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Turecamo S, Downie CG, Wolska A, Mora S, Otvos JD, Connelly MA, Remaley AT, Conners KM, Joo J, Sampson M, Bielinski SJ, Shearer JJ, Roger VL. Lipoprotein Insulin Resistance Score and Mortality Risk Stratification in Heart Failure. Am J Med 2024; 137:640-648. [PMID: 38583752 PMCID: PMC11213682 DOI: 10.1016/j.amjmed.2024.03.033] [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: 03/06/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Higher total serum cholesterol is associated with lower mortality in heart failure. Evaluating associations between lipoprotein subfractions and mortality among people with heart failure may provide insights into this observation. METHODS We prospectively enrolled a community cohort of people with heart failure from 2003 to 2012 and assessed vital status through 2021. Plasma collected at enrollment was used to measure lipoprotein subfractions via nuclear magnetic resonance spectroscopy. A composite score of 6 lipoprotein subfractions was generated using the lipoprotein insulin resistance index (LP-IR) algorithm. Using covariate-adjusted proportional hazards regression models, we evaluated associations between LP-IR score and all-cause mortality. RESULTS Among 1382 patients with heart failure (median follow-up 13.9 years), a one-standard-deviation (SD) increment in LP-IR score was associated with lower mortality (hazard ratio [HR] 0.93; 95% confidence interval [CI], 0.97-0.99). Among LP-IR parameters, mean high-density lipoprotein (HDL) particle size was significantly associated with lower mortality (HR per 1-SD decrement in mean HDL particle size = 0.83; 95% CI, 0.78-0.89), suggesting that the inverse association between LP-IR score and mortality may be driven by smaller mean HDL particle size. CONCLUSIONS LP-IR score was inversely associated with mortality among patients with heart failure and may be driven by smaller HDL particle size.
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Affiliation(s)
- Sarah Turecamo
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Carolina G Downie
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Anna Wolska
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - James D Otvos
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Katherine M Conners
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jungnam Joo
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Maureen Sampson
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Suzette J Bielinski
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Joseph J Shearer
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Véronique L Roger
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
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Tsabedze N, Mpanya D, Bailly C, Nel S, Grinter S, Ramsay M, Krause A, Wells Q, Manga P. Clinical characteristics and one-year all-cause mortality outcomes in Africans with dilated cardiomyopathy. Int J Cardiol 2023; 387:131142. [PMID: 37364715 DOI: 10.1016/j.ijcard.2023.131142] [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: 03/06/2023] [Revised: 06/07/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
AIMS Dilated cardiomyopathy (DCM) is a common cause of heart failure in sub-Saharan Africa (SSA). The affected individuals present with new-onset heart failure with reduced ejection fraction and no identifiable primary or secondary aetiology. We aim to describe the clinical characteristics of participants with heart failure of unknown origin. METHODS We screened 161 participants with heart failure of unknown origin and prospectively excluded primary and secondary causes of DCM. All study participants were subjected to laboratory biochemical testing, echocardiography, cardiovascular magnetic resonance (CMR) imaging and invasive coronary angiography. RESULTS The study comprised 93 participants with a mean age of 47.5 SD 13.1 years. Forty-six (56.1%) participants had evidence of late gadolinium enhancement (LGE) on imaging, and LGE was visualised in the mid wall in 28 (61.0%) of these participants. After a median duration of 13.4 months [interquartile range (IQR): 8.8-28.9 months], 18 (19%) participants died. Non-survivors had a higher median left atrial volume index (44.9 mL/m2 (IQR: 34.4-58.7) compared to survivors [32.9 mL/m2 (IQR: 24.5-47.0), p = 0.017)]. The rate of all-cause rehospitalisation was 29.3%, of which 17 of the 22 re-hospitalisations were heart failure related. CONCLUSION Dilated cardiomyopathy in Africans primarily affects young males. In our cohort, this disease was associated with an all-cause mortality of 19% in one year. In SSA, large multicenter studies are required to investigate this disease's pathogenesis and outcomes.
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Affiliation(s)
- Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa.
| | - Dineo Mpanya
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Claude Bailly
- Division of Human Genetics, National Health Laboratory Services and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samantha Nel
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Sacha Grinter
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
| | - Michele Ramsay
- Division of Human Genetics, National Health Laboratory Services and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amanda Krause
- Division of Human Genetics, National Health Laboratory Services and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Quinn Wells
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Pravin Manga
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa
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Paixão da Silva E, Ranielly Dos Santos Avelino R, Zuza Diniz RV, Dantas de Lira NR, Monteiro Lourenço Queiroz SI, Gomes Dantas Lopes MM, Maurício Sena-Evangelista KC. Body composition, lipid profile and clinical parameters are predictors of prognosis in patients with heart failure: Two-year follow-up. Clin Nutr ESPEN 2023; 56:52-58. [PMID: 37344083 DOI: 10.1016/j.clnesp.2023.04.029] [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: 09/11/2022] [Revised: 04/16/2023] [Accepted: 04/28/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Heart failure (HF) is a complex syndrome that leads to changes in body composition and eventually results in unfavorable outcomes. AIM This study aimed to evaluate body composition, lipid profiles and clinical parameters of patients with HF, and their associations with both survival and unfavorable clinical outcomes. METHODS This prospective cohort study included 94 adults and older people with HF. Body composition was assessed by bioelectrical impedance analysis (BIA). Anthropometric variables and lipid profile were also evaluated. Electronic medical records were checked to collect information on clinical outcomes (mortality and hospitalization), considering a follow-up period of 24 months. Survival was calculated using the Kaplan-Meier estimate, and the curves compared using Log-Rank. The death risk rate (Hazard Ratio, HR) was calculated using Cox's univariate models. RESULTS Mean age was 55.1 (13.9) years and there was a higher frequency of males. There was a predominance of HF with reduced ejection fraction, and ischemic etiology. Patients with New York Heart Association (NYHA) functional classification I/II had a better overall survival rate at 24 months than those with NYHA III/IV (univariate HR 4.93 (1.76-13.82); p = 0.001). Greater survival rates were found in patients without chronic kidney disease (CKD) (univariate HR 2.93 (1.59-5.39); p = 0.01). In the multivariate analyses, both dyslipidemia (adjusted HR 3.84 (1.22-12.00); p = 0.021) and increased fat mass index (FMI) were associated with overall survival rate (adjusted HR 3.59 (1, 10-11.74); p = 0.034). CONCLUSION The severity of HF symptoms and the presence of chronic kidney disease are associated with higher mortality. Increased fat mass index and dyslipidemia are predictors of favorable outcomes in this population.
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Affiliation(s)
- Eduardo Paixão da Silva
- Multiprofessional Residency in Health - Cardiology, Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (EPS, RRSA, RVZD, NRDL, MMGDL, KCMSE), Brazil
| | - Regina Ranielly Dos Santos Avelino
- Multiprofessional Residency in Health - Cardiology, Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (EPS, RRSA, RVZD, NRDL, MMGDL, KCMSE), Brazil
| | - Rosiane Viana Zuza Diniz
- Multiprofessional Residency in Health - Cardiology, Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (EPS, RRSA, RVZD, NRDL, MMGDL, KCMSE), Brazil; Department of Clinical Medicine, Health Sciences Center, Federal University of Rio Grande Do Norte (RVZD), Brazil
| | - Niethia Regina Dantas de Lira
- Multiprofessional Residency in Health - Cardiology, Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (EPS, RRSA, RVZD, NRDL, MMGDL, KCMSE), Brazil; Brazilian Hospital Services Company. Onofre Lopes University Hospital, Health Sciences Center, Federal University of Rio Grande Do Norte (NRDL), Brazil
| | | | - Márcia Marília Gomes Dantas Lopes
- Multiprofessional Residency in Health - Cardiology, Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (EPS, RRSA, RVZD, NRDL, MMGDL, KCMSE), Brazil; Department of Nutrition, Health Sciences Center, Federal University of Rio Grande Do Norte (MMGDL, KCMSE), Brazil
| | - Karine Cavalcanti Maurício Sena-Evangelista
- Multiprofessional Residency in Health - Cardiology, Onofre Lopes University Hospital, Federal University of Rio Grande Do Norte (EPS, RRSA, RVZD, NRDL, MMGDL, KCMSE), Brazil; Department of Nutrition, Health Sciences Center, Federal University of Rio Grande Do Norte (MMGDL, KCMSE), Brazil.
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Charach L, Grosskopf I, Galin L, Guterman I, Karniel E, Charach G. Low Cholesterol Levels in Younger Heart Failure Patients May Predict Unfavorable Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1314. [PMID: 37512127 PMCID: PMC10384220 DOI: 10.3390/medicina59071314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Hypercholesterolemia is a main risk-factor leading to ischemic heart disease (IHD). However, among patients with heart failure, the use of lipid lowering drugs in the presence of low cholesterol might be dangerous. This 18-year longitudinal study of patients ≤51 years old investigated the relationship between baseline total cholesterol, low-density lipoprotein cholesterol (LDL-c) and triglyceride levels, and survival among patients with severe HF. Materials and Methods: The average NYHA score of 82 patients ≤51 years old with heart failure was 2.61. They were followed for a mean of 11.3 years (15 months-20 years). Total mortality was 22%. Patients were divided into three groups. Group 1 had plasma LDL-c levels ≤ 80 mg/dl, Group 2, 80-115 mg/dl and Group 3 > 115 mg/dl. Results: Patients with the highest baseline total cholesterol, triglyceride and LDL-c levels > 115 mg/dl had a better survival rate (83%) compared to those with LDL-c < 80 mg/dl (50% survival, p = 0.043). The association between higher LDL-c levels and lower mortality was most noticeable among patients with heart failure. Conclusion: Longitudinal follow-up found that low LDL-c levels may indicate poorer prognosis among patient with heart failure who are ≤51 years old, similar to elderly heart failure patients. Cholesterol lowering drugs in younger patients with heart failure may increase mortality.
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Affiliation(s)
- Lior Charach
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Itamar Grosskopf
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Leonid Galin
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Irit Guterman
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eli Karniel
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gideon Charach
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Evaluation of the Association between Low-Density Lipoprotein (LDL) and All-Cause Mortality in Geriatric Patients with Hip Fractures: A Prospective Cohort Study of 339 Patients. J Pers Med 2023; 13:jpm13020345. [PMID: 36836579 PMCID: PMC9967768 DOI: 10.3390/jpm13020345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Many factors affect the prognosis of hip fractures in the elderly. Some studies have suggested a direct or indirect association among serum lipid levels, osteoporosis, and hip fracture risk. LDL levels were found to have a statistically significant nonlinear U-shaped relationship with hip fracture risk. However, the relationship between serum LDL levels and the prognosis of patients with hip fractures remains unclear. Therefore, in this study, we assessed the influence of serum LDL levels on patient mortality over a long-term follow-up period. METHODS Elderly patients with hip fractures were screened between January 2015 and September 2019, and their demographic and clinical characteristics were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between LDL levels and mortality. Analyses were performed using Empower Stats and R software. RESULTS Overall, 339 patients with a mean follow-up period of 34.17 months were included in this study. Ninety-nine patients (29.20%) died due to all-cause mortality. Linear multivariate Cox regression models showed that LDL levels were associated with mortality (HR = 0.69, 95%CI: 0.53, 0.91, p = 0.0085) after adjusting for confounding factors. However, the linear association was unstable, and nonlinearity was identified. An LDL concentration of 2.31 mmol/L was defined as the inflection point for prediction. A LDL level < 2.31 mmol/L was associated with mortality (HR = 0.42, 95%CI: 0.25, 0.69, p = 0.0006), whereas LDL > 2.31 mmol/L was not a risk factor for mortality (HR = 1.06, 95%CI: 0.70, 1.63, p = 0.7722). CONCLUSIONS The preoperative LDL level was nonlinearly associated with mortality in elderly patients with hip fractures, and the LDL level was a risk indicator of mortality. Furthermore, 2.31 mmol/L could be considered a predictor cut-off for risk.
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Zhao L, Zhao X, Tian P, Liang L, Huang B, Huang L, Feng J, Zhang Y, Zhang J. Predictive value of remnant cholesterol level for all-cause mortality in heart failure patients. Front Cardiovasc Med 2023; 10:1063562. [PMID: 36873397 PMCID: PMC9975541 DOI: 10.3389/fcvm.2023.1063562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/25/2023] [Indexed: 02/17/2023] Open
Abstract
Background Lower cholesterol levels are associated with increased mortality in heart failure (HF) patients. Remnant cholesterol corresponds to all cholesterol not found in high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The prognostic role of remnant cholesterol in HF remains unknown. Objective To reveal the relationship between the baseline remnant cholesterol level and all-cause mortality in HF patients. Methods This study enrolled 2,823 patients hospitalized for HF. Kaplan-Meier analysis, Cox regression, C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the prognostic value of remnant cholesterol for all-cause mortality in HF. Results The mortality rate was lowest in the fourth quartile of remnant cholesterol, which had an adjusted hazard ratio (HR) for death of 0.56 [HR: 0.39, 95% confidence interval (CI): 0.46-0.68, p < 0.001] relative to the first quartile. After adjustment, a one-unit increase in the level of remnant cholesterol was associated with a 41% decrease in the risk of all-cause mortality (HR: 0.59, 95% CI: 0.47-0.73, p < 0.001). A refinement in risk prediction was observed after adding remnant cholesterol quartile to the original model (ΔC-statistic = 0.010, 95% CI: 0.003-0.017; NRI = 0.036, 95% CI: 0.003-0.070; IDI = 0.025, 95% CI: 0.018-0.033; all p < 0.05). Conclusion Low remnant cholesterol levels are associated with increased all-cause mortality in HF patients. The addition of the remnant cholesterol quartile improved the predictive value over traditional risk factors. Clinical Trial Registration ClinicalTrials.gov, Unique Identifier: NCT02664818.
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Affiliation(s)
- Lang Zhao
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuemei Zhao
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pengchao Tian
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Liang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Boping Huang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyan Huang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiayu Feng
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuhui Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Degoricija V, Klobučar I, Potočnjak I, Dokoza Terešak S, Vidović L, Pregartner G, Berghold A, Habisch H, Madl T, Frank S. Cholesterol Content of Very-Low-Density Lipoproteins Is Associated with 1-Year Mortality in Acute Heart Failure Patients. Biomolecules 2022; 12:biom12101542. [PMID: 36291751 PMCID: PMC9599569 DOI: 10.3390/biom12101542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Considering the relationship between the extent of metabolic derangement and the disease severity in heart failure, we hypothesized that the lipid content of very-low-density lipoprotein (VLDL) may have prognostic value for 1 year mortality in acute heart failure (AHF). Baseline serum levels of VLDL cholesterol (VLDL-C), VLDL triglycerides (VLDL-TG), VLDL phospholipids (VLDL-PL), and VLDL apolipoprotein B (VLDL-apoB) were measured using NMR spectroscopy. We calculated the ratios of the respective VLDL lipids and VLDL apoB (VLDL-C/VLDL-apoB, VLDL-TG/VLDL-apoB, and VLDL-PL/VLDL-apoB), as estimators of the cholesterol, triglyceride, and phospholipid content of VLDL particles and tested their association with mortality. Out of 315 AHF patients, 118 (37.5%) patients died within 1 year after hospitalization for AHF. Univariable Cox regression analyses revealed a significant inverse association of VLDL-C/VLDL-apoB (hazard ratio (HR) 0.43, 95% confidence interval (CI) 0.29−0.64, p < 0.001), VLDL-TG/VLDL-apoB (HR 0.79, 95% CI 0.71−0.88, p < 0.001), and VLDL-PL/VLDL-apoB (HR 0.37, 95% CI 0.25−0.56, p < 0.001) with 1 year mortality. Of the tested parameters, only VLDL-C/VLDL-apoB remained significant after adjustment for age and sex, as well as other clinical and laboratory parameters that showed a significant association with 1 year mortality in the univariable analyses. We conclude that cholesterol content of circulating VLDL (VLDL-C/VLDL-apoB) might be of prognostic value in AHF.
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Affiliation(s)
- Vesna Degoricija
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Medicine, Sisters of Charity University Hospital Centre, 10000 Zagreb, Croatia
| | - Iva Klobučar
- Department of Cardiology, Sisters of Charity University Hospital Centre, 10000 Zagreb, Croatia
| | - Ines Potočnjak
- Institute for Clinical Medical Research and Education, Sisters of Charity University Hospital Centre, 10000 Zagreb, Croatia
| | - Sanda Dokoza Terešak
- Department of Emergency Medicine, Sisters of Charity University Hospital Centre, 10000 Zagreb, Croatia
| | - Luka Vidović
- Department of Medicine, Sisters of Charity University Hospital Centre, 10000 Zagreb, Croatia
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics und Documentation, Medical University of Graz, 8036 Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics und Documentation, Medical University of Graz, 8036 Graz, Austria
| | - Hansjörg Habisch
- Gottfried Schatz Research Center, Molecular Biology and Biochemistry, Medical University of Graz, 8010 Graz, Austria
| | - Tobias Madl
- Gottfried Schatz Research Center, Molecular Biology and Biochemistry, Medical University of Graz, 8010 Graz, Austria
- BioTechMed-Graz, 8010 Graz, Austria
| | - Saša Frank
- Gottfried Schatz Research Center, Molecular Biology and Biochemistry, Medical University of Graz, 8010 Graz, Austria
- BioTechMed-Graz, 8010 Graz, Austria
- Correspondence:
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Liu HH, Zhang M, Chen RZ, Zhou JY, Qian J, Dou KF, Yan HB, Li JJ. Low-density lipoprotein cholesterol in oldest old with acute myocardial infarction: Is lower the better? Age Ageing 2022; 51:6695455. [PMID: 36088600 DOI: 10.1093/ageing/afac202] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 06/24/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND the relationship between low-density lipoprotein cholesterol (LDL-C) and adverse outcomes among the older people remains controversial. OBJECTIVE to further clarify the association between admission LDL-C levels and cardiovascular mortality (CVM) among oldest old individuals (≥80 years) with acute myocardial infarction (AMI). DESIGN a prospective cohort study. SETTING two-centre. SUBJECTS a consecutive sample of 1,224 oldest old individuals with AMI admitted to Beijing FuWai and Shenzhen FuWai hospitals. METHODS all individuals were subdivided according to baseline LDL-C levels (<1.8, 1.8-2.6 and ≥ 2.6 mmol/l) and further stratified by high-sensitivity C-reactive protein (hsCRP) concentrations (<10 and ≥10 mg/l). The primary outcome was CVM. The time from admission to the occurrence of CVM or the last follow-up was analysed in Kaplan-Meier and Cox analyses. RESULTS the median age of the overall population was 82 years. During an average of 24.5 months' follow-up, 299 cardiovascular deaths occurred. Kaplan-Meier analysis showed that LDL-C < 1.8 mmol/l group had the highest CVM among oldest old individuals with AMI. Multivariate Cox regression analysis further revealed that compared with those with LDL-C levels <1.8 mmol/l, subjects with LDL-C levels ≥2.6 mmol/l (hazard ratio: 0.67, 95% confidence interval: 0.46-0.98) had significantly lower risk of CVM, especially in those with high hsCRP levels. Moreover, when categorising according to LDL-C and hsCRP together, data showed that individuals with low LDL-C and high hsCRP levels had the highest CVM. CONCLUSIONS LDL-C < 1.8 mmol/l was associated with a high CVM after AMI in oldest old individuals, especially when combined with high hsCRP levels, which may need to be confirmed by randomised controlled trials.
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Affiliation(s)
- Hui-Hui Liu
- Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing 100037, China
| | - Meng Zhang
- Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing 100037, China
| | - Run-Zhen Chen
- Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing 100037, China
| | - Jin-Ying Zhou
- Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing 100037, China
| | - Jie Qian
- Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing 100037, China
| | - Ke-Fei Dou
- Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing 100037, China
| | - Hong-Bing Yan
- Department of Coronary Artery Disease, FuWai Hospital Chinese Academy of Medical Sciences, LangShan Road 12, ShenZhen 518000, China
| | - Jian-Jun Li
- Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing 100037, China
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Li HB, Fu BQ, Tan T, Li XH, Wang SH, Wei XB, Wang ZH. Low-Density Lipoprotein Cholesterol and Mortality Risk in Elderly Patients Undergoing Valve Replacement Surgery: A Propensity Score Matching Analysis. Front Nutr 2022; 9:842734. [PMID: 35592628 PMCID: PMC9113219 DOI: 10.3389/fnut.2022.842734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The prognostic value of low-density lipoprotein cholesterol (LDL-C) in elderly patients is controversial. This study aimed to elucidate the relationship between the preoperative LDL-C and adverse outcomes in elderly patients undergoing valve replacement surgery (VRS). METHODS A total of 2,552 aged patients (age ≥ 60 years) undergoing VRS were retrospectively recruited and divided into two groups according to LDL-C level on admission: low LDL-C (<70 mg/dL, n = 205) and high LDL-C groups (≥ 70 mg/dL, n = 2,347). The association between the preoperative LDL-C with in-hospital and one-year mortality was evaluated by propensity score matching analysis and multivariate analysis. RESULTS The mean age was 65 ± 4 years and 1,263 (49.5%) were men. Patients in the low LDL-C group were significantly older (65.9 ± 4.6 vs. 64.9 ± 4.1, p = 0.002), with more male (65.4 vs. 48.1%, p < 0.001), higher alanine transaminase (ALT) (21 vs. 19, p = 0.001), lower serum albumin (35.3 ± 4.6 vs. 37.1 ± 4.1, p < 0.001), higher serum creatinine (92.2 ± 38.2 vs.84.6 ± 26.1, p = 0.006), lower lymphocyte count (1.7 ± 0.7 vs. 1.9 ± 0.6, p < 0.001), lower hemoglobin (121.9 ± 22.3 vs. 130.2 ± 16.5, p < 0.001), lower platelet count (171.3 ± 64.3 vs. 187.7 ± 58.7, p < 0.001), lower prognostic nutrition index (44 ± 6.2 vs. 46.7 ± 5.8, p < 0.001), and more severe tricuspid regurgitation (33.7 vs. 25.1%, p = 0.008). The rates of in-hospital death (11.2 vs. 3.7%, p < 0.001) and major adverse clinical events (17.6 vs. 9.6%, p < 0.001) were significantly higher in the low LDL-C group. The cumulative one-year death rate was significantly higher in the low LDL-C group (Log-Rank = 16.6, p < 0.001). After matching analysis and multivariate analysis, no association between LDL-C level and adverse outcomes was detected (all p > 0.05). CONCLUSION Our study did not support the negative relationship between LDL-C level and mortality risk in elderly patients undergoing VRS.
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Affiliation(s)
- Han-biao Li
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bing-qi Fu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Tong Tan
- Shantou University Medical College, Shantou, China
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-hua Li
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shou-hong Wang
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Shou-hong Wang
| | - Xue-biao Wei
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Xue-biao Wei
| | - Zhong-hua Wang
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Zhong-hua Wang
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10
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Zeng X, Zhou X, Tan XR, Chen YQ. Admission LDL-C and long-term mortality in patients with acute aortic dissection: a survival analysis in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1345. [PMID: 34532482 PMCID: PMC8422143 DOI: 10.21037/atm-21-3511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The level of blood lipid is closely related to prognosis in cardiovascular diseases. This study aims to analyze the effect of serum low-density lipoprotein cholesterol (LDL-C) levels on the long-term mortality in acute aortic dissection (AAD). A lower admission LDL-C level is associated with an increased risk of long-term mortality in AAD. METHODS We analyzed the data of 284 patients with AAD admitted to the First Affiliated Hospital of Shantou University Medical College from February 2016 to September 2019. Patients were followed up post-discharge. All patients were divided into either an LDL-C low-level group or an LDL-C high-level group according to the optimal cut-off point obtained by the receiver operating characteristic (ROC) curve. The endpoint outcome was long-term mortality in AAD. A survival analysis and Cox proportional hazards model were used. RESULTS According to the Youden index, the optimal cut-off point for LDL-C was 2.755 mmol/L. The Kaplan-Meier survival analysis curves showed that the long-term mortality of the LDL-C low-level group (<2.755 mmol/L) was significantly higher than that of the LDL-C high-level group (≥2.755 mmol/L) (log-rank χ2=13.912, P<0.001). After multivariate Cox regression analysis, LDL-C <2.755 mmol/L was still significantly associated with long-term mortality in AAD (HR=3.287, 95% CI: 1.637-6.600, P=0.001). In addition, cystatin C was also an independent risk factor for the long-term prognosis of AAD (HR=1.253, 95% CI: 1.057-1.486, P=0.009). CONCLUSIONS A lower admission LDL-C level may be associated with an increased risk of long-term mortality in AAD.
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Affiliation(s)
- Xin Zeng
- Department of Geriatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xuan Zhou
- Department of Internal Medicine, Fujian Medical University Xiamen Humanity Hospital, Xiamen, China
| | - Xue-Rui Tan
- Department of Cardiovascular Internal Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ye-Qun Chen
- Department of Cardiovascular Internal Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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11
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Giles JT, Wasko MCM, Chung CP, Szklo M, Blumenthal RS, Kao A, Bokhari S, Zartoshti A, Stein CM, Bathon JM. Exploring the Lipid Paradox Theory in Rheumatoid Arthritis: Associations of Low Circulating Low-Density Lipoprotein Concentration With Subclinical Coronary Atherosclerosis. Arthritis Rheumatol 2019; 71:1426-1436. [PMID: 30883031 DOI: 10.1002/art.40889] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/12/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) patients with the lowest circulating low-density lipoprotein (LDL) concentrations are at heightened risk of cardiovascular events. However, the atherosclerosis burden within this subgroup is unknown. METHODS RA patients pooled from 4 cohort studies of cardiovascular disease (CVD; n = 546) were compared with non-RA controls from the Multi-Ethnic Study of Atherosclerosis (n = 5,279). Those taking lipid-lowering medications were excluded. Differences in cardiac computed tomography-derived Agatston coronary artery calcium (CAC) scores between the RA and control groups were compared across strata of LDL concentration. RESULTS Among those with low LDL concentrations (<70 mg/dl), mean adjusted CAC scores were >4-fold higher for RA patients than for controls (18.6 versus 4.6 Agatston units, respectively; P < 0.001), a difference significantly greater than that in any other LDL concentration stratum except LDL concentration ≥160 mg/dl. Similarly, 32% of the RA patients with low LDL concentration had a CAC score of ≥100 Agatston units compared with only 7% of controls in the same LDL concentration stratum (odds ratio 5.97; P < 0.001), a difference significantly greater than that in all of the other LDL concentration strata. Low LDL concentration was most strongly associated with higher CAC score among RA patients who were white, had ever smoked, or were not obese. Other than a higher frequency of current smokers, RA patients with low LDL concentrations did not have more CVD risk factors or higher measures of RA disease activity or severity than RA patients with higher LDL concentrations. CONCLUSION RA patients with low LDL concentration may represent a group for whom heightened screening and prevention of atherosclerotic CVD is appropriate.
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Affiliation(s)
| | - Mary Chester M Wasko
- Allegheny Health Network, Temple University School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | - Amy Kao
- EMD Serono Research & Development Institute, Inc., Billerica, Maryland
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12
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Oikawa T, Sakata Y, Nochioka K, Miura M, Tsuji K, Onose T, Abe R, Kasahara S, Sato M, Shiroto T, Takahashi J, Miyata S, Shimokawa H. Prognostic Impact of Statin Intensity in Heart Failure Patients With Ischemic Heart Disease: A Report From the CHART-2 (Chronic Heart Failure Registry and Analysis in the Tohoku District 2) Study. J Am Heart Assoc 2018. [PMID: 29540427 PMCID: PMC5907545 DOI: 10.1161/jaha.117.007524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The beneficial prognostic impact of statins has been established in patients with ischemic heart disease but not in those with heart failure (HF). In addition, it is still unclear whether patients benefit from statins regardless of low‐density lipoprotein cholesterol levels. Methods and Results We examined 2444 consecutive stage C or D HF patients with ischemic heart disease registered in CHART‐2 (Chronic Heart Failure Registry and Analysis in the Tohoku District 2), a multicenter, prospective, observational cohort study in Japan. Patients were divided into 3 groups according to the Japanese standard doses of statins and statin‐intensity categories defined by the 2013 American College of Cardiology and American Heart Association guidelines: higher (moderate‐high)‐intensity (n=868), lower (low)‐intensity (n=526), and no statin (n=1050). The median follow‐up period was 6.4 years (13929 person‐years). Analysis with the inverse probability of treatment weighted using a propensity score for multiple treatment revealed that both the higher‐intesity group (hazard ratio [HR]: 0.68; P<0.001) and the lower‐intensity group (HR: 0.82; P<0.001) had significantly lower incidence of the primary end point—a composite of all‐cause death and HF admission—compared with the no statin group. The higher‐intensity statin group had significantly lower incidence of the primary end point (HR: 0.82; P<0.001), all‐cause death (HR: 0.83; P<0.001), and HF admission (HR: 0.78; P<0.001) than the lower‐intensity statin group. Moreover, the use of statins, either higher‐ or lower‐intensity, was associated with reduced incidence of the primary end point, regardless of low‐density lipoprotein cholesterol levels. Conclusions These results suggest that statin use, particularly the use of higher‐intensity statins, has a beneficial prognostic impact in HF patients with ischemic heart disease, regardless of low‐density lipoprotein cholesterol levels. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00418041.
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Affiliation(s)
- Takuya Oikawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masanobu Miura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kanako Tsuji
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeo Onose
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ruri Abe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shintaro Kasahara
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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13
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Medical significance of simultaneous application of red blood cell distribution width (RDW) and neopterin as diagnostic/prognostic biomarkers in clinical practice. Pteridines 2017. [DOI: 10.1515/pterid-2017-0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Abstract
In our individual and collaborative studies, we have played a part in pioneering investigations on the usefulness of biomarkers – red blood cell distribution width (RDW) and neopterin. This mini review includes historical data on the topic and is related to the first contributions in this field, as well as to the possibilities for further improvement and simultaneous application of RDW and neopterin measurements in the prevention, prognosis and treatment of a great number of socially important disease conditions (arterial, cardiovascular, brain vascular, peripheral artery diseases, inflammations, autoimmune states, cancers and leukemias, addictions, etc.). When comparing the results obtained with the immunobiochemical biomarker neopterin with RDW, they are reported to be very similar as independent predictors of the same pathological states in the human body although their biomedical origins are very different. Both the parameters were until now successfully, but only separately used in medical practice. The combined use of these two biomarkers can shed some more light on their interrelationships and provide some clues as to how the interaction between immune system activation and red blood cells biology are intertwined.
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14
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Linden M, Bernert S, Funke A, Dreinhöfer KE, Jöbges M, von Kardorff E, Riedel-Heller SG, Spyra K, Völler H, Warschburger P, Wippert PM. [Medical rehabilitation from a lifespan perspective]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:445-452. [PMID: 28204902 DOI: 10.1007/s00103-017-2520-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lifespan research investigates the development of individuals over the course of life. As medical rehabilitation deals with primary and secondary prophylaxis, treatment, and compensation of chronic illnesses, a lifespan perspective is needed for the classification and diagnosis of chronic disorders, the assessment of course modifying factors, the identification of vulnerable life periods and critical incidents, the implementation of preventive measures, the development of methods for the evaluation of prior treatments, the selection and prioritization of interventions, including specialized inpatient rehabilitation, the coordination of therapies and therapists, and for evaluations in social and forensic medicine. Due to the variety of individual risk constellations, illness courses and treatment situations across the lifespan, personalized medicine is especially important in the context of medical rehabilitation, which takes into consideration hindering and fostering factors alike.
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Affiliation(s)
- Michael Linden
- Rehabilitationswissenschaftlicher Verbund Berlin, Brandenburg und Sachsen (BBS), Luisenstr. 13, 10117, Berlin, Deutschland.
- Forschungsgruppe Psychosomatische Rehabilitation, CBF, Hs II, E01, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
| | - Sebastian Bernert
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ariane Funke
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Karsten E Dreinhöfer
- Abt. für Orthopädie und Unfallchirurgie, Medical Park Berlin Humboldtmühle, Berlin, Deutschland
| | - Michael Jöbges
- Brandenburgklinik Berlin-Brandenburg, Berlin, Deutschland
| | - Ernst von Kardorff
- Institut für Rehabilitationswissenschaften, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | | | - Karla Spyra
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Heinz Völler
- Professur für Rehabilitationswissenschaften, Universität Potsdam, Potsdam, Deutschland
| | - Petra Warschburger
- Professur für Beratungspsychologie, Universität Potsdam, Potsdam, Deutschland
| | - Pia-Maria Wippert
- Professur für Sport- und Gesundheitspsychologie, Universität Potsdam, Potsdam, Deutschland
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15
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Magri CJ, Tian TX, Camilleri L, Xuereb R, Galea J, Fava S. Red blood cell distribution width and myocardial scar burden in coronary artery disease. Postgrad Med J 2017; 93:607-612. [PMID: 28490545 DOI: 10.1136/postgradmedj-2016-134781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/19/2017] [Accepted: 04/02/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Red blood cell distribution width (RDW) is a novel independent marker of cardiovascular disease including heart failure, coronary artery disease and myocardial ischaemia. The aim of the study was to investigate a possible relationship between RDW and myocardial scar burden, as assessed by a MIBI viability scan. A secondary objective was to assess whether there is an association between RDW and left ventricular ejection fraction (LVEF). METHODS The study comprised 123 subjects with ischaemic heart disease who underwent a myocardial viability scan between June 2008 and July 2014. Haemoglobin, mean corpuscular volume, RDW, platelet count, mean platelet volume (MPV), estimated glomerular filtration rate, fasting blood glucose, liver and lipid profiles were evaluated for all patients. The extent of myocardial scarring and LVEF were noted. Data were analysed using IBM SPSS Statistics 22.0. Univariate followed by multivariate analyses were performed to assess for independent predictors of myocardial scarring and LVEF, respectively. RESULTS The mean age of the study population was 63.5 years; most of the subjects were men. The median LVEF was 31% and median percentage of myocardial scarring was 8.7%. Multivariate analyses revealed that RDW, HDL-cholesterol and alanine transaminase were independent predictors of myocardial scarring while RDW, MPV, LDL-cholesterol and gamma-glutamyl transpeptidase were independent predictors of LVEF. CONCLUSIONS Increased RDW is an independent predictor both of myocardial scar burden and of impaired left ventricular function in subjects with coronary artery disease.
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Affiliation(s)
- Caroline Jane Magri
- Department of Cardiology, Mater Dei Hospital, Msida, Malta.,University of Malta Medical School, University of Malta, Tal-Qroqq, Msida, Malta
| | - Tan Xiao Tian
- Department of Medicine, Mater Dei Hospita, Tal-Qroqq, Msida, Malta
| | - Liberato Camilleri
- Statistics & Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - Robert Xuereb
- Department of Cardiology, Mater Dei Hospital, Msida, Malta.,University of Malta Medical School, University of Malta, Tal-Qroqq, Msida, Malta
| | - Joseph Galea
- University of Malta Medical School, University of Malta, Tal-Qroqq, Msida, Malta.,Department of Cardiac Services, Mater Dei Hospital, Tal-Qroqq, Msida, Malta
| | - Stephen Fava
- University of Malta Medical School, University of Malta, Tal-Qroqq, Msida, Malta.,Department of Medicine, Mater Dei Hospita, Tal-Qroqq, Msida, Malta
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16
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Hammami R, Jdidi J, Triki F, Hammami B, Abid L, Ksouda K, Hammami S, Abid D, Hentati M, Kammoun S. [Statins Use in Elderly Patients]. Therapie 2015; 78:therapie150057. [PMID: 26524698 DOI: 10.2515/therapie/2015057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 04/16/2015] [Indexed: 02/28/2024]
Abstract
The risk of cardiovascular disease in elderly is significantly higher than in young subjects; paradoxically some treatments that have proven their efficacy in reducing cardiovascular risk are often under prescribed in this age group. The benefits of statins in secondary cardiovascular prevention are well established in patients <80 years. In primary prevention, these drugs reduce the risk of myocardial infarction and stroke, but their effects on cardiovascular mortality remain uncertain. In very elderly patients, there are no randomized trials relative to the impact of statins on morbi-mortality in primary prevention as well in secondary prevention. Adverse effects in the elderly seem to be statistically similar to those occurring in young people , but the prescription in very old people should be individualized, taking into account the life expectancy, the life quality, the comorbidities, and especially the risk of drug interactions.
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Affiliation(s)
- Rania Hammami
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
| | - Jihen Jdidi
- Service de Médecine Préventive, CHU Hedi Chaker, Sfax, Tunisie
| | - Faten Triki
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
| | | | - Leila Abid
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
| | - Kamilia Ksouda
- Laboratoire de Pharmacologie, Faculté de Médecine, Sfax, Tunisie
| | - Serria Hammami
- Laboratoire de Pharmacologie, Faculté de Médecine, Sfax, Tunisie
| | - Dorra Abid
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
| | - Mourad Hentati
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
| | - Samir Kammoun
- Service de Cardiologie de Sfax, CHU Hedi Chaker, Sfax, Tunisie
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17
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Rose G, Crocco P, De Rango F, Corsonello A, Lattanzio F, De Luca M, Passarino G. Metabolism and successful aging: Polymorphic variation of syndecan-4 (SDC4) gene associate with longevity and lipid profile in healthy elderly Italian subjects. Mech Ageing Dev 2015; 150:27-33. [PMID: 26254886 DOI: 10.1016/j.mad.2015.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 07/27/2015] [Accepted: 08/03/2015] [Indexed: 11/25/2022]
Abstract
Evidences from model systems and humans have suggested that genetic alterations in cell-ECM interactions and matrix-mediated cellular signaling cascades impact different aspects of metabolism and thereby life span. In this frame, a genetic variant (rs1981429) in the SDC4 gene encoding for syndecan-4, a central mediator of cell adhesion, has been associated with body composition in children and coronary artery disease in middle-age subjects. In order to test the hypothesis that syndecans might affect life span by affecting metabolic endophenotypes, 11 SNPs within the SDC4 gene were tested for association with longevity in a cohort of 64-107 aged individuals. We then determined whether the longevity-associated SNPs were correlated with metabolic parameters in the age group 64-85 years. RobustSNP association tests showed that rs1981429 was negatively associated with longevity (Theop=0.028), but also with high levels of triglyceride (Theop=0.028) and low levels of low-density lipoprotein-cholesterol (LDL-C) (Theop=0.009). On the other hand, rs2251252 was found to be positively correlated with longevity (Theop=0.018) and high LDL-C (Theop=0.022). On the whole, our results suggest that SDC4 alleles affect lipid profile in elderly subjects and may in part mediate the link between LDL-C and longevity.
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Affiliation(s)
- Giuseppina Rose
- Department of Biology, Ecology and Earth Science, University of Calabria, Rende 87036, Italy.
| | - Paolina Crocco
- Department of Biology, Ecology and Earth Science, University of Calabria, Rende 87036, Italy
| | - Francesco De Rango
- Department of Biology, Ecology and Earth Science, University of Calabria, Rende 87036, Italy
| | | | - Fabrizia Lattanzio
- Scientific Direction of the Italian National Research Centre on Ageing, Ancona 6100, Italy
| | - Maria De Luca
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Giuseppe Passarino
- Department of Biology, Ecology and Earth Science, University of Calabria, Rende 87036, Italy
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18
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Lv YB, Yin ZX, Chei CL, Qian HZ, Kraus VB, Zhang J, Brasher MS, Shi XM, Matchar DB, Zeng Y. Low-density lipoprotein cholesterol was inversely associated with 3-year all-cause mortality among Chinese oldest old: data from the Chinese Longitudinal Healthy Longevity Survey. Atherosclerosis 2015; 239:137-42. [PMID: 25602855 PMCID: PMC4441211 DOI: 10.1016/j.atherosclerosis.2015.01.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 12/25/2014] [Accepted: 01/05/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Low-density lipoprotein cholesterol (LDL-C) is a risk factor for survival in middle-aged individuals, but conflicting evidence exists on the relationship between LDL-C and all-cause mortality among the elderly. The goal of this study was to assess the relationship between LDL-C and all-cause mortality among Chinese oldest old (aged 80 and older) in a prospective cohort study. METHODS LDL-C concentration was measured at baseline and all-cause mortality was calculated over a 3-year period. Multiple statistical models were used to adjust for demographic and biological covariates. RESULTS During three years of follow-up, 447 of 935 participants died, and the overall all-cause mortality was 49.8%. Each 1 mmol/L increase of LDL-C concentration corresponded to a 19% decrease in 3-year all-cause mortality (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.71-0.92). The crude HR for abnormally higher LDL-C concentration (≥3.37 mmol/L) was 0.65 (0.41-1.03); and the adjusted HR was statistically significant around 0.60 (0.37-0.95) when adjusted for different sets of confounding factors. Results of sensitivity analysis also showed a significant association between higher LDL-C and lower mortality risk. CONCLUSIONS Among the Chinese oldest old, higher LDL-C level was associated with lower risk of all-cause mortality. Our findings suggested the necessity of re-evaluating the optimal level of LDL-C among the oldest old.
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Affiliation(s)
- Yue-Bin Lv
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhao-Xue Yin
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Choy-Lye Chei
- Health Services and Systems Research, Duke-NUS Graduate Medical School Singapore, Singapore
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Virginia Byers Kraus
- Duke Molecular Physiology Institute, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Juan Zhang
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Melanie Sereny Brasher
- Department of Sociology and Anthropology, Department of Human Development and Family Studies, University of Rhode Island, Kingston, RI, USA
| | - Xiao-Ming Shi
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - David Bruce Matchar
- Health Services and Systems Research, Duke-NUS Graduate Medical School Singapore, Singapore; Center for Clinical Health Policy Research and Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Yi Zeng
- Center for the Study of Aging and Human Development and the Geriatric Division of School of Medicine, Duke University, Durham, NC, USA; Center for Study of Healthy Aging and Development Studies, Peking University, Beijing, China.
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