1
|
Yeoh A, Yang Z, Cheung R, Do A, Ahmed A, Wong RJ. Incidence of Cirrhosis and Hepatocellular Carcinoma Among Veterans With Noncirrhotic Metabolic Dysfunction-associated Fatty Liver Disease. J Clin Gastroenterol 2024; 58:718-725. [PMID: 37678412 DOI: 10.1097/mcg.0000000000001921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND AIMS Despite the high prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD), the long-term incidence of cirrhosis or hepatocellular carcinoma (HCC) among adults with MAFLD is not well described. Using a national cohort of United States Veterans, we evaluated the overall incidence and predictors of cirrhosis and HCC among adults with noncirrhotic MAFLD. METHODS Data from the 2010 to 2022 Veterans Affairs database were used to identify adults with noncirrhotic MAFLD using established definitions. Five and 10-year incidence of cirrhosis and HCC were assessed and stratified by demographics and relevant clinical variables. Multivariate Cox proportional hazard models were utilized to determine predictors of cirrhosis and HCC. RESULTS Among 969,253 patients with noncirrhotic MAFLD (94.5% males, 70.2% non-Hispanic white, mean age of 62.7 ± 12.2 y), the 10-year incidence of cirrhosis and HCC was 3.70% (95% CI: 3.66-3.74) and 0.69% (95% CI: 0.67-0.70), respectively. When stratified by race/ethnicity, the 10-year incidence of cirrhosis was lowest among Asians (2.63%, 95% CI: 2.37-2.88) and highest among Hispanics (4.60%, 95% CI: 4.45-4.75), a pattern also observed with HCC. Significant disparities in risk of cirrhosis or HCC were observed when stratified by sex, substance use, and comorbidities. Risks of cirrhosis and HCC were highest in patients with baseline fibrosis-4 >2.67. CONCLUSION This large study provides important epidemiological data describing the natural history of adults with MAFLD. Disparities in risk of cirrhosis and HCC were observed by demographic and clinical characteristics, emphasizing the importance of early identification of MAFLD with modifiable high-risk features to implement earlier interventions to improve long-term outcomes.
Collapse
Affiliation(s)
- Aaron Yeoh
- Department of Medicine, Division of Gastroenterology, Stanford
| | - Zeyuan Yang
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Ramsey Cheung
- Department of Medicine, Division of Gastroenterology, Stanford
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Albert Do
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, CT
| | - Aijaz Ahmed
- Department of Medicine, Division of Gastroenterology, Stanford
| | - Robert J Wong
- Department of Medicine, Division of Gastroenterology, Stanford
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| |
Collapse
|
2
|
Alam MZ, Sheoti IH. The burden of diabetes and hypertension on healthy life expectancy in Bangladesh. Sci Rep 2024; 14:7936. [PMID: 38575655 PMCID: PMC10995204 DOI: 10.1038/s41598-024-58554-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
Diabetes and hypertension are among the leading causes of death in Bangladesh. This study examined hypertension, diabetes, and either or both, free life expectancy, to measure the effect of the diseases on the overall health of individuals in Bangladesh with regional variations. We utilized data from Bangladesh Sample Vital Statistics 2018 for mortality and Bangladesh Demographic and Health Survey 2017-2018 for diabetes and hypertension. The Sullivan method was employed to estimate age-specific hypertension and diabetes-free life expectancy. Altogether, 10.3% of the people aged 18-19 years lived with either diabetes or hypertension. The hypertension-free life expectancy was 40.4 years, and the diabetes-free life expectancy was 53.2 years for those aged 15-19. Overall, individuals would expect to spend 38.7% of their lives with either of the diseases. Females suffered more from hypertension and males from diabetes. Still, females suffered more from the aggregate of both. Rural people had more diabetes and hypertension-free life expectancy than those of urban. Individuals of Mymensingh had the highest life expectancy free of both diseases compared to other divisions of Bangladesh. Diabetes and hypertension affect a considerable proportion of the life of the population in Bangladesh. Policy actions are needed to guide the prevention, diagnosis, and treatment of both diseases, specifically focusing on women and urban populations. Widespread health-enhancing actions need to be taken to diminish the effect of these two diseases in Bangladesh.
Collapse
Affiliation(s)
- Md Zakiul Alam
- Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh.
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Maryland, 21205, USA.
| | - Isna Haque Sheoti
- Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh
| |
Collapse
|
3
|
Jula A. Sodium - a systematic review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2024; 68:10319. [PMID: 38327996 PMCID: PMC10845896 DOI: 10.29219/fnr.v68.10319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 11/25/2022] [Accepted: 10/25/2023] [Indexed: 02/09/2024] Open
Abstract
Blood pressure (BP) rises along with increasing sodium intake from early childhood to late adulthood, and leads to hypertension among most men and women living in Nordic and Baltic countries. Elevated BP is the leading global risk factor for premature deaths and disability-adjusted life-years. A reduction in sodium intake is essential in the prevention of hypertension in individuals, in the lowering of BP levels, in the treatment of hypertensive individuals, and in decreasing risks associated with elevated BP. There is a progressive linear dose-response relationship between sodium intake and BP beginning from a sodium intake of less than 0.8 g/day. Sodium reduction decreases BP linearly by a dose-response manner down to a sodium intake level of less than 2 g/day. Randomised intervention studies with a duration of at least 4 weeks confirm the efficiency and safety of reducing blood sodium intake to a level of less than 2 g/day. Results from prospective cohort studies show that higher sodium intake is positively associated with an increased risk of stroke and cardiovascular events and mortality among the general adult population, and the associations are linear in studies using proper sodium assessment methods. Analyses assessing sodium intake using at least two 24-h urine samples have shown a linear positive relationship between sodium intake and the risk of a cardiovascular event or death. Based on an overall evaluation of the available data, a limitation of the sodium intake to 2.0 g/day is suggested for adults. The optimal sodium intake level would be probably about 1.5 g/day. Sodium intake recommended for children can be extrapolated from the recommended sodium intake for adults. According to national dietary surveys, the average sodium intakes in Nordic countries range in adult men from 3.6 to 4.4 g/day and in adult women from 2.6. to 3.2 g/day, and in Baltic countries in men from 2.6 to 5.1 g/day and in women from 1.8 to 3.6 g/day.
Collapse
Affiliation(s)
- Antti Jula
- Department of Clinical Medicine, University of Turku, Turku, Finland
| |
Collapse
|
4
|
Nath S, Jiang T, Barrow J, Simon L. Treatment deferral for elevated blood pressure at a dental school clinic. J Dent Educ 2024; 88:51-55. [PMID: 37727061 DOI: 10.1002/jdd.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/07/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Current guidelines by the American Dental Association (ADA) recommend deferral of elective dental care for elevated blood pressure. However, it is unknown how frequently this impacts dental treatment. The purpose of this study was to evaluate rates of asymptomatic hypertension and treatment deferral at a dental school clinic. METHODS This was a retrospective study with data extracted from a chart review of all patients presenting for care at a dental school teaching practice. Differences in dental procedures, the time between visits, and the number of antihypertensive medications were calculated between patients with and without a blood pressure reading exceeding current guidelines for elective treatment. RESULTS Among 26,821 individuals, 1265 had a visit with elevated blood pressure. Blood pressure readings at the next visit were significantly lower (systolic blood pressure 137 [95% confidence interval {CI} 135-138] mmHg, diastolic blood pressure 82 [95% CI 81-83 mmHg], p < 0.001), although only 24 patients reported taking a new medication. Only 4.1% of these patients had a procedure deferred; for those that did, the average intervisit time was 88.2 days (95% CI 77.7-98.7 days). CONCLUSIONS The majority of patients with blood pressure readings exceeding current ADA recommendations for treatment were treated without evidence of harm. Patients were also unlikely to return to the clinic with new medications for blood pressure after a visit with an elevated blood pressure reading. Oral health providers must weigh the risks and benefits of care deferral and can consider an expanded role in hypertension management in dental settings when caring for patients with elevated blood pressure.
Collapse
Affiliation(s)
- Sapna Nath
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Tien Jiang
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Jane Barrow
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Lisa Simon
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Boudreaux BD, Romero EK, Diaz KM. Sedentary behavior and risk of cardiovascular disease and all-cause mortality in United States adults with hypertension. J Hypertens 2023; 41:1793-1801. [PMID: 37605821 DOI: 10.1097/hjh.0000000000003540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Growing evidence has implicated sedentary behavior is associated with cardiovascular and all-cause mortality, independent of moderate to vigorous physical activity (MVPA). Contrary to national physical activity guidelines, reductions in sedentary behavior are not promoted as a lifestyle modification in hypertensive adults. This may be in part because of a paucity of evidence demonstrating that sedentary behavior confers morbidity and mortality risk in hypertensive adults. PURPOSE To examine the association between device-measured sedentary behavior and risk of cardiovascular and all-cause mortality and in hypertensive adults. METHODS Data for this analysis come from the 2003 to 2006 National Health and Nutrition Examination Survey, a nationally representative survey of US adults. Sedentary behavior and MVPA were assessed with an ActiGraph 7164 accelerometer. Hypertension was classified as blood pressure at least 140/≥90 mmHg or antihypertensive medication use. RESULTS Median follow-up was 14.5 years. After adjusting for covariates and MVPA, greater time spent in sedentary behavior was associated with an increased risk of cardiovascular mortality [quartile 1: REF, quartile 2: hazard ratio = 1.41 [95% confidence interval (95% CI) 0.83-2.38], quartile 3: hazard ratio = 1.25 (95% CI 0.81-1.94), quartile 4: hazard ratio = 2.14 (95% CI 1.41-3.24); P trend <0.001]. Greater sedentary behavior was also associated with an increased risk of all-cause mortality [quartile 1: REF: quartile 2: hazard ratio = 1.13 (95% CI 0.83-1.52), quartile 3: hazard ratio = 1.33 (95% CI 1.00-1.78), quartile 4: hazard ratio = 2.06 (95% CI 1.60, 2.64); P trend <0.001]. CONCLUSION Greater sedentary behavior is associated with increased risk of cardiovascular mortality and all-cause mortality among US adults with hypertension. These findings suggest reductions in sedentary behavior should be considered to reduce mortality risk in hypertensive adults.
Collapse
|
6
|
Polecka A, Olszewska N, Danielski Ł, Olszewska E. Association between Obstructive Sleep Apnea and Heart Failure in Adults-A Systematic Review. J Clin Med 2023; 12:6139. [PMID: 37834783 PMCID: PMC10573908 DOI: 10.3390/jcm12196139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sacubitril/valsartan on OSA outcomes. METHODS We analyzed case-control, observational studies, and randomized controlled trials. Prevalence rates, PAP treatment, and HF pharmacotherapy were assessed. RESULTS Numerous studies revealed a high prevalence of OSA in HF patients, particularly with preserved ejection fraction. PAP treatment consistently improved an apnea-hypopnea index, left ventricular ejection fraction, oxygen saturation, and overall quality of life. Emerging evidence suggests that SGLT2i and sacubitril/valsartan might influence OSA outcomes through weight loss, improved metabolic profiles, and potential direct effects on upper airway muscles. CONCLUSIONS The complex interplay between OSA and HF necessitates a multifaceted approach. PAP treatment has shown promising results in improving OSA symptoms and HF parameters. Additionally, recent investigations into the effects of HF pharmacotherapy on OSA suggest their potential as adjunctive therapy. This review provides insights for clinicians and researchers, highlighting the importance of addressing OSA and HF in patient management strategies.
Collapse
Affiliation(s)
- Agnieszka Polecka
- Doctoral School of the Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Natalia Olszewska
- Student Research Group, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Łukasz Danielski
- Student Research Group, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Ewa Olszewska
- Sleep Apnea Surgery Center, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| |
Collapse
|
7
|
Sun Q, Hu Y, Yu C, Guo Y, Pei P, Yang L, Chen Y, Du H, Sun D, Pang Y, Burgess S, Sansome S, Ning F, Chen J, Chen Z, Li L, Lv J. Healthy lifestyle and life expectancy free of major chronic diseases at age 40 in China. Nat Hum Behav 2023; 7:1542-1550. [PMID: 37430072 PMCID: PMC7615116 DOI: 10.1038/s41562-023-01624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/27/2023] [Indexed: 07/12/2023]
Abstract
Whether a healthy lifestyle helps achieve gains in life expectancy (LE) free of major non-communicable diseases and its share of total LE in Chinese adults remains unknown. We considered five low-risk lifestyle factors: never smoking or quitting for reasons other than illness, no excessive alcohol use, being physically active, healthy eating habits and healthy body fat levels. Here we show that after a median follow-up of 11.1 years for 451,233 Chinese adults, the LE free of cardiovascular diseases, cancer and chronic respiratory diseases (95% confidence interval) at age 40 years for individuals with all five low-risk factors was on average 6.3 (5.1-7.5) years (men) and 4.2 (3.6-5.4) years (women) longer than those with 0-1 low-risk factors. Correspondingly, the proportion of disease-free LE to total LE increased from 73.1% to 76.3% for men and from 67.6% to 68.4% for women. Our findings suggest that promoting healthy lifestyles could be associated with gains in disease-free LE in the Chinese population.
Collapse
|
8
|
Ramezankhani A, Azizi F, Hadaegh F. Lifetime risk of cardiovascular disease stratified by traditional risk factors: Findings from the cohort of Tehran lipid and glucose study. Hellenic J Cardiol 2023; 73:36-46. [PMID: 36914096 DOI: 10.1016/j.hjc.2023.03.003] [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: 08/21/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND We aimed to estimate the lifetime risk (LTR) of cardiovascular disease (CVD) in the Iranian population, stratified by sex and traditional risk factors including high body mass index (BMI), hypertension, diabetes, smoking, and hypercholesterolemia. METHODS We included 10222 (4430 men) participants aged ≥20 years without CVD at baseline. LTRs at index ages 20 and 40 years and number of years lived without CVD was estimated. We further assessed the effect of traditional risk factors on the LTR of CVD and the number of years lived without CVD, stratified by sex and index ages. RESULTS During a median follow-up of 18 years, 1326 participants (774 men) developed CVD and 430 (238 men) died from non-cardiovascular causes. At age 20, the remaining LTR for CVD was 66.7% (95% CI 62.9-70.4) in men and 52.0% (47.6-56.8) in women, with similar LTRs at age 40 for both men and women. The LTRs at both index ages for those with ≥3 risk factors were about 30% and 55% higher in men and women, respectively, than those without any of the five risk factors. At the age of 20, men with ≥3 risk factors lived 24.1 fewer years without CVD compared with men with no risk factors; the corresponding value was 8 years in their female counterparts. CONCLUSIONS Our findings suggest that both sexes may benefit from effective prevention strategies early in the life course, despite the observed differences between men and women in LTR for CVD and number of years lived without CVD.
Collapse
Affiliation(s)
- Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
9
|
Brewer PL, D'Agata AL, Roberts MB, Wild RA, Shadyab AH, Saquib N, Manson J, Eaton CB, Sullivan MC. Association of Preterm Birth With Prevalent and Incident Hypertension, Early-Onset Hypertension, and Cardiovascular Disease in the Women's Health Initiative. Am J Cardiol 2023; 192:132-138. [PMID: 36791524 DOI: 10.1016/j.amjcard.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 02/16/2023]
Abstract
Increasing evidence suggests preterm birth is a risk factor for hypertension and cardiovascular disease (CVD) in adulthood. Whether there is effect modification by hypertension on CVD risk is unknown. To investigate the associations between preterm birth, hypertension, and incident CVD, we identified 2,303 women aged 50 to 79 years who self-reported being born preterm from the Women's Health Initiative. Using multivariable logistic regression, prevalent hypertension at enrollment, age at hypertension diagnosis, and antihypertensive medication use were compared by birth status (preterm, full-term). Risk of incident hypertension, coronary heart disease, and CVD were analyzed using multivariable Cox proportional-hazard models. Both models adjusted for age, race/ethnicity, education, smoking, physical activity, body mass index, and diabetes mellitus. Significant associations were found between preterm birth and prevalent hypertension (37% vs 33.1%; adjusted odds ratio 1.26 [95% confidence interval (CI) 1.15 to 1.28] p = <0.0001), early-onset hypertension (<50 years) (14.7% vs 11.7%; adjusted odds ratio 1.31, 95% CI 1.15 to 1.48, p = <0.0001), and incident hypertension (53.2% vs 51%; ajusted hazard ratio 1.10, 95% CI 1.03 to 1.19, p = 0.008). Preterm-born women reported taking more antihypertensive medications (2.9% vs 2.6%, p = 0.04). Preterm birth had a nonsignificant association with CVD risk, but when stratified by prevalent hypertension, women born preterm without hypertension had elevated CVD risk compared with women born full-term without prevalent hypertension. Women with prevalent hypertension, preterm and full-term, had similar magnitudes of elevations in CVD risk. In conclusion, preterm birth increases the risk of hypertension and coronary heart disease. With 10% of the population born preterm, birth history should be assessed as a CVD risk factor.
Collapse
Affiliation(s)
- Pamela L Brewer
- College of Nursing, University of Rhode Island, Providence, Rhode Island.
| | - Amy L D'Agata
- College of Nursing, University of Rhode Island, Providence, Rhode Island
| | - Mary B Roberts
- Center for Primary Care and Prevention, Care New England Medical Group/Primary Care and Specialty Services, Pawtucket, Rhode Island
| | - Robert A Wild
- Departments of Biostatistics and Epidemiology; Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Aladdin H Shadyab
- School of Medicine, University of California San Diego, San Diego, California
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Al Bukayriyah, Saudi Arabia
| | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Charles B Eaton
- Department of Epidemiology, Brown University, Providence, Rhode Island; Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mary C Sullivan
- College of Nursing, University of Rhode Island, Providence, Rhode Island
| |
Collapse
|
10
|
Martín-Fernández J, Alonso-Safont T, Polentinos-Castro E, Esteban-Vasallo MD, Ariza-Cardiel G, González-Anglada MI, Sánchez-Perruca L, Rodríguez-Martínez G, Rotaeche-del-Campo R, Bilbao-González A. Impact of hypertension diagnosis on morbidity and mortality: a retrospective cohort study in primary care. BMC PRIMARY CARE 2023; 24:79. [PMID: 36959558 PMCID: PMC10037862 DOI: 10.1186/s12875-023-02036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Hypertension is responsible for a huge burden of disease. The aim of this study was to evaluate the impact of newly diagnosed hypertension on the occurrence of kidney or cardiovascular events (K/CVEs) and on mortality among community dwellers. METHODS Retrospective cohort study, conducted from January, 2007, to December, 2018. All patients (age > 18) newly diagnosed with hypertension and no previous K/CVEs in 2007 and 2008, in the primary care centers of Madrid (Spain) (n = 71,770), were enrolled. The control group (n = 72,946) included patients without hypertension, matched by center, sex and age. The occurrence of kidney or CV events, including mortality from these causes and total mortality were evaluated using Cox regression and multistate models. Data were collected from three sources: personal data from administrative records, clinical data from medical records, and mortality data from regional and national databases. RESULTS The median follow-up was 138.61 months (IQR: 124.68-143.97 months). There were 32,896 K/CVEs (including 3,669 deaths from these causes) and 12,999 deaths from other causes. Adjusted for sex, smoking, diabetes and socioeconomic status, K/CVEs HR was 4.36 (95% CI: 3.80-5.00) for diagnoses before 45 years of age, 2.45(95% CI: 2.28- 2.63) for diagnosis between 45 to 54 years, and HR decreased to 1.86 (95% CI: 1.64-210) for diagnoses over age 85. Total mortality risk was only higher for hypertension diagnosed before 55 years of age (HR: 2.47, 95% CI: 1.90-3.19 for ages 18 to 44; and HR: 1.14, 95% CI: 1.02-1.28 for ages 45 to 54). CONCLUSION The diagnosis of hypertension in the community environment, in patients without evidence of previous kidney or CV disease, is associated with a large increase in the risk of K/CVEs, but especially in individuals diagnosed before the age of 55. This diagnosis is only associated with an increase in kidney or cardiovascular mortality or overall mortality when it occurs before age 55.
Collapse
Affiliation(s)
- Jesus Martín-Fernández
- Oeste Family and Community Care Teaching Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Tamara Alonso-Safont
- Technical Directorate of Health Information Systems, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Elena Polentinos-Castro
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
- Research Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | | | - Gloria Ariza-Cardiel
- Oeste Family and Community Care Teaching Unit, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Mª Isabel González-Anglada
- Department of Medical Specialties and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Internal Medicine Service, Alcorcón Foundation University Hospital, Madrid, Spain
| | - Luis Sánchez-Perruca
- Technical Directorate of Health Information Systems, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Gemma Rodríguez-Martínez
- Don Luis Infant Health Center, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Rafael Rotaeche-del-Campo
- Alza Health Center, Osakidetza, OSI Donostia, Research Group in AP IIS Biodonostia, San Sebastián, Spain
| | - Amaia Bilbao-González
- Health Services Research Network in Chronic Diseases, REDISSEC- ISCIII, Madrid, Spain
- Research Network On Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), ISCIII, Madrid, Spain
- Osakidetza, Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain
- Kronikgune Health Services Research Institute, Barakaldo, Spain
- Department of Medicine, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| |
Collapse
|
11
|
Kraus MJ, Smits JM, Meyer AL, Strelniece A, van Kins A, Boeken U, Reinecke A, Provaznik Z, Van Caenegem O, Ancion A, Berchtold-Herz M, Van Cleemput JJA, Haverich A, Laufer G, Gummert J, Karck M, Warnecke G, Raake PW, Frey N, Kreusser MM. Outcomes in patients with cardiac amyloidosis undergoing heart transplantation: the eurotransplant experience. J Heart Lung Transplant 2023; 42:778-785. [PMID: 36710093 DOI: 10.1016/j.healun.2023.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND When advanced heart failure occurs in cardiac amyloidosis, prognosis is poor. In this setting heart transplantation (HTX) is a treatment option for selected patients. We here present the results of post-transplantation outcomes in cardiac amyloidosis within the Eurotransplant area, investigating possible predictors of survival. METHODS Of 115 patients undergoing HTX due to cardiac amyloidosis in the Eurotransplant region between November 1987 and May 2020, detailed assessment prior to transplantation was available in 85 patients. The present study was conducted in a retrospective approach. Primary endpoint was mortality after HTX. Baseline variables were entered in a Cox proportional hazards model with the primary endpoint as a dependent variable. RESULTS Median overall survival following HTX was 6.3 years in the overall collective and the subgroup. Univariate Cox proportional hazards model revealed a significant relationship between overall survival and the transplantation period (2008 to 2020 vs 1987 to 2007; median survival 9.7 years vs 1.8 years, hazard ratio 0.45, p = 0.01). Further predictors were albumin concentration (hazard ratio 0.92, p < 0.001), and systolic blood pressure (hazard ratio 0.96, p < 0.001). The transplant period as well as albumin concentration remained significant independent predictors in the AL sub cohort in a multivariate Cox proportional hazards model. CONCLUSIONS HTX is a viable treatment option for patients at an advanced stage of cardiac amyloidosis as overall survival after transplantation has improved in the modern age. Patients at a very advanced stage of the disease, indicated by low serum albumin and blood pressure, show worse outcomes following HTX. Optimal timing and careful patient selection may therefore be particularly important to further improve post-HTX survival in amyloidosis patients.
Collapse
Affiliation(s)
- Martin J Kraus
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany.
| | | | - Anna L Meyer
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | | | | | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany
| | - Alexander Reinecke
- Department of Cardiology, Angiology and Intensive Care, University of Kiel, Kiel, Germany
| | - Zdenek Provaznik
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Oliver Van Caenegem
- Cardiovascular Department, Intensive Care Unit, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium (deceased)
| | - Arnaud Ancion
- Cardiology, Centre Hospitalier Universitaire Sart-Tilman, Liège, Belgium
| | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany; Department of Medicine, University Heart Center Freiburg, Freiburg, Germany
| | | | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenther Laufer
- Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Jan Gummert
- Heart and Diabetes Center Nord-Rhein-Westfalen, Ruhr University Bochum, Bochum, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Philip W Raake
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany; Department of Cardiology, University Hospital of Augsburg, Augsburg Germany
| | - Norbert Frey
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Internal Medicine III, Division of Cardiology, University of Heidelberg, Heidelberg, Germany; DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| |
Collapse
|
12
|
Voutilainen A, Brester C, Kolehmainen M, Tuomainen TP. Epidemiological analysis of coronary heart disease and its main risk factors: are their associations multiplicative, additive, or interactive? Ann Med 2022; 54:1500-1510. [PMID: 35603961 PMCID: PMC9132387 DOI: 10.1080/07853890.2022.2078875] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The purpose of this study was to discover how considering multiplicative, additive, and interactive effects modifies results of a prospective cohort study on coronary heart disease (CHD) incidence and its main risk factors. MATERIAL AND METHODS The Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study provided the study material, 2682 Eastern Finnish middle-aged men, followed since the 1980s. We applied multiplicative and additive survival models together with different statistical metrics and confidence intervals for risk ratios and risk differences to estimate the nature of associations. RESULTS The mean (SD) follow-up time among men who were free of CHD at baseline (n = 1958) was 21.4 (10.4) years, and 717 (37%) of them had the disease and 301 (15%) died for CHD before the end of follow-up. All tested non-modifiable and modifiable risk factors statistically significantly predicted CHD incidence. We detected three interactions: circulating low-density lipoprotein cholesterol (LDL-C) × age, obesity × age, and obesity × smoking of which LDL-C × age was the most evident one. High LDL-C increased the risk of CHD more among men younger than 50 [risk ratio (RR) 2.10] than those older than 50 (RR 1.22). LDL-C status was the only additive covariate. The additive effect of high LDL-C increased almost linearly up to 18 years and then reached a plateau. The simple multiplicative survival model stressed glycemic status as the strongest modifiable risk factor for developing CHD [hazard ratio (HR) for diabetes vs. normoglycemia was 2.69], whereas the model considering interactions and time dependence emphasised the role of LDL-C status (HR for high LDL-C vs. lower than borderline was 4.43). Age was the strongest non-modifiable predictor. CONCLUSIONS Including covariate interactions and time dependence in survival models potentially refine results of epidemiological analyses and ease to define the order of importance across CHD risk factors. KEY MESSAGESIncluding covariate interactions and time dependence in survival models potentially refine results of epidemiological analyses on coronary heart disease.Including covariate interactions and time dependence in survival models potentially ease to define the order of importance across coronary heart disease risk factors.
Collapse
Affiliation(s)
- Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Christina Brester
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko Kolehmainen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
13
|
Noble RMN, Jahandideh F, Armstrong EA, Bourque SL, Yager JY. Broccoli Sprouts Promote Sex-Dependent Cardiometabolic Health and Longevity in Long-Evans Rats. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13468. [PMID: 36294045 PMCID: PMC9603818 DOI: 10.3390/ijerph192013468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Antioxidants and anti-inflammatory compounds are potential candidates to prevent age-related chronic diseases. Broccoli sprouts (BrSp) are a rich source of sulforaphane-a bioactive metabolite known for its antioxidant and anti-inflammatory properties. We tested the effect of chronic BrSp feeding on age-related decline in cardiometabolic health and lifespan in rats. Male and female Long-Evans rats were fed a control diet with or without dried BrSp (300 mg/kg body weight, 3 times per week) from 4 months of age until death. Body weight, body composition, blood pressure, heart function, and glucose and insulin tolerance were measured at 10, 16, 20, and 22 months of age. Behavioral traits were also examined at 18 months of age. BrSp feeding prolonged life span in females, whereas in males the positive effects on longevity were more pronounced in a subgroup of males (last 25% of survivors). Despite having modest effects on behavior, BrSp profoundly affected cardiometabolic parameters in a sex-dependent manner. BrSp-fed females had a lower body weight and visceral adiposity while BrSp-fed males exhibited improved glucose tolerance and reduced blood pressure when compared to their control counterparts. These findings highlight the sex-dependent benefits of BrSp on improving longevity and delaying cardiometabolic decline associated with aging in rats.
Collapse
Affiliation(s)
- Ronan M. N. Noble
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Forough Jahandideh
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Edward A. Armstrong
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Stephane L. Bourque
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Department of Pharmacology, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Jerome Y. Yager
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 2G3, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| |
Collapse
|
14
|
Arjani S, Bostonian TJ, Prasath V, Quinn PL, Chokshi RJ. Cost-effectiveness of adrenal vein sampling- vs computed tomography-guided adrenalectomy for unilateral adrenaloma in primary aldosteronism. J Endocrinol Invest 2022; 45:1899-1908. [PMID: 35612811 DOI: 10.1007/s40618-022-01821-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Adrenalectomies performed for the treatment of primary aldosteronism due to unilateral adenoma are traditionally confirmed with, and guided by, results from adrenal vein sampling (AVS). However, the usefulness of AVS at the expense of cost and complications is debated, and many institutions have independent protocols that use AVS to varying degrees. METHODS Cost-effectiveness of AVS- vs computed tomography (CT)-based adrenalectomy was calculated using decision tree models. The tree was populated with values describing biochemical post-operative outcomes from the published literature; patients were placed into AVS- or CT-dependent treatment arms. Biochemical outcomes were defined based on patients' potassium levels and aldosterone-renin ratios. Patients underwent adrenalectomies and received medical management dosed based on surgical outcomes. Costs were represented by Medicare (FY2021) reimbursement rates (US$) and quality-adjusted life-years (QALYs) were calculated using published morbidity and survival data. A willingness-to-pay of $100,000 per QALY gained was set to determine the most cost-effective strategy. The primary outcome was the incremental cost-effectiveness ratio (ICER) associated with biochemical outcomes. RESULTS The base case analyses favored the use of AVS-guided care, which cost $307.65 more but yielded 0.78 more QALYs, resulting in an ICER of $392.57. These results were upheld by all one-way and two-way sensitivity analyses. In 100,000 random-sampling simulations, AVS-guided care was favored 100% of the time. CONCLUSIONS For patients with primary aldosteronism receiving adrenalectomies with curative intent, the more cost-effective method based on biochemical outcomes is AVS-based care. Recent literature suggests biochemical resolution should be favored over clinical resolution, due to long-term detriments of increased aldosterone independent of clinical symptoms.
Collapse
Affiliation(s)
- S Arjani
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - V Prasath
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - P L Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - R J Chokshi
- Department of Surgery, Division of Surgical Oncology, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA.
| |
Collapse
|
15
|
Kwon A, Kim GH, Kim MS. Clinical implications of central blood pressure measured by radial tonometry and automated office blood pressure measured using automatic devices in cardiovascular diseases. Front Cardiovasc Med 2022; 9:906021. [PMID: 36035931 PMCID: PMC9403538 DOI: 10.3389/fcvm.2022.906021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Central aortic systolic blood pressure (CBP) measured by carotid-femoral pulse wave analysis (cfPWA) is a gold standard method to estimate true arterial pressure. However, the impact of the CBP level measured by radial PWA on cardiovascular (CV) risk assessment is unclear. This study aimed to determine the impact on CV outcome assessment and the association between the optimal levels of non-invasively measured CBP and automated office blood pressure (OBP) in clinical practice. Materials and methods A total of 2,115 patients underwent non-invasive semiautomated radial artery applanation tonometry (Omron HEM-9000AI) in the Department of Internal Medicine, St. Vincent’s Hospital, from July 2011 to December 2015. The patients were followed for at least 5 years, and atherosclerotic cardiovascular (ASCVD) outcomes were collected. Results Among 2,115 patients (mean age 58 ± 14 years, 50.4% men) who were followed up, the median follow-up period was 52 months (range: 1–104 months). The total number of patients with ASCVD events was 163 (7.70%). In multivariate Cox regression analysis, a CBP of more than 125 mmHg and an automated OBP of more than 131 mmHg were independently associated with a significant increase in ASCVD outcomes. After adjusting for confounding factors, the hazard ratio for ASCVD events increased by 12.5, 11.7, and 12.7%, for every 10 mmHg increase in automated OBP, CBP, and central pulse pressure (PP), respectively. Conclusion This study demonstrated that the automated OBP measured using the method used in real clinical practice and CBP measured by radial tonometry were associated with an increased risk for adverse ASCVD outcomes.
Collapse
Affiliation(s)
- Ami Kwon
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Gee-Hee Kim
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- *Correspondence: Gee-Hee Kim,
| | - Min-Sik Kim
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
16
|
Clarke PM, Tran-Duy A, Roope LSJ, Stiles JA, Barnett AG. The comparative mortality of an elite group in the long run of history: an observational analysis of politicians from 11 countries. Eur J Epidemiol 2022; 37:891-899. [PMID: 35739361 PMCID: PMC9223251 DOI: 10.1007/s10654-022-00885-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
This study aims to compare the mortality rate and life expectancy of politicians with those of the age and gender-matched general populations. This was an observational analysis of mortality rates of politicians (i.e. members of national parliaments with available data on dates of birth, death and election, gender, and life tables) in 11 developed countries. Politicians were followed from date of first election until either death or the last available year with life table data. Relative mortality differences were estimated using standardised mortality ratios (SMRs). Absolute inequalities were quantified as the difference in survival by deducting a population’s remaining life expectancy from politicians’ remaining life expectancy at age 45, estimated using Gompertz parametric proportional hazards models. We included 57,561 politicians (with follow-up ranging from 1816–2016 for France to 1949–2017 for Germany). In almost all countries politicians had similar rates of mortality to the general population in the early part of the twentieth century. Relative mortality and survival differences (favouring politicians) increased considerably over the course of the twentieth century, with recent SMRs ranging from 0.45 (95%CI 0.41–0.50) in Italy to 0.82 (95%CI 0.69–0.95) in New Zealand. The peak life expectancy gaps ranged from 4.4 (95% CI, 3.5–5.4) years in the Netherlands to 7.8 (95% CI, 7.2–8.4) years in the US. Our results show large relative and absolute inequalities favouring politicians in every country. In some countries, such as the US, relative inequalities are at the greatest level in over 150 years.
Collapse
Affiliation(s)
- Philip M Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK. .,Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Laurence S J Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Jay A Stiles
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Adrian G Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
17
|
Prevalence, Awareness, Treatment, and Control of Hypertension among Adult Residents of Tehran: The Tehran Cohort Study. Glob Heart 2022; 17:31. [PMID: 35586741 PMCID: PMC9104493 DOI: 10.5334/gh.1120] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
|
18
|
The Association between Serum Resistin Level, Resistin (-420C/G) Single Nucleotide Variant, and Markers of Endothelial Dysfunction, including Salt Taste Preference in Hypertensive Patients. Nutrients 2022; 14:nu14091789. [PMID: 35565757 PMCID: PMC9102533 DOI: 10.3390/nu14091789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Resistin action links to conditions such as diabetes, obesity, but its role in hypertension is less well understood. This study aimed to estimate the relationship between resistin (−420G/C) single nucleotide variant (SNV) and markers associated with endothelial dysfunction in hypertension. Methods: The study enrolled 162 hypertensive patients (HT) and 165 non-hypertensive (NHT) patients. Resistin serum concentration was estimated with immuoenzymatic assay. Anthropometric measurements, blood pressure and arterial stiffness index (SI), uric acid (UA) serum concentration, and salty taste preference of normal (NS) or high (HS) were assessed in the study. Genotyping was achieved by polymerase chain reaction-restriction fragment length polymorphism. Results: Resistin concentration and SI do not differ significantly between HT and NHT individuals; UA significantly increased in HT subjects. Resistin, UA, and SI did not differ among particular resistin genotypes in HT, NHT, NS, or HS groups. GG and CG genotypes were more frequent (OR 1.57 (95% CI; 1.01–2.43); p = 0.04) in hypertensive individuals than the NHT group, but less frequent (OR 0.58 (95% CI; 0.37–0.91); p = 0.01) in HS patients compared to NS individuals. Concerning HT patients with different salt preferences, GG + CG genotypes were less frequent (OR 0.50 (95% CI; 0.26–0.97); p = 0.04) in the HS group than in NS individuals. HT carriers of GG and CG genotype have significantly increased UA concentrations compared to the respective NHT subjects. HS individuals carrying GG and CG genotypes have higher SI values than the NS group. Allele G of SNV (−420G/C) adjusted for age, BMI, serum resistin, UA concentration, salt taste preference, SI, and HR values increased the risk of developing hypertensive phenotype 1.8 fold. Conclusions: Resistin SNV (−420G/C) is related to several markers associated with endothelial dysfunction, including salt taste preference in hypertensive patients.
Collapse
|
19
|
Consolazio D, Gattoni ME, Russo AG. Exploring gender differences in medication consumption and mortality in a cohort of hypertensive patients in Northern Italy. BMC Public Health 2022; 22:768. [PMID: 35428215 PMCID: PMC9013154 DOI: 10.1186/s12889-022-13052-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background This paper aims to assess the presence of gender differences in medication use and mortality in a cohort of patients affected exclusively by hypertension, in 193 municipalities in the Lombardy Region (Northern Italy), including Milan's metropolitan area. Methods A retrospective cohort study was conducted (N = 232,507) querying administrative healthcare data and the Register of Causes of Death. Hypertensive patients (55.4% women; 44.6% men) in 2017 were identified; gender differences in medication use (treatment, 80% compliance) and deaths (from all causes and CVDs) were assessed at two-year follow-ups in logistic regression models adjusted for age class, census-based deprivation index, nationality, and pre-existing health conditions. Models stratified by age, deprivation index, and therapeutic compliance were also tested. Results Overall, women had higher odds of being treated, but lower odds of therapeutic compliance, death from all causes, and death from CVDs. All the outcomes had clear sex differences across age classes, though not between different levels of deprivation. Comparing patients with medication adherence, women had lower odds of death from all causes than men (with a narrowing protective effect as age increased), while no gender differences emerged in non-compliant patients. Conclusions Among hypertensive patients, gender differences in medication consumption and mortality have been found, but the extent to which these are attributable to a female socio-cultural disadvantage is questionable. The findings reached, with marked age-dependent effects in the outcomes investigated, suggest a prominent role for innate sex differences in biological susceptibility to the disease, whereby women would take advantage of the protective effects of their innate physiological characteristics, especially prior to the beginning of menopause. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13052-9.
Collapse
|
20
|
Lantelme P, Harbaoui B, Courand PY. Hypertension management: Back to the future. Arch Cardiovasc Dis 2022; 115:249-251. [DOI: 10.1016/j.acvd.2022.02.009] [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: 11/18/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/02/2022]
|
21
|
Metz M, Pierre JL, Yan LD, Rouzier V, St‐Preux S, Exantus S, Preval F, Roberts N, Tymejczyk O, Malebranche R, Deschamps MM, Pape JW, McNairy ML. Hypertension continuum of care: Blood pressure screening, diagnosis, treatment, and control in a population-based cohort in Haiti. J Clin Hypertens (Greenwich) 2022; 24:246-254. [PMID: 35199944 PMCID: PMC8925011 DOI: 10.1111/jch.14399] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 01/13/2023]
Abstract
Cardiovascular disease (CVD) is the number one cause of death in low-income countries including Haiti, with hypertension (HTN) being the leading risk factor. This study aims to identify gaps in the HTN continuum of screening, diagnosis, treatment, and blood pressure (BP) control. Sociodemographic and clinical data were collected from a population-based sample of adults ≥18 years in Port-au-Prince (PAP) from March 2019 to April 2021. HTN was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or use of antihypertensive medication. Screening was defined as ever having had a BP measurement; diagnosis as previously being informed of a HTN diagnosis; treatment as having taken antihypertensives in the past 2 weeks; and controlled as taking antihypertensives and having BP < 140/90 mmHg. Factors associated with attaining each step in the continuum were assessed using Poisson multivariable regressions. Among 2737 participants, 810 (29% age-standardized) had HTN, of whom 97% had been screened, 72% diagnosed, 45% treated, and 13% controlled. There were no significant differences across age groups or sex. Obesity (BMI ≥ 30) was a significant factor associated with receiving treatment compared to normal weight (BMI < 25), with a prevalence ratio (PR) of 1.5 (95% CI 1.1-2.0). Having secondary or higher education was associated with higher likelihood of controlled BP (PR 1.9 [95% CI 1.1-3.3]). In this urban Haitian population, the greatest gaps in HTN care are treatment and control. Targeted interventions are needed to improve these steps, including broader access to affordable treatment, timely distribution of medications, and patient adherence to HTN medication.
Collapse
Affiliation(s)
- Miranda Metz
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Jean Lookens Pierre
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Lily Du Yan
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
- Division of General Internal MedicineDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Vanessa Rouzier
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
- Division of General Internal MedicineDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Stephano St‐Preux
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Serfine Exantus
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Fabyola Preval
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Nicholas Roberts
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Olga Tymejczyk
- City University of New York Institute for Implementation Science in Population HealthNew YorkNew YorkUSA
| | | | - Marie Marcelle Deschamps
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Jean W. Pape
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Margaret L. McNairy
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
- Division of General Internal MedicineDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| |
Collapse
|
22
|
Li D, Wang L, Zhou Z, Song L, Chen S, Yang Y, Hu Y, Wang Y, Wu S, Tian Y. Lifetime risk of cardiovascular disease and life expectancy with and without cardiovascular disease according to changes in metabolic syndrome status. Nutr Metab Cardiovasc Dis 2022; 32:373-381. [PMID: 34893414 DOI: 10.1016/j.numecd.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/07/2021] [Accepted: 10/17/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS The relationship between dynamic changes in metabolic syndrome (MetS) status and lifetime risk of cardiovascular disease (CVD) has not been reliably quantified. This study aimed to estimate lifetime risk of CVD and life expectancy with and without CVD according to dynamic MetS status. METHODS AND RESULTS Dynamic changes in MetS status were assessed: MetS-free, MetS-chronic, MetS-developed, and MetS-recovery groups. We used Modified Kaplan-Meier method to estimate lifetime risk and used multistate life table method to calculate life expectancy. Participants free of CVD at index ages 35 (n = 40 168), 45 (n = 33 569), and 55 (n = 18 546) years. At index age 35 years, we recorded 1341 CVD events during a median follow-up of 6.1 years. Lifetime risk of 33.9% (95% CI: 26.9%-41.0%) in MetS-recovery group was lower than that of 39.4% (95% CI: 36.1%-42.8%) in MetS-chronic group. Lifetime risk of 37.8% (95% CI: 30.6%-45.1%) in MetS-developed group was higher than that of 26.4% (95% CI: 22.7%-30.0%) in MetS-free group. At index age 35 years, life expectancy free of CVD for MetS-recovery group (44.1 years) was higher than that for MetS-chronic group (38.8 years). Life expectancy free of CVD for MetS-developed group (41.9 years) was lower than that for MetS-free group (46.7 years). CONCLUSIONS Recovery from MetS was associated with decreased lifetime risk of CVD and a longer life expectancy free of CVD, whereas development of MetS was associated with increased lifetime risk of CVD and a shorter life expectancy free of CVD.
Collapse
Affiliation(s)
- Dankang Li
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Lulin Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Ziyi Zhou
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, No.57 Xinhua East Road, Tangshan City, 063001, China
| | - Yingping Yang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, Beijing, 100191, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, No.57 Xinhua East Road, Tangshan City, 063001, China.
| | - Yaohua Tian
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, And State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.
| |
Collapse
|
23
|
Lee JH, Duster M, Roberts T, Devinsky O. United States Dietary Trends Since 1800: Lack of Association Between Saturated Fatty Acid Consumption and Non-communicable Diseases. Front Nutr 2022; 8:748847. [PMID: 35118102 PMCID: PMC8805510 DOI: 10.3389/fnut.2021.748847] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
Abstract
We reviewed data on the American diet from 1800 to 2019. Methods: We examined food availability and estimated consumption data from 1800 to 2019 using historical sources from the federal government and additional public data sources. Results: Processed and ultra-processed foods increased from <5 to >60% of foods. Large increases occurred for sugar, white and whole wheat flour, rice, poultry, eggs, vegetable oils, dairy products, and fresh vegetables. Saturated fats from animal sources declined while polyunsaturated fats from vegetable oils rose. Non-communicable diseases (NCDs) rose over the twentieth century in parallel with increased consumption of processed foods, including sugar, refined flour and rice, and vegetable oils. Saturated fats from animal sources were inversely correlated with the prevalence of NCDs. Conclusions: As observed from the food availability data, processed and ultra-processed foods dramatically increased over the past two centuries, especially sugar, white flour, white rice, vegetable oils, and ready-to-eat meals. These changes paralleled the rising incidence of NCDs, while animal fat consumption was inversely correlated.
Collapse
Affiliation(s)
- Joyce H. Lee
- Department of Neurology, New York University, Grossman School of Medicine, New York, NY, United States
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Miranda Duster
- Department of Neurology, New York University, Grossman School of Medicine, New York, NY, United States
| | - Timothy Roberts
- New York University, Health Sciences Library, New York, NY, United States
| | - Orrin Devinsky
- Department of Neurology, New York University, Grossman School of Medicine, New York, NY, United States
| |
Collapse
|
24
|
Park DJ, Yoon CS, Choi SE, Xu H, Kang JH, Lee SS. Risk factors for thrombotic events in Korean patients with systemic lupus erythematosus. Sci Rep 2021; 11:23529. [PMID: 34876633 PMCID: PMC8651713 DOI: 10.1038/s41598-021-03074-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022] Open
Abstract
Thrombotic events (TE), including deep vein thrombosis, stroke, and myocardial infarction, occur in 30-40% of patients with systemic lupus erythematosus (SLE) resulting in substantial morbidity and mortality. We explored the risk factors for TE in SLE patients. We analyzed data obtained during a prospective cohort based on the KORean lupus NETwork (KORNET) registry, and enrolled 259 SLE patients with clinical data available at the onset of SLE. TE was defined as the presence of arterial or venous thrombosis. Multivariate Cox-proportional hazards analysis was performed to investigate risk factors for TE. During a mean follow-up of 103.3 months (SD 53.4), 27 patients (10.4%) had a TE. In multivariate analysis, hypertension (hazard ratio [HR] 7.805, 95% confidence interval [CI]: 1.929-31.581; P = 0.004), anti-phospholipid syndrome (APS) (HR 12.600, 95% CI: 4.305-36.292; P < 0.001), mean daily prednisolone > 5 mg/day (HR 3.666, 95% CI: 1.318-10.197; P = 0.013), and SLICC/ACR Damage Index (SDI) score (HR 1.992, 95% CI: 1.465-2.709; P < 0.001) were significantly associated with the development of TE in SLE patients. Instead, use of an ACEi or ARB (HR 0.159, 95% CI: 0.043-0.594; P = 0.006) was a protective factor against TE development in these patients. In conclusion, hypertension, higher mean daily dose of prednisolone, diagnosis of APS, and higher SDI were risk factors for TE in patients with SLE. On the other hand, the use of an ACEi or ARB was associated with a reduced risk of TE.
Collapse
Affiliation(s)
- Dong-Jin Park
- grid.411597.f0000 0004 0647 2471Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Chang-Seok Yoon
- grid.411597.f0000 0004 0647 2471Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Sung-Eun Choi
- grid.411597.f0000 0004 0647 2471Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Haimuzi Xu
- grid.411597.f0000 0004 0647 2471Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Ji-Hyoun Kang
- grid.411597.f0000 0004 0647 2471Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Shin-Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
| |
Collapse
|
25
|
Holmlund T, Ekblom B, Börjesson M, Andersson G, Wallin P, Ekblom-Bak E. Association between change in cardiorespiratory fitness and incident hypertension in Swedish adults. Eur J Prev Cardiol 2021; 28:1515-1522. [PMID: 32812803 DOI: 10.1177/2047487320942997] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/28/2020] [Indexed: 09/03/2023]
Abstract
AIMS To explore how change in cardiorespiratory fitness is associated with incident hypertension in adults, and whether the association varies between sex, age, body mass index, cardiorespiratory fitness at baseline and follow-up time. A second aim is to study how change in other lifestyle-related variables affects the results. METHODS A total of 91,728 participants (48% women), normotensive at baseline, with two examinations from occupational health service screenings between 1982 and 2019 (mean duration 4.3 years) were included. Cardiorespiratory fitness was assessed as estimated maximal oxygen consumption using submaximal cycle testing. Change in cardiorespiratory fitness was expressed as the percentage change per year. Incident hypertension was defined as systolic blood pressure of 140 mmHg or greater or diastolic blood pressure of 90 mmHg or greater, or self-reported physician-diagnosed hypertension, at second examination. RESULTS A large increase (≥3% annual change) in cardiorespiratory fitness was associated with a 11% lower risk of incident hypertension compared with maintainers (-1 to +1%), after multi-adjustment including change in smoking, body mass index, diet, stress and exercise habits. On the contrary, a small (-1 to -<3%) and large (≥-3%) decrease in cardiorespiratory fitness associated with a 21% and 25% higher risk compared with maintainers. Longer duration between the examinations was associated with stronger risk associations. Preserving, or changing to, risk level for the other lifestyle variables was associated with a higher risk of incident hypertension. However, a simultaneous maintenance of or increase in cardiorespiratory fitness attenuated the risk associated with smoking, and stress. CONCLUSION Preserving or increasing cardiorespiratory fitness should be part of any long-term strategy to decrease the risk of incident hypertension.
Collapse
Affiliation(s)
- Tobias Holmlund
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Sweden
| | - Björn Ekblom
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Sweden
| | - Mats Börjesson
- Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
| | | | - Peter Wallin
- Research Department, HPI Health Profile Institute, Sweden
| | - Elin Ekblom-Bak
- Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Sweden
| |
Collapse
|
26
|
Lantelme P, Moulayat C, Courand PY, Mouly-Bertin C, Debouzy-Berge C, Rial MO, Iwaz J, Harbaoui B, Riche B, Rabilloud M. Gain in net survival from hypertension control over the last half-century. Eur J Prev Cardiol 2021; 29:169-177. [PMID: 34269383 DOI: 10.1093/eurjpc/zwab094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 11/12/2022]
Abstract
AIMS This study determined whether the improvements in hypertension management over the last five decades have influenced subjects' prognosis. METHODS AND RESULTS The study considered 5693 eligible subjects seen January 1969 to February 1991 (follow-up until December 2003) or January 1995 to October 2014 (follow-up until July 2016) in an all-grade hypertension reference centre. Missing data or incomplete follow-ups led to exclude 1036 subjects (18%). The outcome was all-cause death. An adjusted modelling of the excess mortality rate assessed subjects' net survival over five inclusion periods to allow for the increase in life expectancy of the general population during the same periods. The analysis of 4657 records (mean age: 47 years; 43.2% women) showed that the proportion of subjects with grade 3 hypertension decreased significantly from 43.3% (1142) to only 6.3% (22) over the five periods and that the net survival improved in men and women regardless of the hypertension grade; i.e. the gain in net survival at 15 years was estimated at 12.3% (95% confidence interval: 8.1-22.3). The 15-year restricted mean survival was estimated at 13 years over the first period and 14.8 years over the last period, which is nearly a 2-year gain in life expectancy at 15 years. CONCLUSION Since the 70s and the advent of modern management, the excess mortality of hypertensive subjects (vs. the general population) was markedly reduced. Within a context of trivialization of blood pressure measurement and reluctance to long-term treatments, physicians should consider this advantage and use it to promote blood pressure control.
Collapse
Affiliation(s)
- Pierre Lantelme
- Université de Lyon, Lyon, France.,Service de Cardiologie, Hôpital de la Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.,CREATIS (CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon), Lyon, France
| | - Chahinaz Moulayat
- Université de Lyon, Lyon, France.,Service de Cardiologie, Hôpital de la Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.,CREATIS (CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon), Lyon, France
| | - Pierre-Yves Courand
- Université de Lyon, Lyon, France.,Service de Cardiologie, Hôpital de la Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.,CREATIS (CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon), Lyon, France
| | - Carine Mouly-Bertin
- Université de Lyon, Lyon, France.,Service de Cardiologie, Hôpital de la Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.,CREATIS (CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon), Lyon, France
| | - Constance Debouzy-Berge
- Université de Lyon, Lyon, France.,Service de Cardiologie, Hôpital de la Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.,CREATIS (CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon), Lyon, France
| | - Marie-Odile Rial
- Université de Lyon, Lyon, France.,Service de Cardiologie, Hôpital de la Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.,CREATIS (CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon), Lyon, France
| | - Jean Iwaz
- Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR5558, Villeurbanne, France
| | - Brahim Harbaoui
- Université de Lyon, Lyon, France.,Service de Cardiologie, Hôpital de la Croix-Rousse and Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.,CREATIS (CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon), Lyon, France
| | - Benjamin Riche
- Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR5558, Villeurbanne, France
| | - Muriel Rabilloud
- Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR5558, Villeurbanne, France
| |
Collapse
|
27
|
Groenland EH, Bots ML, Asselbergs FW, de Borst GJ, Kappelle LJ, Visseren FLJ, Spiering W. Apparent treatment resistant hypertension and the risk of recurrent cardiovascular events and mortality in patients with established vascular disease. Int J Cardiol 2021; 334:135-141. [PMID: 33932429 DOI: 10.1016/j.ijcard.2021.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
AIM To quantify the relation between apparent treatment resistant hypertension (aTRH) and the risk of recurrent major adverse cardiovascular events (MACE including stroke, myocardial infarction and vascular death) and mortality in patients with stable vascular disease. METHODS 7455 hypertensive patients with symptomatic vascular disease were included from the ongoing UCC-SMART cohort between 1996 and 2019. aTRH was defined as an office blood pressure ≥140/90 mmHg despite treatment with ≥3 antihypertensive drugs including a diuretic. Cox proportional hazard models were used to quantify the relation between aTRH and the risk of recurrent MACE and all-cause mortality. In addition, survival for patients with aTRH was assessed, taking competing risk of non-vascular mortality into account. RESULTS A total of 1557 MACE and 1882 deaths occurred during a median follow-up of 9.0 years (interquartile range 4.8-13.1 years). Compared to patients with non-aTRH, the 614 patients (8%) with aTRH were at increased risk of cardiovascular mortality (HR 1.27; 95% CI 1.03-1.56) and death from any cause (HR 1.25; 95% CI 1.07-1.45) but not recurrent MACE (HR 1.13; 95% CI 0.95-1.34). At the age of 50 years, patients with aTRH after a first cardiovascular event on average had a 6.4 year shorter median life expectancy free of recurrent MACE than patients with non-aTRH. CONCLUSION In hypertensive patients with clinically manifest vascular disease, aTRH is related to a higher risk of vascular death and death from any cause. Moreover, patients with aTRH after a first cardiovascular event have a 6.4 year shorter median life expectancy free of recurrent cardiovascular disease.
Collapse
Affiliation(s)
- Eline H Groenland
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | | |
Collapse
|
28
|
Ismail MA, Norhayati MN, Mohamad N. Olive leaf extract effect on cardiometabolic profile among adults with prehypertension and hypertension: a systematic review and meta-analysis. PeerJ 2021; 9:e11173. [PMID: 33868820 PMCID: PMC8035902 DOI: 10.7717/peerj.11173] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/07/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to determine the effectiveness of olive leaf extract on cardiometabolic profiles among prehypertensive and hypertensive groups. METHODOLOGY The Cochrane central register of controlled trials, Medline (1966 to April week 1, 2020), Embase (1966 to April week 1, 2020) and trial registries for relevant randomized clinical trials were used. Published and unpublished randomized clinical trials were reviewed and evaluated. Random effects models were used to estimate the continuous outcomes and mean differences (MDs); both with 95% confidence intervals (CIs). The primary outcomes were changes in systolic and diastolic BP. The secondary outcomes were changes in lipid profile, glucose metabolism, inflammatory markers for CVD, kidney and liver functions safety parameters. We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias and quality of evidence. RESULTS Five trials were included involving 325 patients aged 18-80 years. Two trials involved high-income countries and three trials involved moderate-income countries. The analysis performed was based on three comparisons. No significant changes were found between systolic or diastolic blood pressure (BP) for the first comparison, 1,000 mg per day for a combined formulation of olive leaf extract versus a placebo. The second comparison, 500 mg per day of olive leaf extract versus placebo or no treatment, showed a significant reduction in systolic BP over a period of at least 8 weeks of follow up (MD -5.78 mmHg, 95% CI [-10.27 to -1.30]) and no significant changes on diastolic BP. The third comparison, 1,000 mg per day of olive leaf extract versus placebo shows no significant difference but an almost similar reduction in systolic BP (-11.5 mmHg in olive leaf extract and -13.7 mmHg in placebo, MD 2.2 mmHg, 95% CI [-0.43-4.83]) and diastolic BP (-4.8 mmHg in olive leaf extract and -6.4 mmHg in placebo, MD 1.60 mmHg, 95% CI [-0.13-3.33]). For secondary outcomes, 1,000 mg per day of olive leaf extract versus captopril showed a reduction in LDL (MD -6.00 mg/dl, 95% CI [-11.5 to -0.50]). The 500 mg per day olive leaf extract versus placebo showed a reduction in inflammatory markers for CVD IL-6 (MD -6.83 ng/L, 95% CI [-13.15 to -0.51]), IL-8 (MD -8.24 ng/L, 95% CI [-16.00 to -0.48) and TNF-alpha (MD -7.40 ng/L, 95% CI [-13.23 to -1.57]). CONCLUSIONS The results from this review suggest the reduction of systolic BP, LDL and inflammatory biomarkers, but it may not provide a robust conclusion regarding the effects of olive leaf extract on cardiometabolic profile due to the limited number of participants in the included trials. REVIEW REGISTRATIONS PROSPERO CDR 42020181212.
Collapse
Affiliation(s)
- Muhammad Asyraf Ismail
- Department of Family Medicine, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Noraini Mohamad
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
29
|
de Oliveira AA, Nunes KP. Hypertension and Erectile Dysfunction: Breaking Down the Challenges. Am J Hypertens 2021; 34:134-142. [PMID: 32866225 DOI: 10.1093/ajh/hpaa143] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/15/2020] [Accepted: 08/29/2020] [Indexed: 02/07/2023] Open
Abstract
A diagnostic of hypertension increases the risk of erectile dysfunction (ED); likewise, ED can be an early sign of hypertension. In both cases, there is evidence that endothelial dysfunction is a common link between the 2 conditions. During hypertension, the sustained and widespread release of procontractile factors (e.g., angiotensin II, endothelin 1, and aldosterone) impairs the balance between vasoconstrictors and vasodilators and, in turn, detrimentally impacts vascular and erectile structures. This prohypertensive state associates with an enhancement in the generation of reactive oxygen species, which is not compensated by internal antioxidant mechanisms. Recently, the innate immune system, mainly via Toll-like receptor 4, has also been shown to actively contribute to the pathophysiology of hypertension and ED not only by inducing oxidative stress but also by sustaining a low-grade inflammatory state. Furthermore, some drugs used to treat hypertension can cause ED and, consequently, reduce compliance with the prescribed pharmacotherapy. To break down these challenges, in this review, we focus on discussing the well-established as well as the emerging mechanisms linking hypertension and ED with an emphasis on the signaling network of the vasculature and corpora cavernosa, the vascular-like structure of the penis.
Collapse
Affiliation(s)
- Amanda Almeida de Oliveira
- Laboratory of Vascular Physiology, Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, Florida, USA
| | - Kenia Pedrosa Nunes
- Laboratory of Vascular Physiology, Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, Florida, USA
| |
Collapse
|
30
|
Cardiovascular and musculoskeletal health disorders associate with greater decreases in physical capability in older women. BMC Musculoskelet Disord 2021; 22:192. [PMID: 33593350 PMCID: PMC7888167 DOI: 10.1186/s12891-021-04056-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/31/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Good physical capability is an important part of healthy biological ageing. Several factors influencing physical capability have previously been reported. Long-term reports on physical capability and the onset of clinical disorders and chronic diseases are lacking. Decrease in physical capacity has been shown to increase mortality. This study focuses on the prevalence of chronic diseases. The primary objective of the study was to reveal the association between physical capability and morbidity. Secondary objectives included the validity of self-reported physical capability and the association between baseline physical capability and mortality. METHODS The OSTPRE (Kuopio Osteoporosis Risk Factor and Prevention Study) prospective cohort involved all women aged 47-56 years residing in the Kuopio Province, Finland in 1989. Follow-up questionnaires were mailed at five-year intervals. Physical capability questions were first presented in 1994. From these women, we included only completely physically capable subjects at our baseline, in 1994. Physical capability was evaluated with five scale self-reports at baseline and in 2014 as follows: completely physically capable, able to walk but not run, can walk up to 1000 m, can walk up to 100 m and temporarily severely incapable. The prevalences of selected chronic diseases, with a minimum prevalence of 10% in 2014, were compared with the change in self-reported physical capability. Additionally, associations between long-term mortality and baseline physical capability of the whole 1994 study population sample were examined with logistic regression. The correlation of self-reported physical capability with functional tests was studied cross-sectionally at the baseline for a random subsample. RESULTS Our study population consisted of 6219 Finnish women with a mean baseline age of 57.0 years. Self-reported physical capability showed statistically significant correlation with functional tests. Cardiovascular diseases and musculoskeletal disorders show the greatest correlation with decrease of physical capability. Prevalence of hypertension increased from 48.7% in the full physical capability group to 74.5% in the "able to walk up to 100 metres" group (p < 0.001). Rheumatoid arthritis showed a similar increase from 2.1 to 7.4% between these groups. Higher baseline body mass index (BMI) decreases long-term capability (P < 0.001). Women reporting full physical capability at baseline had a mortality rate of 15.1%, in comparison to 48.5% in women within the "able to walk up to 100 m" group (p = 0.357). Mortality increased steadily with worsening baseline physical capability. CONCLUSIONS The results of this study show that chronic diseases, particularly cardiovascular and musculoskeletal disorders, correlate with faster degradation of physical capability in the elderly. Similar results are shown for increase in BMI. We also demonstrate that the risk of mortality over a 20-year period is higher in individuals with poor baseline physical capability.
Collapse
|
31
|
Krečak I, Morić Perić M, Zekanović I, Holik H, Coha B, Gverić-Krečak V, Lucijanić M. No Impact of the Increased Number of Cardiovascular Risk Factors on Thrombosis and Survival in Polycythemia Vera. Oncol Res Treat 2021; 44:201-203. [PMID: 33503631 DOI: 10.1159/000514347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Ivan Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia,
| | | | - Ivan Zekanović
- Department of Internal Medicine, General Hospital of Zadar, Zadar, Croatia
| | - Hrvoje Holik
- Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Božena Coha
- Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Velka Gverić-Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia
| | | |
Collapse
|
32
|
Associations of blood pressure levels with clinical events in older patients receiving home medical care. Hypertens Res 2020; 44:197-205. [DOI: 10.1038/s41440-020-00538-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 11/08/2022]
|
33
|
Ramezankhani A, Blaha MJ, Mirbolouk MH, Azizi F, Hadaegh F. Multi-state analysis of hypertension and mortality: application of semi-Markov model in a longitudinal cohort study. BMC Cardiovasc Disord 2020; 20:321. [PMID: 32631245 PMCID: PMC7336626 DOI: 10.1186/s12872-020-01599-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background Most previous research has studied the association of hypertension with cardiovascular disease (CVD) and all-cause mortality by focusing on the transition from the initial state to a single outcome. We investigated the impact of hypertension, defined according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) (new) and the Seventh Report of the Joint National Committee (JNC7) (old), on CVD death and all-cause mortality considering non-fatal CVD as an intermediate event between two CVD-free and mortality states. Methods A total of 3002 Iranian population (47.4% men), aged ≥50 years were followed from 1999 to 2014. Two multi-state semi-Markov models with three transitions were defined for CVD death and all-cause mortality as two outcomes. The multivariable Cox model was used to estimate the effect of hypertension on transition hazards. The mean of 15-year life expectancy of participants in each transition was estimated using the restricted mean survival time. Results The ACC/AHA guideline increased the prevalence of hypertension from 43.3 to 68.6%. Among CVD-free individuals, hypertension was significantly associated with increased risk of non-fatal CVD [Hazard Ratio, 1.52 (1.28–1.81) and 1.48 (1.21–1.80)], CVD death [2.96 (2.06–4.25) and 1.98 (1.30–3.04)] and all-cause mortality [1.64 (1.32–2.05) and 1.31 (1.01–1.69)] according the old and new guidelines, respectively. However, after incident non-fatal CVD, the association between hypertension and mortality events was not significant according to both definitions. Hypertensive participants experienced a first non-fatal CVD about 0.9 and 0.6 years earlier than normotensive population according to JNC7 and the 2017 ACC/AHA guidelines, respectively. Conclusion Hypertension, according to JNC7 and the ACC/AHA guidelines, significantly increased the risk of mortality events among CVD-free population although the risk was attenuated using ACC/AHA guideline. Hypertension also decreased the number of years lived without CVD and early onset of CVD, and consequently, an increase in the time spent with these diseases. After non-fatal CVD, hypertension had no significant impact on mortality risk according to both guidelines.
Collapse
Affiliation(s)
- Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Mohammad Hassan Mirbolouk
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
34
|
Ye X, Zeng QT, Facelli JC, Brixner DI, Conway M, Bray BE. Predicting Optimal Hypertension Treatment Pathways Using Recurrent Neural Networks. Int J Med Inform 2020; 139:104122. [PMID: 32339929 PMCID: PMC10490557 DOI: 10.1016/j.ijmedinf.2020.104122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND In ambulatory care settings, physicians largely rely on clinical guidelines and guideline-based clinical decision support (CDS) systems to make decisions on hypertension treatment. However, current clinical evidence, which is the knowledge base of clinical guidelines, is insufficient to support definitive optimal treatment. OBJECTIVE The goal of this study is to test the feasibility of using deep learning predictive models to identify optimal hypertension treatment pathways for individual patients, based on empirical data available from an electronic health record database. MATERIALS AND METHODS This study used data on 245,499 unique patients who were initially diagnosed with essential hypertension and received anti-hypertensive treatment from January 1, 2001 to December 31, 2010 in ambulatory care settings. We used recurrent neural networks (RNN), including long short-term memory (LSTM) and bi-directional LSTM, to create risk-adapted models to predict the probability of reaching the BP control targets associated with different BP treatment regimens. The ratios for the training set, the validation set, and the test set were 6:2:2. The samples for each set were independently randomly drawn from individual years with corresponding proportions. RESULTS The LSTM models achieved high accuracy when predicting individual probability of reaching BP goals on different treatments: for systolic BP (<140 mmHg), diastolic BP (<90 mmHg), and both systolic BP and diastolic BP (<140/90 mmHg), F1-scores were 0.928, 0.960, and 0.913, respectively. CONCLUSIONS The results demonstrated the potential of using predictive models to select optimal hypertension treatment pathways. Along with clinical guidelines and guideline-based CDS systems, the LSTM models could be used as a powerful decision-support tool to form risk-adapted, personalized strategies for hypertension treatment plans, especially for difficult-to-treat patients.
Collapse
Affiliation(s)
- Xiangyang Ye
- Department of Biomedical Informatics, The University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA.
| | - Qing T Zeng
- Department of Biomedical Informatics, The University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA; Department of Clinical Research and Leadership, The George Washington University, 2600 Virginia Ave., NW, First Floor, Washington DC, 20037, USA
| | - Julio C Facelli
- Department of Biomedical Informatics, The University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Diana I Brixner
- Department of Pharmacotherapy, The University of Utah, 30 South 2000 East, Salt Lake City, UT, 84108, USA
| | - Mike Conway
- Department of Biomedical Informatics, The University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| | - Bruce E Bray
- Department of Biomedical Informatics, The University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, USA
| |
Collapse
|
35
|
Elfassy T, Zeki Al Hazzouri A, Cai J, Baldoni PL, Llabre MM, Rundek T, Raij L, Lash JP, Talavera GA, Wassertheil‐Smoller S, Daviglus M, Booth JN, Castaneda SF, Garcia M, Schneiderman N. Incidence of Hypertension Among US Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos, 2008 to 2017. J Am Heart Assoc 2020; 9:e015031. [PMID: 32476602 PMCID: PMC7429033 DOI: 10.1161/jaha.119.015031] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/24/2020] [Indexed: 12/23/2022]
Abstract
Background Among US Hispanics/Latinos, the largest ethnic minority population in the United States, hypertension incidence has not been thoroughly reported. The goal of this study was to describe the incidence of hypertension among US Hispanic/Latino men and women of diverse Hispanic/Latino background. Methods and Results We studied 6171 participants of the Hispanic Community Health Study/Study of Latinos, a diverse group of self-identified Hispanics/Latinos from 4 US urban communities, aged 18 to 74 years, and free from hypertension in 2008 to 2011 and re-examined in 2014 to 2017. Hypertension was defined as self-reported use of anti-hypertension medication, or measured systolic blood pressure ≥130 mm Hg, or diastolic blood pressure ≥80 mm Hg. Results were weighted given the complex survey design to reflect the target population. Among men, the 6-year age-adjusted probability of developing hypertension was 21.7% (95% CI, 19.5-24.1) and differed by Hispanic/Latino background. Specifically, the probability was significantly higher among men of Cuban (27.1%; 95% CI, 20.2-35.2) and Dominican (28.1%; 95% CI, 19.5-38.8) backgrounds compared with Mexican Americans (17.6%; 95% CI: 14.5-21.2). Among women, the 6-year age-adjusted probability of developing hypertension was 19.7% (95% CI, 18.1-21.5) and also differed by Hispanic/Latino background. Specifically, the probability was significantly higher among women of Cuban (22.6%; 95% CI, 18.3-27.5), Dominican (23.3%; 95% CI, 18.0-29.5), and Puerto Rican (28.2%; 95% CI, 22.7-34.4) backgrounds compared with Mexican Americans (16.0%; 95% CI, 13.9-18.4). Conclusions Hypertension incidence varies by Hispanic/Latino background, with highest incidence among those of Caribbean background.
Collapse
Affiliation(s)
- Tali Elfassy
- Department of Public Health SciencesUniversity of Miami, Miller School of MedicineMiamiFL
| | | | - Jianwen Cai
- Department of BiostatisticsUniversity of North Carolina at Chapel HillNC
| | - Pedro L. Baldoni
- Department of BiostatisticsUniversity of North Carolina at Chapel HillNC
| | | | - Tatjana Rundek
- Department of NeurologyEvelyn F. McKnight Brain InstituteUniversity of MiamiFL
| | | | - James P. Lash
- Department of MedicineUniversity of IllinoisChicagoIL
| | | | | | - Martha Daviglus
- Feinberg School of MedicineNorthwestern UniversityEvanstonIL
| | - John N. Booth
- Department of EpidemiologyUniversity of Alabama at Birmingham School of Public HealthBirminghamAL
| | | | - Melawhy Garcia
- School of Public HealthSan Diego State UniversitySan DiegoCA
| | | |
Collapse
|
36
|
Treff NR, Eccles J, Marin D, Messick E, Lello L, Gerber J, Xu J, Tellier LC. Preimplantation Genetic Testing for Polygenic Disease Relative Risk Reduction: Evaluation of Genomic Index Performance in 11,883 Adult Sibling Pairs. Genes (Basel) 2020; 11:E648. [PMID: 32545548 PMCID: PMC7349610 DOI: 10.3390/genes11060648] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/18/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
Preimplantation genetic testing for polygenic disease risk (PGT-P) represents a new tool to aid in embryo selection. Previous studies demonstrated the ability to obtain necessary genotypes in the embryo with accuracy equivalent to in adults. When applied to select adult siblings with known type I diabetes status, a reduction in disease incidence of 45-72% compared to random selection was achieved. This study extends analysis to 11,883 sibling pairs to evaluate clinical utility of embryo selection with PGT-P. Results demonstrate simultaneous relative risk reduction of all diseases tested in parallel, which included diabetes, cancer, and heart disease, and indicate applicability beyond patients with a known family history of disease.
Collapse
Affiliation(s)
- Nathan R. Treff
- Genomic Prediction Inc. 675 US Highway One, North Brunswick, NJ 08902, USA; (J.E.); (D.M.); (E.M.); (L.L.); (J.X.); (L.C.A.M.T.)
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA
| | - Jennifer Eccles
- Genomic Prediction Inc. 675 US Highway One, North Brunswick, NJ 08902, USA; (J.E.); (D.M.); (E.M.); (L.L.); (J.X.); (L.C.A.M.T.)
| | - Diego Marin
- Genomic Prediction Inc. 675 US Highway One, North Brunswick, NJ 08902, USA; (J.E.); (D.M.); (E.M.); (L.L.); (J.X.); (L.C.A.M.T.)
| | - Edward Messick
- Genomic Prediction Inc. 675 US Highway One, North Brunswick, NJ 08902, USA; (J.E.); (D.M.); (E.M.); (L.L.); (J.X.); (L.C.A.M.T.)
| | - Louis Lello
- Genomic Prediction Inc. 675 US Highway One, North Brunswick, NJ 08902, USA; (J.E.); (D.M.); (E.M.); (L.L.); (J.X.); (L.C.A.M.T.)
- Department of Physics and Astronomy, Hannah Administration Building, Michigan State University, 426 Auditorium Rd., East Lansing, MI 48824, USA
| | - Jessalyn Gerber
- Department of Genetics, Rutgers University, Piscataway, NJ 08854, USA;
| | - Jia Xu
- Genomic Prediction Inc. 675 US Highway One, North Brunswick, NJ 08902, USA; (J.E.); (D.M.); (E.M.); (L.L.); (J.X.); (L.C.A.M.T.)
| | - Laurent C.A.M. Tellier
- Genomic Prediction Inc. 675 US Highway One, North Brunswick, NJ 08902, USA; (J.E.); (D.M.); (E.M.); (L.L.); (J.X.); (L.C.A.M.T.)
- Department of Physics and Astronomy, Hannah Administration Building, Michigan State University, 426 Auditorium Rd., East Lansing, MI 48824, USA
| |
Collapse
|
37
|
Schroeder EC, DuBois L, Sadowsky M, Hilgenkamp TIM. Hypertension in Adults With Intellectual Disability: Prevalence and Risk Factors. Am J Prev Med 2020; 58:630-637. [PMID: 32059987 PMCID: PMC7174133 DOI: 10.1016/j.amepre.2019.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/14/2019] [Accepted: 12/15/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Individuals with intellectual disability have a high prevalence of obesity and low physical activity levels, which are risk factors for hypertension. This study estimated the prevalence of hypertension in a global data set of adults with intellectual disability participating in Special Olympics and investigated the role of physical activity and obesity in hypertension risk. METHODS A total of 33,122 individuals aged ≥18 years with intellectual disability who participated in Special Olympic events from 2014 to 2018 had their brachial blood pressure, BMI, and self-reported physical activity assessed. Hypertension was classified using 2017 American College of Cardiology/American Heart Association guidelines (systolic blood pressure≥130 mmHg and diastolic blood pressure≥80 mmHg). Data were analyzed in 2019. RESULTS Participants were aged 31 (SD=11) years, 64% male, and had a resting blood pressure of 121 (SD=16)/76 (SD=12) mmHg. The population was 48% (95% CI=47.5%, 48.6%) hypertensive. Male participants had a higher prevalence of hypertension (50.7%, 95% CI=50.1%, 51.4%) than female participants (43.1%, 95% CI=42.2%, 44.0%), with prevalence increasing with age. Odds of hypertension increased when performing no or insufficient physical activity and with increasing obesity (p<0.01), tripling (OR=3.06, 3.66) for all individuals who performed no physical activity except for those of normal weight (OR=1.72), and doubling (OR=2.13-3.87) for individuals who were obese or morbidly obese across all physical activity levels. CONCLUSIONS This study is the first to determine population-based prevalence rates of hypertension in individuals with intellectual disability. It highlights the similarity in prevalence to the general population. The results emphasize the importance of population-wide screening, increasing physical activity, and reducing obesity in decreasing cardiovascular risk in this population.
Collapse
Affiliation(s)
- Elizabeth C Schroeder
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | | | | | - Thessa I M Hilgenkamp
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois; Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, Nevada.
| |
Collapse
|
38
|
The Effect of Hypertension Duration and the Age of Onset on CV Risk Factors Expression in Perimenopausal Women. Int J Hypertens 2019; 2019:9848125. [PMID: 31885899 PMCID: PMC6925926 DOI: 10.1155/2019/9848125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 12/31/2022] Open
Abstract
Background The impact of hypertension duration and the time of onset on the expression of metabolic syndrome (MS) and other CV risk factors, in perimenopausal women, have not been studied so far. Methods. A total of 202 women, old 47–59 years, and diagnosed with hypertension, were recruited from primary care practices in eastern Croatia. The categories of hypertension duration were defined as <5, 5–10, and >10 years. Data were analyzed by standard statistical procedures. Results The proportion of women with MS increases in parallel with hypertension duration (p = 0.025). Among the examined CV risk factors, significant increase in parallel with hypertension duration was found for body mass index (p = 0.007) and triglycerides (p = 0.07). The highest proportion of women with diabetes duration of less than 5 years, indicating recent diabetes onset, was found in the category of hypertension duration of less than 5 years, corresponding with the onset of hypertension in the time around menopause (p = 0.003). The strongest linear correlations with BMI and waist circumference were found for total serum cholesterol (r = 0.355 and 0.499, respectively). Conclusion Hypertension onset at the time around menopause appears together with abdominal obesity and may be a driving force for CV risk factor accumulation in postmenopausal women.
Collapse
|
39
|
Yuan C, Kulkarni K, Dashevsky BZ. Preventive Care: How Mammography Utilization Changes as Women Age. J Am Coll Radiol 2019; 17:238-247. [PMID: 31628897 DOI: 10.1016/j.jacr.2019.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of comorbid conditions and age on mammography use. METHODS We used data from the 2011 to 2015 Medical Expenditure Panel Survey, which contained records for 40,752 women over the age of 40. Use was defined as a mammogram within the previous 1 or 2 years, analyzed separately. A logit model was employed to evaluate associations between use and comorbidities and age. Statistical significance was defined by a P < .05 by two-sided test. RESULTS Of the 36,575 women in our study sample, 45.9%, 43.6%, 3.9%, and 5.7% reported a history of hypertension (HTN), hyperlipidemia (HLD), prior heart attack (MI), and prior stroke, respectively. Among women without a comorbid condition, there was 47.3% annual mammography use. HTN and HLD were associated with increased use (2.5 and 6.8 percentage points [pp], P< .01). In comparison, prior MI was associated with decreased annual use (-8.2 pp, P < .01). Prior stroke was not significantly associated with annual mammography (-1.5 pp, P = .42). Results were similar for biennial use. The age trend in use showed that the age with maximum screening use was approximately 60 years. DISCUSSION Mammography use was higher in patients with HTN and HLD and lower in patients with prior MI and stroke, which may reflect differences in comorbidity-related general health care use. Use increased until it peaked around age 60. An understanding of how mammography use naturally evolves as people age may help better target specific populations and improve overall use of preventive care.
Collapse
Affiliation(s)
- Cindy Yuan
- Department of Radiology, University of Chicago, Chicago, Illinois.
| | - Kirti Kulkarni
- Department of Radiology, University of Chicago, Chicago, Illinois
| | | |
Collapse
|
40
|
Zeng H, Jiang R, Zhou M, Wu L, Tian B, Zhang Y, Qu F. Measuring patient activation in Chinese patients with hypertension and/or diabetes: reliability and validity of the PAM13. J Int Med Res 2019; 47:5967-5976. [PMID: 31601130 PMCID: PMC7045661 DOI: 10.1177/0300060519868327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective Patient activation is important in the management of chronic diseases (CDs), especially hypertension and diabetes. The 13-item short form Patient Activation Measure (PAM13) is widely used, but data are lacking for China. The study aim was to assess the reliability and validity of the PAM13 in Chinese patients with hypertension and/or diabetes in a community management setting. Methods A cross-sectional survey was conducted at four community health centres in Kunming (Yunnan province, China) Participants were patients (n = 519) with hypertension and/or type 2 diabetes mellitus being managed at the community health centres. Patient activation was measured using the Chinese version of the PAM13. Reliability and validity were tested using Cronbach’s α and confirmatory factor analysis. Results The male to female ratio was 1:1.65. In total, 307 (60.3%) patients had ≤9 years of education and 213 (41.8%) had a low household income (≤5000 RMB/month). Cronbach’s α was 0.920 and item–total correlations ranged from 0.535 to 0.714. Confirmatory factor analysis showed a good fit to the data. Conclusions The PAM13 shows good reliability and validity for measuring patient activation in Chinese patients with CDs (hypertension and/or diabetes).
Collapse
Affiliation(s)
- Huijuan Zeng
- School of Public Health, Kunming Medical University, Kunming, China.,Department of Nephrology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Runsheng Jiang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Mei Zhou
- School of Public Health, Kunming Medical University, Kunming, China
| | - Linxiong Wu
- School of Public Health, Kunming Medical University, Kunming, China
| | - Bo Tian
- School of Public Health, Kunming Medical University, Kunming, China
| | - Yao Zhang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Fanwei Qu
- School of Public Health, Kunming Medical University, Kunming, China
| |
Collapse
|
41
|
Hou L, Jin X, Ma J, Qian J, Huo Y, Ge J. Perception and self-management of hypertension in Chinese cardiologists (CCHS): a multicenter, large-scale cross-sectional study. BMJ Open 2019; 9:e029249. [PMID: 31562148 PMCID: PMC6773313 DOI: 10.1136/bmjopen-2019-029249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To determine the frequency of risk factors for hypertension among Chinese cardiologists using a nation-wide survey. DESIGN Multicenter, cross-sectional observational study. SETTING 2441 hospitals across China were surveyed between September 2016 and August 2017. PARTICIPANTS All in-service cardiologists were surveyed (n=28 924). INTERVENTIONS WeChat-based electronic data capture system, a social application in China (Tencent, Nanshan, China), was used for data acquisition. Physician subscribed to the WeChat official account of the China Cardiologist Heart Study, and filled out an online questionnaire that included age, gender, level of in-service hospital, professional title, academic degree, area of expertise and cardiovascular risk factors. All information was required. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the presence of cardiovascular risk factors. The secondary outcome was the impact of the risk factors on the occurrence of hypertension. RESULTS Among 28 924 Chinese cardiologists who completed the questionnaire, 57.6% had blood pressure of 130-139/80-89 mm Hg (5.3% were taking antihypertensive drugs) and 22.0% had blood pressure >140/>90 mm Hg (36.5% were taking antihypertensive drugs). The multivariable analysis showed that age, gender, academic degree, hospital level, body mass index (BMI), smoking and comorbidities were independently associated with hypertension among cardiologists (all p<0.05). Age, female gender, BMI, smoking, family history of cardiovascular diseases (CVDs) and comorbidities were independently associated with taking antihypertensive drugs among hypertensive cardiologists (all p<0.05). Age, hospital level, professional title, BMI, family history of CVDs and comorbidities were independently associated with reaching target blood pressure among hypertensive cardiologists taking antihypertensive drugs. CONCLUSION Chinese cardiologists do not recognise and pay attention to their own blood pressure. Their rate of antihypertensive treatment was low. The identified risk factors could be used to identify cardiologists at higher risk for hypertension and for implementing preventive interventions.
Collapse
Affiliation(s)
- Lei Hou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cardiology, Tongren hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Xuejuan Jin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianying Ma
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
42
|
Sharp TE, Polhemus DJ, Li Z, Spaletra P, Jenkins JS, Reilly JP, White CJ, Kapusta DR, Lefer DJ, Goodchild TT. Renal Denervation Prevents Heart Failure Progression Via Inhibition of the Renin-Angiotensin System. J Am Coll Cardiol 2019; 72:2609-2621. [PMID: 30466519 DOI: 10.1016/j.jacc.2018.08.2186] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/10/2018] [Accepted: 08/20/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previously, we have shown that radiofrequency (RF) renal denervation (RDN) reduces myocardial infarct size in a rat model of acute myocardial infarction (MI) and improves left ventricular (LV) function and vascular reactivity in the setting of heart failure following MI. OBJECTIVES The authors investigated the therapeutic efficacy of RF-RDN in a clinically relevant normotensive swine model of heart failure with reduced ejection fraction (HFrEF). METHODS Yucatan miniswine underwent 75 min of left anterior descending coronary artery balloon occlusion to induce MI followed by reperfusion (R) for 18 weeks. Cardiac function was assessed pre- and post-MI/R by transthoracic echocardiography and every 3 weeks for 18 weeks. HFrEF was classified by an LV ejection fraction <40%. Animals who met inclusion criteria were randomized to receive bilateral RF-RDN (n = 10) treatment or sham-RDN (n = 11) at 6 weeks post-MI/R using an RF-RDN catheter. RESULTS RF-RDN therapy resulted in significant reductions in renal norepinephrine content and circulating angiotensin I and II. RF-RDN significantly increased circulating B-type natriuretic peptide levels. Following RF-RDN, LV end-systolic volume was significantly reduced when compared with sham-treated animals, leading to a marked and sustained improvement in LV ejection fraction. Furthermore, RF-RDN improved LV longitudinal strain. Simultaneously, RF-RDN reduced LV fibrosis and improved coronary artery responses to vasodilators. CONCLUSIONS RF-RDN provides a novel therapeutic strategy to reduce renal sympathetic activity, inhibit the renin-angiotensin system, increase circulating B-type natriuretic peptide levels, attenuate LV fibrosis, and improve left ventricular performance and coronary vascular function. These cardioprotective mechanisms synergize to halt the progression of HFrEF following MI/R in a clinically relevant model system.
Collapse
Affiliation(s)
- Thomas E Sharp
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - David J Polhemus
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Zhen Li
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Pablo Spaletra
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - J Stephen Jenkins
- Department of Cardiology, Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana
| | - John P Reilly
- Department of Cardiology, Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana
| | - Christopher J White
- Department of Cardiology, Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana
| | - Daniel R Kapusta
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - David J Lefer
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana.
| | - Traci T Goodchild
- Cardiovascular Research Center, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Science Center, New Orleans, Louisiana
| |
Collapse
|
43
|
Wan EYF, Yu EYT, Chin WY, Fong DYT, Choi EPH, Tang EHM, Lam CLK. Burden of CKD and Cardiovascular Disease on Life Expectancy and Health Service Utilization: a Cohort Study of Hong Kong Chinese Hypertensive Patients. J Am Soc Nephrol 2019; 30:1991-1999. [PMID: 31492808 DOI: 10.1681/asn.2018101037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 06/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The relative effects of combinations of CKD, heart disease, and stroke on risk of mortality, direct medical costs, and life expectancy are unknown. METHODS In a retrospective cohort study of 506,849 Chinese adults in Hong Kong with hypertension, we used Cox regressions to examine associations between all-cause mortality and combinations of moderate CKD (eGFR of 30-59 ml/min per 1.73 m2), severe CKD (eGFR of 15-29 ml/min per 1.73 m2), heart disease (coronary heart disease or heart failure), and stroke, and modeling to estimate annual public direct medical costs and life expectancy. RESULTS Over a median follow-up of 5.8 years (2.73 million person-years), 55,666 deaths occurred. Having an increasing number of comorbidities was associated with incremental increases in mortality risk and medical costs and reductions in life expectancy. Compared with patients who had neither CKD nor cardiovascular disease, patients with one, two, or three conditions (heart disease, stroke, and moderate CKD) had relative risk of mortality increased by about 70%, 160%, and 290%, respectively; direct medical costs increased by about 70%, 160%, and 280%, respectively; and life expectancy at age 60 years decreased by about 5, 10, and 15 years, respectively. Burdens were higher with severe CKD. CONCLUSIONS This study demonstrated extremely high mortality risk and medical cost increases for severe CKD, exceeding the combined effects from heart disease and stroke. Mortality risks and costs for moderate CKD, heart disease, and stroke were similar individually and roughly multiplicative for any combination. These findings suggest that to reduce mortality and health care costs in patients with hypertension, CKD prevention and intervention merits priority equal to that of cardiovascular disease.
Collapse
Affiliation(s)
- Eric Yuk Fai Wan
- Departments of Family Medicine and Primary Care and .,Pharmacology and Pharmacy, and
| | | | | | | | | | | | | |
Collapse
|
44
|
Kalçık M, Doğan T, Yetim M, Kocamış Sİ, Dönmez O, Bekar L. The Relationship between the Retinal Nerve Fiber Layer Thickness and the Presence of Fragmented QRS Complexes in Patients with Hypertension. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2019. [DOI: 10.5799/jcei/5758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
45
|
Chen Y, Waqar AB, Yan H, Wang Y, Liang J, Fan J. Renovascular Hypertension Aggravates Atherosclerosis in Cholesterol-Fed Rabbits. J Vasc Res 2019; 56:28-38. [PMID: 30947215 DOI: 10.1159/000498897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypertension is a major risk factor for atherosclerotic disease. However, it is still not clear whether mechanical stress caused by hypertension directly affects the atherosclerotic development in the aorta and coronary arteries. OBJECTIVES AND METHODS We generated a hypertensive (HTN) rabbit model by surgical removal of the left kidney and partial ligation of the right renal artery. After a 16-week cholesterol diet, we compared aortic and coronary atherosclerosis of HTN rabbits with those of normotensive rabbits. RESULTS Hypertension did not affect lipid and apolipoprotein levels in plasma but led to a 3.0-fold increase in aortic atherosclerosis and a 1.7-fold increase in coronary atherosclerosis compared with control rabbits. Enhanced atherosclerosis in HTN rabbits was caused by significant increases in macrophages and smooth muscle cells in the lesions. Furthermore, oxidized LDL contents in the lesions were significantly increased in HTN rabbits. In addition, HTN rabbits exhibited prominent hyaline arteriolosclerosis in coronary arterioles. CONCLUSIONS These results indicate that hyper tension not only enhances atherosclerosis in large arteries including the aorta and coronary arteries but also affects hyaline arteriolosclerosis in small arteries.
Collapse
Affiliation(s)
- Yajie Chen
- Department of Molecular Pathology, Faculty of Medicine, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Ahmed Bilal Waqar
- Department of Molecular Pathology, Faculty of Medicine, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Haizhao Yan
- Department of Molecular Pathology, Faculty of Medicine, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Yanli Wang
- Department of Pathology, Xi'an Medical University, Xi'an, China
| | - Jingyan Liang
- Research Center for Vascular Biology, School of Medicine, Yangzhou University, Yangzhou, China
| | - Jianglin Fan
- Department of Molecular Pathology, Faculty of Medicine, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan, .,School of Biotechnology and Health Sciences, Wuyi University, Jiangmen, China,
| |
Collapse
|
46
|
Higher Mortality in Men Compared with Women following Distal Radius Fracture in Population Aged 50 Years or Above: Are Common Distal Radius Fracture Classifications Useful in Predicting Mortality? BIOMED RESEARCH INTERNATIONAL 2019; 2019:5359204. [PMID: 30809543 PMCID: PMC6364117 DOI: 10.1155/2019/5359204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/06/2019] [Indexed: 12/11/2022]
Abstract
Introduction Distal radius fractures (DRF) are one of the most common fractures with growing incidence in developed countries and are a reliable predictor of another osteoporotic fracture. Data concerning DRF mortality are conflicting and vague. Usefulness of common DRF classification systems in predicting mortality is unexplored. Methods We identified all patients hospitalized between January 1st 2008 and May 30th 2015 with isolated distal radius fracture, aged 50 y/o or above, in a 1st level trauma center in Poland. Fractures were evaluated according to AO, Frykman, and Fernandez classifications. Mortality ratios and long-term survival analysis with Kaplan-Meier estimator and log-rank tests with univariate and multivariate Cox proportional hazards model were used. Results We enrolled 1308 consecutive patients. The average age of the entire cohort was 72.5 ± 12 years. The study group consisted of 256 men (19.6%) with mean age 66 ± 12 y/o and 1052 women (80.4%) with mean age 74 ± 12 y/o. Men were statistically younger at the time of the fracture than women (p<0.0001). After 1-year follow-up the overall study group mortality ratio was 4.5%, being 2.2-fold higher in men compared to women. In long-term survival analysis, excess men mortality remained significant. Factors associated with higher mortality at any point of the study were age (HR: 1.08, 95%CI: 1.07-1.10, p<0.000001), male sex (HR: 1.92, 95%CI: 1.34-2.77; p<0.001), AO type A (HR: 1.64 95%CI 1.19-2.25, p<0.01), and Frykman type I (HR: 2.12 95%CI: 1.36-3.29, p<0.001). Conclusion Distal radius fractures are connected with premature mortality. Men have higher mortality compared with women following distal radius fracture in population aged 50 years or above. Simple extra articular fractures classified as AO type A or Frykman type I may be predictors of higher mortality in DRF cohort.
Collapse
|
47
|
Lv X, Niu H, Qu Y, Li M, Li L, Ma X, Jiang S, Gao C, Wang R, Zhang P, Li B. Awareness, treatment and control of hypertension among hypertensive patients aged 18 to 59 years old in the northeast of China. Sci Rep 2018; 8:17019. [PMID: 30451878 PMCID: PMC6243001 DOI: 10.1038/s41598-018-34923-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 10/26/2018] [Indexed: 01/22/2023] Open
Abstract
Hypertension not only has a high prevalence, but also brings disease burden to the affected patients. To assess the level of awareness, treatment and control of hypertension in the northeast of China, we investigated the rates of awareness, treatment and control of hypertension and identified its related factors among hypertensive patients aged 18 to 59 years old in Jilin, China. The data (n = 4632) for the present study were extracted from a cross-sectional study in Jilin. Among individuals with hypertension, the standardized rates of awareness, treatment and control of hypertension were 44.9%, 36.5%, 24.3%, respectively. The rates of awareness and treatment of hypertension among middle aged patients were higher than those among young patients. Compared to patients with normal Body Mass index (BMI), obese hypertensive patients had a higher rate of treatment (43.7% vs. 25.9%) and a lower rate of control (18.9% vs. 29.6%). Compared to patients with normal BMI, patients who were obese were more likely to take measures to treat hypertension (OR = 2.50, 95%CI: 2.05-3.05); but were less likely to have well-controlled blood pressure (OR = 0.55, 95%CI: 0.40-0.78). BMI is one of the influencing factors of hypertension awareness, treatment and control among patients 18 to 59 years old with hypertension.
Collapse
Affiliation(s)
- Xin Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
- Jilin Women and Children Health Hospital, Changchun, 130061, China
| | - Huikun Niu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Yangming Qu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Meiqi Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Lu Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Xiaoyu Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Shan Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Chunshi Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
| | - Rui Wang
- Department of Thoracic Surgery, the First Hospital of Jilin University, Changchun, 130021, China
| | - Peng Zhang
- Department of Neurology, Stroke Center, the First Hospital of Jilin University, Changchun, 130021, China
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China.
| |
Collapse
|
48
|
Jardim TV, Witham MD, Abrahams-Gessel S, Gómez-Olivé FX, Tollman S, Berkman L, Gaziano TA. Cardiovascular Disease Profile of the Oldest Adults in Rural South Africa: Data from the HAALSI Study (Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities). J Am Geriatr Soc 2018; 66:2151-2157. [PMID: 30312474 PMCID: PMC6417425 DOI: 10.1111/jgs.15567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize the cardiovascular disease (CVD) profile of individuals aged 80 and older in rural South Africa. DESIGN First wave of population-based longitudinal cohort. SETTING Agincourt subdistrict (Mpumalanga Province) in rural South Africa. PARTICIPANTS Adults residents (N = 5,059). MEASUREMENTS In-person interviews were conducted to obtain social, behavioral, economic, and clinical data. Prevalence of hypertension, diabetes, dyslipidemia, high waist-to-hip ratio, overweight and obesity, high-risk high-sensitivity C-reactive protein, smoking, stroke, myocardial infarction, angina pectoris, and heart failure in individuals younger than 65, aged 65 to 79, and aged 80 and older were compared. Associations between self-reported treatments and determinants of hypertension treatment in those aged 80 and older were assessed using multivariable regression. RESULTS Of 5,059 individuals included, 549 (10.8%) were aged 80 and older, and their CVD prevalence was 17.9% (stroke 3.8%, myocardial infarction 0.5%, angina pectoris 13.5%, heart failure 0.7%). Hypertension prevalence in this group was 73.8%, and along with angina pectoris, it increased with age (p<.001), whereas overweight and obesity (46.4%), dyslipidemia (39.1%), and smoking prevalences (3.1%) decreased (p<.001). Hypertension treatment was significantly associated with being aged 80 and older (odds ratio (OR)=1.48; 95% confidence interval (CI)=1.14-1.92, p=.003). Male sex (OR=0.73, 95% CI=0.66-0.88, p=.001), being an immigrant (OR=0.80, 95% CI=0.65-0.98; p=.03), higher socioeconomic status (OR=1.28, 95% CI=1.06-1.53, p=.009), and higher depression score (OR=1.12, 95% CI=1.05-1.19, p<.001) were associated with hypertension treatment in those aged 80 and older. CONCLUSION This is the first study to characterize the CVD profile of individuals aged 80 and older in sub-Saharan Africa and provides baseline data for comparison with future studies in this rapidly growing age group. J Am Geriatr Soc 66:2151-2157, 2018.
Collapse
Affiliation(s)
- Thiago Veiga Jardim
- Division of Cardiovascular Medicine, Brigham &
Women’s Hospital, Boston, MA
- Center for Health Decision Science, Harvard T.H. Chan
School of Public Health, Boston, MA
| | - Miles D Witham
- Ageing and Health, School of Medicine, University of
Dundee, Scotland, UK
| | | | - F. Xavier Gómez-Olivé
- Medical Research Council / University of the Witwatersrand
Rural Public Health and Health Transitions Research Unit, School of Public Health,
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South
Africa
- Center for Population and Development Studies, Harvard T.H.
Chan School of Public Health, Harvard University, Cambridge, Massachusetts,
USA
| | - Stephen Tollman
- Medical Research Council / University of the Witwatersrand
Rural Public Health and Health Transitions Research Unit, School of Public Health,
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South
Africa
- Center for Population and Development Studies, Harvard T.H.
Chan School of Public Health, Harvard University, Cambridge, Massachusetts,
USA
- INDEPTH Network, Accra, Ghana
| | - Lisa Berkman
- Center for Population and Development Studies, Harvard T.H.
Chan School of Public Health, Harvard University, Cambridge, Massachusetts,
USA
| | - Thomas A. Gaziano
- Division of Cardiovascular Medicine, Brigham &
Women’s Hospital, Boston, MA
- Center for Health Decision Science, Harvard T.H. Chan
School of Public Health, Boston, MA
| |
Collapse
|
49
|
Egan B, Flack J, Patel M, Lombera S. Insights on β-blockers for the treatment of hypertension: A survey of health care practitioners. J Clin Hypertens (Greenwich) 2018; 20:1464-1472. [PMID: 30289609 PMCID: PMC6220865 DOI: 10.1111/jch.13375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/20/2018] [Accepted: 08/03/2018] [Indexed: 01/18/2023]
Abstract
A quantitative survey was completed by 103 primary care physicians (PCPs) and 59 cardiologists who regularly prescribed β-blockers to assess knowledge and use of this heterogeneous drug class for hypertension. More cardiologists than PCPs chose β-blockers as initial antihypertensive therapy (30% vs 17%, P < 0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. Cardiologists rated "impact on energy" and "arterial vasodilation" as more important than PCPs (P < 0.05/<0.01, respectively). Awareness of vasodilation was greater for carvedilol (52%) than nebivolol (31%). Association between β-blockers and clinical variables included nebivolol with β1 -selectivity, nebivolol and carvedilol with vasodilation and efficacy in older patients and African Americans, metoprolol with heart rate reduction, and atenolol and metoprolol with weight gain and hyperglycemia. Physicians preferred prescribing β-blockers with lower risk of incident diabetes. Clinical practice guidelines influenced physician prescribing more than formularies or performance metrics. This survey captures physicians' perceptions/use of various β-blockers and clinically relevant knowledge gaps.
Collapse
Affiliation(s)
- Brent Egan
- University of South Carolina School of Medicine-Greenville, Greenville, South Carolina
| | - John Flack
- Department of Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | | | | |
Collapse
|
50
|
Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4550] [Impact Index Per Article: 758.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|