. Differences in nicotine dependence prevalence between those with co-occurring MDE and SUD and those without both conditions were more than 2 times larger for those 50 years and older vs those aged 18 to 49 years (eg, ages ≥50 years vs 18-25 years: 18.69 percentage point difference [83.32% vs 64.63%] vs 7.67 percentage point difference [48.88% vs 41.21%]; P < .001). Conclusions and Relevance In this cross-sectional study, there were significant reductions in nicotine dependence prevalence from 2006 to 2019 among US adults with cigarette use and all examined subgroups 26 years and older. Adults 50 years and older (especially those with MDE and/or SUD) had the highest nicotine dependence prevalence compared with other age groups, highlighting the importance of assisting with smoking cessation efforts and addressing nicotine dependence for this older population. Evidence-based tobacco cessation strategies tailored to age and comorbidities are needed.
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Affiliation(s)
- Beth Han
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Emily B. Einstein
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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Vujosevic S, Fantaguzzi F, Salongcay R, Brambilla M, Torti E, Cushley L, Limoli C, Nucci P, Peto T. Multimodal Retinal Imaging in Patients with Diabetes Mellitus and Association with Cerebrovascular Disease. Ophthalmic Res 2023; 66:1044-1052. [PMID: 37253334 DOI: 10.1159/000531249] [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: 03/03/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION This study aimed to evaluate the association between macular optical coherence tomography angiography (OCT-A) metrics, characteristics of ultrawide field (UWF) imaging, and cerebrovascular disease in patients with diabetes mellitus (DM) with different stages of diabetic retinopathy (DR). METHODS 516 eyes of 258 DM patients were enrolled in two centers (Milan and Belfast). UWF color fundus photos (CFPs) were obtained with Optos California (Optos, PLC) and graded for both DR severity and predominantly peripheral lesions presence (>50% of CFP lesions) by two independent graders. OCT-A (3 × 3 mm), available in 252 eyes of 136 patients, was used to determine perimeter, area, and circularity index of the foveal avascular zone and vessel density (VD); perfusion density (PD); fractal dimension on superficial, intermediate (ICP), and deep capillary plexuses; flow voids (FVs) in the choriocapillaris. RESULTS Out of 516 eyes, 108 eyes (20.9%) had no DR, and 6 eyes were not gradable. The remaining 402 eyes were as follows: 10.3% (53) had mild nonproliferative DR (NPDR), 38.2% (197) had moderate NPDR, 11.8% (61) had severe NPDR, and 17.6% (91) had proliferative DR. A worse DR stage was associated with a history of stroke (p = 0.044). Logistic regression analysis after taking into account sex, type of DM, age, DM duration, and OCT-A variables found that PD and VD on ICP were significantly associated with presence of stroke and DR severity. CONCLUSION OCT-A metrics show an association with the presence of cerebrovascular complications, providing potentially useful parameters to estimate vascular risk in patients with DM.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | | | | | - Marco Brambilla
- Department of Medical Physics, University Hospital Maggiore della Carità, Novara, Italy
| | - Emanuele Torti
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Laura Cushley
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Celeste Limoli
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
- University of Milan, Milan, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Bonnesen K, Pedersen L, Ehrenstein V, Grønkjær MS, Sørensen HT, Hallas J, Lash TL, Schmidt M. Impact of Lifestyle and Socioeconomic Position on the Association Between Non-steroidal Anti-inflammatory Drug Use and Major Adverse Cardiovascular Events: A Case-Crossover Study. Drug Saf 2023; 46:533-543. [PMID: 37131013 DOI: 10.1007/s40264-023-01298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION It is unknown whether the cardiovascular risks associated with non-steroidal anti-inflammatory drug (NSAID) use differ according to lifestyle and socioeconomic position. OBJECTIVE We examined the association between NSAID use and major adverse cardiovascular events (MACE) within subgroups defined by lifestyle and socioeconomic position. METHODS We conducted a case-crossover study of all adult first-time respondents to the Danish National Health Surveys of 2010, 2013, or 2017, without previous cardiovascular disease, who experienced a MACE from survey completion through 2020. We used a Mantel-Haenszel method to obtain odds ratios (ORs) of the association between NSAID use (ibuprofen, naproxen, or diclofenac) and MACE (myocardial infarction, ischemic stroke, heart failure, or all-cause death). We identified NSAID use and MACE via nationwide Danish health registries. We stratified the analyses by body mass index, smoking status, alcohol consumption, physical activity level, marital status, education, income, and employment. RESULTS Compared with non-use, the OR of MACE was 1.34 (95% confidence interval: 1.23-1.46) for ibuprofen, 1.48 (1.04-2.43) for naproxen, and 2.18 (1.72-2.78) for diclofenac. When comparing NSAID use with non-use or the individual NSAIDs with each other, we observed no notable heterogeneity in the ORs within subgroups of lifestyle and socioeconomic position for any NSAID. Compared with ibuprofen, diclofenac was associated with increased risk of MACE in several subgroups with high cardiovascular risk, e.g., individuals with overweight (OR 1.52, 1.01-2.39) and smokers (OR 1.54, 0.96-2.46). CONCLUSIONS The relative increase in cardiovascular risk associated with NSAID use was not modified by lifestyle or socioeconomic position.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Marie Stjerne Grønkjær
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Timothy Lee Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Liang T, Xie C, Lv B, Su L, Long J, Liu S, Huang X, Pei P, Pan R, Lan J. Age at smoking initiation and smoking cessation influence the incidence of stroke in China: a 10-year follow-up study. J Thromb Thrombolysis 2023:10.1007/s11239-023-02812-y. [PMID: 37099076 DOI: 10.1007/s11239-023-02812-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 04/27/2023]
Abstract
Our study aimed to explore the correlation between age at smoking initiation and smoking cessation for the risk for stroke in China. We investigated 50,174 participants from one of the urban areas of China Kadoorie Biobank (CKB) Study. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for association between smoking and incidence of stroke were estimated using Cox regression model. During a median of 10.7 years of follow-up, 4370 total stroke cases were documented. Among men, comparing current smokers to never smokers, the HR of total stroke for current smokers was 1.279 (95% CI, 1.134-1.443) for total stroke. The HRs of total stroke were 1.344 (1.151-1.570) for those started smoking at age less than 20 years, 1.254 (1.090-1.443) for those started smoking at age 20-30 years, and 1.205 (1.012-1.435) for those started smoking at age 30 year and above, with a dose-response relation (P for trend, 0.004). Comparing former smokers to current smokers, in the low pack-year group, those stopped smoking at age less than 65 years had a 18.2% decreased risk for total stroke (0.818; 0.673-0.994). The decreased risk was not found in those stopped smoking at age 65 years and above. Similar results were observed in the high pack-year group. In conclusion, we found that current smokers had a higher stroke risk than never smokers, and the risk increased with a younger age at smoking initiation. Smoking cessation can reduce the risk for stroke, especially could benefit from cessation at a younger age.
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Affiliation(s)
- Tian Liang
- School of Public Health of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Changping Xie
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545007, China
| | - Bangjun Lv
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545007, China
| | - Li Su
- School of Public Health of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jianxiong Long
- School of Public Health of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Shengying Liu
- School of Public Health of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Xiaolan Huang
- School of Public Health of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Pei Pei
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China
| | - Rong Pan
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545007, China.
| | - Jian Lan
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545007, China.
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Bonnesen K, Ehrenstein V, Grønkjaer MS, Pedersen L, Lash TL, Schmidt M. Impact of lifestyle and socioeconomic position on use of non-steroidal anti-inflammatory drugs: A population-based cohort study. Pharmacoepidemiol Drug Saf 2023; 32:455-467. [PMID: 36382802 DOI: 10.1002/pds.5571] [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: 07/07/2022] [Revised: 10/10/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Lifestyle and socioeconomic position may confound the link between non-steroidal anti-inflammatory drugs (NSAIDs) and cardiovascular events, if associated with NSAID use. We examined this association. METHODS We conducted a cohort study of all adult first-time responders to the Danish National Health Surveys of 2010, 2013, or 2017 without an NSAID prescription within 3 months before survey completion (n = 407 395). Study exposures were weight, smoking status, alcohol consumption, binge drinking frequency, physical activity level, marital status, highest achieved level of education, income, and employment status. We used a Cox model to compute hazard ratios of time to first redemption of an NSAID prescription and a cumulative odds model to compute odds ratios (ORs) of redeeming one additional NSAID prescription in the year after survey completion. RESULTS Total follow-up time was 1 931 902 years. The odds of redeeming one additional NSAID prescription in the year after survey completion varied within all categories of lifestyle and socioeconomic position. The largest ORs were observed within categories of weight (1.70, 95% CI: 1.65-1.74 for obesity vs. normal weight), smoking status (1.24, 95% CI: 1.21-1.27 for current vs. never use), and education (1.44, 95% CI: 1.39-1.49 for primary or other vs. university or higher education). The Cox model showed consistent results. CONCLUSIONS Markers of unhealthy lifestyle and low socioeconomic position were associated with initiation and prolonged NSAID use. Consideration of lifestyle and socioeconomic markers as potential confounders in NSAID studies is therefore recommended.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Marie S Grønkjaer
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Morten Schmidt
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Balakrishnan P, Jacyshyn-Owen E, Eberl M, Friedrich B, Etter T. Real-world demographic patterns of users of a digital primary prevention service for diabetes. Cardiovasc Endocrinol Metab 2023; 12:e0275. [PMID: 36582668 PMCID: PMC9750647 DOI: 10.1097/xce.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022]
Abstract
Rapid urbanization has led to an exponential increase in lifestyle-associated metabolic disorders presenting a huge socioeconomic burden. Waya is a digital prevention program that guides overweight and obese individuals to maintain a healthy lifestyle through exercise, diet, and educational videos. Objectives and aims We aimed to study the demographic patterns of the Waya cohort and examine the prevalence of diabetes (the most common lifestyle-associated metabolic disorder) and its risk factors in comparison to the GEDA 2014/2015-European Health Interview Survey population. Methods Waya participants who registered by 1 October 2020 and who answered at least one health survey question were included in this study. Factors such as obesity, hypertension, and diabetes between the two populations were compared using Chi-square test. Results Of the 837 participants, 86.1% were women. The proportion of obese participants was higher in Waya than in the German Health Update (GEDA) cohort (women: 39.4% vs. 18%, P < 0.05; men: 37.1% vs. 18.3%, P < 0.05), whereas the proportion of participants with hypertension (women: 12.1% vs. 30.9% in GEDA, P < 0.05; men: 22.4% vs. 32.8% in GEDA, P < 0.05) was lower. The proportion of women with diabetes was low in our cohort (3.9% vs. 7% in GEDA, P < 0.05); however, the proportion of men with diabetes remained the same between the two groups. We observed significant differences between the GEDA and Waya cohorts due to changes in the prevalence pattern over time or target bias of the digital program. Conclusion These findings showcase the usability of Waya in collecting real-world insights, which will be beneficial in monitoring the prevalence of chronic metabolic disorders and associated risk factors over time.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1424] [Impact Index Per Article: 1424.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Østergaard HB, Humphreys V, Hengeveld EM, Honoré JB, Mach F, Visseren FLJ, Westerink J, Yadav G, Mosenzon O. Cardiovascular risk and lifetime benefit from preventive treatment in type 2 diabetes: A post hoc analysis of the CAPTURE study. Diabetes Obes Metab 2023; 25:435-443. [PMID: 36199242 PMCID: PMC10092227 DOI: 10.1111/dom.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 02/02/2023]
Abstract
AIM To assess the potential gain in the number of life-years free of a (recurrent) cardiovascular disease (CVD) event with optimal cardiovascular risk management (CVRM) and initiation of glucose-lowering agents with proven cardiovascular benefit in people with type 2 diabetes (T2D). MATERIALS AND METHODS 9,416 individuals with T2D from the CAPTURE study, a non-interventional, cross-sectional, multinational study, were included. The diabetes lifetime-perspective prediction model was used for calculating individual 10-year and lifetime CVD risk. The distribution of preventive medication use was assessed according to predicted CVD risk and stratified for history of CVD. For the estimation of absolute individual benefit from lifelong preventive treatment, including optimal CVRM and the addition of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT-2is), the model was combined with treatment effects from current evidence. RESULTS GLP-1 RA or SGLT-2i use did not greatly differ between patients with and without CVD history, while use of blood pressure-lowering medication, statins and aspirin was more frequent in patients with CVD. Mean (standard deviation [SD]) lifetime benefit from optimal CVRM was 3.9 (3.0) and 1.3 (1.9) years in patients with and without established CVD, respectively. Further addition of a GLP-1 RA and an SGLT-2i in patients with CVD gave an added mean (SD) lifetime benefit of 1.2 (0.6) years. CONCLUSIONS Life-years gained free of (recurrent) CVD by optimal CVRM and the addition of a GLP-1 RA or aSGLT-2i is dependent on baseline CVD status. These results aid individualizing prevention and promote shared decision-making in patients with T2D.
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Affiliation(s)
| | | | | | | | - François Mach
- Cardiology Division, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gourav Yadav
- Novo Nordisk Global Business Services, Bengaluru, India
| | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Jiang L, Chen S, Wu Y, Zhou D, Duan L. Prediction of coronary heart disease in gout patients using machine learning models. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:4574-4591. [PMID: 36896513 DOI: 10.3934/mbe.2023212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Growing evidence shows that there is an increased risk of cardiovascular diseases among gout patients, especially coronary heart disease (CHD). Screening for CHD in gout patients based on simple clinical factors is still challenging. Here we aim to build a diagnostic model based on machine learning so as to avoid missed diagnoses or over exaggerated examinations as much as possible. Over 300 patient samples collected from Jiangxi Provincial People's Hospital were divided into two groups (gout and gout+CHD). The prediction of CHD in gout patients has thus been modeled as a binary classification problem. A total of eight clinical indicators were selected as features for machine learning classifiers. A combined sampling technique was used to overcome the imbalanced problem in the training dataset. Eight machine learning models were used including logistic regression, decision tree, ensemble learning models (random forest, XGBoost, LightGBM, GBDT), support vector machine (SVM) and neural networks. Our results showed that stepwise logistic regression and SVM achieved more excellent AUC values, while the random forest and XGBoost models achieved more excellent performances in terms of recall and accuracy. Furthermore, several high-risk factors were found to be effective indices in predicting CHD in gout patients, which provide insights into the clinical diagnosis.
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Affiliation(s)
- Lili Jiang
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Sirong Chen
- School of Mathematical Sciences, Soochow University, Suzhou, China
| | - Yuanhui Wu
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Da Zhou
- School of Mathematical Sciences, Xiamen University, Xiamen, China
| | - Lihua Duan
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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