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Wu CK, Yar N, Chen YY. Continuous aspirin treatment improves cardiovascular events and all-cause mortality in hemodialysis patients with peripheral artery disease. Ren Fail 2024; 46:2380754. [PMID: 39039846 PMCID: PMC11268230 DOI: 10.1080/0886022x.2024.2380754] [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: 02/08/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Hemodialysis (HD) patients with peripheral arterial disease (PAD) are at heightened risk of adverse vascular events, and aspirin positively affects those outcomes. We aimed to investigate the association between different patterns of aspirin use and clinical vascular events in chronic HD patients with PAD. METHODS This retrospective nationwide cohort study enrolled 758 chronic HD patients who had been diagnosed with PAD between January 1, 2008, and December 31, 2012, and followed up until the end of 2020. Patients were divided into three groups according to medication possession ratio (MPR) and continued use of aspirin (i.e., low MPR, high MPR but discontinuous prescription, and high MPR and continuous prescription). Percutaneous transluminal angioplasty (PTA), surgical bypass, lower leg amputation, cardiovascular events, cerebrovascular events, and all-cause mortality were evaluated. RESULTS High MPR and continuous aspirin use had the lowest incidence of all-cause mortality and cardiovascular events compared with the two other groups, and it was significantly associated with low risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality (aHR: 0.58 [0.41-0.83], 0.49 [0.25-0.95], 0.57 [0.40-0.81], and 0.70 [0.55-0.88], respectively). Kaplan-Meier analysis revealed that event-free rates of PTA, cardiovascular events, and all-cause mortality of patients with high MPR and continuous aspirin treatment were the highest among the three groups (p < 0.05). CONCLUSION Among HD patients with PAD, high MPR and continuous aspirin use significantly reduced the risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality and improved the event-free rates of PTA, cardiovascular events, and all-cause mortality during long-term follow-up.
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Affiliation(s)
- Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Noi Yar
- College of Management, School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Yun-Yi Chen
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Research, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Taipei, Taiwan
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Wasim R, Singh A, Islam A, Mohammed S, Anwar A, Mahmood T. High Mobility Group Box 1 and Cardiovascular Diseases: Study of Act and Connect. Cardiovasc Toxicol 2024; 24:1268-1286. [PMID: 39242448 DOI: 10.1007/s12012-024-09919-5] [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: 10/16/2023] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
Cardiovascular disease is the deadly disease that can result in sudden death, and inflammation plays an important role in its onset and progression. High mobility group box 1 (HMGB1) is a nuclear protein that regulates transcription, DNA replication, repair, and nucleosome assembly. HMGB1 is released passively by necrotic tissues and actively secreted by stressed cells. Extracellular HMGB1 functions as a damage associated molecular patterns molecule, producing numerous redox forms that induce a range of cellular responses by binding to distinct receptors and interactors, including tissue inflammation and regeneration. Extracellular HMGB1 inhibition reduces inflammation and is protective in experimental models of myocardial ischemia/reperfusion damage, myocarditis, cardiomyopathies caused by mechanical stress, diabetes, bacterial infection, or chemotherapeutic drugs. HMGB1 administration following a myocardial infarction followed by permanent coronary artery ligation improves cardiac function by stimulating tissue regeneration. HMGB1 inhibits contractility and produces hypertrophy and death in cardiomyocytes, while also stimulating cardiac fibroblast activity and promoting cardiac stem cell proliferation and differentiation. Maintaining normal nuclear HMGB1 levels, interestingly, protects cardiomyocytes from apoptosis by limiting DNA oxidative stress, and mice with HMGB1cardiomyocyte-specific overexpression are partially protected from cardiac injury. Finally, elevated levels of circulating HMGB1 have been linked to human heart disease. As a result, following cardiac damage, HMGB1 elicits both detrimental and helpful responses, which may be due to the formation and stability of the various redox forms, the particular activities of which in this context are mostly unknown. This review covers recent findings in HMGB1 biology and cardiac dysfunction.
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Affiliation(s)
- Rufaida Wasim
- Department of Pharmacy, Integral University, Lucknow, 226026, India.
- Faculty of Pharmacy, Integral University, Lucknow, 226026, India.
| | - Aditya Singh
- Department of Pharmacy, Integral University, Lucknow, 226026, India
| | - Anas Islam
- Department of Pharmacy, Integral University, Lucknow, 226026, India
| | - Saad Mohammed
- Department of Pharmacy, Integral University, Lucknow, 226026, India
| | - Aamir Anwar
- Department of Pharmacy, Integral University, Lucknow, 226026, India
| | - Tarique Mahmood
- Department of Pharmacy, Integral University, Lucknow, 226026, India
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3
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Pelletier-Galarneau M, Cabra A, Szabo E, Angadageri S. Real-world evidence study on the impact of SPECT MPI, PET MPI, cCTA and stress echocardiography on downstream healthcare utilisation in patients with coronary artery disease in the US. BMC Cardiovasc Disord 2024; 24:543. [PMID: 39379835 PMCID: PMC11462745 DOI: 10.1186/s12872-024-04225-y] [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: 05/03/2024] [Accepted: 09/30/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is associated with a large clinical and economic burden. However, consensus on the optimal approach to CAD diagnosis is lacking. This study sought to compare downstream healthcare resource utilisation following different cardiac imaging modalities, to inform test selection for CAD diagnosis. METHODS Claims and electronic health records data from the Decision Resources Group Real-World Evidence US Data Repository were analysed for 2.5 million US patients who underwent single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI), positron emission tomography myocardial perfusion imaging (PET MPI), coronary computed tomography angiography (cCTA), or stress echocardiography between January 2016 and March 2018. Patients were stratified into nine cohorts based on suspected or existing CAD diagnosis, pre-test risk, and prior events or interventions. Downstream healthcare utilisation, including additional diagnostic imaging, coronary angiography, and cardiac-related health system encounters, was compared by cohort and index imaging modality. RESULTS Among patients with suspected CAD diagnosed within 3 months of the index test, PET MPI was associated with lower downstream utilisation; 25-37% of patients who underwent PET MPI required additional downstream healthcare resources compared with 40-49% of patients who received SPECT MPI, 35-41% of patients who underwent cCTA, and 44-47% of patients who received stress echocardiography. Patients who underwent PET MPI experienced fewer acute cardiac events (5.3-9.4%) and generally had lower rates of healthcare encounters (0.8-4.1%) and invasive coronary angiography (ICA, 15.4-24.2%) than those who underwent other modalities. SPECT MPI was associated with more downstream ICA (31.3-38.2%) and a higher rate of cardiac events (9.5-13.2%) compared with PET MPI (5.3-9.4%) and cCTA (6.9-9.9%). Across all cohorts, additional diagnostic imaging was 1.6 to 4.7 times more frequent with cCTA compared with PET MPI. CONCLUSION Choice of imaging modality for CAD diagnosis impacts downstream healthcare utilisation. PET MPI was associated with lower utilisation across multiple metrics compared with other imaging modalities studied.
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Paskiewicz A, Wang FM, Ishigami J, Pang Y, Sang Y, Ballew SH, Grams ME, Heiss G, Coresh J, Matsushita K. Peripheral artery disease and risk of kidney outcomes: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2024; 397:118558. [PMID: 39276420 PMCID: PMC11467911 DOI: 10.1016/j.atherosclerosis.2024.118558] [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: 04/17/2024] [Revised: 06/24/2024] [Accepted: 08/06/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND AND AIMS The potential impact of peripheral artery disease (PAD) on kidney outcomes is not well understood. The aim of this study was to explore the association between PAD and end-stage kidney disease (ESKD) and chronic kidney disease (CKD). METHODS Among 14,051 participants (mean age 54 [SD 6 years]) from the Atherosclerosis Risk in Communities study, we categorized PAD status as symptomatic PAD (intermittent claudication or leg revascularization), asymptomatic PAD (ankle-brachial index [ABI] ≤0.90 without clinical history of symptoms), and ABI 0.91-1.00, 1.01-1.10, 1.11-1.20 (reference), 1.21-1.30, and >1.30. We evaluated their associations with two kidney outcomes: ESKD (the need of renal replacement therapy or death due to kidney disease) and CKD (ESKD cases or an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 with a ≥25 % decline from the baseline) using multivariable Cox proportional hazards models. RESULTS Over ∼30 years of follow-up, there were 598 cases of incident ESKD and 4686 cases of incident CKD. After adjusting for potential confounders, both symptomatic PAD and asymptomatic PAD conferred a significantly elevated risk of ESKD (hazard ratio 2.28 [95 % confidence interval 1.23-4.22] and 1.75 [1.19-2.57], respectively). Corresponding estimates for CKD were 1.54 (1.14-2.09) and 1.63 (1.38-1.93). Borderline low ABI 0.91-1.00 also showed elevated risk of adverse kidney outcomes after adjustment for demographic variables. Largely consistent results were observed across demographic and clinical subgroups. CONCLUSIONS Symptomatic PAD and asymptomatic PAD were independently associated with an elevated risk of ESKD and CKD. These results highlight the importance of monitoring kidney function in persons with PAD, even when symptoms are absent.
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Affiliation(s)
- Amy Paskiewicz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frances M Wang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Junichi Ishigami
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yuanjie Pang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yingying Sang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shoshana H Ballew
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Optimal Aging Institute, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Morgan E Grams
- Division of Precision Medicine, Department of Medicine, New York University, New York, NY, USA
| | - Gerardo Heiss
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Optimal Aging Institute, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Desai R, Damarlapally N, Bareja S, Arote V, SuryaVasudevan S, Mehta K, Ashfaque M, Jayachandran Y, Sampath S, Behera A, Srivatsava A, Nawab S, Dadana S. A systematic review and meta-analysis evaluating the association of high sensitivity troponin levels with outcomes in patients with stable coronary artery disease. Curr Med Res Opin 2024; 40:1685-1695. [PMID: 39235073 DOI: 10.1080/03007995.2024.2401632] [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: 05/08/2024] [Revised: 08/28/2024] [Accepted: 09/03/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND High-sensitivity cardiac troponins (Hs-cTns) are reliable indicators of myocardial injury, but their relationship with cardiovascular outcomes remains less understood. This study explores the association between adverse cardiac events and Hs-cTnT levels exceeding 14 ng/L in patients with stable CAD. METHODS Thirteen pertinent studies were identified using specific keywords from a pool of 208 articles retrieved from PubMed, Scopus, and Google Scholar, spanning 2013 to 2023. The primary outcomes included all-cause mortality (ACM), myocardial infarction (MI), cardiovascular death (CVD), rehospitalization due to decompensated heart failure (RDHF), need for revascularization, and stroke. Comprehensive meta-analysis (CMA) was employed to analyze the data for odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using I2 statistics, and both qualitative assessment (Newcastle-Ottawa Scale) and quantitative analysis (Egger's and Beggs test, funnel plots) were conducted. RESULTS The analysis included 29,115 participants (74.72% male) with a mean age of 68.34 years. It revealed a significantly elevated risk of ACM among stable CAD patients with Hs-cTnT levels >14 ng/L compared to those with levels <14 ng/L (11.2% vs. 3.3%; OR = 5.46; 95% CI = 1.53-19.54; p = 0.009). Similarly, higher risks were observed for MI (10.9% vs 3.6%; OR = 3.12; 95% CI = 0.98-9.95, p = 0.053), CVD (8.1% vs. 2.1%; OR = 3.37; 95% CI = 1.74-6.50; p < 0.0001), and RDHF (6.62% vs. 0.92%; OR = 9.46; 95% CI = 4.65-19.24; p < 0.0001). Notably, major adverse cardiovascular events (MACE) exhibited a stronger association with Hs-cTnT levels (18.2% vs 7.81%; OR = 1.89; 95% CI = 0.80-4.43; I2 = 97%; p = 0.14) compared to Hs-cTnI levels (20.1% vs 21.1%; OR = 1.30; 95% CI = 1.03-1.64; I2 <0.0001%; p = 0.03). CONCLUSION Elevated levels of Hs-cTnT (>14 ng/L) are significantly associated with increased risks of RDHF and ACM in patients with stable CAD. Further large-scale prospective studies are warranted to refine risk assessment strategies and mitigate cardiovascular mortality in this population.
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Affiliation(s)
| | - Nanush Damarlapally
- Department of Health Sciences, Houston Community College (Coleman), Houston, TX, USA
| | - Srijan Bareja
- Government Medical College and Hospital, Chandigarh, India
| | | | | | | | | | | | | | | | | | - Shariq Nawab
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sriharsha Dadana
- Department of Hospital Medicine, Cheyenne Regional Medical Center, Cheyenne, WY, USA
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Maas DPMSM, Willems LH, Kranendonk J, Kramers C, Warlé MC. Impact of CYP2C19 Genotype Status on Clinical Outcomes in Patients with Symptomatic Coronary Artery Disease, Stroke, and Peripheral Arterial Disease: A Systematic Review and Meta-Analysis. Drugs 2024; 84:1275-1297. [PMID: 39235670 PMCID: PMC11512840 DOI: 10.1007/s40265-024-02076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Clopidogrel is widely used for the secondary prevention of atherothrombotic events in patients with coronary artery disease (CAD), ischemic stroke, and peripheral arterial disease (PAD). CYP2C19 plays a pivotal role in the conversion of clopidogrel to its active metabolite. Clopidogrel-treated carriers of a CYP2C19 loss-of-function allele (LOF) may have a higher risk of new atherothrombotic events. Previous studies on genotype-guided treatment were mainly performed in CAD and showed mixed results. PURPOSE To simultaneously investigate the impact of CYP2C19 genotype status on the rate of atherothrombotic events in the most common types of atherosclerotic disease (CAD, stroke, PAD). METHODS A comprehensive search in Pubmed, EMBASE, and MEDLINE from their inception to July 23rd 2023 was performed. Randomized controlled trials (RCTs) comparing genotype-guided and standard antithrombotic treatment, and cohort studies and post hoc analyses of RCTs concerning the association between CYP2C19 genotype status and clinical outcomes in clopidogrel-treated patients were included. The primary efficacy endpoint was major adverse cardiovascular events (MACE) and the safety end point major bleeding. Secondary endpoints were myocardial infarction, stent thrombosis, and ischemic stroke. RESULTS Forty-four studies were identified: 11 studies on CAD, 29 studies on stroke, and 4 studies on PAD. In CAD, genotype-guided therapy significantly reduced the risk of MACE [risk ratio (RR) 0.60, 95% confidence interval (CI) 0.43-0.83], myocardial infarction (RR 0.53, 95% CI 0.42-0.68), and stent thrombosis (RR 0.64, 95% CI 0.43-0.94), compared with standard antithrombotic treatment. The rate of major bleeding did not differ significantly (RR 0.93, 95% CI 0.70-1.23). Most RCTs were performed in patients after percutaneous coronary intervention (9/11). In stroke, LOF carriers had a significantly higher risk of MACE (RR 1.61, 95% CI 1.25-2.08) and recurrent ischemic stroke (RR 1.89, 95% CI 1.48-2.40) compared with non-carriers. No significant differences were found in major bleeding (RR 0.90, 95% CI 0.43-1.89). In the 6955 patients with symptomatic PAD treated with clopidogrel in the EUCLID trial, no differences in MACE or major bleeding were found between LOF carriers and non-carriers. In three smaller studies on patients with PAD treated with clopidogrel after endovascular therapy, CYP2C19 genotype status was significantly associated with atherothrombotic events. CONCLUSIONS Genotype-guided treatment significantly decreased the rate of atherothrombotic events in patients with CAD, especially after PCI. In patients with history of stroke, LOF carriers treated with clopidogrel had a higher risk of MACE and recurrent stroke. The available evidence in PAD with regard to major adverse limb events is too limited to draw meaningful conclusions. REGISTRATION PROSPERO identifier no. CRD42020220284.
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Affiliation(s)
- Dominique P M S M Maas
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Loes H Willems
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Josephine Kranendonk
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelis Kramers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Clinical Pharmacy, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Yeh JN, Yip HK, Shao PL, Chiang JY, Wu SC, Sung PH, Sheu JJ, Guo J. Combination of melatonin-delivered endothelial progenitor cells with S-nitroso-N-acetyl-DL-penicillamine for improving critical limb ischemia in the rat. Am J Transl Res 2024; 16:5020-5037. [PMID: 39398551 PMCID: PMC11470315 DOI: 10.62347/ocft1003] [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: 10/18/2023] [Accepted: 02/10/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND This study tested whether combined shock wave (SW)-facilitated melatonin (Mel) delivered into endothelial progenitor cells (EPCs) (EPCSW-Mel) plus S-nitroso-N-acetyl-DL-penicillamine (SNAP) was superior to merely one modality alone for improving critical limb ischemia (CLI) in rats. METHODS SD rats (n = 50) were equally categorized into group 1 (sham-control), group 2 (CLI), group 3 (CLI + SNAP), group 4 (CLI + EPCSW-Mel), and group 5 (CLI + EPCSW-Mel + SNAP), and ischemia-involved quadriceps were harvested by day 14. RESULTS An in vitro study showed that at time points of 24/48/72 h, the cell viability/protein expression of endothelial nitric oxide synthase (eNOS)/and cellular expression of nitric oxide (NO) were highest in EPCs, lowest in EPCs + menadione, and much higher in EPCSW-Mel + Mena than in EPCs + Mena + Mel. Protein levels of oxidative-stress (NOX-1/NOX-2/oxidized protein)/early (AN-V+/PI-)/late (AN-V+/PI+) apoptosis and total intracellular/mitochondrial reactive oxygen species ROS exhibited an antithetical trend of cell viability among the groups (all P<0.0001). Matrigel assay of angiogenesis/positively-stained NO cells showed that they were much higher in EPCs + SNAP than in EPCs only (all P<0.0001). Ex vivo angiogenesis/arterial relaxation of carotid-artery rings were highest in left-common-carotid-artery (LCCA) + SNAP, lowest in LCCA + Mena, and notably higher in LCCA than in LCCA + Mena + SNAP (all P<0.0001). Laser Doppler showed ischemic to normal-blood-flow (INBF) ratio was highest in group 1, lowest in group 2, and it progressively increased from groups 3 to 5 (all P<0.0001). The protein levels of oxidative-stress (NOX-1/NOX-4/oxidized protein)/apoptotic [cleaved-caspase-3/cleaved apoptosis/mitochondrial-damage (cytosolic-cytochrome-C/p-DRP-1)]/fibrotic (Smad3/TGF-β)/inflammatory (MMP-9/IL-1β/TNF-α/NF-κB) biomarkers, exhibited an opposite trend, whereas the protein level of endothelial-cell surface markers (CD31/vWF/eNOS) and number of small vessels exhibited an identical pattern of INBF ratio among the groups (all P<0.0001). CONCLUSIONS Combined EPCSW-Mel and SNAP therapy offered a synergic effect toward rescuing from CLI.
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Affiliation(s)
- Jui-Ning Yeh
- Department of Cardiology, The First Affiliated Hospital, Jinan UniversityGuangzhou 510630, Guangdong, China
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung 83301, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial HospitalKaohsiung 83301, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial HospitalKaohsiung 83301, Taiwan
- Department of Nursing, Asia UniversityTaichung 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical UniversityTaichung 40402, Taiwan
| | - Pei-Lin Shao
- Department of Nursing, Asia UniversityTaichung 41354, Taiwan
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen UniversityKaohsiung 80424, Taiwan
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical UniversityKaohsiung 80708, Taiwan
| | - Shun-Cheng Wu
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical UniversityKaohsiung 80787, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical UniversityKaohsiung 80787, Taiwan
- Post-Baccalaureate Program in Nursing, Asia UniversityTaichung 41354, Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung 83301, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial HospitalKaohsiung 83301, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial HospitalKaohsiung 83301, Taiwan
| | - Jiunn-Jye Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of MedicineKaohsiung 83301, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial HospitalKaohsiung 83301, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301, Taiwan
| | - Jun Guo
- Department of Cardiology, The First Affiliated Hospital, Jinan UniversityGuangzhou 510630, Guangdong, China
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8
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Botto F, Garcia-Zamora S. Is colchicine on its way to a place in the polypill for cardiovascular prevention? Atherosclerosis 2024; 398:118594. [PMID: 39303433 DOI: 10.1016/j.atherosclerosis.2024.118594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Affiliation(s)
- Fernando Botto
- Clinical Research Unit, Instituto Cardiovascular de Buenos Aires (ICBA), Argentina.
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Bate KA, Genetzakis E, Vescovi J, Gray MP, Celermajer DS, McGuire HM, Grieve SM, Vernon ST, Cartland SP, Yang JY, Kavurma MM, Figtree GA. Vascular Cytokines and Atherosclerosis: Differential Serum Levels of TRAIL, IL-18, and OPG in Obstructive Coronary Artery Disease. Biomolecules 2024; 14:1119. [PMID: 39334884 PMCID: PMC11430378 DOI: 10.3390/biom14091119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/16/2024] [Accepted: 08/30/2024] [Indexed: 09/30/2024] Open
Abstract
The risk-factor-based prediction of atherosclerotic coronary artery disease (CAD) remains suboptimal, particularly in the absence of any of the standard modifiable cardiovascular risk factors (SMuRFs), making the discovery of biomarkers that correlate with atherosclerosis burden critically important. We hypothesized that cytokines and receptors associated with inflammation in CAD-tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interleukin-18 (IL-18), and osteoprotegerin (OPG)-would be independently associated with CAD. To determine this, we measured the serum biomarker levels of 993 participants from the BioHEART study who had CT coronary angiograms that were scored for severity of stenosis and plaque composition. We found that the quartiles of TRAIL, OPG, and IL-18 were significantly associated with disease scores, and that the IL-18/TRAIL and OPG/TRAIL ratios demonstrated significant differences between no CAD vs. STEMI whereas only the OPG/TRAIL ratio showed differences between no CAD and obstructive CAD (stenosis > 50%). However, these associations did not persist after adjustment for age, sex, SMuRFs, and a family history of CAD. In conclusion, TRAIL, IL-18, and OPG and the derived ratios of IL-18/TRAIL and OPG/TRAIL demonstrate significant associations with raw disease scores and risk factors, but these markers are not discriminatory biomarkers for the prediction of CAD when incorporated into multi-variable risk models.
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Affiliation(s)
- Katharine A. Bate
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Elijah Genetzakis
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
| | - Joshua Vescovi
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
- Sydney Precision Data Science Centre, University of Sydney, Camperdown, NSW 2006, Australia
- School of Mathematics and Statistics, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Michael P. Gray
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
| | - David S. Celermajer
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Heart Research Institute, The University of Sydney, Newtown, NSW 2042, Australia
- Department of Cardiology, Royal Price Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Helen M. McGuire
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Ramaciotti Facility for Human Systems Biology, University of Sydney, Camperdown, NSW 2006, Australia
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW 2006, Australia
| | - Stephen T. Vernon
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Siân P. Cartland
- Heart Research Institute, The University of Sydney, Newtown, NSW 2042, Australia
| | - Jean Y. Yang
- Sydney Precision Data Science Centre, University of Sydney, Camperdown, NSW 2006, Australia
- School of Mathematics and Statistics, The University of Sydney, Camperdown, NSW 2006, Australia
- The Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Mary M. Kavurma
- Heart Research Institute, The University of Sydney, Newtown, NSW 2042, Australia
| | - Gemma A. Figtree
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, NSW 2065, Australia
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
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10
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El-Andari R, Bozso SJ, Fialka NM, Kang JJH, Hassanabad AF, Nagendran J. Alternative Approaches to Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention, How Do They Compare?: A Systematic Review and Meta-Analysis. Cardiol Rev 2024; 32:392-401. [PMID: 36688825 DOI: 10.1097/crd.0000000000000524] [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: 01/24/2023]
Abstract
Coronary artery disease (CAD) is a leading cause of mortality worldwide. Severe symptomatic CAD is treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Alternative CABG (ACABG) approaches including thoracotomy, off-pump, total endoscopic, and robotic-assisted CABG are increasing in prevalence to address the increased early risk of CABG. This systematic review and meta-analysis aims to review the contemporary literature comparing outcomes after ACABG and PCI. Pubmed, Medline, and Embase were systematically searched by 2 authors for articles comparing the outcomes after ACABG and PCI. A total of 1154 articles were screened, and 11 were included in this review. The RevMan 5.4 software was used to perform a meta-analysis of the pooled data. Individual studies found rates of long-term survival, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction (MI), and repeat revascularization either favored ACABG or did not differ significantly. Pooled estimates of the compiled data identified rates of MACCE, MI, and repeat revascularization favored ACABG. The results of this review demonstrated the favorable rates of long-term mortality, MACCE, MI, and repeat revascularization for ACABG in addition to similar short-term mortality and stroke when compared with PCI. Advancement of both CABG and PCI continues to improve patient outcomes. With the increasing prevalence of ACABG, similar studies will need to be undertaken with further direct comparisons between ACABG and PCI. Finally, hybrid revascularization should continue to be explored for its combined benefits of long-term outcomes, short-term safety, and ability to achieve complete revascularization.
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Affiliation(s)
- Ryaan El-Andari
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Sabin J Bozso
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Nicholas M Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jimmy J H Kang
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Jeevan Nagendran
- From the Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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11
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Porras CP, de Boer AR, Koop Y, Vaartjes I, Teraa M, Hazenberg CEVB, Verhaar MC, Vernooij RWM. Sex Differences in Mortality Risk after the First Hospitalisation with Lower Extremity Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2024; 68:378-384. [PMID: 38697256 DOI: 10.1016/j.ejvs.2024.04.039] [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: 07/04/2023] [Revised: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE Lower extremity peripheral arterial disease (PAD) is a severe condition that increases the risk of major adverse cardiovascular events, major adverse limb events, and all cause mortality. This study aimed to investigate the mortality risk among females and males hospitalised for the first time with lower extremity PAD. METHODS Three cohorts of patients who were admitted for the first time with lower extremity PAD in 2007 - 2010, 2011 - 2014, and 2015 - 2018 were constructed. For the 2007 - 2010 and 2011 - 2014 cohorts, the 28 day, one year, and five year mortality rates were calculated, assessing survival time from date of hospital admission until date of death, end of study period, or censoring. For the 2015 - 2018 cohort, only 28 day and one year mortality were investigated due to lack of follow up data. Mortality rates of these cohorts were compared with the general population using standardised mortality rates (SMRs), and the risk of death between sexes was evaluated using Cox proportional hazards models. Cox models were adjusted for age, cardiovascular disease, and diabetes mellitus to account for potential confounding factors. RESULTS In total, 7 950, 9 670, and 13 522 patients were included in the 2007 - 2010, 2011 - 2014, and 2015 - 2018 cohorts, respectively. Over 60% of individuals in each cohort were males. Mortality rates at 28 day and one year remained stable across all cohorts, while the five year mortality rate increased for both males and females in the 2011 - 2014 cohort. The SMRs both of females and males with PAD were significantly higher than in the general population. Multivariable regression analyses found no significant differences in mortality risk between sexes at 28 day and one year. However, the five year mortality risk was lower in females, with a hazard ratio of 0.89 (95% confidence interval [CI] 0.83 - 0.97) in the 2007 - 2010 cohort and 0.88 (95% CI 0.82 - 0.94) in the 2011 - 2014 cohort. CONCLUSION The five year mortality risk has increased, and females face a lower mortality risk than males. Lower extremity PAD still carries unfavourable long term consequences compared with the general population.
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Affiliation(s)
- Cindy P Porras
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Annemarijn R de Boer
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Yvonne Koop
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ilonca Vaartjes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.
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12
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Woo K, Murphy C, Gregg E, Moralejo J, LeBlanc K, Brandys T. Management of Pain in People Living With Chronic Limb Threatening Ischemia: Highlights From a Rapid Umbrella Review. J Wound Ostomy Continence Nurs 2024; 51:371-376. [PMID: 39313972 DOI: 10.1097/won.0000000000001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Peripheral artery disease is a complex health condition. It is associated with atherosclerotic occlusive lesions in the arteries limiting normal blood flow, mostly involving the lower extremities, leading to chronic limb-threatening ischemia (CLTI). Chronic unrelenting ischemic leg pain can be debilitating and distressing, contributing to poor health-related quality of life. Comprehensive management of pain associated with CLTI requires multimodal approaches that draw on a range of strategies and specialist treatments delivered by an interdisciplinary team across various health care settings. We recognized a significant gap in evidence-based strategies that are accessible, appropriate, acceptable, effective, and safe for the elderly with CLTI-associated pain. We therefore conducted an umbrella review or overview of multiple existing reviews that employ a rigorous and transparent method to comprehensively identify and synthesize relevant literature including systematic, scoping, and narrative reviews. The purpose of this umbrella review was to aggregate and compare various management options to inform best practices and quality indicators for the management of ischemic pain in older patients with peripheral artery disease.
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Affiliation(s)
- Kevin Woo
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
| | - Christine Murphy
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
| | - Emily Gregg
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
| | - Joshua Moralejo
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
| | - Kimberly LeBlanc
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
| | - Tim Brandys
- Kevin Woo, PhD, RN, NSWOC(C), WOCC(C), Queen's University, University Health Network, Kingston, Ontario
- Christine Murphy, PhD, RN, NSWOC(C), WOCC(C), The Ottawa Hospital, Ottawa, Ontario
- Emily Gregg, MSc, RN, Queen's University, Kingston, Ontario
- Joshua Moralejo, MScCH, RN, NSWOC(C), WOCC(C), University Health Network, Kingston, Ontario
- Kimberly LeBlanc, PhD, RN, NSWOC(C), WOCC(C), Wound, Ostomy and Continence Institute, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC), Ottawa, Ontario
- Tim Brandys, MD, MEd, FRCSC, FACS, The Ottawa Hospital,Ottawa, Ontario
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13
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Toftgård J, Hedskog H, Rune L, Svedenhag J, Riva G. Association of postsystolic shortening on stress echocardiography and significant coronary artery stenosis: A single-centre retrospective cohort study. Clin Physiol Funct Imaging 2024; 44:371-380. [PMID: 38659382 DOI: 10.1111/cpf.12883] [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: 09/25/2023] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Postsystolic shortening (PSS) is one of the proposed quantitative measures to predict myocardial ischaemia in the stress echocardiographic (SE) evaluation. It is previously known that hypo-/akinesia (HA) correlates well with coronary stenosis. However, some patients undergoing SE only present with PSS, and their risk of significant coronary stenosis is less clear. This study aimed to evaluate the association between PSS and significant coronary stenosis compared with HA. METHODS This was a retrospective cohort study at the hospital of S:t Görans, Stockholm, Sweden. All patients who underwent SE to investigate inducible ischaemia between 1 January 2018 and 15 October 2021 were eligible for inclusion. Exclusion criteria were normal SE and inconclusive test. Pathological SE were divided into two groups, patients with HA and those with PSS. Outcome was significant coronary artery stenosis visualized by invasive coronary angiography. RESULTS The final study population consisted of 108 patients (73 PSS, 35 HA). The presence of HA was associated with a higher risk of significant stenosis compared to those with PSS (63% vs. 23%, p < 0.001). This relationship was observed among males (p < 0.001), but not among females (p = 0.133). Nonsignificant stenosis trended to be more common among patients with PSS (21% vs. 6%, p = 0.053) CONCLUSIONS: The finding of PSS without HA was associated with a lower risk of significant coronary stenosis than HA. However, patients with PSS still often had nonsignificant coronary stenosis and PSS in the evaluation for nonobstructive coronary artery disease (CAD) should be further investigated.
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Affiliation(s)
- Joel Toftgård
- Department of Clinical Physiology, Capio S:t Göran Hospital, Stockholm, Sweden
| | - Henrik Hedskog
- Department of Clinical Physiology, Capio S:t Göran Hospital, Stockholm, Sweden
| | - Lars Rune
- Department of Clinical Physiology, Capio S:t Göran Hospital, Stockholm, Sweden
| | - Jan Svedenhag
- Department of Clinical Physiology, Capio S:t Göran Hospital, Stockholm, Sweden
| | - Gabriel Riva
- Department of Cardiology, Capio S:t Göran Hospital, Stockholm, Sweden
- Department of Clinical Science and Education, KI SÖS, Stockholm, Sweden
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14
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Lin DSH, Huang KC, Lin TT, Lee JK, Lin LY. Effects of Colchicine on Major Adverse Limb and Cardiovascular Events in Patients With Peripheral Artery Disease. Mayo Clin Proc 2024; 99:1374-1387. [PMID: 39115507 DOI: 10.1016/j.mayocp.2024.05.004] [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] [Received: 01/28/2024] [Revised: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE To assess the effects of colchicine, which has been shown to reduce the risks of coronary artery disease but scarcely studied in peripheral artery disease (PAD), on major adverse limb events (MALE) in patients with PAD. METHODS This is a retrospective study based on a nationwide database. Patients who were diagnosed with PAD between 2010 and 2020 and prescribed with colchicine after the diagnosis of PAD were identified. Patients were then categorized into the colchicine or the control group according to drug use. Propensity score matching was performed to mitigate selection bias. Risks of MALE (including lower limb revascularization and nontraumatic amputation) and major adverse cardiovascular events were compared between the two groups. RESULTS After patient selection and propensity score matching, there were 60,219 patients in both colchicine and control groups. After a mean follow-up of 4.5 years, the risk of MALE was significantly lower in the colchicine group compared with control (subdistribution HR, 0.75; 95% CI, 0.71 to 0.80), as were the incidence of both components of MALE, lower limb revascularization and major amputations. Colchicine treatment was also associated with lower risk of cardiovascular death. The lower risk of MALE observed with colchicine therapy was accentuated in the subgroup of patients receiving concomitant urate-lowering medications. CONCLUSION In patients diagnosed with PAD, the use of colchicine is associated with lower risks of MALE and cardiovascular death. Anti-inflammatory therapy with colchicine may provide benefits in vascular beds beyond the coronary arteries.
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Affiliation(s)
- Donna Shu-Han Lin
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Kuan-Chih Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ting-Tse Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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15
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Gohil MN, Muruganantham B, Raval M, Bearne LM. Translation, cross-cultural adaptation, and validation of a Gujarati version of a theory of planned behavior questionnaire that assesses walking treatment beliefs in people with intermittent claudication. JOURNAL OF VASCULAR NURSING 2024; 42:182-190. [PMID: 39244330 DOI: 10.1016/j.jvn.2024.05.004] [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: 09/01/2023] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Walking as a treatment is recommended for people with intermittent claudication (IC), but participation tends to be poor. Walking treatment beliefs, as defined by the Theory of Planned Behaviour (TPB) are associated with walking behavior, so assessing and designing interventions targeting walking treatment beliefs are crucial. To assess walking treatment beliefs in people with IC in Gujarat, a translated, culturally adapted questionnaire that assesses the four TPB constructs (attitude, subjective normative beliefs, perceived behavioral control beliefs, and intention to walk) is required. AIM To translate and cross-culturally assess the content validity and face validity of a Gujarati version of a TPB questionnaire that assesses walking treatment beliefs. MATERIALS AND METHODS A forward-backward translation of the 12-item TPB questionnaire was applied using a standardized approach. The translated versions were compared with the original questionnaire, and ten experts, rated each item according to: clarity, semantic, appropriateness, and cultural relevance. Content Validity Index (CVI), item level content validity (I-CVI), Scale -content validity index (S-CVI/Ave), and universal agreement (UA) were computed to summarize the overall content validity of the questionnaire as well as a proportion of agreement with content experts. Face validity was assessed using a think-aloud approach with ten patients with IC. This cognitive interviewing approach (think-aloud approach) asked participants to describe their thoughts whilst completing the questionnaire. Responses were analyzed thematically. RESULTS There was complete agreement between experts for 9/12 items (I-CVI=1.00), leading to an overall agreement (S-CVI/Ave) of 0.98. For face validation, at least 50% of the participants had no significant problems with any question in the questionnaire. Most problems participants encountered were straightforward, such as re-reading some questions or considering the questions carefully before answering. CONCLUSION The Gujarati TPB questionnaire had excellent content validity and was comprehensible and answerable by the majority of our participants with IC and, therefore, had good face validity; this will enable walking treatment beliefs to be assessed in people with IC.
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Affiliation(s)
- Megha Nishith Gohil
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Anand, Gujarat, India.
| | - Balaganapathy Muruganantham
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Anand, Gujarat, India
| | | | - Lindsay Mary Bearne
- Population Health Research Institute, St George's, University of London, United Kingdom
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16
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Chua J, Tan B, Wong D, Garhöfer G, Liew XW, Popa-Cherecheanu A, Loong Chin CW, Milea D, Li-Hsian Chen C, Schmetterer L. Optical coherence tomography angiography of the retina and choroid in systemic diseases. Prog Retin Eye Res 2024; 103:101292. [PMID: 39218142 DOI: 10.1016/j.preteyeres.2024.101292] [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: 05/17/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
Optical coherence tomography angiography (OCTA) has transformed ocular vascular imaging, revealing microvascular changes linked to various systemic diseases. This review explores its applications in diabetes, hypertension, cardiovascular diseases, and neurodegenerative diseases. While OCTA provides a valuable window into the body's microvasculature, interpreting the findings can be complex. Additionally, challenges exist due to the relative non-specificity of its findings where changes observed in OCTA might not be unique to a specific disease, variations between OCTA machines, the lack of a standardized normative database for comparison, and potential image artifacts. Despite these limitations, OCTA holds immense potential for the future. The review highlights promising advancements like quantitative analysis of OCTA images, integration of artificial intelligence for faster and more accurate interpretation, and multi-modal imaging combining OCTA with other techniques for a more comprehensive characterization of the ocular vasculature. Furthermore, OCTA's potential future role in personalized medicine, enabling tailored treatment plans based on individual OCTA findings, community screening programs for early disease detection, and longitudinal studies tracking disease progression over time is also discussed. In conclusion, OCTA presents a significant opportunity to improve our understanding and management of systemic diseases. Addressing current limitations and pursuing these exciting future directions can solidify OCTA as an indispensable tool for diagnosis, monitoring disease progression, and potentially guiding treatment decisions across various systemic health conditions.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Xin Wei Liew
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alina Popa-Cherecheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Emergency University Hospital, Department of Ophthalmology, Bucharest, Romania
| | - Calvin Woon Loong Chin
- Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Fondation Ophtalmologique Adolphe De Rothschild, Paris, France
| | - Christopher Li-Hsian Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland; Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria; Fondation Ophtalmologique Adolphe De Rothschild, Paris, France; Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria.
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17
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Szydlowska B, Ding Y, Moore C, Cai Z, Torres-Castanedo CG, Collins CP, Jones E, Hersam MC, Sun C, Ameer GA. Polydiolcitrate-MoS 2 Composite for 3D Printing Radio-Opaque, Bioresorbable Vascular Scaffolds. ACS APPLIED MATERIALS & INTERFACES 2024; 16:45422-45432. [PMID: 39102678 PMCID: PMC11368090 DOI: 10.1021/acsami.4c07364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 08/07/2024]
Abstract
Implantable polymeric biodegradable devices, such as biodegradable vascular scaffolds, cannot be fully visualized using standard X-ray-based techniques, compromising their performance due to malposition after deployment. To address this challenge, we describe a new radiopaque and photocurable liquid polymer-ceramic composite (mPDC-MoS2) consisting of methacrylated poly(1,12 dodecamethylene citrate) (mPDC) and molybdenum disulfide (MoS2) nanosheets. The composite was used as an ink with microcontinuous liquid interface production (μCLIP) to fabricate bioresorbable vascular scaffolds (BVS). Prints exhibited excellent crimping and expansion mechanics without strut failures and, importantly, with X-ray visibility in air and muscle tissue. Notably, MoS2 nanosheets displayed physical degradation over time in phosphate-buffered saline solution, suggesting the potential for producing radiopaque, fully bioresorbable devices. mPDC-MoS2 is a promising bioresorbable X-ray-visible composite material suitable for 3D printing medical devices, such as vascular scaffolds, that require noninvasive X-ray-based monitoring techniques for implantation and evaluation. This innovative biomaterial composite system holds significant promise for the development of biocompatible, fluoroscopically visible medical implants, potentially enhancing patient outcomes and reducing medical complications.
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Affiliation(s)
- Beata
M. Szydlowska
- Department
of Materials Science and Engineering, Northwestern
University, Evanston, Illinois 60208, United States
- Center
for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, Illinois 60208, United States
| | - Yonghui Ding
- Center
for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, Illinois 60208, United States
- Department
of Biomedical Engineering, Northwestern
University, Evanston, Illinois 60208, United States
| | - Connor Moore
- Center
for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, Illinois 60208, United States
| | - Zizhen Cai
- Department
of Materials Science and Engineering, Northwestern
University, Evanston, Illinois 60208, United States
| | - Carlos G. Torres-Castanedo
- Department
of Materials Science and Engineering, Northwestern
University, Evanston, Illinois 60208, United States
| | - Caralyn P. Collins
- Center
for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, Illinois 60208, United States
- Department
of Mechanical Engineering, Northwestern
University, Evanston, Illinois 60208, United States
| | - Evan Jones
- Center
for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, Illinois 60208, United States
- Department
of Mechanical Engineering, Northwestern
University, Evanston, Illinois 60208, United States
| | - Mark C. Hersam
- Department
of Materials Science and Engineering, Northwestern
University, Evanston, Illinois 60208, United States
- Center
for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, Illinois 60208, United States
- Department
of Chemistry, Northwestern University, Evanston, Illinois 60208, United States
- Department
of Electrical and Computer Engineering, Northwestern University, Evanston, Illinois 60208, United States
| | - Cheng Sun
- Center
for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, Illinois 60208, United States
- Department
of Mechanical Engineering, Northwestern
University, Evanston, Illinois 60208, United States
| | - Guillermo A. Ameer
- Center
for Advanced Regenerative Engineering (CARE), Northwestern University, Evanston, Illinois 60208, United States
- Department
of Biomedical Engineering, Northwestern
University, Evanston, Illinois 60208, United States
- Department
of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, United States
- Simpson
Querrey Institute, Northwestern University, Evanston, Illinois 60208, United States
- Chemistry
for Life Processes Institute, Northwestern
University, Evanston, Illinois 60208, United States
- International
Institute for Nanotechnology, Northwestern
University, Evanston, Illinois 60208, United States
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Jarosinski MC, Hafeez MS, Sridharan ND, Andraska EA, Meyer JM, Khamzina Y, Tzeng E, Reitz KM. Markers of optimal medical therapy are associated with improved limb outcomes after elective revascularization for intermittent claudication. J Vasc Surg 2024:S0741-5214(24)01785-3. [PMID: 39208918 DOI: 10.1016/j.jvs.2024.08.033] [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: 05/21/2024] [Revised: 08/02/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Optimal medical therapy (OMT) is a modifiable factor that decreases mortality and cardiovascular events in patients with severe peripheral arterial disease. We hypothesized that preintervention OMT would be associated with improved 1-year reintervention and major adverse limb event (MALE) rates after elective endovascular revascularization for intermittent claudication (IC). METHODS Using the Vascular Quality Initiative (2010-2020), we identified patients with IC undergoing elective endovascular, hybrid, and open surgical interventions. Preoperative antiplatelet, statin, and nonsmoking status defined OMT components and created three groups: complete (all components), partial (1-2 components), and no OMT. The primary outcome was 1-year reintervention. Secondary outcomes included MALE and factors associated with OMT usage. Multivariable logistic regression generated adjusted odds ratios (aOR). RESULTS There were 39,088 patients (14,907 [38.1%] complete, 22,054 [56.4%)] partial, 2127 [5.4%] no OMT) who met our criteria. Patients with any OMT were more frequently older with more cardiovascular diseases and diabetes (P < .0001). Patients without OMT were more likely to be Black or with Medicare or Medicaid (P < .05). Observed 1-year reintervention (5.3% complete OMT, 6.1% partial OMT, 8.3% no OMT; P < .001) and MALE (5.6% complete OMT, 6.3% partial OMT, 8.8% no OMT; P < .001) were decreased by partial or complete OMT compared with no OMT. Complete OMT significantly decreased the adjusted odds of reintervention and MALE by 28% (aOR, 0.72, 95% confidence interval [95% CI], 0.59-0.88) and 30% (aOR, 0.70; 95% CI, 0.58-0.85), respectively, compared with no OMT. Partial OMT decrease the adjusted odds of reintervention and MALE by 24% (aOR, 0.76; 95% CI, 0.63-0.92) and 26% (aOR, 0.74; 95% CI, 0.62-0.89), respectively. CONCLUSIONS Preintervention OMT is an underused, modifiable risk factor associated with improved 1-year reintervention and MALE. Vascular surgeons are uniquely positioned to initiate and maintain OMT in patients with IC before revascularization to optimize patient outcomes.
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Affiliation(s)
- Marissa C Jarosinski
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Muhammed S Hafeez
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Natalie D Sridharan
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Elizabeth A Andraska
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joseph M Meyer
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD
| | - Yekaterina Khamzina
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Edith Tzeng
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Katherine M Reitz
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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Song S, Chen L, Yu R, Zhu J. Neutrophil-to-lymphocyte ratio as a predictor of all-cause and cardiovascular mortality in coronary heart disease and hypertensive patients: a retrospective cohort study. Front Endocrinol (Lausanne) 2024; 15:1442165. [PMID: 39234507 PMCID: PMC11371692 DOI: 10.3389/fendo.2024.1442165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/31/2024] [Indexed: 09/06/2024] Open
Abstract
Background To date, no studies have investigated the correlation between the neutrophil-to-lymphocyte ratio (NLR) and the long-term risk of mortality in individuals with both coronary heart disease (CHD) and hypertension. This study aims to evaluate the association between NLR and all-cause and cardiovascular mortality among this patient population. Methods National Death Index (NDI) and National Health and Nutrition Examination Survey (NHANES 2001-2018) were the data sources. A nonlinear association between the NLR and mortality risk was shown by restricted cubic spline (RCS) analysis. Using a weighted Cox proportional hazards model, we quantitatively evaluated the effect of NLR on mortality risk.The capacity of NLR to forecast survival was assessed by evaluating time-dependent receiver operating characteristic (ROC) curves. A mediating influence analysis was conducted to assess the influence of NLR on mortality through eGFR as a mediator. Results The study involved a total of 2136 individuals. During the median follow-up interval of 76.0 months, 801 deaths were recorded. The RCS analysis showed NLR and mortality risk to have a nonlinear relationship. Two groups were established based on the participants' NLR levels: a group with high NLR (NLR > 2.65) and a group with low NLR (NLR < 2.65). After adjusting for potential confounding factors, the Cox proportional hazards model revealed that participants with an increased NLR faced a significantly higher risk of cardiovascular mortality. (HR 1.58, 95% CI 1.33-1.82, p < 0.0001) and all-cause mortality (HR 1.46, 95% CI 1.30-1.62, p < 0.0001). An analysis of interactions and data stratification corroborated the validity of our findings. eGFR was identified as a partial mediator in the association between NLR and mortality rates, contributing 12.17% and 9.66% of the variance in all-cause and cardiovascular mortality, respectively. The predictive performance for cardiovascular mortality was quantified using ROC curves, with respective AUC values of 0.67, 0.65, and 0.64 for predictions over 3, 5, and 10 years. The AUC values for all-cause mortality were 0.66, 0.64, and 0.63 for the same time frames. Conclusion For patients with CHD and hypertension, an elevated NLR serves as an independent prognostic indicator for both all-cause and cardiovascular mortality.
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Affiliation(s)
- Songhong Song
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China
| | - Liwen Chen
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China
| | - Rong Yu
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China
| | - Jinxiu Zhu
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China
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Ermawan R, Pintaningrum Y, Indrayana Y. The predictors of coronary slow flow in patients undergoing coronary angiography. Egypt Heart J 2024; 76:103. [PMID: 39136846 PMCID: PMC11322457 DOI: 10.1186/s43044-024-00536-9] [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: 05/02/2024] [Accepted: 08/04/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND A new challenge in coronary artery disease treatment has emerged, where specific populations exhibit ischemic symptoms without any obstruction in the epicardial coronary artery. Instead, they exhibit slow coronary contrast flow, referred to as coronary slow flow (CSF). This study aims to identify several predictors of CSF. RESULTS This case-control study was conducted at the Regional General Hospital of West Nusa Tenggara Province in Indonesia from December 2016 to February 2024. The study involved sixty subjects, with 30 in each group of CSF and normal epicardial coronary artery angiogram (NECA). CSF is enforced by the TIMI frame count (TFC) greater than 27 frames. Among all the predictors studied, coronary artery diameter (p < 0.001) and random blood sugar (p = 0.049) were found to affect the CSF significantly. In the multivariate analysis, coronary artery diameter remained a significant predictor (adjusted OR 10.08, 95% CI 2.64-38.50, p < 0.001), with an optimal cut-off point of more than 3.56 mm, a sensitivity of 76.7%, and a specificity of 70.7% (AUC = 0.787, p < 0.001). CONCLUSION The coronary artery diameter strongly predicts CSF in patients undergoing coronary angiography.
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Affiliation(s)
- Romi Ermawan
- Faculty of Medicine, Mataram University, FK UNRAM, Jl. Pendidikan, No. 37, Mataram, NTB, Indonesia.
| | - Yusra Pintaningrum
- Faculty of Medicine, Mataram University, FK UNRAM, Jl. Pendidikan, No. 37, Mataram, NTB, Indonesia
| | - Yanna Indrayana
- Faculty of Medicine, Mataram University, FK UNRAM, Jl. Pendidikan, No. 37, Mataram, NTB, Indonesia
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21
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Li W, Liao X, Geng D, Yang J, Chen H, Hu S, Dai M. Mindfulness therapy for patients with coronary heart disease: A systematic review and meta-analysis. Int J Nurs Pract 2024:e13276. [PMID: 39129297 DOI: 10.1111/ijn.13276] [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: 11/21/2023] [Revised: 05/04/2024] [Accepted: 05/17/2024] [Indexed: 08/13/2024]
Abstract
AIM Coronary heart disease (CHD) is a prevalent cardiovascular disease with high mortality rates worldwide. Patients with CHD often experience adverse psychological stress related to the disease's diagnosis, treatment and recovery phases. This stress can hurt sleep quality and overall quality of life. Mindfulness-based interventions (MBIs) have been studied as a psychotherapeutic approach to alleviating the psychological stress associated with CHD. This study aimed to determine the effectives of MBIs for health outcomes in patients with CHD. METHODS A total of eight English-language databases were searched, and eight relevant studies were included in the analysis. The included studies were assessed for literature quality, and data were extracted and analysed using Review Manager 5.3. RESULTS A total of eight studies involving 802 participants were included in the analysis. Compared to control groups, MBIs significantly reduced anxiety, depression, perceived stress, and systolic blood pressure. However, there was no significant effect on diastolic blood pressure, quality of life or body mass index. One study reported that MBIs significantly improved sleep quality in patients with acute myocardial infarction after percutaneous coronary intervention but had no significant effect on body mass index. CONCLUSION MBIs had significant effects on anxiety and depression in patients with CHD, reduced perceived stress and were associated with reductions in systolic blood pressure and improvements in sleep quality. However, they did not significantly affect diastolic blood pressure, quality of life or body mass index.
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Affiliation(s)
- Weina Li
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoqin Liao
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dandan Geng
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiechao Yang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hu Chen
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuqin Hu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengqiao Dai
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Zan J, Dong X, Yang H, Yan J, He Z, Tian J, Zhang Y. Application of the Unbalanced Ensemble Algorithm for Prognostic Prediction Outcomes of All-Cause Mortality in Coronary Heart Disease Patients Comorbid with Hypertension. Risk Manag Healthc Policy 2024; 17:1921-1936. [PMID: 39135612 PMCID: PMC11317517 DOI: 10.2147/rmhp.s472398] [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: 04/05/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024] Open
Abstract
Purpose This study sought to develop an unbalanced-ensemble model that could accurately predict death outcomes of patients with comorbid coronary heart disease (CHD) and hypertension and evaluate the factors contributing to death. Patients and Methods Medical records of 1058 patients with coronary heart disease combined with hypertension and excluding those acute coronary syndrome were collected. Patients were followed-up at the first, third, sixth, and twelfth months after discharge to record death events. Follow-up ended two years after discharge. Patients were divided into survival and nonsurvival groups. According to medical records, gender, smoking, drinking, COPD, cerebral stroke, diabetes, hyperhomocysteinemia, heart failure and renal insufficiency of the two groups were sorted and compared and other influencing factors of the two groups, feature selection was carried out to construct models. Owing to data unbalance, we developed four unbalanced-ensemble prediction models based on Balanced Random Forest (BRF), EasyEnsemble, RUSBoost, SMOTEBoost and the two base classification algorithms based on AdaBoost and Logistic. Each model was optimised using hyperparameters based on GridSearchCV and evaluated using area under the curve (AUC), sensitivity, recall, Brier score, and geometric mean (G-mean). Additionally, to understand the influence of variables on model performance, we constructed a SHapley Additive explanation (SHAP) model based on the optimal model. Results There were significant differences in age, heart rate, COPD, cerebral stroke, heart failure and renal insufficiency in the nonsurvival group compared with the survival group. Among all models, BRF yielded the highest AUC (0.810; 95% CI, 0.778-0.839), sensitivity (0.990; 95% CI, 0.981-1.000), recall (0.990; 95% CI, 0.981-1.000), and G-mean (0.806; 95% CI, 0.778-0.827), and the lowest Brier score (0.181; 95% CI, 0.178-0.185). Therefore, we identified BRF as the optimal model. Furthermore, red blood cell count (RBC), body mass index (BMI), and lactate dehydrogenase were found to be important mortality-associated risk factors. Conclusion BRF combined with advanced machine learning methods and SHAP is highly effective and accurately predicts mortality in patients with CHD comorbid with hypertension. This model has the potential to assist clinicians in modifying treatment strategies to improve patient outcomes.
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Affiliation(s)
- Jiaxin Zan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, People’s Republic of China
| | - Xiaojing Dong
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, People’s Republic of China
| | - Hong Yang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, People’s Republic of China
| | - Jingjing Yan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, People’s Republic of China
| | - Zixuan He
- Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jing Tian
- Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Yanbo Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, People’s Republic of China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, People’s Republic of China
- School of Health Services and Management, Shanxi University of Chinese Medicine, Taiyuan, People’s Republic of China
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23
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Su X, Zhang M, Yang G, Cui X, Yuan X, Du L, Pei Y. Bioinformatics and machine learning approaches reveal key genes and underlying molecular mechanisms of atherosclerosis: A review. Medicine (Baltimore) 2024; 103:e38744. [PMID: 39093811 PMCID: PMC11296484 DOI: 10.1097/md.0000000000038744] [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: 01/15/2024] [Accepted: 06/07/2024] [Indexed: 08/04/2024] Open
Abstract
Atherosclerosis (AS) causes thickening and hardening of the arterial wall due to accumulation of extracellular matrix, cholesterol, and cells. In this study, we used comprehensive bioinformatics tools and machine learning approaches to explore key genes and molecular network mechanisms underlying AS in multiple data sets. Next, we analyzed the correlation between AS and immune fine cell infiltration, and finally performed drug prediction for the disease. We downloaded GSE20129 and GSE90074 datasets from the Gene expression Omnibus database, then employed the Cell-type Identification By Estimating Relative Subsets Of RNA Transcripts algorithm to analyze 22 immune cells. To enrich for functional characteristics, the black module correlated most strongly with T cells was screened with weighted gene co-expression networks analysis. Functional enrichment analysis revealed that the genes were mainly enriched in cell adhesion and T-cell-related pathways, as well as NF-κ B signaling. We employed the Lasso regression and random forest algorithms to screen out 5 intersection genes (CCDC106, RASL11A, RIC3, SPON1, and TMEM144). Pathway analysis in gene set variation analysis and gene set enrichment analysis revealed that the key genes were mainly enriched in inflammation, and immunity, among others. The selected key genes were analyzed by single-cell RNA sequencing technology. We also analyzed differential expression between these 5 key genes and those involved in iron death. We found that ferroptosis genes ACSL4, CBS, FTH1 and TFRC were differentially expressed between AS and the control groups, RIC3 and FTH1 were significantly negatively correlated, whereas SPON1 and VDAC3 were significantly positively correlated. Finally, we used the Connectivity Map database for drug prediction. These results provide new insights into AS genetic regulation.
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Affiliation(s)
- Xiaoxue Su
- Vascular Surgery Department of Weifang Yidu Central Hospital, Weifang, Shandong, China
| | - Meng Zhang
- Vascular Surgery Department of Weifang Yidu Central Hospital, Weifang, Shandong, China
| | - Guinan Yang
- Department of Urology, People’s Hospital of Qingdao West Coast New Area, Qingdao, Shandong, China
| | - Xuebin Cui
- Vascular Surgery Department of Weifang Yidu Central Hospital, Weifang, Shandong, China
| | | | | | - Yuanmin Pei
- Vascular Surgery Department of Weifang Yidu Central Hospital, Weifang, Shandong, China
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24
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Lai SW, Kuo YH, Liao KF. Association Between Coronary Artery Disease and Herpes Zoster: A Cohort Study in Taiwan. Open Forum Infect Dis 2024; 11:ofae394. [PMID: 39130082 PMCID: PMC11310590 DOI: 10.1093/ofid/ofae394] [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: 03/23/2024] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
Background Coronary artery disease (CAD) and herpes zoster represent significant health burdens, and their potential interrelationships remain understudied. This cohort study aimed to address the existing knowledge gap by systematically exploring whether people with CAD are at increased risk for developing herpes zoster. Methods Using the 2006-2015 claims data of the National Health Insurance Program in Taiwan, we identified participants aged ≥20 years with a new diagnosis of CAD as the CAD group. We selected sex- and age-matched participants without CAD as the non-CAD group. The incidence rate of herpes zoster at the end of follow-up was calculated. A multivariable Cox proportional hazards regression model was used to measure the hazard ratio and 95% CI for herpes zoster associated with covariables. Results The overall incidence rate of herpes zoster was 1.14-fold greater in the CAD group as compared with the non-CAD group (6.52 vs 5.74 per 1000 person-years; 95% CI, 1.08-1.20). After controlling for covariables, the adjusted hazard ratio of herpes zoster was 1.21 (95% CI, 1.14-1.27) for the CAD group as compared with the non-CAD group. Conclusions This cohort study provides valuable insights into the potential association between CAD and the risk of developing herpes zoster. The findings may have implications for preventive strategies of herpes zoster in people with CAD. Further research and collaboration with diverse groups will be critical to validate and extend our findings.
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Affiliation(s)
- Shih-Wei Lai
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Hung Kuo
- Department of Research, Taichung Tzu Chi Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- College of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taichung, Taiwan
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25
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Yuan R, Qian L, Xu H, Yun W. Cucurbitacins mitigate vascular neointimal hyperplasia by suppressing cyclin A2 expression and inhibiting VSMC proliferation. Animal Model Exp Med 2024; 7:397-407. [PMID: 38970173 PMCID: PMC11369011 DOI: 10.1002/ame2.12457] [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: 01/08/2024] [Accepted: 05/30/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Restenosis frequently occurs after percutaneous angioplasty in patients with vascular occlusion and seriously threatens their health. Substantial evidence has revealed that preventing vascular smooth muscle cell proliferation using a drug-eluting stent is an effective approach to improve restenosis. Cucurbitacins have been demonstrated to exert an anti-proliferation effect in various tumors and a hypotensive effect. This study aims to investigate the role of cucurbitacins extracted from Cucumis melo L. (CuECs) and cucurbitacin B (CuB) on restenosis. METHODS C57BL/6 mice were subjected to left carotid artery ligation and subcutaneously injected with CuECs or CuB for 4 weeks. Hematoxylin-Eosin, immunofluorescence and immunohistochemistry staining were used to evaluate the effect of CuECs and CuB on neointimal hyperplasia. Western blot, real-time PCR, flow cytometry analysis, EdU staining and cellular immunofluorescence assay were employed to measure the effects of CuECs and CuB on cell proliferation and the cell cycle in vitro. The potential interactions of CuECs with cyclin A2 were performed by molecular docking. RESULTS The results demonstrated that both CuECs and CuB exhibited significant inhibitory effects on neointimal hyperplasia and proliferation of vascular smooth muscle cells. Furthermore, CuECs and CuB mediated cell cycle arrest at the S phase. Autodocking analysis demonstrated that CuB, CuD, CuE and CuI had high binding energy for cyclin A2. Our study also showed that CuECs and CuB dramatically inhibited FBS-induced cyclin A2 expression. Moreover, the expression of cyclin A2 in CuEC- and CuB-treated neointima was downregulated. CONCLUSIONS CuECs, especially CuB, exert an anti-proliferation effect in VSMCs and may be potential drugs to prevent restenosis.
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Affiliation(s)
- Ruqiang Yuan
- Advanced Institute for Medical SciencesDalian Medical UniversityDalianChina
| | - Lei Qian
- Advanced Institute for Medical SciencesDalian Medical UniversityDalianChina
| | - Hu Xu
- Health Science CenterEast China Normal UniversityShanghaiChina
| | - Weijing Yun
- Advanced Institute for Medical SciencesDalian Medical UniversityDalianChina
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Arredondo Eve A, Tunc E, Mehta D, Yoo JY, Yilmaz HE, Emren SV, Akçay FA, Madak Erdogan Z. PFAS and their association with the increased risk of cardiovascular disease in postmenopausal women. Toxicol Sci 2024; 200:312-323. [PMID: 38758093 DOI: 10.1093/toxsci/kfae065] [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] [Indexed: 05/18/2024] Open
Abstract
Cardiovascular diseases (CVDs) are one of the major causes of death globally. In addition to traditional risk factors such as unhealthy lifestyles (smoking, obesity, sedentary) and genetics, common environmental exposures, including persistent environmental contaminants, may also influence CVD risk. Per- and polyfluoroalkyl substances (PFASs) are a class of highly fluorinated chemicals used in household consumer and industrial products known to persist in our environment for years, causing health concerns that are now linked to endocrine disruptions and related outcomes in women, including interference of the cardiovascular and reproductive systems. In postmenopausal women, higher levels of PFAS are observed than in premenopausal women due to the cessation of menstruation, which is crucial for PFAS excretion. Because of these findings, we explored the association between perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), and perfluorobutanesulfonic acid in postmenopausal women from our previously established CVD study. We used liquid chromatography with tandem mass spectrometry, supported by machine learning approaches, and the detection and quantification of serum metabolites and proteins. Here, we show that PFOS can be a good predictor of coronary artery disease, whereas PFOA can be an intermediate predictor of coronary microvascular disease. We also found that the PFAS levels in our study are significantly associated with inflammation-related proteins. Our findings may provide new insight into the potential mechanisms underlying the PFAS-induced risk of CVDs in this population. This study shows that exposure to PFOA and PFOS is associated with an increased risk of cardiovascular disease in postmenopausal women. PFOS and PFOA levels correlate with amino acids and proteins related to inflammation. These circulating biomarkers contribute to the etiology of CVD and potentially implicate a mechanistic relationship between PFAS exposure and increased risk of cardiovascular events in this population.
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Affiliation(s)
- Alicia Arredondo Eve
- Department of Food Science and Human Nutrition, University of Illinois Urbana-Champaign, Urbana, Illinois 61801, United States
| | - Elif Tunc
- Research and Training Hospital, Katip Celebi University, Izmir, 35310, Turkey
| | - Dhruv Mehta
- Department of Computer Science, University of Illinois Urbana-Champaign, Urbana, Illinois 61801, United States
| | - Jin Young Yoo
- Department of Food Science and Human Nutrition, University of Illinois Urbana-Champaign, Urbana, Illinois 61801, United States
| | - Huriye Erbak Yilmaz
- Research and Training Hospital, Katip Celebi University, Izmir, 35310, Turkey
- Izmir Biomedicine and Genome Center, Balcova, Izmir, 35340, Turkey
| | - Sadık Volkan Emren
- Research and Training Hospital, Katip Celebi University, Izmir, 35310, Turkey
| | | | - Zeynep Madak Erdogan
- Department of Food Science and Human Nutrition, University of Illinois Urbana-Champaign, Urbana, Illinois 61801, United States
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, Illinois 61801, United States
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27
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Kim JH, Hong JH, Jung JG, Jung WT, Nam KY, Roh JS, Choi YW, Bang J, Huh H, Lee HJ, Moon J, Kim J, Sunwoo J. Pharmacokinetic and Safety Comparison of Fixed-Dose Combination of Cilostazol/Rosuvastatin (200 + 20 mg) Versus Concurrent Administration of the Separate Components in Healthy Adults. Clin Pharmacol Drug Dev 2024; 13:842-851. [PMID: 38469999 DOI: 10.1002/cpdd.1390] [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: 12/11/2023] [Accepted: 01/23/2024] [Indexed: 03/13/2024]
Abstract
The combined cilostazol and rosuvastatin therapy is frequently used for coronary artery disease treatment. This open-label, 3 × 3 crossover clinical trial evaluated the pharmacokinetics and safety of a fixed-dose combination (FDC) of cilostazol/rosuvastatin (200 + 20 mg) versus a concurrent administration of the separate components (SCs) under both fasted and fed conditions. Among 48 enrolled healthy adults, 38 completed the study. Participants were administered a single oral dose of cilostazol/rosuvastatin (200 + 20 mg), either as an FDC or SCs in a fasted state, or FDC in a fed state, in each period of the trial. Blood samples were taken up to 48 hours after dosing, and plasma concentrations were analyzed using validated liquid chromatography-tandem mass spectrometry. The geometric mean ratios of FDC to SCs for area under the plasma concentration-time curve from time zero to the last quantifiable concentration (AUClast) and maximum plasma concentration (Cmax) were 0.94/1.05 and 1.06/1.15 for cilostazol and rosuvastatin, respectively (AUClast/Cmax). Compared with that during fasting, fed-state administration increased the AUClast and Cmax for cilostazol by approximately 72% and 160% and decreased these parameters for rosuvastatin by approximately 39% and 43%, respectively. To conclude, the FDC is bioequivalent to the SCs, with notable differences in pharmacokinetics when administered in a fed state. No significant safety differences were observed between the treatments.
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Affiliation(s)
- Jae Hoon Kim
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, Republic of Korea
- Department of Medical Science, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jang Hee Hong
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, Republic of Korea
- Department of Pharmacology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jin-Gyu Jung
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Won Tae Jung
- Korea United Pharmaceutical Corporation, Seoul, Republic of Korea
| | - Kyu-Yeol Nam
- Korea United Pharmaceutical Corporation, Seoul, Republic of Korea
| | - Jae Seok Roh
- Korea United Pharmaceutical Corporation, Seoul, Republic of Korea
| | - Youn Woong Choi
- Korea United Pharmaceutical Corporation, Seoul, Republic of Korea
| | - Junbae Bang
- Korea United Pharmaceutical Corporation, Seoul, Republic of Korea
| | - Hyunwook Huh
- Korea United Pharmaceutical Corporation, Seoul, Republic of Korea
| | - Hye J Lee
- Caleb Multilab Corporation, Seoul, Republic of Korea
| | - JungHa Moon
- Caleb Multilab Corporation, Seoul, Republic of Korea
| | - Jaehee Kim
- Caleb Multilab Corporation, Seoul, Republic of Korea
| | - Jung Sunwoo
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, Republic of Korea
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Oflar E, Akdeniz E, Yıldız C, Koyuncu A, Mavi B, Karabulut D, Çağlar FNT, Kavala AA, Türkyılmaz S. Evaluation of systemic immune-inflammation index for predicting severity of lower extremity arterial disease. Vascular 2024; 32:797-803. [PMID: 38705727 DOI: 10.1177/17085381241251772] [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: 05/07/2024]
Abstract
OBJECTIVE Predictive value of systemic immune-inflammation index (SII) has been shown in clinical outcomes and complexity of coronary artery disease, acute coronary syndrome, and heart failure. We sight to evaluate value of SII in patients with lower extremity arterial disease (LEAD). METHODS A total of 271 patients diagnosed with LEAD were included to our study. Blood samples of the patients were collected and analyzed for biochemical variables and complete blood count parameters. SII value of each patient was calculated. The complexity of atherosclerotic disease was classified according to Trans-Atlantic Inter-Society Consensus (TASC II) classification. RESULTS Patients with TASC C-D were older than patients in TASC A-B group (63.06 ± 9.24 years and 60.85 ± 8.75 years, respectively). Other co-morbidities were comparable in both groups. Hemoglobin level and lymphocyte count were significantly lower, neutrophil, platelet counts, and SII values were significantly higher in patients with TASC C-D disease compared to that of patients with TASC A-B disease. SII showed significant correlation with the severity of LEAD (r = 0.363, p < .001). SII value of 664.24 predicted TASC C-D disease with a sensitivity and specificity of 60.8% and 73.3%, respectively. Results of multivariate logistic regression analysis showed that SII had higher odds ratio compared to platelet, neutrophil, and lymphocyte counts. CONCLUSION Higher SII may indicate probability of more complex LEAD. This relationship seems plausible in terms of similar pathophysiology of coronary artery disease and peripheral artery disease.
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Affiliation(s)
- Ersan Oflar
- Cardiology Department, Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Evliya Akdeniz
- Cardiology Department, Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cennet Yıldız
- Cardiology Department, Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Atilla Koyuncu
- Cardiology Department, Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Büşra Mavi
- Cardiology Department, Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Dilay Karabulut
- Cardiology Department, Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Ali Aycan Kavala
- Cardiovascular Surgery Department, Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Saygın Türkyılmaz
- Cardiovascular Surgery Department, Bakırkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Ozuynuk-Ertugrul AS, Kirsan CB, Erkan AF, Ekici B, Komurcu-Bayrak E, Coban N. Genetic variants of ANRIL and coronary artery disease: Insights from a Turkish study population. Gene 2024; 917:148475. [PMID: 38631653 DOI: 10.1016/j.gene.2024.148475] [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: 01/24/2024] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND AIM Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally despite advancements in treatment. Long non-coding RNAs (lncRNAs) play crucial roles in the atherosclerotic process, with ANRIL being one such lncRNA. This study explored the association between ANRIL polymorphisms (rs1333049:C > G, rs564398:T > C, and rs10757274:A > G) and CAD along with CAD risk factors in a Turkish patient group. METHODS The study included 1285 participants, consisting of 736 patients diagnosed with CAD (mean age = 63.3 ± 10.5 years) and 549 non-CAD controls (mean age = 57.52 ± 11.01 years). Genotypes for rs1333049, rs564398, and rs10757274 were determined using qRT-PCR. RESULTS G allele carriage of both rs1333049 and rs10757274 polymorphisms were associated with higher Gensini score, SYNTAX score, total cholesterol, and triglyceride levels in female CAD patients and non-CAD males. Females with rs564398 CC genotype were more susceptible to CAD (p = 0.02) and severe CAD (p = 0.05). Moreover, the G and T alleles of rs10757274 and rs564398 were more prevalent among hypertensive males. Also, carrying the C allele for rs564398 was associated with a decreased risk for type 2 diabetes mellitus (T2DM) (p = 0.02). Besides, carriers of the rs1333049 C allele for decreased risk for T2DM (p = 0.03) and CAD complexed with T2DM (p = 0.04) in logistic regression analyses. CONCLUSIONS In conclusion, selected ANRIL polymorphisms were associated with CAD presence/severity and CAD risk factors, T2DM, and hypertension. Notably, this study, the largest sample-sized study examining the effects of selected polymorphisms on CAD and its risk factors among Turkish individuals, supported the findings of previous studies conducted on different ethnicities.
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Affiliation(s)
- Aybike Sena Ozuynuk-Ertugrul
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Genetics, Istanbul, Turkey; Istanbul University Institute of Graduate Studies in Health Sciences, Istanbul, Turkey
| | - Cemre Buse Kirsan
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Genetics, Istanbul, Turkey; Istanbul University Institute of Graduate Studies in Health Sciences, Istanbul, Turkey
| | - Aycan Fahri Erkan
- Ufuk University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Berkay Ekici
- Ufuk University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Evrim Komurcu-Bayrak
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Genetics, Istanbul, Turkey
| | - Neslihan Coban
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Genetics, Istanbul, Turkey.
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30
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Church L, Spahr A, Marschner S, Wallace J, Chow C, King S. Evaluating the impact of oral hygiene instruction and digital oral health education within cardiac rehabilitation clinics: A protocol for a novel, dual centre, parallel randomised controlled trial. PLoS One 2024; 19:e0306882. [PMID: 38990852 PMCID: PMC11239009 DOI: 10.1371/journal.pone.0306882] [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: 09/06/2023] [Accepted: 06/24/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Diseases of the periodontal tissues including gingivitis and periodontitis can affect up to 90% and 50% of the population respectively. These conditions are multifactorial inflammatory conditions involving a dysbiotic biofilm that, if left untreated, can lead to the destruction of the supporting structures of the teeth and have significant systemic implications, specifically on cardiovascular health. The elevation of inflammatory markers, particularly high-sensitive C-reactive protein (hsCRP), are strongly associated with an increased risk of atherosclerosis, a key risk factor for cardiovascular disease (CVD). HsCRP as well as other inflammatory markers can be detected in blood samples as early as 21 days after ceasing toothbrushing, due to the immune response to stagnant oral biofilm. The most effective way to ensure oral biofilm cannot remain on oral tissues, thus preventing periodontitis and reducing inflammatory CVD risk, is with good oral hygiene. The primary aim of this study is to assess whether individualised oral hygiene instruction (OHI) partnered with a digital oral health education (DOHE) package can improve the oral health of patients living with CVD. METHODS AND ANALYSIS A total of 165 participants will be recruited from the Westmead and Blacktown Mt Druitt cardiac rehabilitation out-patient clinics into this dual centre, single blind, parallel design, randomised controlled trial. A baseline oral health clinical examination will be completed, followed by a self-report questionnaire before they are randomised in a 1:1:1 ratio into one of 3 arms as follows: individualised OHI partnered with DOHE (Group A), (Group B) DOHE only (Group B), and control/usual care (no oral health education) (Group C). Groups will have their intervention repeated at the 6-week follow-up. After completing the 12-week follow-up, Group B and Group C will receive tailored OHI. Group C will also receive the DOHE package. The primary outcome is the change in approximal plaque index score between baseline and 6-week follow up. ETHICS AND DISSEMINATION The study has been approved by the Western Sydney Local Health District Human Ethics Committee 2023/ETH00516. Results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER ACTRN12623000449639p ANZCTR: https://www.anzctr.org.au/.
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Affiliation(s)
- Lauren Church
- The University of Sydney Dental School, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
| | - Axel Spahr
- The University of Sydney Dental School, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
| | - Janet Wallace
- School of Health Sciences, Oral Health, The University of Newcastle, Ourimbah, New South Wales, Australia
| | - Clara Chow
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
- The University of Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Shalinie King
- The University of Sydney Dental School, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
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Sivakumar A, Satam K, Wu Z, Alameddine D, Aboian E, Chaer R, Schermerhorn M, Moreira C, Guzman R, Ochoa Chaar CI. Presentation and patterns of reinterventions after revascularization in patients with premature peripheral arterial disease. J Vasc Surg 2024:S0741-5214(24)01516-7. [PMID: 39002606 DOI: 10.1016/j.jvs.2024.07.021] [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: 04/12/2024] [Revised: 06/30/2024] [Accepted: 07/06/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE Premature peripheral arterial disease (PAD) (age ≤50 years) has been shown to negatively impact the outcomes of lower extremity revascularization (LER). Patients with premature PAD have an increased risk of major amputation compared with older patients. The primary goal of this study is to compare the frequency of reinterventions after LER in patients with premature PAD to their older counterparts with common age of presentation (ie, 60-80 years). METHODS A retrospective review of consecutive patients undergoing LER for PAD in a single center was performed. Clinical, procedural, and socioeconomic characteristics were compared between patients with premature PAD and the older group. Perioperative and long-term outcomes were captured and compared including mortality, major amputation, reintervention rate and frequency, as well as major adverse limb events. RESULTS There were 1274 patients who underwent LER (4.3% premature, 61.8% age 60-80). Patients with premature PAD were more likely to be females of racial minorities. Notably, the mean Distressed Communities Index score was significantly higher in the premature PAD group compared with the older patients. Patients with premature PAD were significantly more likely to have end-stage renal disease but less likely to have hypertension, hyperlipidemia, and coronary artery disease compared with older patients. There was no significant difference in perioperative complications. After a mean follow-up of 5 years, patients with premature PAD were significantly more likely to undergo more frequent reinterventions compared with older patients. Kaplan-Meier curves showed similar overall survival and major adverse limb event-free survival between the two groups. CONCLUSIONS Patients with premature PAD are likely to undergo more frequent reinterventions after initial LER and have similar 5-year survival curves compared with patients at least 20 years older. Demographic and socioeconomic differences impacting patients with premature PAD, even in this relatively underpowered institutional experience, are striking and warrant further investigation.
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Affiliation(s)
- Anishaa Sivakumar
- Division of Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, CT.
| | - Keyuree Satam
- Division of Vascular and Endovascular Surgery, Stanford Hospital, Palo Alto, CA
| | - Zhen Wu
- Department of Environmental Health Science, Yale School of Public Health, Yale University, New Haven, CT
| | - Dana Alameddine
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Edouard Aboian
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Rabih Chaer
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Marc Schermerhorn
- Division of Vascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Carla Moreira
- Divison of Vascular Surgery, Department of Surgery, Brown University, Providence, RI
| | - Raul Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
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Li Y, Zhong W, Huang C, Peng J, Li H. Apolipoprotein E E3/E4 genotype is associated with an increased risk of premature coronary artery disease. BMC Cardiovasc Disord 2024; 24:353. [PMID: 38987708 PMCID: PMC11234594 DOI: 10.1186/s12872-024-04021-8] [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: 03/31/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVE Dyslipidemia is one of the causes of coronary heart disease (CAD), and apolipoprotein E (APOE) gene polymorphism affects lipid levels. However, the relationship between APOE gene polymorphisms and premature CAD (PCAD, male CAD patients with ≤ 55 years old and female with ≤ 65 years old) risk had different results in different studies. The aim of this study was to assess this relationship and to further evaluate the relationship between APOE gene polymorphisms and PCAD risk in the Hakka population. METHODS This study retrospectively analyzed 301 PCAD patients and 402 age matched controls without CAD. The APOE rs429358 and rs7412 polymorphisms were genotyped by polymerase chain reaction (PCR) -chip technique. The distribution of APOE genotypes and alleles between the case group and the control group was compared. The relationship between APOE genotypes and PCAD risk was obtained by logistic regression analysis. RESULTS The frequency of the APOE ɛ3/ɛ4 genotype (18.9% vs. 10.2%, p = 0.001) and ε4 allele (11.1% vs. 7.0%, p = 0.007) was higher in the PCAD patients than that in controls, respectively. PCAD patients with ɛ2 allele had higher TG level than those with ɛ3 allele, and controls carried ɛ2 allele had higher HDL-C level and lower LDL-C level than those carried ɛ3 allele. Regression logistic analysis showed that BMI ≥ 24.0 kg/m2 (BMI ≥ 24.0 kg/m2 vs. BMI 18.5-23.9 kg/m2, OR: 1.763, 95% CI: 1.235-2.516, p = 0.002), history of smoking (Yes vs. No, OR: 5.098, 95% CI: 2.910-8.930, p < 0.001), ɛ3/ɛ4 genotype (ɛ3/ɛ4 vs. ɛ3/ɛ3, OR: 2.203, 95% CI: 1.363-3.559, p = 0.001), ε4 allele (ε4 vs. ε3, OR: 2.125, 95% CI: 1.333-3.389, p = 0.002), and TC level (OR: 1.397, 95% CI: 1.023-1.910, p = 0.036) were associated with PCAD. CONCLUSIONS In summary, BMI ≥ 24.0 kg/m2, history of smoking, APOE ɛ3/ɛ4 genotype, and TC level were independent risk factors for PCAD. It means that young individuals who are overweight, have a history of smoking, and carried APOE ɛ3/ɛ4 genotype had increased risk of PCAD.
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Affiliation(s)
- Youqian Li
- Center for Cardiovascular Diseases, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, No. 63 Huangtang Road, Meijiang District, Meizhou, China.
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, Meizhou, China.
| | - Wei Zhong
- Center for Cardiovascular Diseases, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, No. 63 Huangtang Road, Meijiang District, Meizhou, China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, Meizhou, China
| | - Changjing Huang
- Center for Cardiovascular Diseases, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, No. 63 Huangtang Road, Meijiang District, Meizhou, China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, Meizhou, China
| | - Junyin Peng
- Center for Cardiovascular Diseases, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, No. 63 Huangtang Road, Meijiang District, Meizhou, China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, Meizhou, China
| | - Hanlin Li
- Center for Cardiovascular Diseases, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, No. 63 Huangtang Road, Meijiang District, Meizhou, China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital, Meizhou Academy of Medical Sciences, Meizhou, China
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Hinton A, Claypool SM, Neikirk K, Senoo N, Wanjalla CN, Kirabo A, Williams CR. Mitochondrial Structure and Function in Human Heart Failure. Circ Res 2024; 135:372-396. [PMID: 38963864 PMCID: PMC11225798 DOI: 10.1161/circresaha.124.323800] [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: 07/06/2024]
Abstract
Despite clinical and scientific advancements, heart failure is the major cause of morbidity and mortality worldwide. Both mitochondrial dysfunction and inflammation contribute to the development and progression of heart failure. Although inflammation is crucial to reparative healing following acute cardiomyocyte injury, chronic inflammation damages the heart, impairs function, and decreases cardiac output. Mitochondria, which comprise one third of cardiomyocyte volume, may prove a potential therapeutic target for heart failure. Known primarily for energy production, mitochondria are also involved in other processes including calcium homeostasis and the regulation of cellular apoptosis. Mitochondrial function is closely related to morphology, which alters through mitochondrial dynamics, thus ensuring that the energy needs of the cell are met. However, in heart failure, changes in substrate use lead to mitochondrial dysfunction and impaired myocyte function. This review discusses mitochondrial and cristae dynamics, including the role of the mitochondria contact site and cristae organizing system complex in mitochondrial ultrastructure changes. Additionally, this review covers the role of mitochondria-endoplasmic reticulum contact sites, mitochondrial communication via nanotunnels, and altered metabolite production during heart failure. We highlight these often-neglected factors and promising clinical mitochondrial targets for heart failure.
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Affiliation(s)
- Antentor Hinton
- Department of Molecular Physiology and Biophysics (A.H., K.N.), Vanderbilt University Medical Center, Nashville
| | - Steven M. Claypool
- Department of Physiology, Mitochondrial Phospholipid Research Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (S.M.C., N.S.)
| | - Kit Neikirk
- Department of Molecular Physiology and Biophysics (A.H., K.N.), Vanderbilt University Medical Center, Nashville
| | - Nanami Senoo
- Department of Physiology, Mitochondrial Phospholipid Research Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (S.M.C., N.S.)
| | - Celestine N. Wanjalla
- Department of Medicine, Division of Clinical Pharmacology (C.N.W., A.K.), Vanderbilt University Medical Center, Nashville
| | - Annet Kirabo
- Department of Medicine, Division of Clinical Pharmacology (C.N.W., A.K.), Vanderbilt University Medical Center, Nashville
- Vanderbilt Center for Immunobiology (A.K.)
- Vanderbilt Institute for Infection, Immunology and Inflammation (A.K.)
- Vanderbilt Institute for Global Health (A.K.)
| | - Clintoria R. Williams
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, OH (C.R.W.)
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Khan MSN, Khan MI, Saqlain A, Umer S, Haider M, Ashiq K. Evaluation of Cardiovascular Risk Factors and Their Association With Coronary Artery Disease in Pakistani Adults. Cureus 2024; 16:e64670. [PMID: 39149655 PMCID: PMC11326748 DOI: 10.7759/cureus.64670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs), especially coronary artery disease (CAD), are a major health burden, and their incidence is rising in countries like Pakistan. OBJECTIVE The objective of this research was to assess the prevalence and association of cardiovascular risk factors with CAD in Pakistani adults. METHODOLOGY The research was carried out from January 2023 to December 2023 at the Pakistan Institute of Medical Sciences (PIMS) Islamabad and Shifa International Hospital Islamabad, Pakistan, using a cross-sectional design. Based on predefined criteria, 320 individuals who were Pakistani nationals and over the age of 18 years old were included. Those having a history of congenital heart disease, pregnancy, significant comorbidities, coronary artery bypass grafting (CABG), or percutaneous coronary intervention (PCI) were excluded. Medical, lifestyle, and demographic data were collected, and clinical evaluations were carried out by qualified healthcare workers. The data was analyzed using descriptive statistics and relevant statistical tests. A p<0.05 was statistically significant. RESULTS The study investigated cardiovascular risk factors and demographic traits in 320 adult Pakistanis. The majority of participants (n=181; 56.56%) were male and aged between 18 and 45. University education was predominant (n=170; 53.13%). Specifically, 147 participants (45.94%) had dyslipidemia, 74 (23.12%) had diabetes mellitus, and 112 (35.0%) had hypertension. Diabetes mellitus (OR: 9.60, 95% CI: 4.52-20.38, p<0.001), dyslipidemia (OR: 1.88, 95% CI: 1.29-2.75, p=0.001), and hypertension (OR: 2.67, 95% CI: 1.72-4.15, p<0.001) showed significant correlations with CAD. Poor socioeconomic status (OR: 3.00, 95% CI: 1.31-6.89, p=0.009) and genetic propensity (OR: 2.00, 95% CI: 1.02-3.92, p=0.040) were also significantly associated with CAD. CONCLUSION Our study highlights diabetes as strongly linked to CAD in Pakistani adults, while socioeconomic status emerges as a significant predictor.
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Affiliation(s)
| | | | - Ali Saqlain
- Internal Medicine, Pakistan Air Force (PAF) Hospital, Islamabad, PAK
| | - Shehryar Umer
- Pathology, HBS Medical and Dental College, Islamabad, PAK
| | - Maithem Haider
- Physiology, HBS Medical and Dental College, Islamabad, PAK
| | - Khubaib Ashiq
- Emergency Medicine, Rawalpindi Medical University, Rawalpindi, PAK
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Reshadmanesh T, Behnoush AH, Farajollahi M, Khalaji A, Ghondaghsaz E, Ahangar H. Circulating Levels of Calprotectin as a Biomarker in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis. Clin Cardiol 2024; 47:e24315. [PMID: 38961752 PMCID: PMC11222710 DOI: 10.1002/clc.24315] [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: 04/05/2024] [Revised: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Calprotectin, also known as MRP8/14, is generated by immune cells and is altered in several inflammatory diseases. Studies have assessed their levels in patients with coronary artery disease (CAD) and its subtypes (stable CAD and acute coronary syndrome [ACS]). Herein, we aimed to systematically investigate these associations through a systematic review and meta-analysis. METHODS A systematic search was conducted in four online databases, including PubMed, Scopus, Embase, and the Web of Science. Relevant studies were retrieved, screened, and extracted. Random-effect meta-analysis was performed for the calculation of standardized mean difference (SMD) and 95% confidence interval (CI). Blood calprotectin levels were compared between CAD patients and controls, as well as CAD subtypes. RESULTS A total of 20 studies were included in the systematic review and meta-analysis, comprising 3300 CAD patients and 1230 controls. Patients with CAD had significantly higher calprotectin levels (SMD 0.81, 95% CI 0.32-1.30, p < 0.01). Similarly, patients with ACS were reported to have higher levels compared to those with stable CAD. However, there was no significant difference in terms of blood calprotectin levels between stable CAD cases and healthy controls. Finally, studies have shown that calprotectin could be used as a diagnostic biomarker of CAD while also predicting major adverse events and mortality in these patients. CONCLUSION Based on our findings, calprotectin, as an inflammatory marker, could be used as a possible biomarker for patients with CAD and ACS. These suggest the possibility of pathophysiological pathways for this involvement and warrant further research on these associations as well as their clinical utility.
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Affiliation(s)
| | - Amir Hossein Behnoush
- School of MedicineTehran University of Medical SciencesTehranIran
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | | | - Amirmohammad Khalaji
- School of MedicineTehran University of Medical SciencesTehranIran
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Elina Ghondaghsaz
- Undergraduate Program in NeuroscienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Hassan Ahangar
- Department of Cardiology, School of Medicine, Mousavi HospitalZanjan University of Medical SciencesZanjanIran
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Church LA, Robins L, Xu F, Qin L, Tran A, Wallace JP, King S. Oral health education strategies for patients living with cardiovascular disease within hospital settings: a scoping review. Front Public Health 2024; 12:1389853. [PMID: 38962771 PMCID: PMC11220159 DOI: 10.3389/fpubh.2024.1389853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024] Open
Abstract
Objective To identify and describe the impact of current oral health education programmes provided to patients in cardiology hospital wards and outpatient clinics. Methods This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews statement. Searches were conducted using electronic databases: Cochrane, Medline, and Scopus, as well as grey literature searching. Results Three eligible studies were identified. All included studies reported generalised poor oral health in their participants at baseline, with significant improvement at follow-up. They all reported significant reductions in plaque deposits and gingival bleeding. One study reported significantly less bacteria on participant tongues, as well as fewer days with post-operative atrial fibrillation in the intervention group. Furthermore, in this study, one patient in the intervention group developed pneumonia, whilst four patients in the control group did. Conclusion Oral health education for patients with cardiovascular disease is limited and many have poor oral health. Educational programmes to improve oral health behaviours in patients with cardiovascular disease can improve both oral and general health outcomes. Implications for public health Oral disease is a modifiable risk factor for cardiovascular disease. Integrating oral health education into cardiology hospital settings is a simple strategy to improve access to oral health information and improve both oral and cardiovascular outcomes.
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Affiliation(s)
- L. A. Church
- The University of Sydney Dental School, The University of Sydney, Sydney, NSW, Australia
- Westmead Applied Research Centre, The University of Sydney, Westmead, NSW, Australia
| | - L. Robins
- The University of Sydney Dental School, The University of Sydney, Sydney, NSW, Australia
| | - F. Xu
- The University of Sydney Dental School, The University of Sydney, Sydney, NSW, Australia
| | - L. Qin
- The University of Sydney Dental School, The University of Sydney, Sydney, NSW, Australia
| | - A. Tran
- The University of Sydney Dental School, The University of Sydney, Sydney, NSW, Australia
| | - J. P. Wallace
- School of Health Sciences, Oral Health, The University of Newcastle, Ourimbah, NSW, Australia
| | - S. King
- The University of Sydney Dental School, The University of Sydney, Sydney, NSW, Australia
- Westmead Applied Research Centre, The University of Sydney, Westmead, NSW, Australia
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Zhong Q, Jin S, Zhang Z, Qian H, Xie Y, Yan P, He W, Zhang L. Identification and verification of circRNA biomarkers for coronary artery disease based on WGCNA and the LASSO algorithm. BMC Cardiovasc Disord 2024; 24:305. [PMID: 38880872 PMCID: PMC11181640 DOI: 10.1186/s12872-024-03972-2] [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: 02/19/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND The role of circular RNAs (circRNAs) as biomarkers of coronary artery disease (CAD) remains poorly explored. This study aimed to identify and validate potential circulating circRNAs as biomarkers for the diagnosis of CAD. METHODS The expression profile of circRNAs associated with CAD was obtained from Gene Expression Omnibus (GEO) database. Differential expression analysis, weighted gene co-expression network analysis (WGCNA) and least absolute shrinkage and selection operation (LASSO) were employed to identify CAD-related hub circRNAs. The expression levels of these hub circRNAs were validated using qRT-PCR in blood samples from 100 CAD patients and 100 controls. The diagnostic performance of these circRNAs was evaluated through logistic regression analysis, receiver operator characteristic (ROC) analysis, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Functional enrichment analyses were performed to predict the possible mechanisms of circRNAs in CAD. RESULTS A total of ten CAD-related hub circRNAs were identified through WGCNA and LASSO analysis. Among them, hsa_circ_0069972 and hsa_circ_0021509 were highly expressed in blood samples of CAD patients, and they were identified as independent predictors after adjustment for relevant confounders. The area under the ROC curve for hsa_circ_0069972 and hsa_circ_0021509 was 0.760 and 0.717, respectively. The classification of patients was improved with the incorporation of circRNAs into the clinical model composed of conventional cardiovascular risk factors, showing an IDI of 0.131 and NRI of 0.170 for hsa_circ_0069972, and an IDI of 0.111 and NRI of 0.150 for hsa_circ_0021509. Functional enrichment analyses revealed that the hsa_circ_0069972-miRNA-mRNA network was enriched in TGF-β、FoxO and Hippo signaling pathways, while the hsa_circ_0021509-miRNA-mRNA network was enriched in PI3K/Akt and MAPK signaling pathways. CONCLUSION Hsa_circ_0069972 and hsa_circ_0021509 were identified by integrated analysis, and they are highly expressed in CAD patients. They may serve as novel biomarkers for CAD.
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Affiliation(s)
- Qilong Zhong
- General Practice Department, The Seventh Hospital of Ningbo, Ningbo, Zhejiang, China
- Zhejiang Key Laboratory of Pathophysiology, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Shaoyue Jin
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Zebo Zhang
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Haiyan Qian
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Yanqing Xie
- Institute of Geriatrics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Peiling Yan
- General Practice Department, The Seventh Hospital of Ningbo, Ningbo, Zhejiang, China
| | - Wenming He
- Institute of Geriatrics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China.
| | - Lina Zhang
- Zhejiang Key Laboratory of Pathophysiology, Health Science Center, Ningbo University, Ningbo, Zhejiang, China.
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China.
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Zhang Z, Chi J, Driskill E, Mont MA, Jones LC, Cui Q. Effect of Patient Age on Total Hip Arthroplasty Outcomes in Patients Who Have Osteonecrosis of the Femoral Head Compared to Patients Who Have Hip Osteoarthritis. J Arthroplasty 2024; 39:1535-1544. [PMID: 38135166 DOI: 10.1016/j.arth.2023.12.029] [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: 09/05/2023] [Revised: 11/13/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) affects both young and old patients. However, outcomes following total hip arthroplasty (THA) for these patients may vary with age. This study aimed to examine the effect of age on THA outcomes for non-traumatic ONFH patients, an area currently lacking research. METHODS Patients who had non-traumatic ONFH undergoing THA with at least 2 years of follow-up were identified using a database and divided into four groups by age. Then, 4 matched control groups of patients who had hip osteoarthritis (OA) were created. Multivariate logistic regression analyses were used to evaluate the rates of medical and surgical complications. Additionally, cohorts with a minimum 5-year follow-up were filtered to obtain further data on surgical outcomes. The study analyzed 85,462 non-traumatic ONFH and 80,120 hip OA patients undergoing THA. RESULTS Multiple medical complications in ONFH patients increased with age. Periprosthetic fracture within 2 years increased with age, while 90-day wound complications, 2-year periprosthetic joint infections, dislocations, and revisions decreased. The trends for complications continued at the 5-year follow-up. Compared to OA patients, those who had ONFH had higher risks of most complications, but this discrepancy decreased with age. CONCLUSIONS In ONFH patients undergoing THA, medical complications generally rise with age, while most surgical complications, including revisions, decrease. It is notable that ONFH patients experienced more complications than those who had OA, but this difference diminished with age.
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Affiliation(s)
- Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia; Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Elizabeth Driskill
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Michael A Mont
- Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
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Chilbert MR, Woodruff AE, Rogers KC. A Practical Guide to Understanding and Treating Peripheral Artery Disease. J Cardiovasc Pharmacol 2024; 83:565-579. [PMID: 38452186 DOI: 10.1097/fjc.0000000000001556] [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] [Received: 09/18/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
ABSTRACT Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic morbidity after coronary heart disease and stroke yet is widely underdiagnosed and undertreated. Treatment of risk factors such as diabetes and cigarette smoking can benefit patients with PAD. Patients should have adequate blood pressure and lipid control to decrease clinical manifestations and symptoms of PAD. Use of antithrombotic medications should be individualized to the patient depending on the presence of symptoms, revascularization, and comorbidities. All patient care providers, including physicians, pharmacists, nurse practitioners, and physician assistants, should incorporate PAD screening in their at-risk patients to improve access for appropriate earlier diagnosis, initiation of guideline directed therapy, and risk factor modification to reduce both major adverse CV and limb outcomes. The purpose of this narrative review is to provide an overview of PAD and summarize clinical trial evidence and guideline recommendations for screening and treatment to increase awareness among health care providers to ultimately have a positive impact on patient care.
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Affiliation(s)
- Maya R Chilbert
- Department of Pharmacy, University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo General Medical Center; and
| | - Ashley E Woodruff
- Department of Pharmacy, University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo General Medical Center; and
| | - Kelly C Rogers
- The University of Tennessee Health Science Center College of Pharmacy
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Aboyans V, Morboeuf O, Grenier B, Jolivel R, Bura-Riviere A. Editor's Choice - Revascularisation for Peripheral Artery Disease in France: Implications for the Implementation of VOYAGER-PAD. Eur J Vasc Endovasc Surg 2024; 67:969-978. [PMID: 38316351 DOI: 10.1016/j.ejvs.2024.01.091] [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: 07/03/2023] [Revised: 12/06/2023] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The VOYAGER-PAD trial demonstrated the interest in dual pathway inhibition (DPI) (low dose rivaroxaban plus aspirin) to reduce limb and cardiovascular events after revascularisation for peripheral artery disease (PAD), but its applicability in clinical practice has not yet been assessed. This study aimed to assess the number of patients revascularised in France for PAD and to estimate the proportion of those matching the VOYAGER-PAD trial selection criteria. A secondary objective was to examine the prognosis of revascularised patients in a real world setting. METHODS This observational retrospective study was conducted on the national hospital discharge database and included all patients with PAD who underwent lower extremity revascularisation for PAD (without lower extremity revascularisation in the two years prior to inclusion) from 1 January 2016 to 31 December 2019. Available VOYAGER-PAD selection criteria were then applied to the study population. RESULTS In total, 180 870 patients were included (mean age 72.0 ± 12.2 years, 30.9% female), with approximately 45 000 patients revascularised annually. Among them, 90 379 (50.0%) matched the VOYAGER-PAD trial criteria (VOYAGER-PAD eligible subgroup; mean age 69.8 ± 12.1 years, 29.5% female). In the study population and the VOYAGER-PAD eligible subgroup, 33.9% and 26.6% of patients had diabetes, 28.1% and 19.9% had chronic coronary artery disease, and 14.6% and 5.7% had renal failure, respectively. Overall, 73.1% of study patients were treated by an endovascular approach (75.5% in the VOYAGER-PAD eligible subgroup). In patients with more than one year of follow up, 45.4% of study patients and 36.0% of the VOYAGER-PAD eligible subgroup experienced a limb or cardiovascular event. The median time until the first event and in hospital death was 4.8 months and 7.8 months, respectively (6.7 months and 12.9 months in the VOYAGER-PAD eligible subgroup). CONCLUSION The burden of PAD for revascularisation and secondary events is considerable. One half of revascularised patients in France are eligible for DPI therapy. Those patients are younger, with fewer comorbidities, and better outcomes.
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Affiliation(s)
- Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, and EpiMaCT, Inserm 1094/IRD270, Limoges University Hospital, Limoges, France.
| | - Olivier Morboeuf
- Medical Affairs, Bayer HealthCare SAS, La Garenne Colombes, France
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Huang S, Joshi A, Shi Z, Wei J, Tran H, Zheng SL, Duggan D, Ashworth A, Billings L, Helfand BT, Qamar A, Bulwa Z, Tafur A, Xu J. Combined polygenic scores for ischemic stroke risk factors aid risk assessment of ischemic stroke. Int J Cardiol 2024; 404:131990. [PMID: 38521508 DOI: 10.1016/j.ijcard.2024.131990] [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: 12/29/2023] [Revised: 03/01/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Current risk assessment for ischemic stroke (IS) is limited to clinical variables. We hypothesize that polygenic scores (PGS) of IS (PGSIS) and IS-associated diseases such as atrial fibrillation (AF), venous thromboembolism (VTE), coronary artery disease (CAD), hypertension (HTN), and Type 2 diabetes (T2D) may improve the performance of IS risk assessment. METHODS Incident IS was followed for 479,476 participants in the UK Biobank who did not have an IS diagnosis prior to the recruitment. Lifestyle variables (obesity, smoking and alcohol) at the time of study recruitment, clinical diagnoses of IS-associated diseases, PGSIS, and five PGSs for IS-associated diseases were tested using the Cox proportional-hazards model. Predictive performance was assessed using the C-statistic and net reclassification index (NRI). RESULTS During a median average 12.5-year follow-up, 8374 subjects were diagnosed with IS. Known clinical variables (age, gender, clinical diagnoses of IS-associated diseases, obesity, and smoking) and PGSIS were all independently associated with IS (P < 0.001). In addition, PGSIS and each PGS for IS-associated diseases was also independently associated with IS (P < 0.001). Compared to the clinical model, a joint clinical/PGS model improved the C-statistic for predicting IS from 0.71 to 0.73 (P < 0.001) and significantly reclassified IS risk (NRI = 0.017, P < 0.001), and 6.48% of subjects were upgraded from low to high risk. CONCLUSIONS Adding PGSs of IS and IS-associated diseases to known clinical risk factors statistically improved risk assessment for IS, demonstrating the supplementary value of inherited susceptibility measurement . However, its clinical utility is likely limited due to modest improvements in predictive values.
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Affiliation(s)
- Sarah Huang
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Abhishek Joshi
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Zhuqing Shi
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Jun Wei
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Huy Tran
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - S Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - David Duggan
- Affiliate of City of Hope, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Annabelle Ashworth
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Liana Billings
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Brian T Helfand
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Arman Qamar
- Cardiovascular Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Zachary Bulwa
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Alfonso Tafur
- Cardiovascular Institute, NorthShore University HealthSystem, Evanston, IL, USA
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
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Kuruvila M, Maddineni K, Koppula SR, Patel B, Ratnani T, Reddy AS, Markandu K. Exploring the Factors Influencing Coronary Heart Disease Prevalence in the US Population: A Retrospective Observational Study. Cureus 2024; 16:e62741. [PMID: 39036263 PMCID: PMC11259818 DOI: 10.7759/cureus.62741] [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] [Accepted: 06/16/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Coronary heart disease (CHD) remains a significant global health concern and is characterized by inadequate blood supply to the myocardium due to the accumulation of plaque in the coronary arteries. Despite therapeutic advancements, prevalence disparities persist across various segments of the U.S. population, posing a significant challenge to healthcare systems. This study aims to find the prevalence disparities of CHD using Behavioral Risk Factor Surveillance System (BRFSS) data. METHODOLOGY A retrospective observational study was done using the 2022 BRFSS dataset on January 17, 2024. The study examined the presence of CHD as the dependent variable and investigated various independent variables. Descriptive and logistic regression analyses were conducted using the BRFSS Web Enabled Analysis Tool (Centers for Disease Control and Prevention, Atlanta, GA). Data management and storage utilized Microsoft Excel, and graphical analysis employed GraphPad Prism, version 9.4.1 (GraphPad Software, Inc., San Diego, CA). RESULTS In demographics, respondents aged 65+ had higher CHD odds, while females exhibited lower risk than males. Hispanics had the lowest odds of CHD among all races. Socioeconomically, inability to work and retirees had higher CHD odds, as did income below $20,000 but ≥$15,000. Poor physical health increased CHD odds, as did having multiple healthcare providers. Medicare users had the highest CHD odds among insurance options. CONCLUSIONS Significant disparities in CHD prevalence were seen across demographic, socioeconomic, health status, and healthcare access dimensions in the United States, emphasizing the urgent need for targeted interventions to address these disparities and improve overall public health outcomes.
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Affiliation(s)
- Mahima Kuruvila
- Internal Medicine, Caribbean Medical University School of Medicine, Chicago, USA
| | | | | | - Bianca Patel
- Pediatrics, Richmond University Medical Center, New York, USA
| | - Tanya Ratnani
- Internal Medicine, Government Medical College, Bilaspur, IND
| | | | - Keethanshan Markandu
- Cardiology, Pennsylvania State University, Penn State College of Medicine, Penn, USA
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Liu M, Xu Z, Wang Z, Wang D, Yang M, Li H, Zhang W, He R, Cheng H, Guo P, Li Z, Liang H. Lipid-lowering, antihypertensive, and antithrombotic effects of nattokinase combined with red yeast rice in patients with stable coronary artery disease: a randomized, double-blinded, placebo-controlled trial. Front Nutr 2024; 11:1380727. [PMID: 38812930 PMCID: PMC11133624 DOI: 10.3389/fnut.2024.1380727] [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: 02/02/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024] Open
Abstract
Nattokinase (NK) and red yeast rice (RYR) are both indicated for their potential in cardiovascular disease prevention and management, but their combined effects especially in coronary artery disease (CAD) are scarcely examined. This 90-day randomized, double-blind trial aims to investigate the effect of NK and RYR supplementations on cardiometabolic parameters in patients with stable CAD. 178 CAD patients were randomized to four groups: NK + RYR, NK, RYR, and placebo. No adverse effects due to the interventions were reported. In comparisons across groups, NK + RYR showed the maximum effect in reducing triglyceride (-0.39 mmol), total cholesterol (-0.66 mmol/L), diastolic blood pressure (-7.39 mmHg), and increase in high-density lipoprotein cholesterol (0.195 mmol/L) than other groups (all p for multiple groups comparison<0.01). Both NK + RYR and NK groups had significantly better-improved lactate dehydrogenase than the others (-29.1 U/L and - 26.4 U/L). NK + RYR group also showed more potent reductions in thromboxane B2 and increases in antithrombin III compared to placebo (both p < 0.01). These improved markers suggest that combined NK and RYR may preferably alter antithrombin and COX-1 pathways, potentially reducing thrombosis risks in CAD patients. Overall, the combined NK and RYR supplementation is safe and more effective than separately in improving cardiometabolic markers among CAD patients with multiple heart medications use.
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Affiliation(s)
- Man Liu
- The Institute of Human Nutrition, College of Public Health, Qingdao University, Qingdao, China
| | - Ziyi Xu
- BYHEALTH Institute of Nutrition & Health, BYHEALTH Co. Ltd., Guangzhou, China
| | - Zongling Wang
- Qingdao Fuwai Cardiovascular Disease Hospital, Qingdao, China
| | - Di Wang
- BYHEALTH Institute of Nutrition & Health, BYHEALTH Co. Ltd., Guangzhou, China
| | - Mingzhe Yang
- BYHEALTH Institute of Nutrition & Health, BYHEALTH Co. Ltd., Guangzhou, China
| | - Hui Li
- Songshan Hospital, Medical College of Qingdao University, Qingdao, China
| | - Wei Zhang
- Songshan Hospital, Medical College of Qingdao University, Qingdao, China
| | - Ruikun He
- BYHEALTH Institute of Nutrition & Health, BYHEALTH Co. Ltd., Guangzhou, China
| | - Huimin Cheng
- The Institute of Human Nutrition, College of Public Health, Qingdao University, Qingdao, China
| | - Peiyu Guo
- The Institute of Human Nutrition, College of Public Health, Qingdao University, Qingdao, China
| | - Zhongxia Li
- BYHEALTH Institute of Nutrition & Health, BYHEALTH Co. Ltd., Guangzhou, China
| | - Hui Liang
- The Institute of Human Nutrition, College of Public Health, Qingdao University, Qingdao, China
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Schlager O. A global burden in cardiovascular medicine of the 21st century: lower extremity artery disease. Eur J Prev Cardiol 2024; 31:801-802. [PMID: 38315629 DOI: 10.1093/eurjpc/zwae041] [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] [Received: 01/20/2024] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Bauer J, Vlcek J, Pauly V, Hesse N, Xia R, Mo L, Chivukula AS, Villgrater H, Dressler M, Hildebrand B, Wolf E, Rizas KD, Bauer A, Kääb S, Tomsits P, Schüttler D, Clauss S. Biomarker Periodic Repolarization Dynamics Indicates Enhanced Risk for Arrhythmias and Sudden Cardiac Death in Myocardial Infarction in Pigs. J Am Heart Assoc 2024; 13:e032405. [PMID: 38639363 PMCID: PMC11179938 DOI: 10.1161/jaha.123.032405] [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: 08/29/2023] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Periodic repolarization dynamics (PRD) is an electrocardiographic biomarker that captures repolarization instability in the low frequency spectrum and is believed to estimate the sympathetic effect on the ventricular myocardium. High PRD indicates an increased risk for postischemic sudden cardiac death (SCD). However, a direct link between PRD and proarrhythmogenic autonomic remodeling has not yet been shown. METHODS AND RESULTS We investigated autonomic remodeling in pigs with myocardial infarction (MI)-related ischemic heart failure induced by balloon occlusion of the left anterior descending artery (n=17) compared with pigs without MI (n=11). Thirty days after MI, pigs demonstrated enhanced sympathetic innervation in the infarct area, border zone, and remote left ventricle paralleled by altered expression of autonomic marker genes/proteins. PRD was enhanced 30 days after MI compared with baseline (pre-MI versus post-MI: 1.75±0.30 deg2 versus 3.29±0.79 deg2, P<0.05) reflecting pronounced autonomic alterations on the level of the ventricular myocardium. Pigs with MI-related ventricular fibrillation and SCD had significantly higher pre-MI PRD than pigs without tachyarrhythmias, suggesting a potential role for PRD as a predictive biomarker for ischemia-related arrhythmias (no ventricular fibrillation versus ventricular fibrillation: 1.50±0.39 deg2 versus 3.18±0.53 deg2 [P<0.05]; no SCD versus SCD: 1.67±0.32 deg2 versus 3.91±0.63 deg2 [P<0.01]). CONCLUSIONS We demonstrate that ischemic heart failure leads to significant proarrhythmogenic autonomic remodeling. The concomitant elevation of PRD levels in pigs with ischemic heart failure and pigs with MI-related ventricular fibrillation/SCD suggests PRD as a biomarker for autonomic remodeling and as a potential predictive biomarker for ventricular arrhythmias/survival in the context of MI.
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Affiliation(s)
- Julia Bauer
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Julia Vlcek
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Valerie Pauly
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Nora Hesse
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Ruibing Xia
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Li Mo
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Aparna Sharma Chivukula
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Hannes Villgrater
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Marie Dressler
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Bianca Hildebrand
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
| | - Eckhard Wolf
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU MunichMunichGermany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU MunichMunichGermany
| | - Konstantinos D. Rizas
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
| | - Axel Bauer
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- University Hospital for Internal Medicine IIIMedical University of InnsbruckInnsbruckAustria
| | - Stefan Kääb
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU MunichMunichGermany
| | - Philipp Tomsits
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Dominik Schüttler
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
| | - Sebastian Clauss
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart AllianceMunichGermany
- Institute of Surgical Research at the Walter‐Brendel‐Centre of Experimental MedicineUniversity Hospital, LMU MunichMunichGermany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU MunichMunichGermany
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Khalpey Z, Kumar U, Aslam U, Deckwa J, Konhilas J. Synergistic Effect of Transmyocardial Revascularization and Platelet-Rich Plasma on Improving Cardiac Function After Coronary Artery Bypass Grafting. Cureus 2024; 16:e60254. [PMID: 38872704 PMCID: PMC11170312 DOI: 10.7759/cureus.60254] [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] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Background Coronary artery disease (CAD) is a global health burden, contributing to mortality and morbidity. A proportion of patients with CAD suffer from diffuse CAD, where conventional revascularization techniques such as percutaneous coronary intervention and coronary artery bypass grafting (CABG) may be insufficient to adequately restore myocardial perfusion. Transmyocardial revascularization (TMR) uses a laser to create microscopic channels in the myocardium, inducing inflammation, angiogenesis, and neovascularization to improve perfusion to ischemic regions. Platelet-rich plasma (PRP) is an autologous concentrate of platelets that contains a myriad of growth factors and bioactive proteins, which have been shown to promote tissue regeneration and wound healing. The combination of TMR and PRP therapies has been proposed to synergistically enhance myocardial revascularization and functional recovery in patients with advanced CAD undergoing surgical revascularization. Methods This study evaluated the efficacy of combining TMR and PRP with CABG in improving cardiac function in diffuse CAD patients. Fifty-two patients were randomized to CABG alone (n = 16), CABG+TMR (n = 17), CABG+PRP (n = 10), and CABG+TMR+PRP (n = 9). TMR was performed using a holmium:YAG laser to create 10 channels in the inferolateral left ventricular wall. PRP was prepared from autologous whole blood and injected into the myocardium adjacent to the TMR channels. Cardiac function was assessed using speckle-tracking echocardiography preoperatively, postoperatively, and at one-year follow-up. Adverse events, including post-operative atrial fibrillation, acute kidney injury, and readmissions, were also recorded. Statistical analyses were performed to compare outcomes between the treatment groups. Results The CABG+TMR+PRP group showed significantly improved global longitudinal strain (GLS) at one year compared to CABG alone (mean GLS -15.96 vs -12.09, p = 0.02). Post-operative left ventricular ejection fraction trended higher in the TMR+PRP group (57.78%) vs other groups, but not significantly. Post-operative atrial fibrillation was higher in the TMR+PRP group (67% vs 25%, p = 0.04), potentially reflecting increased inflammation. No significant differences were observed in other adverse events. Conclusions The results of this study suggest a synergistic benefit of combining TMR and PRP therapies as an adjunct to CABG in patients with diffuse CAD. The significant improvement in GLS at one year in the TMR+PRP group compared to CABG alone indicates enhanced myocardial remodeling and functional recovery, which may translate to improved long-term outcomes. The higher incidence of postoperative atrial fibrillation in the TMR+PRP group warrants further investigation but may reflect the heightened inflammatory response necessary for angiogenesis and tissue regeneration. Prospective, randomized controlled trials with larger sample sizes and longer follow-up periods are needed to validate these findings and optimize treatment protocols. Nonetheless, concomitant TMR+PRP therapy represents a promising approach to augmenting myocardial revascularization and recovery in patients with advanced CAD undergoing surgical revascularization.
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Affiliation(s)
- Zain Khalpey
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
| | - Ujjawal Kumar
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
| | - Usman Aslam
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
- Department of General Surgery, HonorHealth, Phoenix, USA
| | - Jessa Deckwa
- Department of Research, Nihon Kohden Digital Health Solutions, Irvine, USA
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d’Ettorre G, Piscitelli P, Pellicani V, Tornese R, Ceccarelli G, d’Ettorre G, La Torre G. Occupational Risk for Coronary Artery Disease in Shift Workers - A Systematic Review. LA MEDICINA DEL LAVORO 2024; 115:e2024015. [PMID: 38686577 PMCID: PMC11181222 DOI: 10.23749/mdl.v115i2.15532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Coronary artery disease (CAD) prevention in shift workers (SWs) poses a significant challenge worldwide, as CAD remains a major cause of mortality and disability. In the past, SWs were found at higher risk of CAD than non-s SWs. Nevertheless, the pathogenic mechanism between shift work and CAD to date is unclear. This systematic review aims to enhance understanding of the risk of CAD occurrence in SWs. METHODS A systematic literature review was conducted from January 2013 to December 2023. MEDLINE/Pubmed databases were used initially, and additional relevant studies were searched from references. Shift work was defined as any schedule outside traditional shifts, including the night shift. RESULTS Fifteen pertinent papers were categorized into risk assessment or risk management. Findings demonstrated an increased risk of CAD among SWs compared to non-SWs, with an increased CAD risk observed for both shift work and night shift work. DISCUSSION Duration-response associations indicate that greater shift exposure is linked to higher CAD risk. SWs incur an increased risk of CAD through the atherosclerotic process. As shift work duration increases as the risk of atherosclerosis is higher, workers demonstrate a higher prevalence and severity of coronary artery plaques. CONCLUSIONS The evidence-based results underscore the increased risk of CAD in SWs and are sufficient for proposing guidelines aimed at reducing the risk of CAD in SWs and at managing people with CAD in return to work characterized by disrupted circadian rhythms.
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Affiliation(s)
- Gabriele d’Ettorre
- Department of Occupational Medicine, Local Health Authority, Lecce, Italy
| | - Prisco Piscitelli
- Department of Experimental Medicine, University of Salento, Lecce, Italy
- Vito Fazzi Hospital. Local Health Autority, Lecce, Italy
| | | | | | - Giancarlo Ceccarelli
- Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
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Song WP, Bo XW, Dou HX, Fan Q, Wang H. Association between periodontal disease and coronary heart disease: A bibliometric analysis. Heliyon 2024; 10:e28325. [PMID: 38571655 PMCID: PMC10988017 DOI: 10.1016/j.heliyon.2024.e28325] [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: 07/24/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
Background Periodontal disease and coronary heart disease are both prevalent diseases worldwide and cause patients physical and mental suffering and a global burden. Recent studies have suggested a link between periodontal disease and coronary heart disease, but there is less research in this field from the perspective of bibliometrics. Objective This study aimed to quantitatively analyze the literature on periodontal disease and coronary heart disease to summarize intellectual bases, research hotspots, and emerging trends and pave the way for future research. Methods The Science Citation Index Expanded database was used to retrieve study records on periodontal disease and coronary heart disease from 1993 to 2022. After manual screening, the data were used for cooperative network analysis (including countries/regions, institutions and authors), keyword analysis, and reference co-citation analysis by CiteSpace software. Microsoft Excel 2019 was applied for curve fitting of annual trend in publications and citations. Results A total of 580 studies were included in the analysis. The number of publications and citations in this field has shown an upward trend over the past 30 years. There was less direct collaboration among authors and institutions in this field but closer collaboration between countries. The United States was the country with the most published articles in this field (169/580, 29.14%). Based on the results of keyword analysis and literature co-citation analysis, C-reactive protein, oral flora, atherosclerosis, infection, and inflammation were previous research hotspots, while global burden and cardiovascular outcomes were considered emerging trends in this field. Conclusion Studies on periodontal disease and coronary heart disease, which have attracted the attention of an increasing number of researchers, have been successfully analyzed using bibliometrics and visualization techniques. This paper will help scholars better understand the dynamic evolution of periodontal disease and coronary heart disease and point out the direction for future research. Clinical significance This paper presents an overview between periodontal disease and coronary heart disease. Further exploration of the two diseases themselves and the potential causal relationship between the two is necessary and relevant, which may impact basic research, diagnosis, and treatment related to both diseases. This will aid the work of researchers and specialist doctors, and ultimately benefit patients with both diseases.
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Affiliation(s)
- Wen-peng Song
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| | - Xiao-wen Bo
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hui-xin Dou
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| | - Qian Fan
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hao Wang
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
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Jalali A, Hassanzadeh A, Najafi MS, Nayebirad S, Dashtkoohi M, Karimi Z, Shafiee A. Predictors of major adverse cardiac and cerebrovascular events after percutaneous coronary intervention in older adults: a systematic review and meta-analysis. BMC Geriatr 2024; 24:337. [PMID: 38609875 PMCID: PMC11015672 DOI: 10.1186/s12877-024-04896-4] [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: 07/01/2023] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
AIM We systematically reviewed and meta-analyzed the predictors of major adverse cardiac and cerebrovascular events (MACE/MACCE) in older adults who underwent PCI. METHODS Three databases, PubMed, Embase, and Scopus, were searched for observational studies considering the out-of-hospital MACE/MACCE in adults ≥ 60 years old with coronary artery disease (acute or chronic) who underwent PCI. Studies were eligible if they had determined at least two statistically significant predictors of MACE/MACCE by multivariable analysis. We used the QUIPS tool to evaluate the risk of bias in the studies. Random-effects meta-analysis was utilized to pool the hazard ratios (HRs) of the most reported predictors. RESULTS A total of 34 studies were included in the review. Older age (HR = 1.04, 95% Confidence Interval (CI): 1.03-1.06, P-value < 0.001), diabetes (HR = 1.36, 95% CI: 1.22-1.53, P < 0.001), history of myocardial infarction (MI) (HR = 1.88, 95% CI: 1.37-2.57, P < 0.001), ST-elevation MI (STEMI) at presentation (HR = 1.72, 95% CI: 1.37-2.18, P < 0.001), reduced left ventricular ejection fraction (LVEF) (HR = 2.01, 95% CI: 1.52-2.65, P < 0.001), successful PCI (HR = 0.35, 95% CI: 0.27-0.47, P < 0.001), eGFR (HR = 0.99, 95% CI: 0.97-1.00; P-value = 0.04) and left main coronary artery (LMCA) disease (HR = 2.07, 95% CI: 1.52-2.84, P < 0.001) were identified as predictors of MACE. CONCLUSION We identified older age, diabetes, history of MI, STEMI presentation, lower LVEF, and LMCA disease increased the risk of MACE/MACCE after PCI in older adults. Meanwhile, higher eGFR and successful PCI predicted lower adverse events risk. Future studies should focus on a more robust methodology and a precise definition of MACE. REGISTRATION PROSPERO (CRD42023480332).
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Affiliation(s)
- Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, 1411713138, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hassanzadeh
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadeq Najafi
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Nayebirad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, 1411713138, Tehran, Iran
| | - Mohadese Dashtkoohi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Karimi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, 1411713138, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, 1411713138, Tehran, Iran.
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Donohue JK, Jarosinski M, Reitz KM, Khamzina Y, Ledyard J, Liang NL, Chaer RA, Sridharan ND. Socioeconomic factors predict successful supervised exercise therapy completion. J Vasc Surg 2024; 79:904-910. [PMID: 38092308 PMCID: PMC10960665 DOI: 10.1016/j.jvs.2023.12.008] [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: 09/21/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 01/04/2024]
Abstract
OBJECTIVE Supervised exercise therapy (SET) for patients with intermittent claudication (IC) can lower the risk of progression to chronic limb-threatening ischemia and amputation, while preserving and restoring functional status. Despite supporting evidence, it remains underutilized, and among those who initiate programs, attrition rates are extremely high. We hypothesize that socioeconomic factors may represent significant barriers to SET completion. METHODS Patients with IC referred to SET at a multi-hospital, single-institution health care system (2018-2022) from a prospectively maintained database were retrospectively analyzed. Our primary endpoint was SET program completion and graduation, defined as completion of 36 sessions. Our secondary endpoints were vascular intervention within 1 year of referral and change in ankle-brachial index (ABI). Baseline demographics were assessed using standard statistical methods. Predictors of SET graduation were analyzed using multivariable logistic regression generating adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Change in ABI was analyzed using t-test between subgroups. Reasons for attrition were tabulated. Patient Health Questionnaire-9 (PHQ-9), metabolic equivalent level, Vascular QOL, Duke Activity Status, and ABI were analyzed using paired t-tests across the entire cohort. RESULTS Fifty-two patients met inclusion criteria: mean age 67.85 ± 10.69 years, 19 females (36.54%), mean baseline ABI of 0.77 ± 0.16. The co-pays for 100% of patients were fully covered by primary and secondary insurance plans. Twenty-one patients (40.38%) completed SET. On multivariable analysis, residence in a ZIP code with median household income <$47,000 (aOR, 0.10; 95% CI, 0.01-0.76; P = .03) and higher body mass index (aOR, 0.81; 95% CI, 0.67-0.99; P = .04) were significant barriers to SET graduation. There were no differences in ABI change or vascular intervention within 1 year between graduates and non-graduates. Non-graduates reported transportation challenges (25.00%), lack of motivation (20.83%), and illness/functional limitation (20.83%) as primary reasons for SET attrition. Metabolic Equivalent Level (P ≤ .01) and Duke Activity Status scores (P = .04) were significantly greater after participating in a SET program. CONCLUSIONS Although SET participation improves lower extremity and functionality outcomes, only 40% of referred patients completed therapy in our cohort. Our findings suggest that both socioeconomic and functional factors influence the odds of completing SET programs, indicating a need for holistic pre-referral assessment to facilitate enhanced program accessibility for these populations.
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Affiliation(s)
- Jack K Donohue
- University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | | | - Katherine M Reitz
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Jonathan Ledyard
- Cardiopulmonary Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Nathan L Liang
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA
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