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Tan J, Li B, Cao J, Xie H. APOE gene polymorphism in ischemic stroke patients from Huizhou and its correlation with blood lipids and homocysteine. J Stroke Cerebrovasc Dis 2024; 33:107990. [PMID: 39227003 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107990] [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: 06/05/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVES To investigate the correlation between apolipoprotein E (APOE) gene polymorphisms and ischemic stroke and its relationship with blood lipids and homocysteine (HCY) level in Huizhou City. MATERIALS AND METHODS In this analytical cross-sectional study, we selected 2612 patients who underwent APOE genotyping from November 2019 to November 2021 at the Third People's Hospital of Huizhou. Among them, 2014 were ischemic stroke patients and 598 were non-stroke patients. The independent variables were ischemic stroke, different genotypes, and different alleles, while the dependent variables were blood lipid levels and HCY levels. RESULTS The distribution frequency of ε4 allele in stroke group was higher than that in non-stroke group (P < 0.05). Compared with ε4 allele carriers in the stroke group, the levels of lipid total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) in ε2 and ε3 allele carriers were significantly lower, while the levels of high-density lipoprotein cholesterol (HDL-C) were significantly higher (P < 0.01). The levels of lipid Lipoprotein a (LPa) and small dense low-density lipoprotein (sdLDL) in ε2 allele carriers in stroke group were significantly lower than those of ε4 allele carriers (P < 0.05). Logistics regression analysis showed that age, TC, HCY level and allele ε4 were positively correlated with the risk of ischemic stroke (P < 0.01), TG level was positively correlated with the risk of ischemic stroke in females (P < 0.01). CONCLUSIONS APOE gene polymorphism is associated with ischemic stroke, and ε4 allele carriers have a higher risk than ε3 allele carriers.
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Affiliation(s)
- Junyu Tan
- The Affiliated Huizhou Hospital, Guangzhou Medical University, Huizhou, Guangdong Province 516002, China.
| | - Bohong Li
- The Affiliated Huizhou Hospital, Guangzhou Medical University, Huizhou, Guangdong Province 516002, China
| | - Jialin Cao
- The Affiliated Huizhou Hospital, Guangzhou Medical University, Huizhou, Guangdong Province 516002, China
| | - Hong Xie
- The Affiliated Huizhou Hospital, Guangzhou Medical University, Huizhou, Guangdong Province 516002, China
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Wu Y, Han X, Qiu J. Impacts of the Zero-Markup Drug Policy on Hospitalization Expenses of Patients with Stroke in Western China: An Interrupted Time Series Analysis. Risk Manag Healthc Policy 2024; 17:777-788. [PMID: 38584876 PMCID: PMC10999200 DOI: 10.2147/rmhp.s456977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/23/2024] [Indexed: 04/09/2024] Open
Abstract
Background In 2016, an innovative medical pricing reform called zero-markup drug policy (ZMDP) was implemented in selected pilot cities in China, which focuses on curbing the unreasonable growth of medical expenses. This study aimed to evaluate the impacts of ZMDP on medical expenditure of stroke in western China. Methods The quantitative data of inpatients diagnosed with stroke was extracted from the medical insurance system in 7 tertiary public hospitals. An interrupted time series (ITS) was used to analyze the instantaneous level and long-term trend changes of hospitalization expenses per visit from January 2015 to November 2018. Results A total of 22,407 stroke inpatients were extracted. The total hospitalization expense per visit had the highest proportion of 20,000 CNY and above (33.66%). After the ZMDP, the median total hospitalization expense and western medicine expense per visit decreased by 631.74 CNY and 966.35 CNY, respectively (P <0.001). Before the policy, the total hospitalization expense, traditional Chinese medicine (TCM) expense, examination expense, treatment expense, laboratory expense and surgical expense per visit showed upward trends (P<0.05), while the anesthesia expense per visit showed a downward trend (P<0.001). When the policy was implemented, the anesthesia expense per visit instantaneously increased by 91.70% (P<0.001). After the policy, the total hospitalization expense, western medicine expense, TCM expense, treatment expense and surgical expense per visit changed from upward trends to downward trends (P<0.05). The anesthesia expense per visit changed from a downward trend to an upward trend (P<0.001), and the examination expense per visit maintained an upward trend (P=0.005). Conclusion The economic burden of stroke inpatients decreased significantly with the implementation of the ZMDP, especially for the drug expenses. The medical service expenses increased significantly, reflecting the improvement in the value of medical staff's technical labor. However, the unexpected increase in the examination expenses was likely to be associated with the unreasonable medical compensation mechanism.
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Affiliation(s)
- Yanghaotian Wu
- Department of Social Medicine and Health Service Management, School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
- Department of Social Medicine, School of Public Health, Southwest Medical University, Luzhou, People’s Republic of China
- Institute of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Xuemei Han
- Institute of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Jingfu Qiu
- Department of Social Medicine and Health Service Management, School of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China
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Mésidor M, Sirois C, Guertin JR, Schnitzer ME, Candas B, Blais C, Cossette B, Poirier P, Brophy JM, Lix L, Tadrous M, Diop A, Hamel D, Talbot D. Effect of statin use for the primary prevention of cardiovascular disease among older adults: a cautionary tale concerning target trials emulation. J Clin Epidemiol 2024; 168:111284. [PMID: 38367659 DOI: 10.1016/j.jclinepi.2024.111284] [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: 09/19/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVES Evidence concerning the effect of statins in primary prevention of cardiovascular disease (CVD) among older adults is lacking. Using Quebec population-wide administrative data, we emulated a hypothetical randomized trial including older adults >65 years on April 1, 2013, with no CVD history and no statin use in the previous year. STUDY DESIGN AND SETTING We included individuals who initiated statins and classified them as exposed if they were using statin at least 3 months after initiation and nonexposed otherwise. We followed them until March 31, 2018. The primary outcome was the composite endpoint of coronary events (myocardial infarction, coronary bypass, and percutaneous coronary intervention), stroke, and all-cause mortality. The intention-to-treat (ITT) effect was estimated with adjusted Cox models and per-protocol effect with inverse probability of censoring weighting. RESULTS A total of 65,096 individuals were included (mean age = 71.0 ± 5.5, female = 55.0%) and 93.7% were exposed. Whereas we observed a reduction in the composite outcome (ITT-hazard ratio (HR) = 0.75; 95% CI: 0.68-0.83) and mortality (ITT-HR = 0.69; 95% CI: 0.61-0.77) among exposed, coronary events increased (ITT-HR = 1.46; 95% CI: 1.09-1.94). All multibias E-values were low indicating that the results were not robust to unmeasured confounding, selection, and misclassification biases simultaneously. CONCLUSION We cannot conclude on the effectiveness of statins in primary prevention of CVD among older adults. We caution that an in-depth reflection on sources of biases and careful interpretation of results are always required in observational studies.
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Affiliation(s)
- Miceline Mésidor
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec, Université Laval, Québec, Canada.
| | - Caroline Sirois
- Centre de recherche du CHU de Québec, Université Laval, Québec, Canada; Faculté de pharmacie, Université Laval, Québec, Canada; Institut national de santé publique du Québec, Québec, Canada
| | - Jason Robert Guertin
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Mireille E Schnitzer
- Faculté de pharmacie et Département de médecine sociale et préventive, Université de Montréal, Montréal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Bernard Candas
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | - Claudia Blais
- Faculté de pharmacie, Université Laval, Québec, Canada; Institut national de santé publique du Québec, Québec, Canada
| | - Benoit Cossette
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Montréal, Canada
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Québec, Canada; Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - James M Brophy
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada; McGill University Hospital Center, Centre for Health Outcomes Research, Montréal, Canada
| | - Lisa Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mina Tadrous
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada
| | - Awa Diop
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Denis Hamel
- Institut national de santé publique du Québec, Québec, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
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Huang H, Zhu H, Ya R. Statin use in older people primary prevention on cardiovascular disease: an updated systematic review and meta-analysis. Rev Cardiovasc Med 2022; 23:114. [PMID: 39076238 PMCID: PMC11273788 DOI: 10.31083/j.rcm2304114] [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: 10/23/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 07/31/2024] Open
Abstract
Background Evidence on statin use for primary prevention of cardiovascular disease (CVD) in older people needs to be extended and updated, aiming to provide further guidance for clinical practice. Methods PubMed, EMBASE, Cochrane Library and Web of Science were searched for eligible observational studies comparing statin use vs. no-statin use for primary prevention of CVD in older people (age ≥ 65 years). The primary outcomes were all-cause mortality, CVD mortality, coronary heart disease (CHD)/myocardial infraction (MI), stroke and total CV events. Risk estimates of each relevant outcome were synthesized as a hazard ratio (HR) with 95% confidence interval (95% CI) using in the random-effects model. Results Twelve eligible observational studies (n = 1,627,434) were enrolled. The pooled results suggested that statin use was associated with a significantly decreased risk of all-cause mortality (HR: 0.54, 95% CI: 0.46-0.63), CVD mortality (HR: 0.51, 95% CI: 0.39-0.65), CHD/MI (HR: 0.83, 95% CI: 0.69-1.00), stroke (HR: 0.79, 95% CI: 0.68-0.92) and total CV events (HR: 0.75, 95% CI: 0.66-0.85). The association in all-cause mortality still remained obvious at higher ages ( ≥ 70 years old, HR: 0.56, 95% CI: 0.44-0.71; ≥ 75 years old, HR: 0.70, 95% CI: 0.60-0.80; ≥ 85 years old, HR: 0.85, 95% CI: 0.74-0.97), ≥ 20% (HR: 0.47, 95% CI: 0.35-0.62) and < 20% diabetic populations (HR: 0.50, 95% CI: 0.40-0.64), and ≥ 50% (HR: 0.68, 95% CI: 0.59-0.79) and < 50% hypertensive populations (HR: 0.38, 95% CI: 0.16-0.88). Conclusions Statin use was related to a 46%, 49%, 17%, 21% and 25% risk reduction on all-cause mortality, CVD mortality, CHD/MI, stroke and total CV events in older patients, respectively. The significant association was also addressed in older patients and ≥ 75 years old individuals for CVD primary prevention.
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Affiliation(s)
- Hao Huang
- Department of Critical Rehabilitation, Shanghai Third Rehabilitation Hospital, 200436 Shanghai, China
| | - Hechen Zhu
- Department of Critical Care Medicine, Huashan Hospital, Fudan University, 200031 Shanghai, China
| | - Ru Ya
- Department of Critical Rehabilitation, Shanghai Third Rehabilitation Hospital, 200436 Shanghai, China
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Alloubani A, Nimer R, Samara R. Relationship between Hyperlipidemia, Cardiovascular Disease and Stroke: A Systematic Review. Curr Cardiol Rev 2021; 17:e051121189015. [PMID: 33305711 PMCID: PMC8950504 DOI: 10.2174/1573403x16999201210200342] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Globally, dyslipidemia has been shown to be an independent predictor of many cardiovascular and cerebrovascular events, which led to recent advocacy towards dyslipidemia prevention and control as a key risk factor and its prognostic significance to reduce the burden of stroke and myocardial infarction (MI). AIMS This study aimed to evaluate hyperlipidemia as a risk factor connected with stroke and CVD. Moreover, having identified this risk factor, the study evaluates how hyperlipidemia has been examined earlier and what can be done in the future. METHODS All prospective studies concerning hyperlipidemia as risk factors for stroke and CVD were identified by a search of PubMed/MEDLINE and EMBASE databases with keywords hyperlipidemia, risk factors, stroke, and cardiovascular disease. RESULTS The constant positive association between the incidence of coronary heart disease and cholesterol concentration of LDL is apparent in observational studies in different populations. Thus, the reduction of LDL cholesterol in those populations, particularly with regard to initial cholesterol concentrations, can reduce the risk of vascular diseases. However, the impact of using lipid-lowering drugs, such as statins, has been demonstrated in several studies as an important factor in decreasing the mortality and morbidity rates of patients with stroke and CVD. CONCLUSION After reviewing all the research mentioned in this review, most studies confirmed that hyperlipidemia is a risk factor for stroke and correlated in patients with CVD.
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Affiliation(s)
- Aladeen Alloubani
- Address correspondence to this author at the Nursing Research Unit, King Hussein Cancer Center, Amman, Jordan;
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Gao L, Faller J, Majmudar I, Nguyen P, Moodie M. Are interventions to improve cardiovascular disease risk factors in premenopausal women effective? A systematic review and meta-analysis. BMJ Open 2021; 11:e042103. [PMID: 34321291 PMCID: PMC8319980 DOI: 10.1136/bmjopen-2020-042103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Non-traditional risk factors place young women at increased risk of cardiovascular disease (CVD) over their lifetime. The current study undertakes a systematic review and meta-analysis of randomised controlled trials (RCTs) that examined the effectiveness of primary prevention interventions for CVD in premenopausal women. METHODS An electronic literature search was performed in key databases in July 2018 and updated in May 2020. RCTs that recruited predominately female participants with a proportion aged under 55 years and that compared primary prevention interventions of CVD with usual practice were included. Two reviewers undertook the selection process for study inclusion. Meta-analysis was conducted for studies based on the same intervention in order to synthesise the results. RESULTS 14 RCTs with sample size ranging from 49 to 39 876 were included. Interventions included diet (2), vitamin E/antioxidants (3), lifestyle modification programme (7) and aspirin (2). The meta-analysis results indicated that diet nor vitamin E/antioxidant did not significantly lower the CVD risk profiles, while lifestyle modification programme involving components of lifestyle education, counselling and multiple follow-ups showed great potential to improve risk profiles. The lifestyle modification intervention improved blood pressure (-2.11 mm Hg, 95% CI -4.32 to 0.11, for systolic and -3.31 mm Hg (95% CI -4.72 to -1.91, for diastolic), physical activity (30.72 MET-min/week, 95% CI 23.57 to 37.87, for moderate physical activity 12.70 MET-min/week, 95% CI 8.27 to 17.14, for vigorous physical activity) and fasting blood glucose (-0.37 mmol/L, 95% CI -0.58 to -0.15). Subgroup meta-analysis in studies with a mean age under 51 years old suggested that lifestyle modification intervention remained to be effective in improving physical activity and fasting blood glucose. CONCLUSION The effective interventions identified in this review although with a small sample size and short duration could potentially inform future design of primary prevention of CVD in premenopausal women.
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Affiliation(s)
- Lan Gao
- Deakin Health Economics, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Jan Faller
- Deakin Health Economics, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Ishani Majmudar
- Deakin Health Economics, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Phuong Nguyen
- Deakin Health Economics, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Deakin University Faculty of Health, Burwood, Victoria, Australia
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Association of statin use in older people primary prevention group with risk of cardiovascular events and mortality: a systematic review and meta-analysis of observational studies. BMC Med 2021; 19:139. [PMID: 34154589 PMCID: PMC8218529 DOI: 10.1186/s12916-021-02009-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Current evidence from randomized controlled trials on statins for primary prevention of cardiovascular disease (CVD) in older people, especially those aged > 75 years, is still lacking. We conducted a systematic review and meta-analysis of observational studies to extend the current evidence about the association of statin use in older people primary prevention group with risk of CVD and mortality. METHODS PubMed, Scopus, and Embase were searched from inception until March 18, 2021. We included observational studies (cohort or nested case-control) that compared statin use vs non-use for primary prevention of CVD in older people aged ≥ 65 years; provided that each of them reported the risk estimate on at least one of the following primary outcomes: all cause-mortality, CVD death, myocardial infarction (MI), and stroke. Risk estimates of each relevant outcome were pooled as a hazard ratio (HR) with a 95% confidence interval (CI) using the random-effects meta-analysis model. The quality of the evidence was rated using the GRADE approach. RESULTS Ten observational studies (9 cohorts and one case-control study; n = 815,667) fulfilled our criteria. The overall combined estimate suggested that statin therapy was associated with a significantly lower risk of all-cause mortality (HR: 0.86 [95% CI 0.79 to 0.93]), CVD death (HR: 0.80 [95% CI 0.78 to 0.81]), and stroke (HR: 0.85 [95% CI 0.76 to 0.94]) and a non-significant association with risk of MI (HR 0.74 [95% CI 0.53 to 1.02]). The beneficial association of statins with the risk of all-cause mortality remained significant even at higher ages (> 75 years old; HR 0.88 [95% CI 0.81 to 0.96]) and in both men (HR: 0.75 [95% CI: 0.74 to 0.76]) and women (HR 0.85 [95% CI 0.72 to 0.99]). However, this association with the risk of all-cause mortality remained significant only in those with diabetes mellitus (DM) (HR 0.82 [95% CI 0.68 to 0.98]) but not in those without DM. The level of evidence of all the primary outcomes was rated as "very low." CONCLUSIONS Statin therapy in older people (aged ≥ 65 years) without CVD was associated with a 14%, 20%, and 15% lower risk of all-cause mortality, CVD death, and stroke, respectively. The beneficial association with the risk of all-cause mortality remained significant even at higher ages (> 75 years old), in both men and women, and in individuals with DM, but not in those without DM. These observational findings support the need for trials to test the benefits of statins in those above 75 years of age.
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Bonnet F, Bénard A, Poulizac P, Afonso M, Maillard A, Salvo F, Berdaï D, Salles N, Rousselot N, Marchi S, Hayes N, Joseph JP. Discontinuing statins or not in the elderly? Study protocol for a randomized controlled trial. Trials 2020; 21:342. [PMID: 32307005 PMCID: PMC7169009 DOI: 10.1186/s13063-020-04259-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The risk/benefit ratio of using statins for primary prevention of cardiovascular (CV) events in elderly people has not been established. The main objectives of the present study are to assess the cost-effectiveness of statin cessation and to examine the non-inferiority of statin cessation in terms of mortality in patients aged 75 years and over, treated with statins for primary prevention of CV events. METHODS The "Statins in the elderly" (SITE) study is an ongoing 3-year follow-up, open-label comparative multi-centre, randomized clinical trial that is being conducted in two parallel groups in outpatient primary care offices. Participants meeting the following criteria are included: people aged 75 years and older being treated with statins as primary prevention for CV events, who provide informed consent. After randomization, patients in the statin-cessation strategy are instructed to withdraw their treatment. In the comparison strategy, patients continue their statin treatment at the usual dosage. The cost-effectiveness of the statin-cessation strategy compared to continuing statins will be estimated through the incremental cost per quality-adjusted life years (QALYs) gained at 36 months, from the perspective of the French healthcare system. Overall mortality will be the primary clinical endpoint. We assumed that the mortality rate at 3 years will be 15%. The sample size was computed to achieve 90% power in showing the non-inferiority of statin cessation, assuming a non-inferiority margin of 5% of the between-group difference in overall mortality. In total, the SITE study will include 2430 individuals. DISCUSSION There is some debate on the value of statins in people over 75 years old, especially for primary prevention of CV events, due to a lack of evidence of their efficacy in this population, potential compliance-related events, drug-drug interactions and side effects that could impair quality of life. Data from clinical trials guide the initiation of medication therapy for primary or secondary prevention of CV disease but do not define the timing, safety, or risks of discontinuing the agents. The SITE study is one of the first to examine whether treatment cessation is a cost-effective and a safe strategy in people of 75 years and over, formerly treated with statins. TRIAL REGISTRATION ClinicalTrials.gov: NCT02547883. Registered on 11 September 2015.
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Affiliation(s)
- Fabrice Bonnet
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Saint-André Hospital, 1 rue Jean Burguet, F-33000, Bordeaux, France.
- ISPED, INSERM U1219, Bordeaux Population Health Research Center, University of Bordeaux, F-33000, Bordeaux, France.
| | - Antoine Bénard
- CHU de Bordeaux, Pôle de Santé Publique, Clinical Epidemiology Unit (USMR), F-33000, Bordeaux, France
- ISPED, INSERM U1219, Bordeaux Population Health Research Center, Team EMOS, UMR 1219, University of Bordeaux, F-33000, Bordeaux, France
| | - Pierre Poulizac
- CHU de Bordeaux, Direction de la Recherche Clinique et de l'Innovation, F-33000, Bordeaux, France
| | - Mélanie Afonso
- Département de Médecine Générale, University of Bordeaux, F-33000, Bordeaux, France
| | - Aline Maillard
- CHU de Bordeaux, Pôle de Santé Publique, Clinical Epidemiology Unit (USMR), F-33000, Bordeaux, France
| | - Francesco Salvo
- ISPED, INSERM U1219, Bordeaux Population Health Research Center, Pharmaco-Epidemiology Team, UMR 1219, University of Bordeaux, F-33000, Bordeaux, France
- CHU de Bordeaux, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
| | - Driss Berdaï
- CHU de Bordeaux, Service de Pharmacologie Médicale, F-33000, Bordeaux, France
| | - Nathalie Salles
- CHU de Bordeaux, Service de Gériatrie, Hôpital Haut-Lévêque, F-33000, Bordeaux, France
| | - Nicolas Rousselot
- Département de Médecine Générale, University of Bordeaux, F-33000, Bordeaux, France
| | - Sébastien Marchi
- CHU de Bordeaux, Direction de la Recherche Clinique et de l'Innovation, F-33000, Bordeaux, France
| | - Nathalie Hayes
- CHU de Bordeaux, Direction de la Recherche Clinique et de l'Innovation, F-33000, Bordeaux, France
| | - Jean-Philippe Joseph
- ISPED, INSERM U1219, Bordeaux Population Health Research Center, University of Bordeaux, F-33000, Bordeaux, France
- Département de Médecine Générale, University of Bordeaux, F-33000, Bordeaux, France
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A stricter control of low-density lipoprotein is necessary for thrombosis reduction in “lower thrombosis risk” patients with atrial fibrillation: a multicenter retrospective cohort study. J Thromb Thrombolysis 2020; 50:849-857. [DOI: 10.1007/s11239-020-02110-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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10
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Kim NH, Kim SG. Fibrates Revisited: Potential Role in Cardiovascular Risk Reduction. Diabetes Metab J 2020; 44:213-221. [PMID: 32347023 PMCID: PMC7188966 DOI: 10.4093/dmj.2020.0001] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 02/05/2020] [Indexed: 12/18/2022] Open
Abstract
Fibrates, peroxisome proliferator-activated receptor-α agonists, are potent lipid-modifying drugs. Their main effects are reduction of triglycerides and increase in high-density lipoprotein levels. Several randomized controlled trials have not demonstrated their benefits on cardiovascular risk reduction, especially as an "add on" to statin therapy. However, subsequent analyses by major clinical trials, meta-analyses, and real-world evidence have proposed their potential in specific patient populations with atherogenic dyslipidemia and metabolic syndrome. Here, we have reviewed and discussed the accumulated data on fibrates to understand their current status in cardiovascular risk management.
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Affiliation(s)
- Nam Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
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Abstract
Abnormal lipoprotein metabolism is an important and modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD), which has been shown in numerous studies to lead to adverse cardiovascular outcomes. As cardiovascular disease (CVD) remains the major cause of morbidity and mortality globally, management of dyslipidemia is a key component of primary and secondary risk-reduction strategies. Because ASCVD risk increases with age, as the population ages, many more people-particularly the elderly-will meet guideline criteria for drug treatment. Statins (HMG-CoA reductase inhibitors) have an unequivocal benefit in reducing ASCVD risk across age groups for secondary prevention. However, the benefit of these drugs for primary prevention in those > 75 years of age remains controversial. We strongly believe that statins should be offered for primary prevention to all older individuals after a shared decision-making process that takes polypharmacy, frailty, and potential adverse effects into consideration. When considering statin therapy in the very old, competing risks of death, and therefore the likelihood that patients will live long enough to benefit from drug therapy, should inform this process. Combination therapies with ezetimibe or proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors should be considered to facilitate the use of tolerable doses of statins. Future investigations of dyslipidemia therapies must appropriately include this at-risk population to identify optimal drugs and drug combinations that have a high benefit:risk ratio for the prevention of ASCVD in the elderly.
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Gyanwali B, Shaik MA, Tan BY, Venketasubramanian N, Chen C, Hilal S. Risk Factors for and Clinical Relevance of Incident and Progression of Cerebral Small Vessel Disease Markers in an Asian Memory Clinic Population. J Alzheimers Dis 2019; 67:1209-1219. [DOI: 10.3233/jad-180911] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bibek Gyanwali
- Memory Aging & Cognition Centre, National University Health System, Singapore
- Department of Pharmacology, National University of Singapore, Singapore
| | - Muhammad Amin Shaik
- Memory Aging & Cognition Centre, National University Health System, Singapore
- Ageing Research Institute for Society and Education, Nanyang Technological University, Singapore
| | | | | | - Christopher Chen
- Memory Aging & Cognition Centre, National University Health System, Singapore
- Department of Pharmacology, National University of Singapore, Singapore
| | - Saima Hilal
- Memory Aging & Cognition Centre, National University Health System, Singapore
- Department of Pharmacology, National University of Singapore, Singapore
- Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Abstract
The evaluation of the real-life benefits and risks of statins in population is a major pharmacoepidemiological issue, given their widespread use for cardiovascular prevention. The purpose of this review was not to be exhaustive but to show the contributions of pharmacoepidemiology for various aspects of the evaluation of statins such as real-life drug use, effectiveness and risk. Statins are among the most used drugs in the world, but recent data show a slight decrease in use. Actual statin users are older, and have more comorbidities than those studied in clinical trials, but this does not seem to compromise their effectiveness, unlike the compliance issues that are common with these drugs. Beyond the known adverse reactions of statins from the clinical trials, risks of statins can be varied and sometimes difficult to evaluate, considering the ubiquity of cholesterol throughout the body, from drug or endogenous molecule metabolism to the construction of cell membranes or cell activities.
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Affiliation(s)
- Julien Bezin
- Inserm, UMR 1219, Bordeaux population health research center, team pharmacoepidemiology, université Bordeaux, 33076 Bordeaux, France.
| | - Nicholas Moore
- Inserm CIC1401, Inserm CR1219, Bordeaux PharmacoEpi, université et CHU de Bordeaux, 33076 Bordeaux, France
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14
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Ross KR, Teague WG, Gaston BM. Life Cycle of Childhood Asthma: Prenatal, Infancy and Preschool, Childhood, and Adolescence. Clin Chest Med 2018; 40:125-147. [PMID: 30691707 DOI: 10.1016/j.ccm.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Asthma is a heterogeneous developmental disorder influenced by complex interactions between genetic susceptibility and exposures. Wheezing in infancy and early childhood is highly prevalent, with a substantial minority of children progressing to established asthma by school age, most of whom are atopic. Adolescence is a time of remission of symptoms with persistent lung function deficits. The transition to asthma in adulthood is not well understood.
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Affiliation(s)
- Kristie R Ross
- Division of Pediatric Pulmonology, Allergy, Immunology and Sleep Medicine, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - W Gerald Teague
- Pediatric Asthma Center of Excellence, Department of Pediatrics, University of Virginia School of Medicine, 409 Lane Road, Building MR4, Room 2112, PO Box 801349, Charlottesville, VA 22908, USA
| | - Benjamin M Gaston
- Division of Pediatric Pulmonology, Allergy, Immunology and Sleep Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Children's Lung Foundation, 2109 Adelbert Road, BRB 827, Cleveland, OH 44106, USA
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15
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Ho CLB, Chowdhury EK, Breslin M, Doust J, Reid CM, Wing LMH, Nelson MR. Short- and long-term association of lipid-lowering drug treatment and cardiovascular disease by estimated absolute risk in the Second Australian National Blood Pressure study. J Clin Lipidol 2018; 13:148-155. [PMID: 30293937 DOI: 10.1016/j.jacl.2018.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/30/2018] [Accepted: 08/31/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is currently insufficient evidence to support the use of lipid-lowering drug treatment (LLT) for primary prevention of cardiovascular disease (CVD) in the elderly. OBJECTIVES We examined the relationship of early initiation of LLT with short- and long-term all-cause and CVD mortality in persons older than 65 years in this post hoc study from the Second Australian National Blood Pressure study (ANBP2). METHODS This was an in- and post-trial observational study. About 4257 hypertensive participants aged 65 to 84 years within Australian family practices were randomized to an angiotensin-converting enzyme inhibitor or a diuretic treatment group. After excluding participants with a prior history of CVD, the cohort was stratified into "LLT" and "no LLT" subgroups based on LLT status at randomization. RESULTS At randomization, the participants had a mean age of 72 years, average blood pressure of 168/91 mm Hg and estimated 5-year CVD risk of 18.7 ± 8.3%. In the overall study population, the association of LLT with long-term (11-years) all-cause and non-CVD mortality was significant (hazard ratio [HR] 0.78 [95% confidence interval {CI} 0.66-0.92, P = .003] and HR 0.70 [95% CI 0.54-0.90, P = .006], respectively). Magnitudes of the association of LLT with long-term mortality and the association with short-term mortality were similar; however, no statistically significant association with short-term mortality was observed. In the subgroup analysis by baseline 5-year CVD risk, LLT participants in the highest risk tertile had a substantially lower relative risk for short-term all-cause mortality (HR 0.31, 95% CI 0.13-0.71, P for interaction .02) compared to those with lower estimated CVD risk. All analyses were adjusted for baseline and in-trial characteristics. CONCLUSION Our study showed a strong association between LLT and reduced long-term all-cause mortality. Thus, our findings support recommendations of the use of LLT in patients over 65 years, particularly those with high CVD risk who were more likely to obtain additional benefits in the short term. The findings also suggested that mortality benefits of LLT for the elderly may take longer to become evident.
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Affiliation(s)
- Chau L B Ho
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Enayet K Chowdhury
- CCRE Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; School of Public Health, Curtin University, Perth, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jenny Doust
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Christopher M Reid
- CCRE Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; School of Public Health, Curtin University, Perth, Australia
| | - Lindon M H Wing
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; CCRE Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Tully PJ, Helmer C, Peters R, Tzourio C. Exploiting Drug-Apolipoprotein E Gene Interactions in Hypertension to Preserve Cognitive Function: The 3-City Cohort Study. J Am Med Dir Assoc 2018; 20:188-194.e4. [PMID: 30292766 DOI: 10.1016/j.jamda.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The objective was to test the hypothesis that antihypertensive drugs have a differential effect on cognition in carriers and noncarriers of the apolipoprotein ε4 (APOE4) polymorphism. DESIGN Prospective population-based cohort, France. SETTING AND PARTICIPANTS A total of 3359 persons using antihypertensive drugs (median age 74 years, 62% women) were serially assessed up to 10 years follow-up. MEASURES Exposure to antihypertensive drug use was established in the first 2 years. Cognitive function was assessed at baseline, 2, 4, 7, and 10 years with a validated test battery covering global cognition, verbal fluency, immediate visual recognition memory, processing speed, and executive function. Clinically significant change in cognitive function was determined using reliable change indices represented as z scores and analyzed with linear mixed-models. RESULTS From 3359 persons exposed to antihypertensive drugs, 653 were APOE4 carriers (5.1% homozygous, 94.9% heterozygous) and median follow-up was 5.2 years (interquartile range 3.7-8.0). In APOE4 carriers, improved general cognitive function over time was associated with exposure to angiotensin converting enzyme inhibitors [β = .14; 95% confidence interval (CI) .06-.23, P = .001] and angiotensin receptor blockers (β = .11; 95% CI .02-.21, P = .019). Improved verbal fluency was associated with angiotensin converting enzyme inhibitors (β = .11; 95% CI .03-.20, P = .012). CONCLUSIONS Renin-angiotensin-system blockade was associated with improved general cognitive function in APOE4 carriers. Findings did not support renin-angiotensin-system drugs' lipophilicity or ability to cross the blood-brain barrier as potential mechanisms. The findings have implications for selecting the optimal antihypertensive drug in older populations at risk of cognitive decline and dementia.
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Affiliation(s)
- Phillip J Tully
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team HEALTHY, Bordeaux, France; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - Catherine Helmer
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team LEHA, Bordeaux, France
| | - Ruth Peters
- Center for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, ACT, Australia; Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Christophe Tzourio
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team HEALTHY, Bordeaux, France
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17
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Tully PJ, Debette S, Tzourio C. The association between systolic blood pressure variability with depression, cognitive decline and white matter hyperintensities: the 3C Dijon MRI study. Psychol Med 2018; 48:1444-1453. [PMID: 28950920 DOI: 10.1017/s0033291717002756] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Accumulating evidence links blood pressure variability (BPV) with white matter hyperintensities (WMH) and stroke. The longitudinal association between BPV with late onset depression (LOD) and cognitive decline remains unexplored. METHODS Prospective cohort study of 2812 participant's age ⩾65 years (median age 72 years, 63.6% female) without dementia or stroke. Serial clinic visits assessed blood pressure, cognitive function, depression disorder, and depressive symptoms. A brain magnetic resonance imaging (MRI) substudy was performed in 1275 persons to examine possible associations with WMH. RESULTS The interaction between symptomatic LOD and systolic BPV was associated with cognitive decline on the Isaac Set Test [slope -4.45; 95% confidence interval (CI) -8.92 to -0.16, p = 0.04], Benton Visual Retention Test (slope -0.89; 95% CI -1.77 to -0.01, p = 0.049), Mini Mental State Examination (slope -1.08; 95% CI -1.86 to -0.30, p = 0.007) and Finger Tapping Test (slope -7.53; 95% CI -13.71 to -1.34, p = 0.017) but not Trail Making Test-A or -B/A. The MRI substudy demonstrated that systolic BPV was associated with cognitive decline via interactions with depression and total WMH volume, but this was not dependent on either deep or periventricular WMH volumes. CONCLUSIONS The findings show that the interaction between systolic BPV with symptomatic depression and WMH increases cognitive decline in persons ⩾65 years of age. Future work could extend these findings by examining systolic BPV in relation to cognitive decline and WMH in older populations with depression.
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Affiliation(s)
- P J Tully
- University of Bordeaux,Inserm,Bordeaux Population Health Research Center,team HEALTHY,UMR1219,Bordeaux,France
| | - S Debette
- University of Bordeaux,Inserm,Bordeaux Population Health Research Center,team HEALTHY,UMR1219,Bordeaux,France
| | - C Tzourio
- University of Bordeaux,Inserm,Bordeaux Population Health Research Center,team HEALTHY,UMR1219,Bordeaux,France
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Katsiki N, Kolovou G, Perez-Martinez P, Mikhailidis DP. Dyslipidaemia in the elderly: to treat or not to treat? Expert Rev Clin Pharmacol 2018; 11:259-278. [PMID: 29303009 DOI: 10.1080/17512433.2018.1425138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The elderly population (i.e. aged ≥ 65 years) is increasing worldwide. Ageing is associated with a higher incidence and prevalence of cardiovascular disease (CVD). Areas covered: The prevalence of CVD risk factors including type 2 diabetes mellitus, hypertension and dyslipidaemia also increases with advancing age, contributing to the higher absolute CVD risk observed in the elderly. The present narrative review comments on the associations of dyslipidaemia with CVD as well as the effects of lifestyle measures and lipid-lowering drugs on lipids and CVD risk with a special focus on the elderly population. Individual treatment goals and therapeutic options according to current guidelines are also reviewed. Finally, we discuss special characteristics of the elderly that may influence the efficacy and safety of drug therapy and should be considered before selection of hypolipidaemic pharmacotherapy. Expert commentary: There may be a greater CVD benefit in older patients following drug therapy compared with younger ones. Treatment goals and therapeutic options should be individualized according to current guidelines. Specific characteristics that may influence the efficacy and safety of drug therapy in the elderly should be considered in relation to dyslipidaemia treatment.
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Affiliation(s)
- Niki Katsiki
- a Second Propedeutic Department of Internal Medicine, Medical School , Aristotle University of Thessaloniki, Hippocration Hospital , Thessaloniki , Greece
| | - Genovefa Kolovou
- b Cardiology Department and LDL-Apheresis Unit , Onassis Cardiac Surgery Center , Athens , Greece
| | - Pablo Perez-Martinez
- c Lipid and Atherosclerosis Unit , IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III , Spain
| | - Dimitri P Mikhailidis
- d Department of Clinical Biochemistry , Royal Free Hospital Campus, University College London Medical School, University College London (UCL) , London , UK
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Bonnet F. Faut-il arrêter les statines chez les personnes âgées ? Rev Med Interne 2018; 39:1-3. [DOI: 10.1016/j.revmed.2017.10.426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 11/26/2022]
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Orkaby AR, Gaziano JM, Djousse L, Driver JA. Statins for Primary Prevention of Cardiovascular Events and Mortality in Older Men. J Am Geriatr Soc 2017; 65:2362-2368. [PMID: 28892121 PMCID: PMC5681374 DOI: 10.1111/jgs.14993] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES We sought to determine whether statin use for primary prevention is associated with a lower risk of cardiovascular events or mortality in older men. DESIGN Prospective cohort study. SETTING Physicians' Health Study participants. PARTICIPANTS 7,213 male physicians ≥70 years without a history of cardiovascular disease (CVD). MEASUREMENTS Multivariable propensity score for statin use with greedy matching (1:1) to minimize confounding by indication. RESULTS Median baseline age was 77 (70-102), median follow-up was 7 years. Non-users were matched to 1,130 statin users. Statin use was associated with an 18% lower risk of all-cause mortality, HR 0.82 (95% CI 0.69-0.98) and non-significant lower risk of CVD events, HR 0.86 (95% CI 0.70-1.06) and stroke, HR 0.70 (95% CI 0.45-1.09). In subgroup analyses, results did not change according to age group at baseline (70-76 or >76 years) or functional status. There was a suggestion that those >76 at baseline did not benefit from statins for mortality, HR 1.14 (95% CI 0.89-1.47), compared to those 70-76 at baseline, HR 0.83 (95% CI 0.61-1.11); however the CIs overlap between the two groups, suggesting no difference. Statin users with elevated total cholesterol had fewer major CVD events than non-users, HR 0.68 (95% CI 0.50-0.94) and HR 1.43 (95% CI 0.99-2.07)), respectively. CONCLUSIONS Statin use was associated with a significant lower risk of mortality in older male physicians ≥70 and a nonsignificant lower risk of CVD events. Results did not change in those who were >76 years at baseline or according to functional status. There was a suggestion that those with elevated total cholesterol may benefit. Further work is needed to determine which older individuals will benefit from statins as primary prevention.
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Affiliation(s)
- Ariela R Orkaby
- Geriatric Research, Education, and Clinical Center (GRECC) and Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - J Michael Gaziano
- Geriatric Research, Education, and Clinical Center (GRECC) and Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Luc Djousse
- Geriatric Research, Education, and Clinical Center (GRECC) and Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jane A Driver
- Geriatric Research, Education, and Clinical Center (GRECC) and Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Association of miR-21, miR-126 and miR-605 gene polymorphisms with ischemic stroke risk. Oncotarget 2017; 8:95755-95763. [PMID: 29221163 PMCID: PMC5707057 DOI: 10.18632/oncotarget.21316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/23/2017] [Indexed: 12/11/2022] Open
Abstract
We investigated whether three common microRNA polymorphisms (miR-21T>C [rs1292037], miR-126G>A [rs4636297] and miR-605T>C [rs2043556]) were associated with ischemic stroke (IS) risk in a Chinese population. The study population comprised 592 ischemic stroke patients and 456 normal controls. The polymorphisms were measured using Snapshot SNP genotyping assays and confirmed by sequencing. Relative expressions of miR-21, miR-126 and miR-605 were measured by quantitative real-time PCR. We found that miR-126 gene rs4636297 polymorphism was associated with decreased ischemic stroke risk (GA vs. GG: AOR=0.64, adjust P=0.025; AA vs. GG: AOR=0.32, adjust P=0.007; dominant model: AOR=0.58, adjust P=0.004). MiR-21 gene rs1292037 and miR-605 gene rs2043556 polymorphisms were not associated with ischemic stroke risk. In addition, compared with normal controls, serum miR-126 level was significantly decreased in ischemic stroke patients, while the miR-21 level was significantly increased. Importantly, patients carrying rs4636297 GA/AA genotypes had higher serum miR-126 level (P<0.05). MiR-126 gene rs4636297 polymorphism and serum miR-126/-21 levels are associated with ischemic stroke risk. Our data indicates that miR-126 and miR-21 play roles in the development of ischemic stroke.
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Kautzky-Willer A, Harreiter J. Sex and gender differences in therapy of type 2 diabetes. Diabetes Res Clin Pract 2017; 131:230-241. [PMID: 28779681 DOI: 10.1016/j.diabres.2017.07.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/09/2017] [Accepted: 07/07/2017] [Indexed: 12/11/2022]
Abstract
Clinical guidelines for the management of type 2 diabetes recommend individual therapy considering age, duration of disease, presence of complication and risk of hypoglycaemia. However, at present, the patient's sex has no impact on clinical decisions. Yet, there is mounting data pointing at biological and psychosocial differences between men and women with great impact on progression of disease and complications. Moreover, choices and preferences of therapeutic strategies as well as adherence to lifestyle and pharmacological interventions differ in both sexes. In addition, drug therapy may have sex-specific side effects. Therefore, there is need of more research on biological differences and of evidence-based individualised targeted sex-sensitive therapeutic concepts. Clinical guidelines must consider relevant sex-differences. Development and implementation of sex-specific programs may help to improve adherence to therapy and to reduce progression of disease and development of complications. A more gender-sensitive clinical approach may improve quality of life and increase health and life expectancy in men and women with type 2 diabetes.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Gender Medicine Institute, Gars am Kamp, Austria.
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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23
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Han BH, Sutin D, Williamson JD, Davis BR, Piller LB, Pervin H, Pressel SL, Blaum CS. Effect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults: The ALLHAT-LLT Randomized Clinical Trial. JAMA Intern Med 2017; 177:955-965. [PMID: 28531241 PMCID: PMC5543335 DOI: 10.1001/jamainternmed.2017.1442] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE While statin therapy for primary cardiovascular prevention has been associated with reductions in cardiovascular morbidity, the effect on all-cause mortality has been variable. There is little evidence to guide the use of statins for primary prevention in adults 75 years and older. OBJECTIVES To examine statin treatment among adults aged 65 to 74 years and 75 years and older when used for primary prevention in the Lipid-Lowering Trial (LLT) component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). DESIGN, SETTING, AND PARTICIPANTS Post hoc secondary data analyses were conducted of participants 65 years and older without evidence of atherosclerotic cardiovascular disease; 2867 ambulatory adults with hypertension and without baseline atherosclerotic cardiovascular disease were included. The ALLHAT-LLT was conducted from February 1994 to March 2002 at 513 clinical sites. INTERVENTIONS Pravastatin sodium (40 mg/d) vs usual care (UC). MAIN OUTCOMES AND MEASURES The primary outcome in the ALLHAT-LLT was all-cause mortality. Secondary outcomes included cause-specific mortality and nonfatal myocardial infarction or fatal coronary heart disease combined (coronary heart disease events). RESULTS There were 1467 participants (mean [SD] age, 71.3 [5.2] years) in the pravastatin group (48.0% [n = 704] female) and 1400 participants (mean [SD] age, 71.2 [5.2] years) in the UC group (50.8% [n = 711] female). The baseline mean (SD) low-density lipoprotein cholesterol levels were 147.7 (19.8) mg/dL in the pravastatin group and 147.6 (19.4) mg/dL in the UC group; by year 6, the mean (SD) low-density lipoprotein cholesterol levels were 109.1 (35.4) mg/dL in the pravastatin group and 128.8 (27.5) mg/dL in the UC group. At year 6, of the participants assigned to pravastatin, 42 of 253 (16.6%) were not taking any statin; 71.0% in the UC group were not taking any statin. The hazard ratios for all-cause mortality in the pravastatin group vs the UC group were 1.18 (95% CI, 0.97-1.42; P = .09) for all adults 65 years and older, 1.08 (95% CI, 0.85-1.37; P = .55) for adults aged 65 to 74 years, and 1.34 (95% CI, 0.98-1.84; P = .07) for adults 75 years and older. Coronary heart disease event rates were not significantly different among the groups. In multivariable regression, the results remained nonsignificant, and there was no significant interaction between treatment group and age. CONCLUSIONS AND RELEVANCE No benefit was found when pravastatin was given for primary prevention to older adults with moderate hyperlipidemia and hypertension, and a nonsignificant direction toward increased all-cause mortality with pravastatin was observed among adults 75 years and older. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000542.
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Affiliation(s)
- Benjamin H Han
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, New York
| | - David Sutin
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, New York
| | - Jeff D Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Barry R Davis
- Coordinating Center for Clinical Trials, University of Texas School of Public Health, Houston
| | - Linda B Piller
- Coordinating Center for Clinical Trials, University of Texas School of Public Health, Houston
| | - Hannah Pervin
- Coordinating Center for Clinical Trials, University of Texas School of Public Health, Houston
| | - Sara L Pressel
- Coordinating Center for Clinical Trials, University of Texas School of Public Health, Houston
| | - Caroline S Blaum
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, New York
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Qi Z, Chen H, Wen Z, Yuan F, Ni H, Gao W, Shen J, Li J, Lin Y, Shan Y, Jin B, Yan P, Shi H, Luo X. Relation of Low-Density Lipoprotein Cholesterol to Ischemic Stroke in Patients With Nonvalvular Atrial Fibrillation. Am J Cardiol 2017; 119:1224-1228. [PMID: 28215412 DOI: 10.1016/j.amjcard.2016.12.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/14/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
Low-density lipoprotein cholesterol (LDL-C) has been demonstrated as an independent risk factor of ischemic stroke, but the association of LDL-C with ischemic stroke in patients with nonvalvular atrial fibrillation (AF) remains uncertain. Our objective was to explore whether LDL-C could refine stroke stratification in patients with AF. A total of 424 nonvalvular patients with AF with ischemic stroke and 391 ones without ischemic stroke were enrolled. No patient had received antithrombotic therapy. Multivariate logistic regression analysis showed that LDL-C was an independent predictor of ischemic stroke in patients with AF, with the adjusted odds ratio of 2.004 (95% confidence interval 1.624 to 2.473; p <0.001). The receiver operating characteristic analysis revealed that the best cut-off value of LDL-C to predict ischemic stroke in patients with AF was 2.48 mmol/L with 56.3% sensitivity and 66.3% specificity (area under the curve: 0.651, p <0.001). In the subgroup analysis based on different CHA2DS2-VASc scores, the predictive value of LDL-C remained significant in patients with a CHA2DS2-VASc score of ≤5. In conclusion, LDL-C was an independent predictor of ischemic stroke, which could potentially refine stroke stratification in patients with AF. A prospective study with a large number of patients is required to validate the current findings.
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Gazzola K, Vigna GB. Hypolipidemic drugs in elderly subjects: Indications and limits. Nutr Metab Cardiovasc Dis 2016; 26:1064-1070. [PMID: 27522161 DOI: 10.1016/j.numecd.2016.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/30/2016] [Accepted: 07/13/2016] [Indexed: 01/10/2023]
Abstract
AIMS Cardiovascular disease is a major cause of death worldwide. Safety and efficacy of lipid lowering therapy have been clearly established for either primary and secondary prevention of cardiovascular events in adults. Nevertheless, the use of hypolipidemic drugs in elderly individuals, especially in the oldest ones, still raises some concerns. Aim of this paper is to review indications and limits of lipid lowering in advanced age, furnishing a practical medical attitude tempered by clinical and geriatric competences. DATA SYNTHESIS While figures from randomized controlled trials and from observational studies seem to support the use of lipid lowering drugs for secondary prevention in the elderly, drawing inferences from primary prevention in old populations is far more challenging. Although these pharmacological agents seem to reduce the incidence of cardiovascular events, they do not prolong survival. In addition, there is some doubt about the cost-effectiveness of treatment because of a more delicate balance between benefit and potential adverse reactions. However, lipid-lowering drugs seem largely underutilized in older age, mainly due to safety concerns that must be reconsidered, at least in part, given the somewhat reassuring results deriving from specific cohort surveys. CONCLUSIONS Data on the use and on the effects of lipid lowering drugs in elderly populations are incomplete, especially those concerning very old subjects without established cardiovascular disease. Comprehensive guidelines for the management of dyslipidemias in this rapidly-growing population is a urgent need, and treatment should be based, besides the aforementioned considerations, on patient preferences, cognitive function and life expectancy.
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Affiliation(s)
- K Gazzola
- Dipartimento Medico, Azienda Ospedaliero-Universitaria di Ferrara, Italy
| | - G B Vigna
- Dipartimento Medico, Azienda Ospedaliero-Universitaria di Ferrara, Italy.
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26
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Tully PJ, Tzourio C. Psychiatric correlates of blood pressure variability in the elderly: The Three City cohort study. Physiol Behav 2016; 168:91-97. [PMID: 27818215 DOI: 10.1016/j.physbeh.2016.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The modifiable factors associated with blood pressure variability (BPV) are still being established and their clinical relevance is poorly understood. Generalized anxiety disorder (GAD) and depression have been implicated with higher BPV in the short term (e.g. hours, days) however their effects on BPV over longer periods are unknown. METHODS In a prospective cohort study, 1454 elderly participants (age 78.5±3.78years, 59% women) underwent structured interview for GAD and major depression. Participants performed home blood pressure monitoring (HBPM) over 3 consecutive days and underwent serial clinic BP measures on 4 separate follow-ups over an 8year period. Systolic and diastolic BPV was calculated using the coefficient of variation (CV) and standard deviation method. Generalized linear models assessed the association between GAD and depression with BPV over an 8year period. RESULTS GAD was associated with significantly increased systolic BPV over 8years in age, sex and mean systolic BP (β=0.25, SE=0.09; p=0.007) and fully adjusted models (β=0.23, SE=0.10; p=0.017). BPV from HBPM was strongly associated with 8year systolic BPV in age-sex (β=3.10, SE=0.82; p<0.001) and fully adjusted models (β=3.09, SE=0.84; p<0.001). The association between GAD and longer term BPV was consistent when analyzing morning and evening HBPM measures of BPV. There was no association between diastolic BPV over 8years with GAD or depression. CONCLUSIONS GAD but not depression was associated with increased systolic BPV over an 8year period controlling for HBPM. GAD has clinical relevance for control of systolic BPV in elderly participants.
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Affiliation(s)
- Phillip J Tully
- Bordeaux Population Health, University of Bordeaux, France; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia.
| | - Christophe Tzourio
- Bordeaux Population Health, University of Bordeaux, France; INSERM, Neuroepidemiology, UMR897, F-33000 Bordeaux, France
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27
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Alkali NH, Bwala SA, Dunga JA, Watila MM, Jibrin YB, Tahir A. Prestroke treatment of stroke risk factors: A cross-sectional survey in central Nigeria. Ann Afr Med 2016; 15:120-5. [PMID: 27549416 PMCID: PMC5402807 DOI: 10.4103/1596-3519.188891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Stroke can be prevented with treatments targeted at hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation, but this is often hampered by under-diagnosis and under-treatment of those risk factors. The magnitude of this problem is not well-studied in sub-Saharan Africa. Materials and Methods: We conducted a cross-sectional survey of stroke patients at a tertiary hospital during January 2010 to July 2013 to determine patient awareness of a pre-existing stroke risk factor and prior use of anti-hypertensive, anti-diabetic, antiplatelet and lipid-lowering agents. We also investigated whether gender and school education influenced patient awareness and treatment of a stroke risk factor prior to stroke. Results: Three hundred and sixty nine stroke patients presented during the study period, of which 344 eligible subjects were studied. Mean age at presentation (±SD) was 55.8 ± 13.7 years, and was not different for men and women. Hypertension, hyperlipidemia, diabetes and atrial fibrillation were prevalent among 83.7%, 26.5%, 25.6% and 9.6% patients respectively. Awareness was high for pre-existing diabetes (81.8%) and hypertension (76.7%), but not for hyperlipidemia (26.4%) and atrial fibrillation (15.2%). Men were better educated than women (p = 0.002), and had better awareness for hyperlipidemia (37.3% versus 13.5%; p = 0.009). Men were also more likely to take drug treatments for a stroke risk factor, but the differences were significant. Conclusions: A high rate of under-diagnosis and under-treatment of hypertension, hyperlipidemia and atrial fibrillation contributes to the stroke burden in sub-Saharan Africa, especially among women. Public health measures including mass media campaigns could help reduce the burden of stroke.
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Affiliation(s)
- Nura H Alkali
- Department of Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Sunday A Bwala
- Department of Medicine, National Hospital Abuja, Abuja, Nigeria
| | - Jacob A Dunga
- Department of Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Musa M Watila
- Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Yusuf B Jibrin
- Department of Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Abdulrahman Tahir
- Department of Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
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28
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Malmi H, Kautiainen H, Virta LJ, Färkkilä MA. Increased short- and long-term mortality in 8146 hospitalised peptic ulcer patients. Aliment Pharmacol Ther 2016; 44:234-45. [PMID: 27240732 DOI: 10.1111/apt.13682] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/09/2015] [Accepted: 05/09/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Incidence and complications of peptic ulcer disease (PUD) have declined, but mortality from peptic ulcer bleeding has remained unchanged. The few recent studies on mortality associated with both uncomplicated and complicated patients with peptic ulcer disease provide contradictory results. AIMS To evaluate short- and long-term mortality, and the main causes of death in peptic ulcer disease. METHODS In this retrospective epidemiologic cohort study, register data on 8146 adult patients hospitalised with peptic ulcer disease during 2000-2008 were collected in the capital region of Finland. All were followed in the National Cause of Death Register until the end of 2009. The data were linked with the nationwide Drug Purchase Register of the Finnish Social Insurance Institution. RESULTS Mean follow-up time was 4.9 years. Overall mortality was substantially increased, standardised mortality ratio 2.53 (95% CI: 2.44-2.63); 3.7% died within 30 days, and 11.8% within 1 year. At 6 months, the survival of patients with perforated or bleeding ulcer was lower compared to those with uncomplicated ulcer; hazard ratios were 2.06 (1.68-2.04) and 1.32 (1.11-1.58), respectively. For perforated duodenal ulcers, both the short- and long-term survival was significantly impaired in women. The main causes of mortality at 1 year were malignancies and cardiovascular diseases. Previous use of statins was associated with significant reduction in all-cause mortality. CONCLUSIONS One-year mortality in patients hospitalised with peptic ulcer disease remained high with no change. This peptic ulcer disease cohort had a clearly decreased survival rate up to 10 years, especially among women with a perforated duodenal ulcer, most likely explained by poorer survival due to underlying comorbidity.
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Affiliation(s)
- H Malmi
- Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Eastern Finland, Kuopio, Finland
| | - L J Virta
- Research Department, The Social Insurance Institution of Finland, Turku, Finland
| | - M A Färkkilä
- Helsinki University Clinic of Gastroenterology, University of Helsinki, Helsinki, Finland
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29
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Norton J, Portet F, Gabelle A, Debette S, Ritchie K, Touchon J, Berr C. Are migraine and non-migrainous headache risk factors for stroke in the elderly? Findings from a 12-year cohort follow-up. Eur J Neurol 2016; 23:1463-70. [PMID: 27399611 DOI: 10.1111/ene.13060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/21/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE There is evidence that migraine is a risk factor for stroke but little is known about this association in elderly people. Furthermore, non-migrainous headache (NMH) has received little attention despite being the most frequently reported type of headache. Late-life migraine and NMH were examined as candidate risk factors for stroke in a community-dwelling elderly sample over a 12-year follow-up. METHODS One thousand nine hundred and nineteen non-institutionalized subjects aged 65+, without dementia (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, DSM-IV criteria) and with no stroke history at baseline, were drawn from the Three-City Montpellier cohort (recruitment 1999-2001) for longitudinal analysis. Ischaemic and haemorrhagic stroke was reported at baseline and at each of the five follow-ups, with cases validated by a panel of experts, according to ICD-10 criteria (International Classification of Diseases, 10th revision). Migraine and NMH were determined at baseline during a neurological interview and examination using 1988 International Headache Society criteria. RESULTS A total of 110 (5.4%) cases of migraine and 179 (8.9%) cases of NMH were identified at baseline. During the median 8.8-year follow-up, incident stroke was observed in 1.9% of baseline migrainers, 6.2% of NMH and 3.6% of those with no lifetime history of headache. Cox proportional hazard models indicated that migraine was not a risk factor for stroke; however, NMH sufferers were twice as likely to have a stroke (hazard ratio 2.00, 95% confidence interval 1.00-3.93, P = 0.049). CONCLUSIONS This study is one of the first to suggest that late-life NMH rather than migraine could be an independent risk factor for stroke and a warning sign. The incidence of stroke in elderly migrainers, seldom reported, is particularly low.
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Affiliation(s)
- J Norton
- Inserm U1061, Montpellier, France.,University of Montpellier, Montpellier, France
| | - F Portet
- Inserm U1061, Montpellier, France.,University of Montpellier, Montpellier, France
| | - A Gabelle
- University of Montpellier, Montpellier, France.,Neurology Department, Memory Resources Research Center, University Hospital Gui de Chauliac, Montpellier, France.,Inserm U1183, Montpellier, France
| | - S Debette
- Inserm U897, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - K Ritchie
- Inserm U1061, Montpellier, France.,University of Montpellier, Montpellier, France.,Faculty of Medicine, Imperial College, London, UK
| | - J Touchon
- Inserm U1061, Montpellier, France.,University of Montpellier, Montpellier, France.,Neurology Department, Memory Resources Research Center, University Hospital Gui de Chauliac, Montpellier, France
| | - C Berr
- Inserm U1061, Montpellier, France.,University of Montpellier, Montpellier, France.,Neurology Department, Memory Resources Research Center, University Hospital Gui de Chauliac, Montpellier, France
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30
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Momose Y, Maeda-Yamamoto M, Nabetani H. Systematic review of green tea epigallocatechin gallate in reducing low-density lipoprotein cholesterol levels of humans. Int J Food Sci Nutr 2016; 67:606-13. [PMID: 27324590 DOI: 10.1080/09637486.2016.1196655] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We conducted a systematic review of the literature for the ability of green tea epigallocatechin gallate (EGCG) to lower low-density lipoprotein cholesterol (LDL-C). Study subjects were limited to healthy individuals and randomized, controlled trials on human serum lipid levels, especially LDL-C, conducted. A total of 17 trials (n = 1356) met all of the inclusion criteria. According to weighted mean differences for changes from baseline with 95% confidence intervals (CI), 107-856 mg/d of EGCG for 4 to 14 weeks reduced LDL-C by -9.29 mg/dl (95% CI, -12.27 to -6.31). Sub-analysis was performed to compare the EGCG lowering effect on LDL-C between non-obese and obese subjects, EGCG dose, baseline of LDL-C levels, or BMI. We concluded that consumption of green tea EGCG resulted in a significant reduction of LDL-C at any baseline level and any dose between 107 and 856 mg/d, and the effect size was slightly dependent on the baseline lipid level of the subjects.
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Affiliation(s)
- Yuko Momose
- a Food Engineering Division , National Food Research Institute , Ibaraki , Japan
| | - Mari Maeda-Yamamoto
- b Food Function Division , National Food Research Institute , Ibaraki , Japan
| | - Hiroshi Nabetani
- a Food Engineering Division , National Food Research Institute , Ibaraki , Japan
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31
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[Reliability and external validity of a questionnaire to assess the knowledge about risk and cardiovascular disease and in patients attending Spanish community pharmacies]. Aten Primaria 2016; 48:586-595. [PMID: 27142591 PMCID: PMC6875968 DOI: 10.1016/j.aprim.2016.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/23/2015] [Accepted: 01/21/2016] [Indexed: 12/04/2022] Open
Abstract
Objetivos Determinar la fiabilidad test-retest de un cuestionario, con validación preliminar, para valorar el conocimiento sobre riesgo cardiovascular (RCV) y enfermedad cardiovascular, en pacientes atendidos en farmacias comunitarias de España. Complementar la validez externa, estableciendo la relación entre una actividad educativa y el aumento del conocimiento sobre RCV y enfermedad cardiovascular. Diseño Subanálisis del estudio clínico controlado EMDADER-CV, en el que se aplicó un cuestionario de conocimiento sobre RCV en 4 momentos. Emplazamiento Farmacia comunitaria española. Participantes Trescientos veintitrés pacientes del grupo control, de los 640 que finalizaron el estudio. Mediciones principales Coeficiente de correlación intraclase para evaluar la fiabilidad en 3 comparaciones (postactividad educativa con semana 16, postactividad educativa con semana 32, y semana 16 con semana 32); y prueba no paramétrica de Friedman para establecer la relación entre una actividad educativa oral y escrita con el aumento del conocimiento. Resultados Para los 323 pacientes, en las 3 comparaciones, los valores del coeficiente de correlación intraclase fueron 0,624; 0,608 y 0,801 (fiabilidad aceptable-buena a excelente). Por su parte, la prueba de Friedman mostró relación entre la actividad educativa y el aumento del conocimiento, estadísticamente significativa (p < 0,0001). Conclusiones Acorde con el coeficiente de correlación intraclase, el cuestionario orientado a valorar el conocimiento sobre el RCV y enfermedad cardiovascular tiene una fiabilidad entre aceptable y excelente, lo cual, sumado a la validación previa, indica que dicho instrumento cumple los criterios de validez y fiabilidad. Además, el cuestionario evidencia capacidad de relacionar un aumento en el conocimiento con una intervención educativa, característica que complementa su validez externa.
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Tully PJ, Debette S, Dartigues JF, Helmer C, Artero S, Tzourio C. Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults. Stroke 2016; 47:1194-200. [DOI: 10.1161/strokeaha.115.012321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/26/2016] [Indexed: 12/25/2022]
Abstract
Background and Purpose—
The aim was to determine the association between antihypertensive drug class and incident stroke controlling for long-term blood pressure (BP) variability (BPV) in people aged ≥65 years.
Methods—
The sample included 5951 participants (median age 74 years, 60% women) taking at least 1 drug for hypertension (3727/5951) or with systolic BP >140 mm Hg or diastolic BP >90 mm Hg. Participants were evaluated for incident fatal and nonfatal stroke to 12 years follow-up. BPV was calculated with the coefficient of variation method and regressed against 9 antihypertensive drug classes (BPV
reg
). Hazard models were used to determine hazard ratios for incident stroke risk attributable to drug class, adjusted for BP, BPV
reg
, covariates, and delayed entry bias.
Results—
There were 273 incident strokes over a median of 9.1 years (interquartile range 6.4–10.4). Stroke risk was generally not reduced by BP-lowering drugs. Angiotensin receptor blockers (hazard ratio 1.56; 95% confidence interval 1.06–2.28;
P
=0.02) and β-blockers (hazard ratio 1.41; 95% confidence interval 1.03–1.92;
P
=0.03) were associated with an increased total stroke risk. Angiotensin receptor blockers and β-blockers were also associated with ischemic strokes after adjustment for systolic BPV. Diastolic BPV was associated with stroke risk in analyses stratified by systolic BP 140 to 160 mm Hg (per 0.10 increase in coefficient of variation, hazard ratio 1.59; 95% confidence interval 1.05–2.40;
P
=0.03).
Conclusions—
The angiotensin receptor blocker and β-blocker drug classes were associated with incident stroke and ischemic stroke in older adults. BPV was generally not associated with incident stroke.
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Affiliation(s)
- Phillip J. Tully
- From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de
| | - Stephanie Debette
- From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de
| | - Jean-François Dartigues
- From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de
| | - Catherine Helmer
- From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de
| | - Sylvaine Artero
- From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de
| | - Christophe Tzourio
- From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de
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