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Pasha R, Bashir B, Omed D, Adam S, Kamath A, Elhofy A, Ferdousi M, Azmi S, Soran H. Impact of Lipid-lowering Therapy on Cancer Risk: A Narrative Review. Clin Ther 2024; 46:411-419. [PMID: 38744540 DOI: 10.1016/j.clinthera.2024.03.004] [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: 11/13/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE There are inconsistent reports of an association between low cholesterol, use of lipid-lowering agents, and carcinogenesis. The purpose of this paper was to examine the relationship between cancer, lipids, statin use, and use of other lipid-lowering therapies. METHODS This comprehensive literature review incorporated article searches in electronic databases (Embase, PubMed, OVID) and reference lists of relevant articles, with the authors' expertise in lipidology. This review considered seminal and novel research looking at the relationship between cholesterol, lipid-lowering therapies, and cancer. FINDINGS Statin use has been reported to reduce the risk for incident cancer or progression of cancer; however, it is unknown whether this reduced risk of carcinogenesis is due to the pleotropic properties of statins or the effects of low cholesterol. The effect of ezetimibe on carcinogenesis has been regarded as neutral, despite earlier concerns of increased cancer risk with its use. Proprotein convertase subtilisin/kexin (PCSK)-9 monoclonal antibodies have been shown to have a neutral effect on carcinogenesis. Despite anti-cancer effects of fibrates in vitro, studies in humans have yielded inconsistent outcomes leaning toward protection against the development and progression of cancer. IMPLICATIONS Statins, fibrates, PCSK9 monoclonal antibodies, and ezetimibe have a neutral effect on cancer risk, and the first three may provide some protection. PSCK9 monoclonal antibodies have the potential to enhance the response to checkpoint inhibitor therapy for cancer. Further research is needed to determine which drugs can be issued in adjuvant therapy to improve outcomes in patients undergoing cancer treatment.
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Affiliation(s)
- Raabya Pasha
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom; NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Bilal Bashir
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom; NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Diya Omed
- Faculty of Medicine, University of Kurdistan, Erbil, Iraq
| | - Safwaan Adam
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Department of Endocrinology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Anoushka Kamath
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Ahmed Elhofy
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Shazli Azmi
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Trust, Manchester, United Kingdom
| | - Handrean Soran
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom; Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Trust, Manchester, United Kingdom.
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Lee J, Park HK, Kwon MJ, Ham SY, Gil HI, Lim SY, Song JU. Increased Apolipoprotein B/Apolipoprotein A-I Ratio Is Associated With Decline in Lung Function in Healthy Individuals: The Kangbuk Samsung Health Study. J Korean Med Sci 2024; 39:e51. [PMID: 38374625 PMCID: PMC10876430 DOI: 10.3346/jkms.2024.39.e51] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/14/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Lung dysfunction and high apolipoprotein B/apolipoprotein A-I (apoB/apoA-I) ratio are both recognized risk factors for cardiovascular disease. However, few studies have examined the association between the apoB/ApoA-I ratio and lung function. Therefore, we investigated whether this ratio is associated with decreased lung function in a large healthy cohort. METHODS We performed a cohort study on 68,418 healthy Koreans (34,797 males, mean age: 38.1 years) who underwent a health examination in 2019. ApoB/apoA-I ratio was categorized into quartiles. Spirometric values at the fifth percentile in our population were considered the lower limit of normal (LLN), which was used to define lung function impairment. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs), using the lowest quartile as the reference, were estimated to determine lung function impairment. RESULTS Mean apoB/apoA-I ratio was 0.67 ± 0.21. Subjects with the highest quartile of this ratio had the lowest predicted forced expiratory volume in one second (FEV1%) and forced vital capacity (FVC%) after controlling for covariates (P < 0.001). However, FEV1/FVC ratio was not significantly different among the four quartiles (P = 0.059). Compared with the lowest quartile (Q1, reference), the aORs (95% CI) for FEV1% < LLN across increasing quartiles (from Q2 to Q4) were 1.216 (1.094-1.351), 1.293 (1.156-1.448), and 1.481 (1.311-1.672) (P for trend < 0.001), respectively. Similarly, the aORs for FVC% < LLN compared with the reference were 1.212 (1.090-1.348), 1.283 (1.147-1.436), and 1.502 (1.331-1.695) with increasing quartiles (P for trend < 0.001). However, the aORs for FEV1/FVC < LLN were not significantly different among groups (P for trend = 0.273). CONCLUSION High apoB/apoA-I ratio was associated with decreased lung function. However, longitudinal follow-up studies are required to validate our findings.
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Affiliation(s)
- Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Min-Jung Kwon
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Il Gil
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Si-Young Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Nguyen XT, Ho Y, Li Y, Song RJ, Leung KH, Rahman SU, Orkaby AR, Vassy JL, Gagnon DR, Cho K, Gaziano JM, Wilson PWF. Serum Cholesterol and Impact of Age on Coronary Heart Disease Death in More Than 4 Million Veterans. J Am Heart Assoc 2023; 12:e030496. [PMID: 37889207 PMCID: PMC10727410 DOI: 10.1161/jaha.123.030496] [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: 04/06/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
Background The lipid hypothesis postulates that lower blood cholesterol is associated with reduced coronary heart disease (CHD) risk, which has been challenged by reports of a U-shaped relation between cholesterol and death in recent studies. We sought to examine whether the U-shaped relationship is true and to assess the impact of age on this association. Method and Results We conducted a prospective cohort study of 4 467 942 veterans aged >18 years, with baseline outpatient visits from 2002 to 2007 and follow-up to December 30, 2018, in the Veterans Health Administration electronic health record system. We observed a J-shaped relation between total cholesterol (TC) and CHD mortality after a comprehensive adjustment of confounding factors: flat for TC <180 mg/dL, and greater risk was present at higher cholesterol levels. Compared with veterans with TC between 180 and 199 mg/dL, the multiadjusted hazard ratios (HRs) for CHD death were 1.03 (95% CI, 1.02-1.04), 1.07 (95% CI, 1.06-1.09), 1.15 (95% CI, 1.13-1.18), 1.25 (95% CI, 1.22-1.28), and 1.45 (95% CI, 1.42-1.49) times greater among veterans with TC (mg/dL) of 200 to 219, 220 to 239, 140 to 259, 260 to 279 and ≥280, respectively. Similar J-shaped TC-CHD mortality patterns were observed among veterans with and without statin use at or before baseline. Conclusions The cholesterol paradox, for example, higher CHD death in patients with a low cholesterol level, was a reflection of reverse causality, especially among older participants. Our results support the lipid hypothesis that lower blood cholesterol is associated with reduced CHD. Furthermore, the hypothesis remained true when TC was low due to use of statins or other lipid-lowering medication.
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Affiliation(s)
- Xuan‐Mai T. Nguyen
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Carle Illinois College of MedicineUniversity of Illinois Urbana ChampaignChampaignILUSA
| | - Yuk‐Lam Ho
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
| | - Yanping Li
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
| | | | - Kenneth H. Leung
- Carle Illinois College of MedicineUniversity of Illinois Urbana ChampaignChampaignILUSA
| | - Saad Ur Rahman
- Carle Illinois College of MedicineUniversity of Illinois Urbana ChampaignChampaignILUSA
| | - Ariela R. Orkaby
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Division on Aging, Department of MedicineBrigham and Women’s HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Jason L. Vassy
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Division of General Internal MedicineBrigham and Women’s HospitalBostonMAUSA
| | - David R. Gagnon
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Boston University School of Public HealthBostonMAUSA
| | - Kelly Cho
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Division on Aging, Department of MedicineBrigham and Women’s HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - J. Michael Gaziano
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Division on Aging, Department of MedicineBrigham and Women’s HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Peter W. F. Wilson
- Atlanta VA Medical CenterDecaturGAUSA
- Emory University Schools of Medicine and Public HealthAtlantaGAUSA
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Oner E, Kahraman S, Agus HZ, Guner A, Dogan AC, Yildiz MM, Erturk M. Naples score is associated with SYNTAX Score in patients with ST-segment elevation myocardial infarction. Coron Artery Dis 2023; 34:504-509. [PMID: 37799047 DOI: 10.1097/mca.0000000000001278] [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: 10/07/2023]
Abstract
OBJECTIVE The Naples Score (NS) predicts adverse outcomes in ST-elevation myocardial infarction (STEMI) patients, but the relationship between NS and the severity of coronary artery disease (CAD) in patients with STEMI has not been studied. In this study, we aimed to evaluate the role of NS at admission in predicting SYNTAX Score (SS). METHOD We gathered the data from 499 consecutive STEMI patients who underwent percutaneous coronary intervention between January 2018 and September 2020. Patients were divided into two groups: low SS group (≤22) and intermediate to high SS group (>22). NS was calculated for both groups besides baseline clinical and demographic variables. RESULTS NS was higher in the intermediate to high SS group and the SS was increasing as the NS escalates. In multivariate logistic regression analysis, the NS was an independent predictor of intermediate to high SS. Additionally, there was a positive correlation between SS and NS. CONCLUSION Presentation NS predicts CAD complexity in patients with STEMI.
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Affiliation(s)
- Ender Oner
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
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Lavie CJ, Rozanski A, Heymsfield SB. Low Cholesterol and Valvular Heart Disease Mortality: Another Cardiovascular Paradox. Am J Cardiol 2023; 206:343-344. [PMID: 37743144 DOI: 10.1016/j.amjcard.2023.08.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana.
| | - Alan Rozanski
- Division of Cardiology, Mt Sinai Morningside Hospital, New York, New York
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
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Park JS, Cho KH, Hong YJ, Kim MC, Sim DS, Kim JH, Ahn Y, Jeong MH. Baseline Lipoprotein(a) Levels and Long-Term Cardiovascular Outcomes After Acute Myocardial Infarction. J Korean Med Sci 2023; 38:e102. [PMID: 37012687 PMCID: PMC10070047 DOI: 10.3346/jkms.2023.38.e102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/27/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Lipoprotein(a) is a known independent risk factor for atherosclerotic cardiovascular disease. However, the prognostic impact of the baseline lipoprotein(a) levels on long-term clinical outcomes among patients with acute myocardial infarction remain unclear. METHODS We analyzed 1,908 patients with acute myocardial infarction from November 2011 to October 2015 from a single center in Korea. They were divided into 3 groups according to their baseline lipoprotein(a) levels: groups I (< 30 mg/dL, n = 1,388), II (30-49 mg/dL, n = 263), and III (≥50 mg/dL, n = 257). Three-point major adverse cardiovascular events (a composite of nonfatal myocardial infarction, nonfatal stroke, and cardiac death) at 3 years were compared among the 3 groups. RESULTS The patients were followed for 1094.0 (interquartile range, 1,033.8-1,095.0) days, during which a total of 326 (17.1%) three-point major adverse cardiovascular events occurred. Group III had higher rates of three-point major adverse cardiovascular events compared with Group I (23.0% vs. 15.7%; log-rank P = 0.009). In the subgroup analysis, group III had higher rates of three-point major adverse cardiovascular events compared with group I in patients with non-ST-segment elevation myocardial infarction (27.0% vs. 17.1%; log-rank P = 0.006), but not in patients with ST-segment elevation myocardial infarction (14.4% vs. 13.3%; log-rank P = 0.597). However, in multivariable Cox time-to-event models, baseline lipoprotein(a) levels were not associated with an increased incidence of three-point major adverse cardiovascular events, regardless of the type of acute myocardial infarction. Sensitivity analyses in diverse subgroups showed similar findings to those of the main analysis. CONCLUSION Baseline lipoprotein(a) levels in Korean patients with acute myocardial infarction were not independently associated with increased major adverse cardiovascular events at 3 years.
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Affiliation(s)
- Joon Sung Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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7
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Cho KH, Kim MC, Choo EH, Choi IJ, Lee SN, Park MW, Park CS, Kim HY, Kim CJ, Sim DS, Kim JH, Hong YJ, Jeong MH, Chang K, Ahn Y. Impact of Low Baseline Low-Density Lipoprotein Cholesterol on Long-Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial Infarction. J Am Heart Assoc 2022; 11:e025958. [PMID: 36000434 PMCID: PMC9496430 DOI: 10.1161/jaha.122.025958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Real‐world data on low baseline low‐density lipoprotein cholesterol (LDL‐C) levels and long‐term postdischarge cardiovascular outcomes in patients with acute coronary syndrome are limited. Methods and Results Of the 10 719 patients enrolled in the Korean registry of acute myocardial infarction between January 2004 and August 2014, we identified 5532 patients who were event free from death, recurrent myocardial infarction, or stroke during the in‐hospital period after successful percutaneous coronary intervention. The co–primary outcomes were 3‐point major adverse cardiovascular events (a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and cardiovascular death at 5 years. Of 5532 patients with acute myocardial infarction (mean age, 62.1±12.8 years; 75.0% men), 446 cardiovascular deaths (8.1%) and 695 three‐point major adverse cardiovascular events (12.6%) occurred at 5 years. In the continuous analysis of LDL‐C, the risk of cardiovascular events increased steeply as LDL‐C levels decreased from 100 mg/dL. For categorical analysis of LDL‐C (<70, 70–99, and ≥100 mg/dL), as LDL‐C levels decreased, clinical outcomes worsened (237/3759 [6.3%] in LDL‐C ≥100 mg/dL versus 123/1291 [9.5%] in LDL‐C 70–99 mg/dL versus 86/482 [17.8%] in LDL‐C <70 mg/dL for cardiovascular death; P‐trend<0.001; and 417/3759 [11.1%] in LDL‐C ≥100 mg/dL versus 172/1291 [13.3%] in LDL‐C 70–99 mg/dL versus 106/482 [22.2%] in LDL‐C <70 mg/dL for 3‐point major adverse cardiovascular event; P‐trend<0.001). In a Cox time‐to‐event multivariable model with LDL‐C levels ≥100 mg/dL as the reference, the baseline LDL‐C level <70 mg/dL was independently associated with an increased incidence of cardiovascular death (adjusted hazard ratio, 1.68 [95% CI, 1.30–2.17]) and 3‐point major adverse cardiovascular event (adjusted hazard ratio, 1.37 [95% CI, 1.10–1.71]). Conclusions In this Korean acute myocardial infarction registry, the baseline LDL‐C level <70 mg/dL was significantly associated with an increased incidence of long‐term cardiovascular events after discharge. (COREA [Cardiovascular Risk and Identification of Potential High‐Risk Population]‐Acute Myocardial Infarction Registry; NCT02806102). Registration URL: https://www.clinicaltrials.gov/; Unique identifier: NCT02806102.
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Affiliation(s)
- Kyung Hoon Cho
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea
| | - Min Chul Kim
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Eun Ho Choo
- Department of Cardiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Ik Jun Choi
- Department of Cardiology Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Incheon Republic of Korea
| | - Su Nam Lee
- Department of Cardiology St Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon Republic of Korea
| | - Mahn-Won Park
- Department of Cardiology Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Daejeon Republic of Korea
| | - Chul Soo Park
- Department of Cardiology Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Hee-Yeol Kim
- Department of Cardiology Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Bucheon Republic of Korea
| | - Chan Joon Kim
- Department of Cardiology Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Doo Sun Sim
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Ju Han Kim
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Young Joon Hong
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Kiyuk Chang
- Department of Cardiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
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Lim JH, Shin CM, Han K, Yoo J, Jin EH, Choi YJ, Lee DH. Nationwide cohort study: cholesterol level is inversely related with the risk of gastric cancer among postmenopausal women. Gastric Cancer 2022; 25:11-21. [PMID: 34468870 DOI: 10.1007/s10120-021-01241-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies showed inverse relationship between hypercholesterolemia and the risk of gastric cancer, especially among male. However evidence among female is inconsistent. We aimed to investigate the relationship between cholesterol level and the risk of gastric cancer among female according to menopausal status. METHODS We analyzed the data from a population-based prospective cohort of female ≥ 30 years old who underwent cancer screening and general health screening provided by the Korean National Health Insurance Corporation in 2009. Under quartile stratification of the level of cholesterol components, we calculated the hazard ratio (HR) for gastric cancer incidence until 2018 for each level group according to the menopausal status at 2009. RESULTS Among total 2,722,614 individuals, 17,649 gastric cancer cases developed after mean 8.26 years of follow-up (premenopausal 3746/1180666; postmenopausal 13,903/1541948). Total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) showed inverse relationship with the risk of gastric cancer among postmenopausal women (adjusted HR (95% confidence interval) for the highest quartile vs. lowest quartile and p-for-trend: 0.88 (0.84-0.92) and < 0.001 for total cholesterol; 0.89 (0.85-0.92) and < 0.001 for HDL-C; 0.92 (0.89-0.97) and 0.001 for LDL-C), whereas none showed statistically significant risk relationship among premenopausal women. Triglyceride was not independently related with gastric cancer risk among both pre- and postmenopausal women. CONCLUSIONS Cholesterol levels, including total cholesterol, HDL-C, and LDL-C, are inversely related with the risk of gastric cancer among postmenopausal women, but not among premenopausal women.
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Affiliation(s)
- Joo Hyun Lim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Cheol Min Shin
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. .,Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Juhwan Yoo
- Department of Biomedicine and Health Science, The Catholic University of Korea, Seoul, Korea
| | - Eun Hyo Jin
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Yoon Jin Choi
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Ho Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
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Association of statin use in older people primary prevention group with risk of cardiovascular events and mortality: a systematic review and meta-analysis of observational studies. BMC Med 2021; 19:139. [PMID: 34154589 PMCID: PMC8218529 DOI: 10.1186/s12916-021-02009-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Current evidence from randomized controlled trials on statins for primary prevention of cardiovascular disease (CVD) in older people, especially those aged > 75 years, is still lacking. We conducted a systematic review and meta-analysis of observational studies to extend the current evidence about the association of statin use in older people primary prevention group with risk of CVD and mortality. METHODS PubMed, Scopus, and Embase were searched from inception until March 18, 2021. We included observational studies (cohort or nested case-control) that compared statin use vs non-use for primary prevention of CVD in older people aged ≥ 65 years; provided that each of them reported the risk estimate on at least one of the following primary outcomes: all cause-mortality, CVD death, myocardial infarction (MI), and stroke. Risk estimates of each relevant outcome were pooled as a hazard ratio (HR) with a 95% confidence interval (CI) using the random-effects meta-analysis model. The quality of the evidence was rated using the GRADE approach. RESULTS Ten observational studies (9 cohorts and one case-control study; n = 815,667) fulfilled our criteria. The overall combined estimate suggested that statin therapy was associated with a significantly lower risk of all-cause mortality (HR: 0.86 [95% CI 0.79 to 0.93]), CVD death (HR: 0.80 [95% CI 0.78 to 0.81]), and stroke (HR: 0.85 [95% CI 0.76 to 0.94]) and a non-significant association with risk of MI (HR 0.74 [95% CI 0.53 to 1.02]). The beneficial association of statins with the risk of all-cause mortality remained significant even at higher ages (> 75 years old; HR 0.88 [95% CI 0.81 to 0.96]) and in both men (HR: 0.75 [95% CI: 0.74 to 0.76]) and women (HR 0.85 [95% CI 0.72 to 0.99]). However, this association with the risk of all-cause mortality remained significant only in those with diabetes mellitus (DM) (HR 0.82 [95% CI 0.68 to 0.98]) but not in those without DM. The level of evidence of all the primary outcomes was rated as "very low." CONCLUSIONS Statin therapy in older people (aged ≥ 65 years) without CVD was associated with a 14%, 20%, and 15% lower risk of all-cause mortality, CVD death, and stroke, respectively. The beneficial association with the risk of all-cause mortality remained significant even at higher ages (> 75 years old), in both men and women, and in individuals with DM, but not in those without DM. These observational findings support the need for trials to test the benefits of statins in those above 75 years of age.
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10
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Role of cholesterol metabolism in the anticancer pharmacology of selective estrogen receptor modulators. Semin Cancer Biol 2020; 73:101-115. [PMID: 32931953 DOI: 10.1016/j.semcancer.2020.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022]
Abstract
Selective estrogen receptor modulators (SERMs) are a class of compounds that bind to estrogen receptors (ERs) and possess estrogen agonist or antagonist actions in different tissues. As such, they are widely used drugs. For instance, tamoxifen, the most prescribed SERM, is used to treat ERα-positive breast cancer. Aside from their therapeutic targets, SERMs have the capacity to broadly affect cellular cholesterol metabolism and handling, mainly through ER-independent mechanisms. Cholesterol metabolism reprogramming is crucial to meet the needs of cancer cells, and different key processes involved in cholesterol homeostasis have been associated with cancer progression. Therefore, the effects of SERMs on cholesterol homeostasis may be relevant to carcinogenesis, either by contributing to the anticancer efficacy of these compounds or, conversely, by promoting resistance to treatment. Understanding these aspects of SERMs actions could help to design more efficacious therapies. Herein we review the effects of SERMs on cellular cholesterol metabolism and handling and discuss their potential in anticancer pharmacology.
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Low total cholesterol and high density lipoprotein are independent predictors of poor outcomes following aneurysmal subarachnoid hemorrhage: A preliminary report. Clin Neurol Neurosurg 2020; 197:106062. [PMID: 32688095 DOI: 10.1016/j.clineuro.2020.106062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (aSAH) is devastating, with delayed cerebral ischemia (DCI) significantly contributing to the high morbidity and mortality rates. Cholesterol has been studied as a measure of nutritional status in other neurological pathologies, but reports examining cholesterol's effects on aSAH outcomes are sparse. This study aimed to elucidate the effect of low total cholesterol (TC) and high density lipoprotein (HDL) on mortality and DCI following aSAH. METHODS We performed a retrospective cohort study at a quaternary academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography and had TC measured on admission. Primary outcomes were mortality and DCI. Secondary outcome was radiographic vasospasm. Univariate and multivariate logistic regressions were performed. RESULTS There were 75 aSAH patients, with an average age of 58.7 ± 1.7 (range: 14-89) and Hunt & Hess score of 2.8 ± 0.1, included for analysis. Those with a low TC < 160 mg/dL had 3 times increased odds of DCI (OR = 3.4; 95 %CI: 1.3-9.0; p = 0.0175) and a nearly 5 times increased odds of death (OR = 4.9; 95 %CI: 1.1-18.3; p = 0.0339). Low HDL < 40 mg/dL was associated with 12 times increased odds of DCI (OR = 12.3; 95 %CI: 2.7-56.4; p = 0.0003) but no significant differences in death (p = 0.2205). In multivariate analysis, low TC was an independent risk factor for increased mortality (OR = 5.6; 95 %CI: 1.2-27.6; p = 0.0335) while low HDL was associated with increased risk for DCI (OR = 17.9; 95 %CI: 3.1-104.4; p = 0.0013). There was no effect of TC or HDL on radiographic vasospasm. CONCLUSIONS Low TC and HDL are independent predictors of increased mortality and DCI, respectively, following aSAH. Low TC and HDL may be markers of poor overall health, in addition to having some pathophysiological effect on cerebral vasculature. These results may have practical implications for the improvement of aSAH prognostication and management.
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Li W, Li M, Wang T, Ma G, Deng Y, Pu D, Liu Z, Wu Q, Liu X, Zhou Q. Controlling Nutritional Status (CONUT) score is a prognostic factor in patients with resected breast cancer. Sci Rep 2020; 10:6633. [PMID: 32313183 PMCID: PMC7171067 DOI: 10.1038/s41598-020-63610-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/27/2020] [Indexed: 02/05/2023] Open
Abstract
The present study aimed to determine the correlation between controlling nutritional status (CONUT) and prognosis in resected breast cancer patients. Totally, 861 breast cancer patients with surgical resection in West China Hospital of Sichuan University between 2007 and 2010 were included. The relationship between CONUT and various clinicopathological factors as well as prognosis was evaluated. The results showed that the optimal cutoff value for CONUT to predict the 5-year survival was 3 and CONUT had a higher area under the ROC curve (AUC) for 5-year disease free survival (DFS) and overall survival (OS) prediction compared with the neutrophil lymphocyte ratio (NLR) and prognostic nutritional index (PNI). High CONUT was significantly correlated with older age, lymph node involvement, advanced T-stage, and surgery type. In the multivariate analysis, CONUT-high patients had worse DFS and OS, when compared with CONUT-low patients. In conclusion, preoperative CONUT is a useful marker for predicting long term outcomes in breast cancer patients after curative resection.
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Affiliation(s)
- Wen Li
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Min Li
- Department of Cancer, The People's Hospital of Yuechi, Guang'an, Sichuan, 638300, P.R. China
| | - Ting Wang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Guangzhi Ma
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Yunfu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Dan Pu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Zhenkun Liu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Qiang Wu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Xuejuan Liu
- Department of Breast Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.
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Ndrepepa G, Holdenrieder S, Cassese S, Xhepa E, Fusaro M, Kastrati A. Hypocholesterolaemia and mortality in patients with coronary artery disease. Eur J Clin Invest 2020; 50:e13194. [PMID: 31863458 DOI: 10.1111/eci.13194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/27/2019] [Accepted: 12/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between hypocholesterolaemia and outcome of patients with coronary artery disease (CAD) remains controversial. We undertook this study to investigate whether there is an association between spontaneous or under statin therapy occurring hypocholesterolaemia and mortality in patients with CAD. MATERIALS AND METHODS This study included 14 952 patients with CAD undergoing percutaneous coronary intervention (PCI). Hypocholesterolaemia was defined as a total cholesterol (TC) <157 mg/dL (the upper limit of 1st quintile of TC). The study outcome was all-cause mortality at 30 days and 3 years after PCI. RESULTS Patients are categorized in four groups according to TC and statin therapy on admission: statin-naïve patients with hypocholesterolaemia (n = 1102), statin-naïve patients without hypocholesterolaemia (n = 7490), statin-treated patients with hypocholesterolaemia (n = 1824) and statin-treated patients without hypocholesterolaemia (n = 4536). In these groups, 30-day all-cause deaths occurred in 3.7%, 1.4%, 1.2% and 0.6% of the patients, respectively; 3-year deaths occurred in 18.0%, 8.4%, 10.9% and 7.2%, of the patients, respectively. After adjustment, hypocholesterolaemia remained independently associated with 30-day (adjusted hazard ratio [HR] = 1.50, 95% confidence interval [CI] 1.07 to 2.09; P < 0001) and 3-year (HR = 1.29 [1.12-1.47]; P < .001) mortality. Statin therapy on admission was independently associated with 30-day (HR = 0.61 [0.43-0.86]; P = .012) and 3-year (HR = 0.82 [0.72-0.94]; P = .017) mortality with no statin-by-cholesterol interaction with respect to 30-day (adjusted Pint = 0.669) or 3-year (adjusted Pint = 0.767) all-cause mortality suggesting that statins reduce the risk of mortality irrespective of cholesterol level. CONCLUSIONS In patients with CAD, hypocholesterolaemia on admission was independently associated with increased risk of all-cause mortality at 30 days and 3 years after PCI.
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Affiliation(s)
- Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Stefan Holdenrieder
- Institut für Laboratoriumsmedizin, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | | | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität, Munich, Germany.,Partner Site Munich Heart Alliance, DZHK (German Centre for Cardiovascular Research), Munich, Germany
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14
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Bahls M, Lorenz MW, Dörr M, Gao L, Kitagawa K, Tuomainen TP, Agewall S, Berenson G, Catapano AL, Norata GD, Bots ML, van Gilst W, Asselbergs FW, Brouwers FP, Uthoff H, Sander D, Poppert H, Hecht Olsen M, Empana JP, Schminke U, Baldassarre D, Veglia F, Franco OH, Kavousi M, de Groot E, Mathiesen EB, Grigore L, Polak JF, Rundek T, Stehouwer CDA, Skilton MR, Hatzitolios AI, Savopoulos C, Ntaios G, Plichart M, McLachlan S, Lind L, Willeit P, Steinmetz H, Desvarieux M, Ikram MA, Johnsen SH, Schmidt C, Willeit J, Ducimetiere P, Price JF, Bergström G, Kauhanen J, Kiechl S, Sitzer M, Bickel H, Sacco RL, Hofman A, Völzke H, Thompson SG. Progression of conventional cardiovascular risk factors and vascular disease risk in individuals: insights from the PROG-IMT consortium. Eur J Prev Cardiol 2020; 27:234-243. [PMID: 31619084 PMCID: PMC7008553 DOI: 10.1177/2047487319877078] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/29/2019] [Indexed: 12/23/2022]
Abstract
AIMS Averaged measurements, but not the progression based on multiple assessments of carotid intima-media thickness, (cIMT) are predictive of cardiovascular disease (CVD) events in individuals. Whether this is true for conventional risk factors is unclear. METHODS AND RESULTS An individual participant meta-analysis was used to associate the annualised progression of systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol with future cardiovascular disease risk in 13 prospective cohort studies of the PROG-IMT collaboration (n = 34,072). Follow-up data included information on a combined cardiovascular disease endpoint of myocardial infarction, stroke, or vascular death. In secondary analyses, annualised progression was replaced with average. Log hazard ratios per standard deviation difference were pooled across studies by a random effects meta-analysis. In primary analysis, the annualised progression of total cholesterol was marginally related to a higher cardiovascular disease risk (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.00 to 1.07). The annualised progression of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol was not associated with future cardiovascular disease risk. In secondary analysis, average systolic blood pressure (HR 1.20 95% CI 1.11 to 1.29) and low-density lipoprotein cholesterol (HR 1.09, 95% CI 1.02 to 1.16) were related to a greater, while high-density lipoprotein cholesterol (HR 0.92, 95% CI 0.88 to 0.97) was related to a lower risk of future cardiovascular disease events. CONCLUSION Averaged measurements of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol displayed significant linear relationships with the risk of future cardiovascular disease events. However, there was no clear association between the annualised progression of these conventional risk factors in individuals with the risk of future clinical endpoints.
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Affiliation(s)
- Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - Matthias W Lorenz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - Lu Gao
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, University of Cambridge, UK
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Stefan Agewall
- Institute of Clinical Sciences, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital Ullevål, Ullevål, Oslo, Norway
| | - Gerald Berenson
- Department of Medicine, Pediatrics, Biochemistry, Epidemiology, Tulane University School of Medicine and School of Public Health and Tropical Medicine, New Orleans, USA
| | - Alberico L Catapano
- IRCSS Multimedica, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Giuseppe D Norata
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- SISA Center for the Study of Atherosclerosis, Bassini Hospital, Italy
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wiek van Gilst
- Department of Experimental Cardiology, University Medical Center Groningen, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Institute of Cardiovascular Science, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Frank P Brouwers
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Heiko Uthoff
- Department of Angiology, University Hospital Basel, Basel, Switzerland
| | - Dirk Sander
- Department of Neurology, Benedictus Hospital Tutzing, Tutzing, Germany
| | - Holger Poppert
- Department of Neurology, Technical University Munich, Munich, Germany
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital and Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Jean Philippe Empana
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre, Paris, France
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Damiano Baldassarre
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Università di Milano, Milan, Italy
| | | | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric de Groot
- Imagelabonline and Cardiovascular, Erichem, The Netherlands
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Liliana Grigore
- Centro Sisa per lo Studio della Aterosclerosi, Bassini Hospital, Cinisello Balsamo, Italy
| | - Joseph F Polak
- Tufts University School of Medicine, Tufts Medical Center, Boston, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, USA
| | - Coen DA Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michael R Skilton
- The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Apostolos I Hatzitolios
- Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki – AHEPA Hospital, Greece
| | - Christos Savopoulos
- Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki – AHEPA Hospital, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Matthieu Plichart
- Centro Sisa per lo Studio della Aterosclerosi, Bassini Hospital, Cinisello Balsamo, Italy
- Assistance Publique, Hôpitaux de Paris, Hôpital Broca, Paris, France
| | | | - Lars Lind
- Department of Medicine, Uppsala University, Uppsala, Sweden
| | - Peter Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Helmuth Steinmetz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- METHODS Core, Centre de Recherche Epidémiologie et Statistique Paris Sorbonne Cité (CRESS), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Paris, France
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Stein Harald Johnsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Caroline Schmidt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Johann Willeit
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Clinical Physiology, Gothenburg, Sweden
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Matthias Sitzer
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
- Department of Neurology, Klinikum Herford, Herford, Germany
| | - Horst Bickel
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, USA
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology | Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - Simon G Thompson
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Ueshima D, Yoshikawa S, Sasaoka T, Hatano Y, Kurihara K, Maejima Y, Isobe M, Ashikaga T. The Hypercholesterolemia Paradox in Percutaneous Coronary Intervention: An Analysis of a Multicenter PCI Registry. Intern Med 2019; 58:345-353. [PMID: 30210130 PMCID: PMC6395118 DOI: 10.2169/internalmedicine.1553-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The aim of this study was to assess the relationship between hypercholesterolemia (HC) and clinical events through a percutaneous coronary intervention (PCI) registry. HC is a well-known independent risk factor for long-term cardiovascular events after PCI. However, it has been reported to be associated with a lower risk of adverse events in patients with cancer or acute coronary syndrome. Methods We analyzed the relationship between HC and adverse events in patients treated with everolimus-eluting stents (EESs) through the Tokyo-MD PCI study (an all-comer, multicenter, observational registry). The propensity score method was applied to select two groups with similar baseline characteristics. Results The unadjusted population included 1,536 HC patients and 330 non-HC patients. Propensity score matching yielded 314 matched pairs. After baseline adjustment, the outcomes of HC patients were significantly better than those of the non-HC patients with respect to the primary endpoint, which was a combination of mortality from all causes, nonfatal myocardial infarction (MI), nonfatal neurological events, and major bleeding [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.39-0.81; p=0.002], and the secondary endpoints, which included a combination of mortality from all causes, nonfatal MI, and nonfatal neurological events (HR 0.59, 95% CI 0.39-0.88; p=0.01), and major bleeding (HR 0.42, 95% CI 0.20-0.88; p=0.02). A subgroup analysis showed age as an interaction factor for the primary endpoint (interaction p=0.035). Conclusion HC was associated with better outcomes in patients who underwent EES implantation, even after baseline adjustment.
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Affiliation(s)
- Daisuke Ueshima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | | | - Taro Sasaoka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | - Yu Hatano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | - Ken Kurihara
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| | | | - Takashi Ashikaga
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
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Correlation of Paraoxonase-1 with the Severity of Crohn's Disease. Molecules 2018; 23:molecules23102603. [PMID: 30314292 PMCID: PMC6222603 DOI: 10.3390/molecules23102603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 12/17/2022] Open
Abstract
Diagnostics of Crohn’s disease (CD) requires noninvasive biomarkers facilitating early detection and differentiation of the disease. Therefore, in this study, we aimed to determine the relationship between paraoxonase-1 (PON-1), the severity of CD, oxidative stress, and inflammation in CD. The CD activity index was based on the current classification. Plasma PON-1 was measured in 47 patients with CD, and in 23 control volunteers. Using quantitative variables such as receiver operating characteristics (ROC) (area under the curve (AUC)), the diagnostic utility of PON-1 in differentiating the severity of CD was assessed. Circulating PON-1 was found to be decreased in the CD group compared to the control group (269.89 vs. 402.56 U/L, respectively), and it correlated well with the disease activity. PON-1 correlated positively with hemoglobin (Hb) (r = 0.539, p < 0.001), hematocrit (Ht) (r = 0.48, p < 0.001), total cholesterol (TC) (r = 0.343, p < 0.001), high density lipoprotein (HDL) (r = 0.536, p < 0.001), low density lipoprotein (LDL) (r = 0.54, p < 0.001), and triglyceride (TG) (r = 0.561, p < 0.001) and correlated negatively with white blood cell count (WBC) (r = −0.262, p = 0.029), platelet count (PLT) (r = −0.326, p = 0.006), C-reactive protein (CRP) (r = −0.61, p < 0.001), and malondialdehyde (MDA) (r = −0.924, p < 0.001). PON-1 as a marker for CD differentiation possessed a sensitivity and specificity of 93.62% and 91.30%, respectively. CD was found to be associated with the decrease in the levels of PON-1, which correlates well with activity of the disease and reflects the intensification of inflammation, as well as intensified lipid peroxidation. High sensitivity and specificity of PON-1 determines its selection as a good screening test for CD severity.
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17
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Jeong SM, Choi S, Kim K, Kim SM, Lee G, Park SY, Kim YY, Son JS, Yun JM, Park SM. Effect of Change in Total Cholesterol Levels on Cardiovascular Disease Among Young Adults. J Am Heart Assoc 2018; 7:e008819. [PMID: 29899019 PMCID: PMC6220545 DOI: 10.1161/jaha.118.008819] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/16/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although high serum cholesterol in young adults is known to be a predictor for cardiovascular events, there is not enough evidence for the association of cholesterol level change with cardiovascular disease (CVD). This study aimed to evaluate whether the change in cholesterol is associated with incidence of CVD among young adults. METHODS AND RESULTS We examined 2 682 045 young adults (aged 20-39 years) who had undergone 2 consecutive national health check-ups provided by Korean National Health Insurance Service between 2002 and 2005. Cholesterol levels were classified into low (<180 mg/dL), middle (180-240 mg/dL) and high (≥240 mg/dL). CVD events were defined as ≥2 days hospitalization attributable to CVD for 10 years follow-up. Increased cholesterol levels were significantly associated with elevated ischemic heart disease risk (adjusted hazard ration [aHR]=1.21; 95% confidence interval [CI]=1.03-1.42 in low-high group and aHR=1.21; 95% CI=1.15-1.27 in middle-high group) and cerebrovascular disease (CEVD) risk (aHR=1.24; 95% CI=1.05-1.47 in low-high group and aHR=1.09; 95% CI=1.02-1.16 in middle-high group). Decreased cholesterol levels were associated with reduced ischemic heart disease risk (aHR=0.91; 95% CI=0.88-0.95 in middle-low group, aHR=0.65; 95% CI=0.56-0.75 in high-low group and aHR=0.68; 95% CI=0.65-0.73 in high-middle group). Furthermore, lower cerebrovascular disease risk (aHR=0.76; 95% CI=0.62-0.92) was observed in the high-low group compared with patients with sustained high cholesterol. CONCLUSIONS The findings of our study indicate that increased cholesterol levels were associated with high CVD risk in young adults. Furthermore, young adults with decreased cholesterol levels had reduced risk for CVD.
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Affiliation(s)
- Su-Min Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Health Promotion Center, Chung-Ang University Hospital, Seoul, Korea
| | - Seong Yong Park
- Big Data Steering Department, National Health Insurance Service, Wonju, Korea
| | - Yeon-Yong Kim
- Big Data Steering Department, National Health Insurance Service, Wonju, Korea
| | - Joung Sik Son
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Korea
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18
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Jeong SM, Choi S, Kim K, Kim SM, Lee G, Son JS, Yun JM, Park SM. Association of change in total cholesterol level with mortality: A population-based study. PLoS One 2018; 13:e0196030. [PMID: 29672595 PMCID: PMC5908176 DOI: 10.1371/journal.pone.0196030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/05/2018] [Indexed: 11/18/2022] Open
Abstract
Background Hypercholesterolemia is a well-established risk factor for coronary heart disease, but the association between cholesterol level change and mortality is not fully understood. We aimed to investigate the association of 2 year (2002–2003 to 2004–2005) change in cholesterol with all-cause and cause-specific mortality in a population-based cohort study. Methods and findings The study population consisted of 269,391 participants aged more than 40 years who were free of myocardial infarction, stroke and cancer using the Korean National Health Insurance Service—National Health Screening Cohort. Cholesterol levels were classified into 1st, 2nd and 3rd tertiles during each of the first and second health examinations, respectively. The participants were followed-up for all-cause and cause-specific mortality from 1 January 2006 to 31 December 2013. Compared to participants who stayed within the 2nd tertile group for cholesterol during both the first and second examinations, participants who became or maintained cholesterol levels to the 1st tertile during the second examination had increased risk of all-cause mortality [adjusted hazard ratio (aHR) with 95% confidence interval (95% CI) = 1.28 (1.18–1.38) in 1st/1st, 1.16 (1.07–1.26) in 2nd/1st and 1.47 (1.32–1.64) in 3rd/1st tertile levels, respectively]. In addition, increased or persistent high cholesterol levels to the 3rd tertile was associated with elevated risk for all-cause mortality [aHR (95% CI) = 1.10 (1.01–1.20) in 1st/2nd, 1.16(1.03–1.31) in 1st/3rd and 1.15(1.05–1.25) in 3rd/3rd tertile levels]. Conclusions Changes in cholesterol levels in either direction to low cholesterol or persistently low cholesterol levels were associated with higher risk of mortality. Particularly, spontaneous decline in cholesterol levels may be a marker for worsening health conditions.
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Affiliation(s)
- Su-Min Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Kyuwoong Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Sung-Min Kim
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joung Sik Son
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea, Seoul, Republic of Korea
- * E-mail:
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19
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DiNicolantonio JJ, McCarty MF. Is interleukin-6 the link between low LDL cholesterol and increased non-cardiovascular mortality in the elderly? Open Heart 2018; 5:e000789. [PMID: 29682295 PMCID: PMC5905839 DOI: 10.1136/openhrt-2018-000789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 12/20/2022] Open
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Charlton J, Ravindrarajah R, Hamada S, Jackson SH, Gulliford MC. Trajectory of Total Cholesterol in the Last Years of Life Over Age 80 Years: Cohort Study of 99,758 Participants. J Gerontol A Biol Sci Med Sci 2017; 73:1083-1089. [DOI: 10.1093/gerona/glx184] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/26/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
- Judith Charlton
- Department of Primary Care and Public Health Sciences, King’s College London, UK
| | - Rathi Ravindrarajah
- Department of Primary Care and Public Health Sciences, King’s College London, UK
| | - Shota Hamada
- Department of Primary Care and Public Health Sciences, King’s College London, UK
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | | | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences, King’s College London, UK
- National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK
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21
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Crowson CS, Rollefstad S, Ikdahl E, Kitas GD, van Riel PLCM, Gabriel SE, Matteson EL, Kvien TK, Douglas K, Sandoo A, Arts E, Wållberg-Jonsson S, Innala L, Karpouzas G, Dessein PH, Tsang L, El-Gabalawy H, Hitchon C, Ramos VP, Yáñez IC, Sfikakis PP, Zampeli E, Gonzalez-Gay MA, Corrales A, Laar MVD, Vonkeman HE, Meek I, Semb AG. Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis. Ann Rheum Dis 2017; 77:48-54. [PMID: 28877868 DOI: 10.1136/annrheumdis-2017-211735] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/30/2017] [Accepted: 08/04/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA. METHODS In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions. RESULTS 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics). CONCLUSIONS In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.
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Affiliation(s)
- Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - George D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Piet L C M van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sherine E Gabriel
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tore K Kvien
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Karen Douglas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Aamer Sandoo
- Department of Rheumatology, Dudley Group NHS Foundation Trust, West Midlands, UK.,School of Sport, Health and Exercise Sciences, Bangor University, Bangor, Wales, UK
| | - Elke Arts
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Solveig Wållberg-Jonsson
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden
| | - Lena Innala
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden
| | - George Karpouzas
- Division of Rheumatology, Harbor UCLA Medical Center RHU, Torrance, California, USA
| | - Patrick H Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Rheumatology Division, UniversitairZiekenhuis and Vrije Universiteit, Brussel, Belgium
| | - Linda Tsang
- Rheumatology Division, UniversitairZiekenhuis and Vrije Universiteit, Brussel, Belgium
| | - Hani El-Gabalawy
- Institute of Musculoskeletal Health and Arthritis, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carol Hitchon
- Institute of Musculoskeletal Health and Arthritis, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Virginia Pascual Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irazú Contreras Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Petros P Sfikakis
- First Department of Propedeutic Medicine, University of Athens, Athens, Greece
| | - Evangelia Zampeli
- First Department of Propedeutic Medicine, University of Athens, Athens, Greece
| | - Miguel A Gonzalez-Gay
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander (Cantabria), Spain
| | - Alfonso Corrales
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander (Cantabria), Spain
| | - Mart van de Laar
- Department of Rheumatology and Clinical Immunology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Inger Meek
- Department of Rheumatology and Clinical Immunology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Yanez ND, Aljasser I, Andre M, Hu C, Juraska M, Lumley T. Assessing the impact of measurement error in modeling change in the absence of auxiliary data. COMMUN STAT-THEOR M 2017. [DOI: 10.1080/03610926.2015.1040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Toyokawa T, Kubo N, Tamura T, Sakurai K, Amano R, Tanaka H, Muguruma K, Yashiro M, Hirakawa K, Ohira M. The pretreatment Controlling Nutritional Status (CONUT) score is an independent prognostic factor in patients with resectable thoracic esophageal squamous cell carcinoma: results from a retrospective study. BMC Cancer 2016; 16:722. [PMID: 27599460 PMCID: PMC5013653 DOI: 10.1186/s12885-016-2696-0] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/07/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the impact of the Controlling Nutritional Status (CONUT) score on survival compared with the platelet to lymphocyte ratio (PLR), the neutrophil to lymphocyte ratio (NLR), and the Glasgow Prognostic Score (GPS) in patients with resectable thoracic esophageal squamous cell carcinoma (ESCC). METHODS One hundred eighty-five consecutive patients who underwent subtotal esophagectomy with curative intent for resectable thoracic ESCC were retrospectively reviewed. Time-dependent receiver operating characteristic curve analyses for 3-year overall survival (OS) as the endpoint were performed, and the maximal Youden indices were calculated to assess discrimination ability and to determine the appropriate cut-off values of CONUT, PLR, and NLR. The patients were then classified into high and low groups based on these cut-off values. Correlations between CONUT and other clinicopathological characteristics were analyzed. Prognostic factors predicting overall survival (OS) and relapse-free survival (RFS) were analyzed using Cox proportional hazards models. RESULTS The areas under the curve predicting 3-year OS were 0.603 for CONUT, 0.561 for PLR, 0.564 for NLR, and 0.563 for GPS. The optimal cut-off values were two for the CONUT score, 193 for PLR, and 3.612 for NLR. The high-CONUT group was significantly associated with lower BMI, high-PLR, high-NLR, and GPS1/2 groups. On univariate analysis, high-CONUT, high-PLR, high-NLR, and GPS 1/2 groups were significantly associated with poorer OS and RFS. Of these factors, multivariate analysis revealed that only the CONUT score was an independent prognostic factor for OS (HR 2.303, 95 % CI 1.191-4.455; p = 0.013) and RFS (HR 2.163, 95 % CI 1.139-4.109; p = 0.018). CONCLUSIONS The CONUT score was an independent predictor of OS and RFS before treatment and was superior to PLR, NLR, and GPS in terms of predictive ability for prognosis in patients with resectable thoracic ESCC.
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Affiliation(s)
- Takahiro Toyokawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Naoshi Kubo
- Department of Gastroenterological Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondohri, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Tatsuro Tamura
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Katsunobu Sakurai
- Department of Gastroenterological Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondohri, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Ryosuke Amano
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Tanaka
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kazuya Muguruma
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masakazu Yashiro
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masaichi Ohira
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Huang YK, Kang WM, Ma ZQ, Liu YQ, Zhou L, Yu JC. Body mass index, serum total cholesterol, and risk of gastric high-grade dysplasia: A case-control study among Chinese adults. Medicine (Baltimore) 2016; 95:e4730. [PMID: 27583914 PMCID: PMC5008598 DOI: 10.1097/md.0000000000004730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Obesity is related to an increased risk of gastric cardia cancer. However, the influences of excess body weight and serum total cholesterol on the risk of gastric high-grade dysplasia have not been fully characterized.A case-control study was conducted to explore the relationships between body mass index (BMI), serum total cholesterol level, and the risk of gastric high-grade dysplasia in Chinese adults. A total of 893 consecutive patients with gastric high-grade dysplasia (537 men and 356 women) and 902 controls (543 men and 359 women) were enrolled from January 2000 to October 2015. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated, and a multivariate analysis was conducted.After adjusting for age, alcohol consumption, smoking status, family history of gastric cancer or esophageal cancer, and serum total cholesterol level, a BMI ranging from 27.5 to 29.9 was significantly related to an increased risk of gastric high-grade dysplasia in both men (adjusted OR = 1.87, 95% CI = 1.24-2.81) and women (adjusted OR = 2.72, 95% CI = 1.44-5.16). The 2 highest BMI categories (27.5-29.9 and ≥30.0) were identified as risk factors for gastric cardia high-grade dysplasia in both men (BMI = 27.5-29.9: adjusted OR = 1.78, 95% CI = 1.02-3.10; BMI ≥ 30.0: adjusted OR = 2.54, 95% CI = 1.27-5.08) and women (BMI = 27.5-29.9: adjusted OR = 2.88, 95% CI = 1.27-6.55; BMI ≥ 30.0: adjusted OR = 2.77, 95% CI = 1.36-5.64), whereas only a BMI ranging from 27.5 to 29.9 was a risk factor for gastric noncardia high-grade dysplasia in both men (adjusted OR = 1.98, 95% CI = 1.25-3.14) and women (adjusted OR = 2.88, 95% CI = 1.43-5.81). In addition, higher serum total cholesterol was associated with an increased risk of gastric noncardia high-grade dysplasia (adjusted OR = 1.83, 95% CI = 1.25-2.69) in women.Increased BMI was associated with an increased risk of gastric high-grade dysplasia in both men and women, and higher serum total cholesterol increased the risk of gastric noncardia high-grade dysplasia in women.
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Affiliation(s)
- Ya-Kai Huang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Wei-Ming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhi-Qiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yu-Qin Liu
- Cell Culture Center, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jian-Chun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Correspondence: Jian-Chun Yu, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China (e-mail: )
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Iqbal A, Zaid M, Munir R, Usman H, Kalbacher H, Scandiuzzi L, Zaidi N. Atypical plasma lipid profiles in leukemia. Clin Chim Acta 2016; 452:129-33. [DOI: 10.1016/j.cca.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/27/2015] [Accepted: 11/04/2015] [Indexed: 01/06/2023]
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Turesson C, Bergström U, Pikwer M, Nilsson JÅ, Jacobsson LT. High serum cholesterol predicts rheumatoid arthritis in women, but not in men: a prospective study. Arthritis Res Ther 2015; 17:284. [PMID: 26458977 PMCID: PMC4603637 DOI: 10.1186/s13075-015-0804-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Environmental exposures, including smoking, hormone-related factors, and metabolic factors, have been implicated in the etiology of rheumatoid arthritis (RA). A previous study has indicated that blood lipid levels may influence the development of RA. The objective of this study was to investigate the impact of serum total cholesterol and triglycerides on the risk of RA in a prospective study. METHODS Among participants in a large population-based health survey (n = 33,346), individuals who subsequently developed RA were identified by linkage to four different registers and a structured review of the medical records. In a nested case-control study, with controls, matched for age, sex, and year of inclusion, from the health survey database, the relation between serum lipids (levels of total cholesterol and triglycerides) and future RA development was examined. RESULTS In total, 290 individuals (151 men and 139 women) whose RA was diagnosed a median of 12 years (range of 1-28) after inclusion in the health survey were compared with 1160 controls. Women with a diagnosis of RA during the follow-up had higher total cholesterol levels at baseline compared with controls: odds ratio (OR) 1.54 per standard deviation; 95 % confidence interval (CI) 1.22-1.94. This association remained statistically significant in multivariate models adjusted for smoking and a history of early menopause and in analyses stratified by rheumatoid factor status and time to RA diagnosis. Total cholesterol had no significant impact on the risk of RA in men (OR 1.03; 95 % CI 0.83-1.26). Triglycerides did not predict RA in men or women. CONCLUSIONS A high total cholesterol was a risk factor for RA in women but not in men. This suggests that sex-specific exposures modify the impact of lipids on the risk of RA. Hormone-related metabolic pathways may contribute to RA development.
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Affiliation(s)
- Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Skåne University Hospital, Inga-Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Ulf Bergström
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Skåne University Hospital, Inga-Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Mitra Pikwer
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Eskilstuna Hospital, Kungsvägen 34, Eskilstuna, 631 88, Sweden.
| | - Jan-Åke Nilsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Skåne University Hospital, Inga-Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Lennart Th Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10, Gothenburg, 413 46, Sweden.
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Abbasi A, Deetman PE, Corpeleijn E, Gansevoort RT, Gans ROB, Hillege HL, van der Harst P, Stolk RP, Navis G, Alizadeh BZ, Bakker SJL. Bilirubin as a potential causal factor in type 2 diabetes risk: a Mendelian randomization study. Diabetes 2015; 64:1459-69. [PMID: 25368098 PMCID: PMC4346199 DOI: 10.2337/db14-0228] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Circulating bilirubin, a natural antioxidant, is associated with decreased risk of type 2 diabetes (T2D), but the nature of the relationship remains unknown. We performed Mendelian randomization in a prospective cohort of 3,381 participants free of diabetes at baseline (age 28-75 years; women 52.6%). We used rs6742078 located in the uridine diphosphate-glucuronosyltransferase locus as an instrumental variable (IV) to study a potential causal effect of serum total bilirubin level on T2D risk. T2D developed in a total of 210 participants (6.2%) during a median follow-up period of 7.8 years. In adjusted analyses, rs6742078, which explained 19.5% of bilirubin variation, was strongly associated with total bilirubin (a 0.68-SD increase in bilirubin levels per T allele; P < 1 × 10(-122)) and was also associated with T2D risk (odds ratio [OR] 0.69 [95% CI 0.54-0.90]; P = 0.006). Per 1-SD increase in log-transformed bilirubin levels, we observed a 25% (OR 0.75 [95% CI 0.62-0.92]; P = 0.004) lower risk of T2D. In Mendelian randomization analysis, the causal risk reduction for T2D was estimated to be 42% (causal OR for IV estimation per 1-SD increase in log-transformed bilirubin 0.58 [95% CI 0.39-0.84]; P = 0.005), which was comparable to the observational estimate (Durbin-Wu-Hausman χ(2) test, P for difference = 0.19). These novel results provide evidence that an elevated bilirubin level is causally associated with the risk of T2D and support its role as a protective determinant.
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Affiliation(s)
- Ali Abbasi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, U.K.
| | - Petronella E Deetman
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rijk O B Gans
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans L Hillege
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
| | - Ronald P Stolk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Mehta R, Gurudath S, Dayansoor S, Pai A, Ganapathy KS. Serum lipid profile in patients with oral cancer and oral precancerous conditions. Dent Res J (Isfahan) 2014; 11:345-50. [PMID: 25097644 PMCID: PMC4119367 DOI: 10.4103/1735-3327.135889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The present study was undertaken to estimate and compare the levels of plasma total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), very low density lipoprotein (VLDL) and triglycerides in patients with oral precancerous lesions/conditions, oral cancer and normal subjects. MATERIALS AND METHODS The study comprised of 60 patients with oral precancerous lesions/conditions, 60 patients with oral cancer and a control group of 60 healthy individuals. The diagnosis of oral precancerous lesions/conditions and oral cancer was confirmed histopathologically. Under aseptic condition 5 ml venous blood of overnight fasting patient was withdrawn from each individual. Serum was separated by centrifugation and plasma levels of TC, LDL, HDL, VLDL and triglycerides were estimated. Descriptive statistical analysis has been carried out in the present study. Analysis of variance has been used to find the significance of study parameters between three or more groups of patients, Post-hoc test as Tukey has been used to find the pair wise significance. Significance is assessed at 5% level of significance. RESULTS Statistically significant decrease in levels of plasma TC, LDL, HDL, VLDL and triglycerides was observed in the precancerous and cancerous groups as compared to the control group. On comparison between precancerous and cancerous groups, significant decrease was observed in cancerous group. CONCLUSION The change in lipid levels may have an early diagnostic or prognostic role in the oral premalignant lesions/conditions and oral cancer. The presence of decreased plasma lipid profile should increase the suspicion of these lesions to be investigated further.
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Affiliation(s)
- Rajul Mehta
- Department of Oral Medicine and Radiology, The Oxford Dental College Hospital and Research Centre, Bangalore, Karnataka, India
| | - Shubha Gurudath
- Department of Oral Medicine and Radiology, KLE Society Dental College Hospital and Research Center, Bangalore, Karnataka, India
| | - Sujatha Dayansoor
- Department of Oral Medicine and Radiology, The Oxford Dental College Hospital and Research Centre, Bangalore, Karnataka, India
| | - Anuradha Pai
- Department of Oral Medicine and Radiology, The Oxford Dental College Hospital and Research Centre, Bangalore, Karnataka, India
| | - K S Ganapathy
- Department of Oral Medicine and Radiology, The Oxford Dental College Hospital and Research Centre, Bangalore, Karnataka, India
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Abstract
Low density lipoprotein cholesterol (LDL-C) is one of the most validated targets in clinical medicine. Large randomized, outcome trials have demonstrated a clear relationship between reducing LDL-C and cardiovascular disease (CVD) risk, which has been maintained to LDL-C levels of <1.8 mmol/L. To assess the benefit of even lower LDL-C it is important to recognize that CVD risk reduction is related to absolute reduction in LDL-C, not to percent change. Furthermore measurement of LDL-C is also critical as recent studies show the Friedewald calculation significantly underestimates true LDL-C values <1.8 mmol/L, distorting the relationship with CVD risk reduction. Discussion of potential harm from low, or lower, LDL-C has centered on cancer, hemorrhagic stroke, and violent death, but there is little evidence from outcome trials to show a relationship with low LDL-C. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors which will reduce LDL-C well below 1.3 mmol/L, will likely provide the clearest answer to both the question of efficacy and safety of low LDL-C within the next few years.
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Affiliation(s)
- Evan A Stein
- Department of Pathology & Laboratory Medicine, University of Cincinnati, Cincinnati, OH 45215, USA.
| | - Frederick J Raal
- Division of Endocrinology and Metabolism, Department of Medicine, Carbohydrate & Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Lim SC, Parajuli KR, Duong HQ, Choi JE, Han SI. Cholesterol induces autophagic and apoptotic death in gastric carcinoma cells. Int J Oncol 2014; 44:805-11. [PMID: 24399152 DOI: 10.3892/ijo.2014.2246] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/30/2013] [Indexed: 02/07/2023] Open
Abstract
Despite conflicting results, there is evidence to suggest an inverse link between total body cholesterol levels and the risk of certain malignancies. Based on previous reports, this phenomenon appears to vary with cancer site, and, in particular, more consistent data on inverse relations was reported in the risk of gastric cancer. In the current study, the effect of cholesterol on gastric cancer cell viability was examined using an in vitro cell culture system. Addition of cholesterol in culture medium resulted in reduced viability and clonogenicity of SNU601, SNU638 and SNU216 gastric cancer cells by induction of both autophagic and apoptotic death. Transient inactivation of ERK1/2 was linked to reduction of cholesterol-mediated cell viability, and tumor necrosis factor‑related apoptosis-inducing ligand receptor 2 (TRAIL‑R2/DR5) was also involved in cell death signaling. In conclusion, these results imply that cholesterol can act as a signal regulator to modulate cell viability and that proper cellular cholesterol levels may be advantageous to suppress growth of gastric carcinomas.
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Affiliation(s)
- Sung-Chul Lim
- Research Center for Resistant Cells, College of Medicine, Chosun Universtity, Gwangju 501-759, Republic of Korea
| | - Keshab Raj Parajuli
- Research Center for Resistant Cells, College of Medicine, Chosun Universtity, Gwangju 501-759, Republic of Korea
| | - Hong-Quan Duong
- Research Center for Resistant Cells, College of Medicine, Chosun Universtity, Gwangju 501-759, Republic of Korea
| | - Jeong Eun Choi
- Research Center for Resistant Cells, College of Medicine, Chosun Universtity, Gwangju 501-759, Republic of Korea
| | - Song Iy Han
- Research Center for Resistant Cells, College of Medicine, Chosun Universtity, Gwangju 501-759, Republic of Korea
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Impact of genetic variants of apolipoprotein E on lipid profile in patients with Parkinson's disease. BIOMED RESEARCH INTERNATIONAL 2013; 2013:641515. [PMID: 24175296 PMCID: PMC3794554 DOI: 10.1155/2013/641515] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/07/2013] [Accepted: 08/19/2013] [Indexed: 11/26/2022]
Abstract
The pathogenesis of Parkinson's disease (PD) seems to involve genetic susceptibility to neurodegeneration. APOE gene has been considered a risk factor for PD. This study aimed to evaluate the association of APOE polymorphism with PD and its influence on lipid profile. We studied 232 PD patients (PD) and 169 individuals without the disease. The studied polymorphism was analyzed by PCR/RFLP. The Fisher's exact test, chi-square, ANOVA, and t-test (P < 0.05) were applied. The APOE3/3 genotype was prevalent in PD patients and Controls (P = 0.713) followed by APOE3/4 (P = 0.772). Both groups showed recommended values for lipid profile, with increase in the values of total cholesterol and LDLc, as well as decreased values of triglycerides in PD patients compared with Controls (P < 0.05 for all of them). Increased levels of HDLc, in PD patients, were associated with the APOE3/3 versus APOE-/4 genotypes (P = 0.012). The APOE polymorphism does not distinguish PD patients from Controls, as opposed to the lipid profile alone or in association with APOE. Furthermore, a relationship between increase of HDLc levels and APOE3 in homozygous was found in PD patients only.
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Zhang J. Epidemiological link between low cholesterol and suicidality: A puzzle never finished. Nutr Neurosci 2013; 14:268-87. [DOI: 10.1179/1476830511y.0000000021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Zhang J, Yan F, Li Y, McKeown RE. Body mass index and suicidal behaviors: a critical review of epidemiological evidence. J Affect Disord 2013; 148:147-60. [PMID: 22999892 DOI: 10.1016/j.jad.2012.05.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 05/02/2012] [Accepted: 05/05/2012] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Obesity has been associated with an elevated risk of depression and other mental health symptoms. An increasing number of robust prospective studies, however, counter-intuitively and consistently suggested that body mass index (BMI) was inversely associated with the risk of completed suicide in a dose-response fashion. The current contribution appraised the epidemiological evidence and examined the nature of the purported relationship. METHOD We conducted a systematic review of English publications of original studies using the terms "obesity", "overweight", "body mass index", "BMI", "attempted suicide", "completed suicide", "suicide ideation", "suicidal behaviors" and "suicide". Data were extracted primarily through MEDLINE and PUBMED databases. RESULTS Almost all cohort studies reported an inverse relationship between BMI and the risk of completed suicide irrespective of region of origin and the gender of study participants. Overall, among men, a high BMI was associated with a low risk of attempted or completed suicide. There was a paradox among women, namely, a high BMI was associated with an elevated risk of attempted suicide but a low risk of completed suicide. LIMITATIONS As a narrative review, the current report was interpretive and qualitative in nature. CONCLUSION Consideration of observational data, methodological issues stemmed from the rarity of deaths by suicide, homogeneity of study populations, heterogeneity of suicide methods, and the corresponding neurobiological changes made interpretation difficult. Intercultural cohort observations across countries may help to weigh the contributions from biological and socio-cultural factors. The purported association not only represents a scientific challenge, it's also an opportunity potentially leading to important insights into prevention of suicide death.
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Affiliation(s)
- Jian Zhang
- Division of epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO box 8015 Statesboro, GA 30465, USA.
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Liang KW, Kuo HN, Lee WL, Liu TJ, Lin WW, Tsao CR, Ting CT, Wang KY. Different Mid-Term Prognostic Predictors of Major Adverse Events in Diabetic and Nondiabetic Peripheral Artery Disease Presenting With Critical Limb Ischemia. Angiology 2013; 67:287-91. [DOI: 10.1177/0003319712475074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared midterm prognostic predictors of peripheral artery disease (PAD) with or without diabetes mellitus (DM) presenting with critical lower limb ischemia (CLI). A total of 172 patients with PAD (109 DM; 63 non-DM) were enrolled. The major adverse events (MAEs) were death or amputation. The diabetic group had a higher MAE rate (39% vs 22%, P = .042) with a mean follow-up duration of 30 ± 19 months. In a multivariate binary logistic regression analysis, revascularization (odds ratio = 0.289, P = .006) and higher serum cholesterol (odds ratio=0.988, P = .027) predicted a lower MAE rate in the DM group. In contrast, the presence of severe chronic kidney disease (stage 4 or 5, odds ratio = 5.238, P = .025) was a positive predictor of MAEs in the nondiabetic group. In conclusion, the prognostic predictors of MAE in diabetic and nondiabetic patients with PAD and CLI were different.
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Affiliation(s)
- Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
- Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
| | - Hsun-Nan Kuo
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Wei-Wen Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
- Department of Life Science, Tung-Hai University, Taichung, Taiwan
| | - Chen-Rong Tsao
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Chih-Tai Ting
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
- Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
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Jukema JW, Cannon CP, de Craen AJM, Westendorp RGJ, Trompet S. The controversies of statin therapy: weighing the evidence. J Am Coll Cardiol 2012; 60:875-81. [PMID: 22902202 DOI: 10.1016/j.jacc.2012.07.007] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/04/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
The debate whether statins, 3-hydroxymethyl-3-methylglutaryl coenzyme A reductase inhibitors, are safe to use has been raging since their introduction in 1987. Statins are generally well tolerated and are believed to have minimal adverse effects. However, individual, specific rare adverse events have been reported, such as elevations of liver enzymes, muscle aches, and very rarely, rhabdomyolysis. Discontinuation and/or reduction in the dose of the statin usually leads to resolution of these side effects. Recently, however, debate has focused on the possible negative long-term effects of statin treatment on cognitive decline, the incidence of cancer, and the development of diabetes mellitus. Recently, the U.S. Food and Drug Administration has expanded the warning for statins with a statement that statin use may lead to cognitive impairment. In this review, we discuss all levels of evidence, from case reports to large randomized controlled clinical trials, for the possible adverse effects of statins on cognitive decline, cancer, and diabetes. After careful consideration of all discussed scientific evidence, we conclude that there is no increased risk of cognitive decline or cancer with statin use. However, statin use is related to a small increased risk of type 2 diabetes mellitus. In view of the overwhelming benefit of statins in the reduction of cardiovascular events, we believe the small absolute risk for development of diabetes is outweighed by the cardiovascular benefits in patients for whom statin therapy is recommended. We, therefore, suggest that clinical practice for statin therapy should not be changed on the basis of the most recent Food and Drug Administration informational warnings.
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Affiliation(s)
- J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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Chiu HF, Kuo CC, Kuo HW, Lee IM, Lee CT, Yang CY. Statin use and the risk of kidney cancer: a population-based case–control study. Expert Opin Drug Saf 2012; 11:543-9. [DOI: 10.1517/14740338.2012.678831] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hui-Fen Chiu
- Kaohsiung Medical University, Institute of Pharmacology, College of Medicine,
Kaohsiung, Taiwan
| | - Chien-Chun Kuo
- Kaohsiung Chang-Gung Memorial Hospital and Chang-Gung University College of Medicine, Division of Nephrology, Department of Internal Medicine,
Kaohsiung, Taiwan
| | - Hsin-Wei Kuo
- Yuan's General Hospital, Division of Nephrology, Department of Internal Medicine,
Kaohsiung, Taiwan
| | - I-Ming Lee
- Kaohsiung Medical University, College of Health Sciences, Department of Public Health,
100 Shih-Chuan 1st RD, Kaohsiung 80708, Taiwan
| | - Chien-Te Lee
- Kaohsiung Chang-Gung Memorial Hospital and Chang-Gung University College of Medicine, Division of Nephrology, Department of Internal Medicine,
Kaohsiung, Taiwan
| | - Chun-Yuh Yang
- Kaohsiung Medical University, College of Health Sciences, Department of Public Health,
100 Shih-Chuan 1st RD, Kaohsiung 80708, Taiwan
- National Health Research Institute, Division of Environmental Health and Occupational Medicine,
Miaoli, Taiwan
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Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TIL, Getz L. Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study. J Eval Clin Pract 2012; 18:159-68. [PMID: 21951982 PMCID: PMC3303886 DOI: 10.1111/j.1365-2753.2011.01767.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline. METHODS We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20-74, who participated in the Nord-Trøndelag Health Study (HUNT 2, 1995-1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total). RESULTS Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89-0.99 per 1.0 mmol L(-1) increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88-1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92-1.24) was not linear but seemed to follow a 'U-shaped' curve, with the highest mortality <5.0 and ≥7.0 mmol L(-1) . Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98-1.15) and in total (HR: 0.98; 95% CI: 0.93-1.03) followed a 'U-shaped' pattern. CONCLUSION Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.
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Affiliation(s)
- Halfdan Petursson
- Research Unit of General Practice, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Tedders SH, Fokong KD, McKenzie LE, Wesley C, Yu L, Zhang J. Low cholesterol is associated with depression among US household population. J Affect Disord 2011; 135:115-21. [PMID: 21802743 DOI: 10.1016/j.jad.2011.06.045] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/28/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Serum cholesterol was reported to be associated with depressed mood, but the studies conducted among household population are rare. METHODS We used the data of 4115 men and 4275 women aged 18 or older, who completed a depression screening interview and had blood collected as a part of the National Health and Nutrition Examination Survey, 2005-2008. The serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were gender-specifically categorized into lower, intermediate, and upper quartiles. Depression was measured using the Patient Health Questionnaire, a 9-item screening instrument asking about the frequency of depression symptoms over the past 2 weeks. RESULTS After adjustment for socio-demographics and behavioral risks, a U-shaped association was detected between severe depression and LDL-C among men. The odds ratios (ORs) of severe depression were 5.13 (95% CI=1.74-15.09), 1 (reference) and 2.28 (1.07-4.86) respectively for the men with lower (<169 mg/dL), intermediate (169-221 mg/dL), and upper quartile (≥ 222 mg/dL) LDL-C. Among women, lower HDL-C was significantly associated with an elevated odds of severe depression [OR=2.96 (1.59-5.52)] compared with upper quartile of HDL-C, the association diminished after adjustment for covariates [OR=1.24 (0.66-2.32)]. No clear pattern of association between cholesterol and moderate depression was observed from either men or women. LIMITATION The inherent limitation of cross-sectional design prevented the authors from investigating causality. CONCLUSIONS A U-shaped association was identified between LDL-C and severe depression among men. Further studies are necessary to explore the biological mechanism and identify the clinical implication among populations vulnerable to psychiatric disorders.
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Affiliation(s)
- Stuart H Tedders
- Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
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Lesser G, Beeri M, Schmeidler J, Purohit D, Haroutunian V. Cholesterol and LDL relate to neuritic plaques and to APOE4 presence but not to neurofibrillary tangles. Curr Alzheimer Res 2011; 8:303-12. [PMID: 21244352 PMCID: PMC3267087 DOI: 10.2174/156720511795563755] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 11/10/2010] [Indexed: 11/22/2022]
Abstract
UNLABELLED Elevated serum total cholesterol (TC) has been considered a risk factor for Alzheimer's disease (AD), but conflicting results have confused understanding of the relationships of serum lipids to the presence of AD in the elderly. METHODS To clarify these issues, we evaluated correlations of admission TC, low-density (LDL) and high-density (HDL)cholesterol directly with the densities of Alzheimer hallmarks--neuritic plaques (NP) and neurofibrillary tangles (NFT)--in nursing home residents (n=281). RESULTS Significant positive associations of TC and LDL with NP densities were found in both the neocortex (TC: r=0.151, p=0.013 and LDL: r=0.190, p=0.005) and the hippocampal/entorhinal (allocortical)region (TC: r=0.182, p=0.002 and LDL: r=0.203, p=0.003). Associations of HDL with NP were less strong but also significant.In contrast, after adjustment for confounders, no correlations of NFT with any lipid were significant.When subjects with any non-AD neuropathology (largely vascular) were excluded, the TC-plaque and LDL-plaque associations for the remaining "Pure AD" subgroup were consistently stronger than for the full sample. The TC- and LDL-plaque correlations were also stronger for the subgroup of 87 subjects with an APOE ε4 allele. CONCLUSIONS The findings indicate that serum TC and LDL levels clearly relate to densities of NP, but not to densities of NFT. The stronger associations found in the subgroup that excluded all subjects with non-AD neuropathology suggest that cerebrovascular involvement does not explain these lipid-plaque relationships. Since the associations of TC/LDL with NP were particularly stronger in ε4 carriers, varying prevalence of this allele may explain some discrepancies among prior studies.
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Affiliation(s)
- G.T. Lesser
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA
- Department of Medicine, Jewish Home Lifecare, New York, NY, USA
| | - M.S. Beeri
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - J. Schmeidler
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - D.P. Purohit
- Department of Pathology, Mount Sinai School of Medicine, New York, USA
| | - V. Haroutunian
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
- Bronx VA Medical Center, Bronx, NY, USA
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Myasoedova E, Crowson CS, Kremers HM, Roger VL, Fitz-Gibbon PD, Therneau TM, Gabriel SE. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann Rheum Dis 2011; 70:482-7. [PMID: 21216812 DOI: 10.1136/ard.2010.135871] [Citation(s) in RCA: 368] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the impact of systemic inflammation and serum lipids on cardiovascular disease (CVD) in rheumatoid arthritis (RA). METHODS In a population-based RA incident cohort (1987 American College of Rheumatology criteria first met between 1988 and 2007), details were collected of serum lipid measures, erythrocyte sedimentation rates (ESRs), C-reactive protein (CRP) measures and cardiovascular events, including ischaemic heart disease and heart failure. Cox models were used to examine the association of lipids and inflammation with the risk of CVD and mortality, adjusting for age, sex and year of RA incidence. RESULTS The study included 651 patients with RA (mean age 55.8 years, 69% female); 67% were rheumatoid factor positive. ESR was associated with the risk of CVD (HR=1.2 per 10 mm/h increase, 95% CI 1.1 to 1.3). Similar findings, although not statistically significant, were seen with CRP (p=0.07). A significant non-linear association for total cholesterol (TCh) with risk of CVD was found, with 3.3-fold increased risk for TCh <4 mmol/l (95% CI 1.5 to 7.2) and no increased risk of CVD for TCh ≥4 mmol/l (p=0.57). Low low-density lipoprotein cholesterol (LDL <2 mmol/l) was associated with marginally increased risk of CVD (p=0.10); there was no increased risk for LDL ≥2 mmol/l (p=0.76). CONCLUSION Inflammatory measures (particularly, ESR) are significantly associated with the risk of CVD in RA. Lipids may have paradoxical associations with the risk of CVD in RA, whereby lower TCh and LDL levels are associated with increased cardiovascular risk.
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Affiliation(s)
- Elena Myasoedova
- Correspondence to Dr Sherine E Gabriel, Department of Health Sciences Research, Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA
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Llaverias G, Danilo C, Wang Y, Witkiewicz AK, Daumer K, Lisanti MP, Frank PG. A Western-type diet accelerates tumor progression in an autochthonous mouse model of prostate cancer. THE AMERICAN JOURNAL OF PATHOLOGY 2010; 177:3180-91. [PMID: 21088217 DOI: 10.2353/ajpath.2010.100568] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Epidemiological studies have provided evidence suggesting an important role for diet and obesity in the development of cancer. Specifically, lipid nutrients of the diet have been identified as important regulators of tumor development and progression. In the present study, we have examined the role of dietary fat and cholesterol in the initiation and progression of prostate cancer using the well-characterized TRAMP mouse model. Consumption of a Western-type diet--that is, enriched in both fat and cholesterol--accelerated prostate tumor incidence and tumor burden compared to mice fed a control chow diet. Furthermore, we also show that this diet increased the extent and the histological grade of prostate tumors. These findings were confirmed by the presence of increased levels of protein markers of advanced tumors in prostates obtained from animals fed a Western-type diet compared to those obtained from control animals. Increased lung metastases in animals fed a Western-type diet were also observed. In addition, we found that with a Western diet, animals bearing tumors presented with reduced plasma cholesterol levels compared with animals fed a control diet. Finally, we show that tumors obtained from animals fed a Western-type diet displayed increased expression of the high-density lipoprotein receptor SR-BI and increased angiogenesis. Taken together, our data suggest that dietary fat and cholesterol play an important role in the development of prostate cancer.
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Affiliation(s)
- Gemma Llaverias
- Department of Stem Cell Biology and Regenerative Medicine, Kimmel Cancer Center, Thomas Jefferson University, 233 S. 10th Street, Philadelphia, PA 19107, USA
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Matsushita Y, Sugihara M, Kaburagi J, Ozawa M, Iwashita M, Yoshida S, Saito H, Hattori Y. Pravastatin use and cancer risk: a meta-analysis of individual patient data from long-term prospective controlled trials in Japan. Pharmacoepidemiol Drug Saf 2010; 19:196-202. [PMID: 19856484 DOI: 10.1002/pds.1870] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the influence of pravastatin therapy on cancer morbidity and mortality by a meta-analysis of individual patient data (IPD) from three independent Japanese large-scale clinical trials. METHODS We conducted a meta-analysis of IPD collected from three large-scale prospective studies, the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study, Kyushu Lipid Intervention Study (KLIS), and Hokuriku Lipid Coronary Heart Disease Study-Pravastatin Atherosclerosis Trial (Holicos-PAT), which compared cardiovascular outcomes with pravastatin therapy and non-statin therapy in Japanese patients with hypercholesterolemia over a follow-up period of >or=4 years. The incidence of cancer or cancer death in the pravastatin and non-statin therapy groups was compared by multivariate Cox proportional hazard models stratified by trial. Subgroup analyses by sex and age were also conducted using the same methods. RESULTS In a total of 13 724 patients (mean age, 58 years; women, 48%) included in the analyses, pravastatin was not associated with an increased risk of developing cancer (hazard ratio [HR], 0.99; 95% confidence interval [95%CI], 0.81-1.19). Similarly, pravastatin therapy did not statistically affect cancer death (HR, 0.86; 95%CI, 0.61-1.21). Moreover, in subgroups analyses, no influence was observed on cancer incidence or death in relation to sex and age. CONCLUSION Pravastatin did not increase the rate of cancer incidence or cancer death in a large population of Japanese patients followed for >70,000 patient-years.
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Affiliation(s)
- Yasuyuki Matsushita
- Clinical Data and Biostatistics Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan.
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Abstract
Hypercholesterolemia is one of the main risk factors for the development of atherosclerosis. Decades of research have shown that lower cholesterol is better, but how low should we go? The average low-density lipoprotein cholesterol (LDL-C) level in the untreated western population is ∼130 mg/dl. However, insights from the early phase of life in animals and humans suggest that adult humans were genetically designed for much lower lipids level than is currently considered ‘average’. Adult animals in the wild and more primitive contemporary human societies share diets that are low in fats, and have similar very low blood cholesterol levels. Furthermore, extrapolation of data from meta-analyses of large trials suggest that the incidence of cardiovascular events would approach zero if the LDL-C were <60 mg/dl in primary prevention and approximately 30 mg/dl in secondary prevention. Such goals, which are considerably lower than the recommendations in current guidelines, might be attainable with the use of newer more potent lipid-lowering therapies. To date, achieving such low lipid levels appears safe, but the generalizability of these findings to broader populations and the clinical benefit on the reduction of cardiovascular complications remains to be proven.
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Affiliation(s)
- Willibald Hochholzer
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert P. Giugliano
- Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, First Floor, Boston, MA 02115, USA
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Trompet S, Jukema JW, Katan MB, Blauw GJ, Sattar N, Buckley B, Caslake M, Ford I, Shepherd J, Westendorp RGJ, de Craen AJM. Apolipoprotein e genotype, plasma cholesterol, and cancer: a Mendelian randomization study. Am J Epidemiol 2009; 170:1415-21. [PMID: 19889709 DOI: 10.1093/aje/kwp294] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Observational studies have shown an association between low plasma cholesterol levels and increased risk of cancer, whereas most randomized clinical trials involving cholesterol-lowering medications have not shown this association. Between 1997 and 2002, the authors assessed the association between plasma cholesterol levels and cancer risk, free from confounding and reverse causality, in a Mendelian randomization study using apolipoprotein E (ApoE) genotype. ApoE genotype, plasma cholesterol levels, and cancer incidence and mortality were measured during a 3-year follow-up period among 2,913 participants in the Prospective Study of Pravastatin in the Elderly at Risk. Subjects within the lowest third of plasma cholesterol level at baseline had increased risks of cancer incidence (hazard ratio (HR) = 1.90, 95% confidence interval (CI): 1.34, 2.70) and cancer mortality (HR = 2.03, 95% CI: 1.23, 3.34) relative to subjects within the highest third of plasma cholesterol. However, carriers of the ApoE2 genotype (n = 332), who had 9% lower plasma cholesterol levels than carriers of the ApoE4 genotype (n = 635), did not have increased risk of cancer incidence (HR = 0.86, 95% CI: 0.50, 1.47) or cancer mortality (HR = 0.70, 95% CI: 0.30, 1.60) compared with ApoE4 carriers. These findings suggest that low cholesterol levels are not causally related to increased cancer risk.
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Affiliation(s)
- Stella Trompet
- Department of Gerontology and Geriatrics, C-2-R Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
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45
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Criqui MH, Golomb BA. Lipid lowering: what and when to monitor. Lancet 2008; 372:516-7. [PMID: 18707970 DOI: 10.1016/s0140-6736(08)61213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael H Criqui
- Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
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46
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Asano K, Kubo M, Yonemoto K, Doi Y, Ninomiya T, Tanizaki Y, Arima H, Shirota T, Matsumoto T, Iida M, Kiyohara Y. Impact of serum total cholesterol on the incidence of gastric cancer in a population-based prospective study: the Hisayama study. Int J Cancer 2008; 122:909-14. [PMID: 17957783 DOI: 10.1002/ijc.23191] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The results of prospective studies that have examined the association between serum cholesterol levels and the incidence of gastric cancer remain controversial. To examine this issue in a general population, a total of 2,604 subjects aged 40 years or older were followed up prospectively for 14 years. During the follow-up period, gastric cancer developed in 97 subjects. The age- and sex-adjusted incidence of gastric cancer by quartiles of serum cholesterol level, namely, <4.06, 4.06-5.32, 5.33-6.04 and >or=6.05 mmol/L, were 3.9, 3.3, 3.1 and 2.1 per 1,000 person-years, respectively. The risk of gastric cancer increased with decreasing cholesterol level (age- and sex-adjusted hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.01-1.49; p = 0.04 for a decrease of 1 mmol/L in serum cholesterol level). This inverse association remained unchanged even after adjustment for other confounding factors, namely, Helicobacter pylori infection, atrophic gastritis, family history of malignant neoplasm, smoking habits, body mass index, hemoglobin A1c, white blood cell count and dietary factors (adjusted HR, 1.28; 95% CI, 1.03-1.58; p = 0.02). This association was significant for intestinal-type gastric cancers, but not for diffuse-type. As regards cancer stage, the inverse cholesterol-cancer association was marginally significant for early gastric cancer after multivariate-adjustment (adjusted HR, 1.25; 95% CI, 0.97-1.61; p = 0.09), but was not for advanced gastric cancer probably due to the small number of cases. In conclusion, our findings suggest that low serum cholesterol levels are an independent risk factor for developing gastric cancer, especially intestinal-type gastric cancer.
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Affiliation(s)
- Kouichi Asano
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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47
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Lim U, Gayles T, Katki HA, Stolzenberg-Solomon R, Weinstein SJ, Pietinen P, Taylor PR, Virtamo J, Albanes D. Serum High-Density Lipoprotein Cholesterol and Risk of Non-Hodgkin Lymphoma. Cancer Res 2007; 67:5569-74. [PMID: 17522388 DOI: 10.1158/0008-5472.can-07-0212] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lymphoma patients often exhibit abnormal lipid metabolism. Recent evidence, however, suggests that a decrease in circulating high-density lipoprotein cholesterol (HDL-C) may occur during lymphomagenesis, reflecting underlying etiology such as inflammation. We investigated the relationship between prediagnostic HDL-C and non-Hodgkin lymphoma (NHL) in the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study cohort. At baseline, serum HDL-C and total cholesterol concentrations from fasting blood, information on diet and lifestyle, and direct measurements of height, weight, and blood pressure were obtained from 27,074 healthy male smokers of ages 50 to 69 years. Cox proportional hazards models with age as underlying time metric was used to estimate relative risks (RR) and 95% confidence intervals (95% CI). We found no association between total or non-HDL cholesterol and the 201 incident NHL cases ascertained during the follow-up (1985-2002), but observed an inverse association between HDL-C and NHL, which changed with length of follow-up. High HDL-C was associated with lower risk of all NHL during the first 10 years (n = 148; RR for 5th versus 1st quintile, 0.35; 95% CI, 0.19-0.62; P(trend) < 0.0001), but not with diagnoses during later follow-up (n = 53; RR, 1.31; 95% CI, 0.55-3.10). The inverse association was similar for NHL subtypes and was not modified by obesity, blood pressure, physical activity, or alcohol intake, but seemed to be stronger in men with lower duration of smoking (P(interaction) = 0.06). Our findings implicate HDL-C as a preclinical indicator of NHL and warrant further prospective investigations for its etiologic contribution.
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Affiliation(s)
- Unhee Lim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Rockville, Maryland 20852, USA.
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Huang X, Chen H, Miller WC, Mailman RB, Woodard JL, Chen PC, Xiang D, Murrow RW, Wang YZ, Poole C. Lower low-density lipoprotein cholesterol levels are associated with Parkinson's disease. Mov Disord 2007; 22:377-81. [PMID: 17177184 PMCID: PMC1906875 DOI: 10.1002/mds.21290] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The apolipoprotein E (APOE) epsilon2 allele has been associated with both Parkinson's disease (PD) and lower low-density lipoprotein cholesterol (LDL-C). We tested the hypothesis that lower LDL-C may be associated with PD. This case-control study used fasting lipid profiles obtained from 124 PD cases and 112 controls. The PD cases were recruited from consecutive cases presenting at our tertiary Movement Disorder Clinic, and the controls were recruited from the spouse populations of the same clinic. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were calculated from unconditional logistic regressions, adjusting for age, gender, smoking status, and use of cholesterol-lowering agents. Lower LDL-C concentrations were associated with a higher occurrence of PD. Compared with participants with the highest LDL-C (> or =138 mg/dL), the OR was 2.2 (95% CI = 0.9-5.1) for participants with LDL-C of 115 to 137, 3.5 (95% CI = 1.6-8.1) for LDL-C of 93 to 114, and 2.6 (95% CI = 1.1-5.9) for LDL-C of < or = 92. Interestingly, use of either cholesterol-lowering drugs, or statins alone, was related to lower PD occurrence. Thus, our data provide preliminary evidence that low LDL-C may be associated with higher occurrence of PD, and/or that statin use may lower PD occurrence, either of which finding warrants further investigation.
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Affiliation(s)
- Xuemei Huang
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599, USA.
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Abstract
BACKGROUND Statins affect the proliferation, survival, and migration of cancer cells, and it is thought that they may have chemopreventive properties in humans. The purpose of the present study was to evaluate the association between statin use and various types of cancer in our hospital-based case-control surveillance study. METHODS Data were collected from patients ages 40-79 years who were admitted to participating hospitals in 3 centers in Philadelphia, New York, and Baltimore from 1991 to 2005. Nurses administered questionnaires to obtain information on medication use and other factors. We compared patients who had any of 10 types of cancer (a total of 4913 patients) with controls admitted for noncancer diagnoses (3900 patients). The following cancers were examined individually: female breast (n = 1185), prostate (n = 1226), colorectal (n = 734), lung (n = 464), bladder (n = 240), leukemia (n = 254), pancreas (n = 220), kidney (n = 226), endometrial (n = 220), and non-Hodgkin lymphoma (n = 144). Logistic regression models were used to estimate odds ratios and 95% confidence intervals among regular statin users compared with never-users. RESULTS Odds ratios were compatible with 1.0 for all cancer types. For the 4 largest cancer sites (breast, prostate, colorectum, and lung), odds ratios did not vary significantly by duration of statin use. CONCLUSIONS Statins are among the most commonly used medications, and durations of use are increasing. The present data do not support either positive or negative associations between statin use and the occurrence of 10 cancer types. Cancer incidence should continue to be monitored among statin users.
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Affiliation(s)
- Patricia F Coogan
- Slone Epidemiology Center, Boston University, Boston, Massachusetts 02215, USA.
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50
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Karagiannis A, Mikhailidis DP, Tziomalos K, Sileli M, Savvatianos S, Kakafika A, Gossios T, Krikis N, Moschou I, Xochellis M, Athyros VG. Serum Uric Acid as an Independent Predictor of Early Death After Acute Stroke. Circ J 2007; 71:1120-7. [PMID: 17587721 DOI: 10.1253/circj.71.1120] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prognostic significance of uric acid (UA) levels in acute stroke is unclear, so the objective of this study was to determine the association between levels of serum UA (SUA) and mortality in acute stroke. METHODS AND RESULTS Consecutive patients (n=435) presenting with ischemic stroke and intracerebral hemorrhage were included in the study. The length of stay in hospital and the occurrence of death were recorded. On univariate analysis, the occurrence of death was associated with older age, smoking, presence of congestive heart failure or atrial fibrillation, absence of hyperlipidemia, and intracerebral hemorrhage as the index event. Furthermore, glucose, urea, creatinine and SUA at admission were significantly higher in patients who died, whereas total and high-density-lipoprotein cholesterol were significantly lower. On multiple logistic regression analysis, the independent relationship between higher SUA levels and death was confirmed (odds ratio (OR), 1.37; 95%confidence interval (CI), 1.13-1.67; p=0.001). The only other variables independently associated with the occurrence of death were urea concentration and presence of atrial fibrillation. If urate was >7.8 mg/dl (0.47 mmol/L), then there would be a high probability of early death (87%). CONCLUSIONS Elevated levels of SUA are independently associated with an increased risk of early death in acute stroke.
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Affiliation(s)
- Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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