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Li J, Shen S, Yu C, Sun S, Zheng P. Integrated single cell-RNA sequencing and Mendelian randomization for ischemic stroke and metabolic syndrome. iScience 2024; 27:110240. [PMID: 39021802 PMCID: PMC11253530 DOI: 10.1016/j.isci.2024.110240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/22/2024] [Accepted: 06/07/2024] [Indexed: 07/20/2024] Open
Abstract
Although more and more evidence has supported that metabolic syndrome (MS) is linked to ischemic stroke (IS), the molecular mechanism and genetic association between them has not been investigated. Here, we combined the existing single-cell RNA sequencing (scRNA-seq) data and mendelian randomization (MR) for stroke to understand the role of dysregulated metabolism in stroke. The shared hub genes were identified with machine learning and WGCNA. A total of six upregulated DEGs and five downregulated genes were selected for subsequent analyses. Nine genes were finally identified with random forest, Lasso regression, and XGBoost method as a potential diagnostic model. scRNA-seq also show the abnormal glycolysis level in most cell clusters in stroke and associated with the expression level of hub genes. The genetic relationship between IS and MS was verified with MR analysis. Our study reveals the common molecular profile and genetic association between ischemic stroke and metabolic syndrome.
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Affiliation(s)
- Jie Li
- Department of Neurosurgery, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Sen Shen
- Department of Neurosurgery, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cong Yu
- Department of Neurosurgery, Shanghai Pudong New area People’s Hospital, Shanghai, China
| | - Shuchen Sun
- Department of Neurosurgery, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ping Zheng
- Department of Neurosurgery, Shanghai Pudong New area People’s Hospital, Shanghai, China
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Wu Z, Luo S, Cai D, Lin W, Hu X, Zhou T, Zhang X, Feng Y, Luo J. The causal relationship between metabolic syndrome and its components and cardiovascular disease: A mendelian randomization study. Diabetes Res Clin Pract 2024; 211:111679. [PMID: 38649068 DOI: 10.1016/j.diabres.2024.111679] [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: 02/16/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
AIM To investigate the causal relationship between metabolic syndrome (MetS) and its components and 14 cardiovascular diseases using Mendelian randomization (MR). METHODS We used summary statistics from large-scale genome-wide association studies of MetS, its components, and cardiovascular diseases. We performed a two-sample MR analysis using the inverse-variance weighted method and other sensitivity methods. We also performed multivariate MR to adjust for potential risk factors. RESULTS Our study found that MetS was causally associated with an increased risk of ischemic stroke, abdominal aortic aneurysm, pulmonary embolism, coronary heart disease, heart failure, and peripheral artery disease. Waist circumference was causally associated with an increased risk of 6 cardiovascular diseases. Type 2 diabetes mellitus, diastolic blood pressure, systolic blood pressure, triglycerides, and high-density lipoprotein cholesterol were all causally associated with coronary heart disease, with varying causal relationships with the remaining 5 cardiovascular diseases. Multivariate MR showed that, except for ischaemic stroke, waist circumference remained causally associated with the remaining five cardiovascular diseases after adjusting for potential confounders. CONCLUSION Our study provides evidence that metabolic syndrome is causally associated with 6 cardiovascular diseases. Waist circumference is the most important component of these relationships. These findings have implications for the prevention and management of metabolic syndrome and cardiovascular diseases.
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Affiliation(s)
- Zejia Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Songyuan Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Dongqin Cai
- Department of Cardiology, School of Medicine South China University of Technology, Guangzhou, 510080, China; Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Wenhui Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xiaolu Hu
- Department of Cardiology, School of Medicine South China University of Technology, Guangzhou, 510080, China; Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Ting Zhou
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Xuxing Zhang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
| | - Jianfang Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Department of Cardiology, School of Medicine South China University of Technology, Guangzhou, 510080, China; Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
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3
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Zhou B, Wang Z, Dou Q, Li W, Li Y, Yan Z, Sun P, Zhao B, Li X, Shen F, Zhang B, Guo M. Long-term outcomes of esophageal and gastric cancer patients with cardiovascular and metabolic diseases: A two-center propensity score-matched cohort study. J Transl Int Med 2023; 11:234-245. [PMID: 37818156 PMCID: PMC10561076 DOI: 10.2478/jtim-2023-0112] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Background and Objectives An increased risk of cardiovascular and metabolic diseases (CVMDs) among patients with cancer suggests a potential link between CVMD and cancer. The impact of CVMD on the survival time of patients with esophageal and gastric cancer remains unknown. We aimed to determine the incidence of CVMD and its impact on the longterm outcomes in esophageal and gastric cancer patients. Methods A total of 2074 cancer patients were enrolled from January 1, 2007 to December 31, 2017 in two hospitals, including 1205 cases of esophageal cancer and 869 cases of gastric cancer, who were followed up for a median of 79.8 and 79.3 months, respectively. Survival time was analyzed using the Kaplan-Meier method before and after propensity score matching. Results The incidence of CVMD in patients with esophageal and gastric cancer was 34.1% (411/1205) and 34.3% (298/869), respectively. The effects of hypertension, diabetes, and stroke on the long-term survival of esophageal and gastric cancer patients were not significant (all P > 0.05). The survival time was significantly longer in esophageal cancer patients without ischemic heart disease than in patients with ischemic heart disease, both before matching (36.5 vs. 29.1 months, P = 0.027) and after matching (37.4 vs. 27.9 months, P = 0.011). The survival time in gastric cancer patients without ischemic heart disease was significantly longer than in patients with ischemic heart disease, both before (28.4 vs.17.5 months, P = 0.032) and after matching (29.5 vs.17.5 months, P = 0.02). Conclusion The survival time of esophageal and gastric cancer patients with ischemic heart disease was significantly reduced compared to that of esophageal and gastric cancer patients without ischemic heart disease.
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Affiliation(s)
- Bo Zhou
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing100853, China
| | - Zhixin Wang
- Department of Gastroenterology and Hepatology, the First Medical Center, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang453003, Henan Province, China
| | - Qifeng Dou
- Department of Urology Surgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang453199, Henan Province, China
| | - Wenbin Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing100029, China
| | - Yangyang Li
- Department of Cardiovascular Surgery, Henan Provincial Chest Hospital, Zhengzhou450008, Henan Province, China
| | - Zhengqiang Yan
- Department of General Surgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang453199, Henan Province, China
| | - Peisheng Sun
- Department of General Surgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang453199, Henan Province, China
| | - Baosheng Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang453199, Henan Province, China
| | - Xiumin Li
- Department of Gastroenterology and Hepatology, the First Medical Center, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang453003, Henan Province, China
- Henan Key Laboratory of Tumor Molecular Therapy Medicine, Xinxiang Medical University, Xinxiang453003, Henan Province, China
| | - Fangfang Shen
- The Key Laboratory for Tumor Translational Medicine, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang453003, Henan Province, China
| | - Bangjie Zhang
- Department of Gastroenterology and Hepatology, the First Medical Center, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang453003, Henan Province, China
| | - Mingzhou Guo
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing100853, China
- Department of Gastroenterology and Hepatology, the First Medical Center, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang453003, Henan Province, China
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Shen C, Liu C, Qiu A. Metabolism-related brain morphology accelerates aging and predicts neurodegenerative diseases and stroke: a UK Biobank study. Transl Psychiatry 2023; 13:233. [PMID: 37385998 DOI: 10.1038/s41398-023-02515-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023] Open
Abstract
Metabolic syndrome (MetS) is characterized by a constellation of metabolic risk factors, including obesity, hypertriglyceridemia, low high-density lipoprotein (HDL) levels, hypertension, and hyperglycemia, and is associated with stroke and neurodegenerative diseases. This study capitalized on brain structural images and clinical data from the UK Biobank and explored the associations of brain morphology with MetS and brain aging due to MetS. Cortical surface area, thickness, and subcortical volumes were assessed using FreeSurfer. Linear regression was used to examine associations of brain morphology with five MetS components and the MetS severity in a metabolic aging group (N = 23,676, age 62.8 ± 7.5 years). Partial least squares (PLS) were employed to predict brain age using MetS-associated brain morphology. The five MetS components and MetS severity were associated with increased cortical surface area and decreased thickness, particularly in the frontal, temporal, and sensorimotor cortex, and reduced volumes in the basal ganglia. Obesity best explained the variation of brain morphology. Moreover, participants with the most severe MetS had brain age 1-year older than those without MetS. Brain age in patients with stroke (N = 1042), dementia (N = 83), Parkinson's (N = 107), and multiple sclerosis (N = 235) was greater than that in the metabolic aging group. The obesity-related brain morphology had the leading discriminative power. Therefore, the MetS-related brain morphological model can be used for risk assessment of stroke and neurodegenerative diseases. Our findings suggested that prioritizing adjusting obesity among the five metabolic components may be more helpful for improving brain health in aging populations.
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Affiliation(s)
- Chenye Shen
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Chaoqiang Liu
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Anqi Qiu
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.
- NUS (Suzhou) Research Institute, National University of Singapore, Suzhou, China.
- Institute of Data Science, National University of Singapore, Singapore, Singapore.
- Department of Health Technology and Informatics, the Hong Kong Polytechnic University, Hung hom, Hong Kong.
- Department of Biomedical Engineering, the Johns Hopkins University, Baltimore, MD, USA.
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Shanah L, Mir T, Uddin MM, Hussain T, Parajuli T, Bhat Z. Clinical outcomes and 30-day readmissions for heart failure with reduced ejection fraction with cardiorenal syndrome: A National Cohort Study. Int J Cardiol 2023; 370:244-249. [PMID: 36328112 DOI: 10.1016/j.ijcard.2022.10.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Literature regarding outcomes of cardiorenal syndrome (CRS) among heart failure with reduced ejection fraction (HFrEF) is limited. OBJECTIVE To study the clinical outcomes and 30-day readmission rates of CRS patients with HFrEF. METHODS Data from the Nationwide Readmissions Database (NRD) that constitutes 49.1% of the stratified sample of all hospitals in the United States (US), representing >95% of the national population, was analyzed for the CRS with HFrEF visits from 2018 to 2019. CRS was defined by the ICD-10 codes. RESULTS Out of the 1,530,749 index CRS-related hospitalizations (mean age:64.37 ± 13.30 years; 38.6%females) 73,126 (6.0%) CKD I-II, 883,119 (72.6%) CKD III-IV, and 258,835 (21.3%) CKD V-and-more related encounters were recorded. Mortality was higher among CKD stage V-and-more in comparison to other subgroups(7.6%vs5.73%;p < 0.001). AKI with underlying CKD was more common among stage III-IV compared to other subgroups (55.9%vs43.7%;p < 0.001). Respiratory failure, the second major complication, was more common among stage V-and-more compared to other subgroups (32.5%vs30%;p < 0.001). The overall CRS-related 30-day readmission rate was 22.7%, with CKD V-and-more accounting for highest rates(29.89%), followed by CKD stage III-IV(20.05%) and CKD I-II(12.99%). The primary etiology for 30-day readmission was cardiovascular among all subgroups (54.2%, 54.6%, and 41.80%, which corresponds to CKD I-II, CKD III-IV and CKD V-and-more, respectively). CONCLUSION CRS among HFrEF accounts for substantial healthcare burden with high 30-day readmission rates. Higher all-cause mortality and 30-day readmissions were associated with worse renal disease. This would suggest that more vigilance is needed by physicians for discharge planning among this patient population.
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Affiliation(s)
- Layla Shanah
- Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Tanveer Mir
- Internal Medicine, Wayne State University, Detroit, MI, USA; Internal Medicine, Baptist Health System, Montgomery, AL, USA.
| | | | - Tanveer Hussain
- Internal Medicine, Wayne State University, Detroit, MI, USA; Critical Care Medicine, Summa Health System, Akron, OH, USA
| | | | - Zeenat Bhat
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
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Valera RJ, Botero-Fonnegra C, Cogollo VJ, Sarmiento-Cobos M, Montorfano L, Rivera C, Hong L, Lo Menzo E, Szomstein S, Rosenthal RJ. Does bariatric surgery change the risk of acute ischemic stroke in patients with a history of transient ischemic attack? A nationwide analysis. Surg Obes Relat Dis 2022; 19:548-554. [PMID: 36581552 DOI: 10.1016/j.soard.2022.11.013] [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: 08/29/2022] [Revised: 11/12/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults. OBJECTIVE We aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery. SETTING Academic hospital, United States. METHODS Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment). RESULTS A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P < .0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P < .0001), showing that patients in the treatment group were less likely to have AIS compared with the control group. CONCLUSIONS After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results.
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Affiliation(s)
- Roberto J Valera
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Cristina Botero-Fonnegra
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Vicente J Cogollo
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Mauricio Sarmiento-Cobos
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Lisandro Montorfano
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Carlos Rivera
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Liang Hong
- Biostatistics Section, Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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Determinants of metabolic syndrome and its prognostic implications among stroke patients in Africa: Findings from the Stroke Investigative Research and Educational Network (SIREN) study. J Neurol Sci 2022; 441:120360. [PMID: 35985161 DOI: 10.1016/j.jns.2022.120360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The prognostic implications of metabolic syndrome (METS) among African stroke patients are poorly understood. This study aimed to investigate the determinants of METS and its prognostic implications among Africans with newly diagnosed stroke in the SIREN study. METHODS We included stroke cases (adults aged >18 years with CT/MRI confirmed stroke). The validated tools comprehensively evaluated vascular, lifestyle, and psychosocial factors. We used logistic regression to estimate adjusted odds ratios (OR) with 95% CIs for the association between METS and risk factors. We also computed the prediction power of the domain of covariates in a sequential manner using the area under the receiver operating curve (ROC) curve. RESULTS Among 3998 stroke subjects enrolled in the study, 76.8% had METS by at least one of the clinical definitions. Factors associated with METS were age > 50 years (OR- 1.46, CI-1.19-1.80), male gender (OR 4.06, CI- 3.28-5.03), income >100USD (OR1.42, CI-1.17-1.71), stress (OR1.46, CI-1.14-1.87), family history of diabetes mellitus (OR1.38, CI-1.06-1.78), and cardiac disease (OR1.42, CI-1.18-1.65). Stroke severity was higher among those with METS (SLS = 5.8 ± 4.3) compared with those without METS (6.2 ± 4.5) at p = 0.037. METS was associated with higher odds (aOR 1.31, CI-1.08-1.58) of one-month fatality after adjusting for stroke severity, age > 50 years, and average monthly income >100USD. CONCLUSION METS is very common among African stroke patients and is associated with stroke severity and worse one-month fatality. Lifestyle interventions may prevent METS and attenuate its impact on stroke occurrence and outcomes.
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Koltsova EA, Petrova EA, Borshch YV. [An overview of risk factors for stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:12-19. [PMID: 36582156 DOI: 10.17116/jnevro202212212212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Stroke is a heterogeneous syndrome, and the definition of risk factors, treatment and prevention tactics depends on the specific pathogenesis of the disease. Risk factors for ischemic and hemorrhagic stroke are similar, but at the same time there are significant differences. The concept of stroke triggers is discussed separately. In addition, a deep understanding of the pathogenetic mechanisms and the development of new strategies for therapy and prevention require an understanding of the genetic mechanisms of stroke risk. Genetic factors may be more modifiable than previously thought. To reduce the burden of stroke in the population, timely identification and management of modifiable risk factors is essential.
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Affiliation(s)
- E A Koltsova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E A Petrova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Y V Borshch
- Pirogov Russian National Research Medical University, Moscow, Russia
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Akinyemiju T, Oyekunle T, Salako O, Gupta A, Alatise O, Ogun G, Adeniyi A, Deveaux A, Hall A, Ayandipo O, Olajide T, Olasehinde O, Arowolo O, Adisa A, Afuwape O, Olusanya A, Adegoke A, Tollefsbol TO, Arnett D, Muehlbauer MJ, Newgard CB, Daramola A. Metabolic Syndrome and Risk of Breast Cancer by Molecular Subtype: Analysis of the MEND Study. Clin Breast Cancer 2021; 22:e463-e472. [PMID: 34980540 PMCID: PMC9641637 DOI: 10.1016/j.clbc.2021.11.004] [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: 08/02/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 12/17/2022]
Abstract
Metabolic syndrome is a cluster of biological irregularities that is a known risk factor for cardiovascular disease, stroke, and diabetes. In a case-control study of 555 West African women, we observed that metabolic syndrome was strongly associated with breast cancer and the aggressive triple-negative molecular subtype, highlighting a need for clinical and lifestyle interventions targeting metabolic syndrome to reduce breast cancer risk in this population.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC; Duke Cancer Institute, School of Medicine, Duke University, Durham, NC; Duke Global Health Institute, Duke University, Durham, NC.
| | - Taofik Oyekunle
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC
| | - Omolola Salako
- College of Medicine and Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria
| | - Anjali Gupta
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC
| | - Olusegun Alatise
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Gabriel Ogun
- Unversity College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | | - April Deveaux
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC
| | - Allison Hall
- Department of Pathology, School of Medicine, Duke University, Durham, NC
| | - Omobolaji Ayandipo
- Unversity College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Thomas Olajide
- College of Medicine and Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria
| | | | - Olukayode Arowolo
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Adewale Adisa
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Oludolapo Afuwape
- Unversity College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Aralola Olusanya
- Unversity College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Aderemi Adegoke
- Our Lady of Apostle Catholic Hospital, Ibadan, Oyo State, Nigeria
| | | | - Donna Arnett
- College of Public Health, University of Kentucky, Lexington, KY
| | - Michael J Muehlbauer
- Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC
| | - Christopher B Newgard
- Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC
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- University of Kansas Medical Center, Kansas City, KS
| | - Adetola Daramola
- College of Medicine and Lagos University Teaching Hospital, University of Lagos, Lagos, Nigeria; University of Kansas Medical Center, Kansas City, KS
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Yang T, Fan K, Cao Y, Yan J, Han Z. Stroke Type, Etiology, Clinical Features and Prognosis of Diabetic Patients in Southern China. Clin Appl Thromb Hemost 2021; 26:1076029620973090. [PMID: 33296224 PMCID: PMC7731598 DOI: 10.1177/1076029620973090] [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] [Indexed: 12/23/2022] Open
Abstract
To analyze the type, etiology, clinical features and prognosis of stroke in southern China diabetic patients. From January to August 2019, acute stroke patients were prospectively enrolled in the Wenzhou Stroke Registry within 7 days of admission to the Hospital. The differences between the 2 groups of stroke patients with or without diabetes were in the following aspects: bleeding site of hemorrhagic stroke, different ischemic stroke etiology, Oxfordshire Community Stroke Project (OCSP) classification, death and disability within 3 months. Of the 497 patients enrolled, 104 (20.9%) were diabetic patients. 114(22.9%) patients had hemorrhagic stroke. The incidence of hemorrhagic stroke in the diabetic group was 10.6%, deep hemorrhage stroke account for 90.9%.In patients with ischemic stroke, the proportions of the new Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiological subtype classifications (atherothrombosis (AT), cardioembolism (CE), small artery disease (SAD), stroke of other determined etiology (SOD) and stroke of undetermined etiology (SUD)) in the diabetic (non-diabetic) group was 43% (31%), 7.5% (14.1%), 27.9% (16.9%), 1% (0.3%), and 20.4% (37.6%), respectively; the proportion of The OCSP classifications(total anterior circulation infarcts(TACI), partial anterior circulation infarcts(PACI), lacunar infarcts(LACI) and posterior circulation infarcts(POCI)) in the diabetic (non-diabetic) group was16.1% (22%), 30.1%(37.2%), 42% (31.4%), and 10.8% (9%), respectively. The 3-month poor prognosis of the diabetic and non-diabetic groups was 23.1% and 28.2%. For diabetic patients, the incidence of hemorrhagic stroke is low, deep hemorrhage is common; SAD and LACI are common in the ischemic stroke; There was no significant difference in the 3-month prognosis between the 2 groups.
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Affiliation(s)
- Ting Yang
- Department of Emergency, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Kai Fan
- Department of Neurology, Zhoukou Central Hospital, Henan Province, China
| | - Yungang Cao
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jueyue Yan
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhao Han
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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11
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Park SK, Jung JY, Oh CM, Choi JM, Kim MH, Ha E, Kim Y, Ryoo JH. Components of metabolic syndrome and their relation to the risk of incident cerebral infarction. Endocr J 2021; 68:253-259. [PMID: 33041272 DOI: 10.1507/endocrj.ej20-0486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Metabolic syndrome (MetS) consists of 5 metabolic components, which are recognized as risk factors for cerebral infarction. The present study was to evaluate the relative influence of individual metabolic component on incident cerebral infarction. Using a data of 209,339 Koreans registered in National Health Information Corporation, we evaluated the risk for incident cerebral infarction according to the number of metabolic component and each metabolic component for 4.37 years' follow-up. Cox proportional hazards model was used to calculate hazard ratios (HRs) for cerebral infarction and their confidence interval (CI). The more metabolic components accompanied the worse metabolic profile, leading increased incidence of cerebral infarction. The risk of cerebral infarction increased proportionally to the number of present metabolic components (number 0: reference, number 1: 1.78 [1.42-2.23], number 2: 2.20 [1.76-2.74], number 3: 2.61 [2.09-3.25] and number 4-5: 3.18 [2.54-3.98]). Compared to subjects without metabolic component, the impact of each component on cerebral infarction was relatively higher in elevated fasting glucose (1.56 [1.14-2.13]) and elevated BP (2.13 [1.66-2.73]), indicating no statistical significance in low HDL-cholesterol (1.53 [0.96-2.44]), high triglyceride (1.24 [0.84-1.84]) and abdominal obesity (1.05 [0.63-1.73]). Proportional relationship was found between the number of metabolic component and risk of cerebral infarction. Out of metabolic components, fasting glucose and BP are more powerful predictor for cerebral infarction.
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Affiliation(s)
- Sung Keun Park
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine, Seoul, Korea
| | - Ju Young Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine, Seoul, Korea
| | - Chang-Mo Oh
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Joong-Myung Choi
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Min-Ho Kim
- Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Eunhee Ha
- Department of Occupational and Environment Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yeji Kim
- Department of Occupational & Environmental Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Jae-Hong Ryoo
- Departments of Occupational and Environmental Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
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12
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Foisy Sauvé M, Spahis S, Delvin E, Levy E. Glycomacropeptide: A Bioactive Milk Derivative to Alleviate Metabolic Syndrome Outcomes. Antioxid Redox Signal 2021; 34:201-222. [PMID: 32338040 DOI: 10.1089/ars.2019.7994] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Significance: Metabolic syndrome (MetS) represents a cluster of cardiometabolic disorders, which accelerate the risk of developing diabetes, nonalcoholic fatty liver disease, and cardiovascular disorders such as atherosclerosis. Oxidative stress (OxS) and inflammation contribute to insulin resistance (IR) that greatly promotes the clinical manifestations of MetS components. Given the growing prevalence of this multifactorial condition, its alerting comorbidities, and the absence of specific drugs for treatment, there is an urgent need of prospecting for alternative nutraceutics as effective therapeutic agents for MetS. Recent Advances: There is a renewed interest in bioactive peptides derived from human and bovine milk proteins given their high potential in magnifying health benefits. Special attention has been paid to glycomacropeptide (GMP), a bioactive and soluble derivative from casein and milk whey, because of the wide range of its health-promoting functions perceived in the MetS and related complications. Critical Issues: In the present review, the challenging issue relative to clinical utility of GMP in improving MetS outcomes will be critically reported. Its importance in alleviating obesity, OxS, inflammation, IR, dyslipidemia, and hypertension will be underlined. The mechanisms of action will be analyzed, and the various gaps of knowledge in this area will be specified. Future Directions: Valuable data from cellular, preclinical, and clinical investigations have emphasized the preventive and therapeutic actions of GMP toward the MetS. However, additional efforts are needed to support its proofs of principle and causative relationship to translate its concept into the clinic. Antioxid. Redox Signal. 34, 201-222.
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Affiliation(s)
- Mathilde Foisy Sauvé
- Research Centre, CHU Sainte-Justine, Montreal, Canada.,Department of Nutrition, Université de Montréal, Montreal, Canada
| | - Schohraya Spahis
- Research Centre, CHU Sainte-Justine, Montreal, Canada.,Department of Nutrition, Université de Montréal, Montreal, Canada
| | - Edgard Delvin
- Research Centre, CHU Sainte-Justine, Montreal, Canada
| | - Emile Levy
- Research Centre, CHU Sainte-Justine, Montreal, Canada.,Department of Nutrition, Université de Montréal, Montreal, Canada
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13
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Serrablo-Torrejon I, Lopez-Valenciano A, Ayuso M, Horton E, Mayo X, Medina-Gomez G, Liguori G, Jimenez A. High intensity interval training exercise-induced physiological changes and their potential influence on metabolic syndrome clinical biomarkers: a meta-analysis. BMC Endocr Disord 2020; 20:167. [PMID: 33172413 PMCID: PMC7653723 DOI: 10.1186/s12902-020-00640-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite the current debate about the effects of high intensity interval training (HIIT), HIIT elicits big morpho-physiological benefit on Metabolic Syndrome (MetS) treatment. However, no review or meta-analysis has compared the effects of HIIT to non-exercising controls in MetS variables. The aim of this study was to determine through a systematic review, the effectiveness of HIIT on MetS clinical variables in adults. METHODS Studies had to be randomised controlled trials, lasting at least 3 weeks, and compare the effects of HIIT on at least one of the MetS clinical variables [fasting blood glucose (BG), high-density lipoprotein (HDL-C) triglyceride (TG), systolic (SBP) or diastolic blood pressure (DBP) and waist circumference (WC)] compared to a control group. The methodological quality of the studies selected was evaluated using the PEDro scale. RESULTS Ten articles fulfilled the selection criteria, with a mean quality score on the PEDro scale of 6.7. Compared with controls, HIIT groups showed significant and relevant reductions in BG (- 0.11 mmol/L), SBP (- 4.44 mmHg), DBP (- 3.60 mmHg), and WC (- 2.26 cm). Otherwise, a slight increase was observed in HDL-C (+ 0.02 mmol/L). HIIT did not produce any significant changes in TG (- 1.29 mmol/L). CONCLUSIONS HIIT improves certain clinical aspects in people with MetS (BG, SBP, DBP and WC) compared to people with MetS who do not perform physical exercise. Plausible physiological changes of HIIT interventions might be related with large skeletal muscle mass implication, improvements in the vasomotor control, better baroreflex control, reduction of the total peripheral resistance, increases in excess post-exercise oxygen consumption, and changes in appetite and satiety mechanisms.
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Affiliation(s)
- I Serrablo-Torrejon
- Faculty Research Centre for Sport, Exercise & Life Sciences, School of Health and Life Sciences, Coventry University, Coventry, UK.
- GO fit LAB, Av. Islas de Filipinas, 7, 28003, Madrid, Spain.
| | - A Lopez-Valenciano
- GO fit LAB, Av. Islas de Filipinas, 7, 28003, Madrid, Spain
- Observatory of Healthy & Active Living, Spain Active Foundation, Centre for Sport Studies, King Juan Carlos University, Madrid, Spain
| | - M Ayuso
- GO fit LAB, Av. Islas de Filipinas, 7, 28003, Madrid, Spain
| | - E Horton
- Faculty Research Centre for Sport, Exercise & Life Sciences, School of Health and Life Sciences, Coventry University, Coventry, UK
| | - X Mayo
- GO fit LAB, Av. Islas de Filipinas, 7, 28003, Madrid, Spain
- Observatory of Healthy & Active Living, Spain Active Foundation, Centre for Sport Studies, King Juan Carlos University, Madrid, Spain
| | - G Medina-Gomez
- Observatory of Healthy & Active Living, Spain Active Foundation, Centre for Sport Studies, King Juan Carlos University, Madrid, Spain
| | - G Liguori
- University of Rhode Island, Kingston, RI, USA
| | - A Jimenez
- GO fit LAB, Av. Islas de Filipinas, 7, 28003, Madrid, Spain
- Observatory of Healthy & Active Living, Spain Active Foundation, Centre for Sport Studies, King Juan Carlos University, Madrid, Spain
- Advanced Wellbeing Research Centre, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
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14
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Abstract
A cluster of metabolic factors have been merged into an entity named the metabolic syndrome. Although the characteristics of this syndrome have varied over time the presently used definition was established in 2009. The presence of three abnormal findings out of five components qualifies a person for the metabolic syndrome: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure and elevated fasting plasma glucose. Cut points have been defined for all components apart from waist circumference, for which national or regional values are used. The metabolic syndrome predicts cardiovascular disease and type 2 diabetes. This associated risk does not exceed its components whereof elevated blood pressure is the most frequent. A successful management should, however, address all factors involved. The management is always based on healthy lifestyle choices but has not infrequently to be supported by pharmacological treatment, especially blood pressure lowering drugs. The metabolic syndrome is a useful example of the importance of multiple targets for preventive interventions. To be successful management has to be individualized not the least when it comes to pharmacological therapy. Frail elderly people should not be over-treated. Knowledge transfer of how risk factors act should be accompanied by continuous trust building and motivation. In complex situations with a mix of biological risk factors, adverse social conditions and unhealthy lifestyle, everything cannot be changed at once. It is better to aim for small steps that are lasting than large, unsustainable steps with relapses to unhealthy behaviours. A person with the metabolic syndrome will always be afflicted by its components, which is the reason that management has to be sustained over a very long time. This review summarizes the knowledge on the metabolic syndrome and its management according to present state of the art.
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Affiliation(s)
- Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jaakko Tuomilehto
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, University of Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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15
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Akinyemiju T, Salako O, Daramola A, Alatise O, Adeniyi A, Ogun G, Ayandipo O, Olajide T, Olasehinde O, Arowolo O, Adisa A, Afuwape O, Olusanya A, Adegoke A, Ojo A, Tollefsbol T, Arnett D. Collaborative Molecular Epidemiology Study of Metabolic Dysregulation, DNA Methylation, and Breast Cancer Risk Among Nigerian Women: MEND Study Objectives and Design. J Glob Oncol 2020; 5:1-9. [PMID: 31194608 PMCID: PMC6613666 DOI: 10.1200/jgo.18.00226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To elucidate the role of metabolic dysregulation and associated DNA methylation changes on breast cancer risk and aggressive subtypes among Nigerian women. We describe the design and methods of a collaborative molecular epidemiology study of breast cancer in Nigerian hospitals. METHODS The Mechanisms for Novel and Established Risk Factors for Breast Cancer in Women of Nigerian Descent (MEND) study was designed as a matched case-control study of 350 patients, age 18 to 75 years, with newly diagnosed, treatment-naïve breast cancer and 350 age-matched healthy controls from surrounding geographic areas. Patients with breast cancer seen for initial diagnosis at four large tertiary hospitals in southwest Nigeria and one affiliated private hospital were recruited. Healthy female controls were selected from a cohort of 4,000 healthy women recruited as part of the Human Heredity and Health (H3) in Africa Chronic Kidney Disease Case-Control Study in Nigeria. Tumor and adjacent normal tissue, and blood and saliva samples were collected for molecular and epigenetic assays. RESULTS Although recruitment is ongoing, a total of 416 patients have been recruited to date, with tumor and blood samples obtained from at least 310 patients. Data on age-matched (± 6 months) controls have also been obtained and harmonized. Lipid assays for 350 pathologically verified cases and 350 age-matched controls is underway, and pathologic characterization of tumors (including immunohistochemistry for subtyping) is ongoing. Data on DNA methylation for tumors and adjacent normal tissue are expected by the end of the study period. CONCLUSION The MEND study will provide a unique, high-quality source of data to evaluate the contribution of metabolic dysregulation such as obesity, diabetes, hypertension, and metabolic syndrome to the biology of breast cancer among Nigerian women and foster collaborative studies relevant for women of African descent globally.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Adewale Adisa
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
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16
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Khafagy AT, Hamdy NA, Hassan EM, Yehia MA, Ismail MM, Abdelkader MM, Shawky NM. Association between metabolic syndrome and atherothrombotic stroke: a clinical study in tertiary care hospital, Minia, Egypt. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0099-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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The Combined Extract of Black Sticky Rice and Dill Improves Poststroke Cognitive Impairment in Metabolic Syndrome Condition. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:9089035. [PMID: 30937145 PMCID: PMC6413387 DOI: 10.1155/2019/9089035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/01/2018] [Accepted: 11/28/2018] [Indexed: 12/14/2022]
Abstract
Despite the increase in cognitive deficit following stroke in metabolic syndrome (MetS) condition, the therapeutic strategy is still limited. Since oxidative stress and neuroinflammation play the crucial roles on the pathophysiology of aforementioned conditions, the cognitive enhancing effect of the combined extract of Oryza sativa and Anethum graveolens was considered based on their antioxidant, anti-inflammation, and neuroprotective effects together with the synergistic effect concept. Male Wistar rats weighing 180-220 g were induced metabolic syndrome-like condition by using a high-carbohydrate high-fat diet (HCHF diet). Then, reperfusion injury following cerebral ischemia was induced by the occlusion of right middle cerebral artery and treated with the combined extract of O. sativa and A. graveolens (OA extract) at doses of 0.5, 5, and 50 mg/kg BW once daily for 21 days. Spatial memory was assessed every 7 days throughout the experimental period. At the end of the study, neuron and glial fibrillary acidic protein- (GFAP-) positive cell densities, the oxidative stress status, AChE, and the expression of proinflammatory cytokines (TNF-α, IL-6) in the hippocampus were determined. The results showed that OA extract at all doses used in this study significantly improved memory together with the reductions of MDA, TNF-α, IL-6, AChE, and density of GFAP-positive cell but increased neuron density in the hippocampus. Taken together, OA is the potential cognitive enhancer in memory impairment following stroke in MetS condition. The possible underlying mechanism may occur partly via the reductions of oxidative stress status, GFAP-positive cell density, and neuroinflammatory cytokines such as TNF-α and IL-6 together with the suppression of AChE activity in the hippocampus. This study suggests that OA is the potential functional ingredient to improve the cognitive enhancer. However, further clinical research is required.
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18
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Kim HJ, Lee H, Lee B, Lee JW, Shin KE, Suh J, Park HW, Kim JA. Diagnostic value of using epicardial fat measurement on screening low-dose chest CT for the prediction of metabolic syndrome: A cross-validation study. Medicine (Baltimore) 2019; 98:e14601. [PMID: 30762814 PMCID: PMC6407965 DOI: 10.1097/md.0000000000014601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There has been a marked increase in the use of low-dose computed tomography (LDCT) for lung cancer screening. However, the potential of LDCT to predict metabolic syndrome (MetS) has not been well-documented in this risk-sharing population. We assessed the reliability of epicardial fat volume (EFV) and epicardial fat area (EFA) measurements on chest LDCT for prediction of MetS.A total of 130 (mean age, 50.2 ± 10.77 years) asymptomatic male who underwent nonelectrocardiography (ECG)-gated LDCT were divided into 2 groups for the main analysis (n = 75) and validation (n = 55). Each group was further divided into subgroups with or without MetS. EFV and EFA were calculated semiautomatically using commercially available software with manual assistance. The area under the curve (AUC) on receiver operating characteristic (ROC) analysis and cutoff values to predict MetS on LDCT were then calculated and validated. Female data were not available for analysis due to small sample size in this self-referred lung cancer screening program.In the analysis group, the mean EFV was 123.12 ± 42.29 and 67.30 ± 20.68 cm for the MetS and non-MetS subgroups, respectively (P < .001), and the mean EFA was 7.95 ± 3.10 and 4.04 ± 1.73 cm, respectively (P < .001). Using 93.65 and 4.94 as the cutoffs for EFV and EFA, respectively, the sensitivity, specificity, positive and negative predictive values, and accuracy for predicting MetS were 84.2% and 84.2%, and 92.9% and 64.3% (P < .001); 80% and 44.4% (P = .01); 94.5% and 92.3%; and 90.7% and 69.3% (P < .001), respectively. The AUC for EFV and EFA for predicting MetS was 0.909 and 0.808 (95% confidence interval, 0.819-1.000 and 0.702-0.914, respectively) (P = .02). Using the same cutoff values in the analysis group, there was no significant difference in diagnostic performance using EFV and EFA between the analysis and validation sets.Although quantification of both EFA and EFV is feasible on non-ECG-gated LDCT, EFV may be used to reliably predict MetS with fairly high and better diagnostic performance in selected population.
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Affiliation(s)
| | - Heon Lee
- Department of Radiology, Wonmi-Gu, Bucheon
| | - Bora Lee
- Graduate School of Statistics, Chung-Ang University, Dongjak-gu, Seoul
| | | | | | - Jon Suh
- Cardiology Soonchunhyang University Hospital Bucheon, Wonmi-Gu, Bucheon
| | - Hyun Woo Park
- Cardiology Soonchunhyang University Hospital Bucheon, Wonmi-Gu, Bucheon
| | - Jeong A. Kim
- Department of Radiology, Ilsan Paik Hospital, Goyang, Republic of Korea
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19
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Kim M, Kim IH, Lim MK, Kim Y, Park B. Increased prevalence of metabolic syndrome in adult cancer survivors: Asian first report in community setting. Cancer Epidemiol 2018; 58:130-136. [PMID: 30576983 DOI: 10.1016/j.canep.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/16/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND To compare the prevalence of metabolic syndrome (MeS) in cancer survivors returning to the community to that of non-cancer controls. METHODS We used baseline data from a nationwide cohort study. 5274 cancer survivors and 20,703 and 21,096 gender- and age-matched controls without and with chronic disease was included. RESULTS The prevalence of MeS was higher in cancer survivors compared to controls without chronic disease, but was lower than that in controls with chronic disease (25.7%, 18.8%, and 32.0%, respectively). The prevalence was 1.56-fold higher in cancer survivors (95% confidence interval = 1.45-1.69) than in controls without chronic disease. The prevalence of each MeS component was significantly higher in cancer survivors compared to controls without chronic disease. Compared to controls, the prevalence was higher in colorectal, breast, cervical, lung, thyroid, prostate, and bladder cancer survivors (OR range = 1.63-2.24, P-value < 0.05), but not in gastric and liver cancer survivors. CONCLUSIONS MeS was generally more prevalent among cancer survivors than in controls without chronic disease, but with heterogeneities in cancer type. Because long-term care and comorbidity prevention are emerging issues in cancer survivors, MeS among those returning to normal life is concerning, and tailored management programs should be developed for specific cancer types.
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Affiliation(s)
- Minkyung Kim
- National Cancer Center Graduate School of Cancer Science and Policy, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
| | - In-Hoo Kim
- National Cancer Center Graduate School of Cancer Science and Policy, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
| | - Min Kyung Lim
- National Cancer Center Graduate School of Cancer Science and Policy, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
| | - Yeol Kim
- National Cancer Center Graduate School of Cancer Science and Policy, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
| | - Boyoung Park
- Department of Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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20
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Akinyemiju T, Sakhuja S, Vin-Raviv N. In-Hospital Mortality and Post-Surgical Complications Among Cancer Patients with Metabolic Syndrome. Obes Surg 2018; 28:683-692. [PMID: 28849323 DOI: 10.1007/s11695-017-2900-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is an important etiologic and prognostic factor for cancer, but few studies have assessed hospitalization outcomes among patients with both conditions. METHODS Data was obtained from the Healthcare Cost and Utilization project Nationwide Inpatient Sample (HCUP-NIS). Study variables were assessed using ICD-9 codes on adults aged 40 years and over admitted to a US hospital between 2007 and 2011 with primary diagnosis of either breast, colorectal, or prostate cancer. We examined in-hospital mortality, post-surgical complications, and discharge disposition among cancer patients with MetS and compared with non-MetS patients. RESULTS Hospitalized breast (OR: 0.31, 95% CI: 0.20-0.46), colorectal (OR: 0.41, 95% CI: 0.35-0.49), and prostate (OR: 0.28, 95% CI: 0.16-0.49) cancer patients with MetS had significantly reduced odds of in-hospital mortality. The odds of post-surgical complications among breast (OR: 1.20, 95% CI: 1.03-1.39) and prostate (OR: 1.22, 95% CI: 1.09-1.37) cancer patients with MetS were higher, but lower by 7% among colorectal cancer patients with MetS. Additionally, breast (OR: 1.21, 95% CI: 1.11-1.32) and colorectal (OR: 1.06, 95% CI: 1.01-1.11) cancer patients with MetS had significantly higher odds for discharge to a skilled nursing facility compared with those without MetS, but this was not statistically significant among prostate cancer patients. CONCLUSIONS Adverse health outcomes were significantly higher among hospitalized patients with a primary diagnosis of cancer and MetS. Future studies are needed to identify clinical strategies for detecting and managing patients with MetS to reduce the likelihood of poor inpatient outcomes.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA. .,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. .,Department of Epidemiology, University of Kentucky, 800 Rose Street, Lexington, KY, 40508, USA.
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA
| | - Neomi Vin-Raviv
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, CO, USA.,School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
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21
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Effect of Tai Chi on Cardiac and Static Pulmonary Function in Older Community-Dwelling Adults at Risk of Ischemic Stroke: A Randomized Controlled Trial. Chin J Integr Med 2018; 25:582-589. [DOI: 10.1007/s11655-018-3056-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 10/27/2022]
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22
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Mosimah CI, Murray PJ, Simpkins JW. Not all clots are created equal: a review of deficient thrombolysis with tissue plasminogen activator (tPA) in patients with metabolic syndrome. Int J Neurosci 2018; 129:612-618. [PMID: 30465701 DOI: 10.1080/00207454.2018.1550400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Metabolic syndrome is a cluster of cardiovascular risk factors associated with a prothrombotic, proinflammatory and hypofibrinolysis state. Although resistance to tissue plasminogen activator (tPA) in metabolic syndrome patients has been associated with a defective fibrinolytic system, the factors and mechanisms underlining such resistance is unclear. While there is a great debate on proposed mechanisms, fundamental questions regarding resistance to tPA in metabolic syndrome patients with ischemic stroke remain unanswered. This article reviews articles and documents published between 2001 and 2017, and provides an overview of metabolic syndrome, factors associated with tPA resistance in metabolic syndrome, conflicting evidence of insufficient dosing of tPA in overweight/obese patients and future directions for research.
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Affiliation(s)
- Charles I Mosimah
- a Department of Clinical and Translational Sciences , West Virginia University , Morgantown , WV , USA
| | - Pamela J Murray
- b Department of Pediatrics , West Virginia University , Morgantown , WV , USA
| | - James W Simpkins
- c Department of Physiology Pharmacology & Neuroscience , West Virginia University , Morgantown , WV , USA
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23
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Dibaba DT, Ogunsina K, Braithwaite D, Akinyemiju T. Metabolic syndrome and risk of breast cancer mortality by menopause, obesity, and subtype. Breast Cancer Res Treat 2018; 174:209-218. [PMID: 30465158 DOI: 10.1007/s10549-018-5056-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate the association between metabolic syndrome (MetS) and risk of breast cancer mortality by menopausal status, obesity, and subtype. METHODS Data from 94,555 women free of cancer at baseline in the National Institute of Health-American Association of Retired Persons Diet and Health Study cohort (NIH-AARP) were used to investigate the prospective associations of baseline MetS and components with risk of breast cancer mortality using Cox proportional hazard regression models adjusted for baseline behavioral and demographic covariates. RESULTS During a mean follow-up duration of 14 years, 607 women in the cohort died of breast cancer. Overall, MetS was associated with a 73% increased risk of breast cancer mortality (HR 1.73; 95% CI 1.09-2.75); the association remained significant among post-menopausal women overall (HR 2.07, 95% CI 1.32, 3.25), and among those with overweight/obesity (HR 1.15, 95% CI 0.81, 1.64). MetS was associated with increased risk of breast cancer mortality for ER+/PR+ (HR 1.28, 95% CI 0.52, 3.16) and lower risk for ER-/PR- (HR 0.44, 95% CI 0.11, 1.75) subtypes; however, the associations were not statistically significant. Of the individual MetS components, high waist circumference (HR 1.32, 95% CI 1.03, 1.70), high cholesterol (HR 1.24, 95% CI 1.05, 1.46), and hypertension (HR 1.24, 95% CI 1.05, 1.46) were independently associated with increased risk of breast cancer mortality. CONCLUSIONS MetS was associated with increased risk of breast cancer mortality, especially among post-menopausal women. Further studies with larger sample sizes are needed to definitively determine the extent to which these associations vary by breast cancer subtype.
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Affiliation(s)
- Daniel T Dibaba
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Kemi Ogunsina
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | | | - Tomi Akinyemiju
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA.
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
- College of Public Health and Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
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24
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A novel algorithm for identifying risk factors for rare events: Predicting transient ischemic attack in young patients with low-risk atrial fibrillation. J Appl Biomed 2018. [DOI: 10.1016/j.jab.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Akinyemiju T, Moore JX, Judd S, Lakoski S, Goodman M, Safford MM, Pisu M. Metabolic dysregulation and cancer mortality in a national cohort of blacks and whites. BMC Cancer 2017; 17:856. [PMID: 29246121 PMCID: PMC5731092 DOI: 10.1186/s12885-017-3807-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 11/21/2017] [Indexed: 12/13/2022] Open
Abstract
Background We examined the association between metabolic dysregulation and cancer mortality in a prospective cohort of Black and White adults. Methods A total of 25,038 Black and White adults were included in the analysis. Metabolic dysregulation was defined in two ways: 1) using the joint harmonized criteria for metabolic syndrome (MetS) and 2) based on factor analysis of 15 variables characterizing metabolic dysregulation. We estimated hazards ratios (HRs) and 95% confidence intervals (CIs) for the association of MetS and metabolic dysregulation with cancer mortality during follow-up using Cox proportional hazards models. Results About 46% of Black and 39% of White participants met the criteria for MetS. Overall, participants with MetS (HR: 1.22, 95% CI: 1.03–1.45) were at increased risk of cancer-related death. In race-stratified analysis, Black participants with MetS had significantly increased risk of cancer mortality compared with those without MetS (HR: 1.32, 95% CI: 1.01–1.72), increasing to more than a 2-fold risk of cancer mortality among those with five metabolic syndrome components (HR: 2.35, 95% CI: 1.01–5.51). Conclusions There are marked racial differences in the prevalence of metabolic dysregulation defined as MetS based on the harmonized criteria. The strong positive associations between MetS and cancer mortality suggests that efforts to improve cancer outcomes in general, and racial disparities in cancer outcomes specifically, may benefit from prevention and management of MetS and its components. Electronic supplementary material The online version of this article (10.1186/s12885-017-3807-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tomi Akinyemiju
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. .,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. .,Department of Epidemiology, University of Kentucky, Lexington, KY, USA.
| | - Justin Xavier Moore
- Departments of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Lakoski
- Division of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University School of Public Health, Atlanta, GA, USA
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medical College, New York, NY, USA.,Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pisu
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Gan YL, Fu JY, Lai OM, Chew BH, Yuen KH, Teng KT, Nesaretnam K, Selvaduray KR, Meganathan P. Effect of palm-based tocotrienols and tocopherol mixture supplementation on platelet aggregation in subjects with metabolic syndrome: a randomised controlled trial. Sci Rep 2017; 7:11542. [PMID: 28912593 PMCID: PMC5599564 DOI: 10.1038/s41598-017-11813-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/30/2017] [Indexed: 02/08/2023] Open
Abstract
Tocotrienols, the unsaturated form of vitamin E, were reported to modulate platelet aggregation and thrombotic mechanisms in pre-clinical studies. Using a Food and Drug Administration (FDA)-approved cartridge-based measurement system, a randomised, double-blind, crossover and placebo-controlled trial involving 32 metabolic syndrome adults was conducted to investigate the effect of palm-based tocotrienols and tocopherol (PTT) mixture supplementation on platelet aggregation reactivity. The participants were supplemented with 200 mg (69% tocotrienols and 31% α-tocopherol) twice daily of PTT mixture or placebo capsules for 14 days in a random order. After 14 days, each intervention was accompanied by a postprandial study, in which participants consumed 200 mg PTT mixture or placebo capsule after a meal. Blood samples were collected on day 0, day 14 and during postprandial for the measurement of platelet aggregation reactivity. Subjects went through a 15-day washout period before commencement of subsequent intervention. Fasting platelet aggregation reactivity stimulated with adenosine diphosphate (ADP) did not show substantial changes after supplementation with PTT mixture compared to placebo (p = 0.393). Concomitantly, changes in postprandial platelet aggregation reactivity remained similar between PTT mixture and placebo interventions (p = 0.408). The results of this study highlight the lack of inhibitory effect on platelet aggregation after short-term supplementation of PTT mixture in participants with metabolic syndrome.
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Affiliation(s)
- Yee-Lin Gan
- Department of Bioprocess Technology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
| | - Ju-Yen Fu
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia.
| | - Oi-Ming Lai
- Department of Bioprocess Technology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Institute of Bioscience, Universiti Putra Malaysia, Selangor, Malaysia
| | - Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Kah-Hay Yuen
- School of Pharmaceuticals Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Kim-Tiu Teng
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
| | - Kalanithi Nesaretnam
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
| | - Kanga Rani Selvaduray
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
| | - Puvaneswari Meganathan
- Nutrition Unit, Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, Kajang, Selangor, Malaysia
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Obadia N, Lessa MA, Daliry A, Silvares RR, Gomes F, Tibiriçá E, Estato V. Cerebral microvascular dysfunction in metabolic syndrome is exacerbated by ischemia-reperfusion injury. BMC Neurosci 2017; 18:67. [PMID: 28886695 PMCID: PMC5591496 DOI: 10.1186/s12868-017-0384-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/31/2017] [Indexed: 12/11/2022] Open
Abstract
Background Metabolic syndrome (MetS) is associated with an increased risk of cerebrovascular diseases, including cerebral ischemia. Microvascular dysfunction is an important feature underlying the pathophysiology of cerebrovascular diseases. In this study, we aimed to investigate the impacts of ischemia and reperfusion (IR) injury on the cerebral microvascular function of rats with high-fat diet-induced MetS. Results We examined Wistar rats fed a high-fat diet (HFD) or normal diet (CTL) for 20 weeks underwent 30 min of bilateral carotid artery occlusion followed by 1 h of reperfusion (IR) or sham surgery. Microvascular blood flow was evaluated on the parietal cortex surface through a cranial window by laser speckle contrast imaging, functional capillary density, endothelial function and endothelial–leukocyte interactions by intravital videomicroscopy. Lipid peroxidation was assessed by TBARs analysis, the expression of oxidative enzymes and inflammatory markers in the brain tissue was analyzed by real-time PCR. The cerebral IR in MetS animals induced a functional capillary rarefaction (HFD IR 117 ± 17 vs. CTL IR 224 ± 35 capillary/mm2; p < 0.05), blunted the endothelial response to acetylcholine (HFD IR −16.93% vs. CTL IR 16.19% from baseline inner diameter p < 0.05) and increased the endothelial–leukocyte interactions in the venules in the brain. The impact of ischemia on the cerebral microvascular blood flow was worsened in MetS animals, with a marked reduction of cerebral blood flow, exposing brain tissue to a higher state of hypoxia. Conclusions Our results demonstrate that during ischemia and reperfusion, animals with MetS are more susceptible to alterations in the cerebral microcirculation involving endothelial dysfunction and oxidative stress events.
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Affiliation(s)
- Nathalie Obadia
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Marcos Adriano Lessa
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Anissa Daliry
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Raquel Rangel Silvares
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Fabiana Gomes
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Rio de Janeiro, RJ, 21045-900, Brazil
| | - Eduardo Tibiriçá
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Rio de Janeiro, RJ, 21045-900, Brazil.,National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Vanessa Estato
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Rio de Janeiro, RJ, 21045-900, Brazil. .,Institute of Drug Technology, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Hypofibrinolytic State in Subjects with Type 2 Diabetes Mellitus Aggravated by the Metabolic Syndrome before Clinical Manifestations of Atherothrombotic Disease. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6519704. [PMID: 28271069 PMCID: PMC5320378 DOI: 10.1155/2017/6519704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/13/2016] [Indexed: 12/21/2022]
Abstract
Background. Metabolic and genetic factors induce plasminogen activator inhibitor type-1 (PAI-1) overexpression; higher PAI-1 levels decrease fibrinolysis and promote atherothrombosis. Aim. To assess PAI-1 antigen levels among subjects with type 2 diabetes mellitus (T2DM) plus Metabolic Syndrome (MetS) before clinical manifestations of atherothrombosis and the contribution of metabolic factors and 4G/5G polymorphism of PAI-1 gene on the variability of PAI-1. Methods. We conducted an observational, cross-sectional assay in a hospital in Mexico City from May 2010 to September 2011. MetS was defined by the International Diabetes Federation criteria. PAI-1 levels and 4G/5G polymorphism were determined by ELISA and PCR-RFLP analysis. Results. We enrolled 215 subjects with T2DM plus MetS and 307 controls. Subjects with T2DM plus MetS had higher PAI-1 levels than the reference group (58.4 ± 21 versus 49.9 ± 16 ng/mL, p = 0.026). A model with components of MetS explained only 12% of variability on PAI-1 levels (R2 = 0.12; p = 0.001), with β = 0.18 (p = 0.03) for hypertension, β = -0.16 (p = 0.05) for NL HDL-c, and β = 0.15 (p = 0.05) for NL triglycerides. Conclusion. Subjects with T2DM plus MetS have elevated PAI-1 levels before clinical manifestations of atherothrombotic disease. Metabolic factors have a more important contribution than 4G/5G polymorphism on PAI-1 plasma variability.
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Boehme AK, Esenwa C, Elkind MSV. Stroke Risk Factors, Genetics, and Prevention. Circ Res 2017; 120:472-495. [PMID: 28154098 PMCID: PMC5321635 DOI: 10.1161/circresaha.116.308398] [Citation(s) in RCA: 820] [Impact Index Per Article: 117.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 12/18/2022]
Abstract
Stroke is a heterogeneous syndrome, and determining risk factors and treatment depends on the specific pathogenesis of stroke. Risk factors for stroke can be categorized as modifiable and nonmodifiable. Age, sex, and race/ethnicity are nonmodifiable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet, and physical inactivity are among some of the more commonly reported modifiable risk factors. More recently described risk factors and triggers of stroke include inflammatory disorders, infection, pollution, and cardiac atrial disorders independent of atrial fibrillation. Single-gene disorders may cause rare, hereditary disorders for which stroke is a primary manifestation. Recent research also suggests that common and rare genetic polymorphisms can influence risk of more common causes of stroke, due to both other risk factors and specific stroke mechanisms, such as atrial fibrillation. Genetic factors, particularly those with environmental interactions, may be more modifiable than previously recognized. Stroke prevention has generally focused on modifiable risk factors. Lifestyle and behavioral modification, such as dietary changes or smoking cessation, not only reduces stroke risk, but also reduces the risk of other cardiovascular diseases. Other prevention strategies include identifying and treating medical conditions, such as hypertension and diabetes, that increase stroke risk. Recent research into risk factors and genetics of stroke has not only identified those at risk for stroke but also identified ways to target at-risk populations for stroke prevention.
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Affiliation(s)
- Amelia K Boehme
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY
| | - Charles Esenwa
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Department of Epidemiology, Mailman School of Public Health (A.K.B., M.S.V.E.) and Department of Neurology, College of Physicians and Surgeons (A.K.B., C.E., M.S.V.E.), Columbia University, New York, NY.
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30
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Tsai MT, Erickson SR, Cohen LJ, Wu CH. The association between comorbid anxiety disorders and the risk of stroke among patients with diabetes: An 11-year population-based retrospective cohort study. J Affect Disord 2016; 202:178-86. [PMID: 27262640 DOI: 10.1016/j.jad.2016.03.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/20/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diabetes and anxiety disorders are independent risk factors for stroke. However, it remains unclear whether the risk of stroke is higher among diabetic patients with comorbid anxiety than without comorbid anxiety. Therefore, the purpose of this study was to investigate the association between comorbid anxiety and the risk of stroke among patients with diabetes. METHODS This is a retrospective cohort study. We used the National Health Insurance Research Database in Taiwan to identify a diabetes cohort with a new diagnosis of an anxiety disorder but without a history of stroke. The enrollment period was 2001-2006 with up to 11 years of follow-up data. Comorbid anxiety was defined by both a clinical diagnosis of the DSM-IV (ICD-9-CM) and prescriptions for anxiolytic medications. Propensity score matching was performed to balance the selected confounders between the anxiety-exposed group and anxiety non-exposed group. Cox-propositional hazard regression models were used to evaluate the association between comorbid anxiety and the risk of stroke. RESULTS Among patients with diabetes (N=40,846), an estimated 5.8% (N=2374) of patients had comorbid anxiety disorders. Diabetic patients with comorbid anxiety were significantly associated with a higher risk of stroke compared to patients without comorbid anxiety (hazard ratio: 1.33, 95% confidence interval: 1.02-1.72). LIMITATIONS The severity of anxiety or diabetes could not be measured from the claims data. Residual confounding may still exist. CONCLUSION A significantly elevated risk of stroke was observed in association with comorbid anxiety among patients with diabetes. Psychiatrists should consider routine screening for anxiety disorders to prevent a stroke event among patients with diabetes.
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Affiliation(s)
- Meng-Ting Tsai
- Department of Pharmacy, Taipei Medical University Hospital, Taiwan; School of Pharmacy, College of Pharmacy, Taipei Medical University, Taiwan
| | - Steven R Erickson
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, United States
| | - Lawrence J Cohen
- Department of Pharmacotherapy, System College of Pharmacy, University of North Texas Health Science Center, United States
| | - Chung-Hsuen Wu
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taiwan; Research Center for Pharmacoeconomics, College of Pharmacy, Taipei Medical University, Taiwan.
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31
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Wu YE, Zhang CL, Zhen Q. Metabolic syndrome in children (Review). Exp Ther Med 2016; 12:2390-2394. [PMID: 27698739 PMCID: PMC5038558 DOI: 10.3892/etm.2016.3632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 08/18/2016] [Indexed: 12/24/2022] Open
Abstract
Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors, including central obesity, insulin resistance, glucose intolerance, dyslipidemia and increased blood pressure. The prevalence of MetS is on the increase worldwide owing to the epidemic of overweight and obesity. The risk of prevalence of MetS greatly increases during adulthood for those children exposed to cardiometabolic risk factors in their early lives. MetS has also been associated with liver fat accumulation in children. Elevated levels of plasma alanine aminotransferase and γ-glutamyl transferase have been associated with liver fat accumulation. The present review aimed to expand knowledge on the clustering of cardiometabolic risk factors responsible for the widespread occurrence of metabolic disease in children.
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Affiliation(s)
- Yue-E Wu
- Department of Respiration, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Chong-Lin Zhang
- Department of Respiration, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Qing Zhen
- Department of Respiration, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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32
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Wang GS, Tong DM, Chen XD, Yang TH, Zhou YT, Ma XB. Metabolic Syndrome Is a Strong Risk Factor for Minor Ischemic Stroke and Subsequent Vascular Events. PLoS One 2016; 11:e0156243. [PMID: 27536865 PMCID: PMC4990187 DOI: 10.1371/journal.pone.0156243] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
Background Minor ischemic stroke (MIS) represents a major global public health problem worldwide due to high incidence. The aim of this study was to investigate whether metabolic syndrome (MetS) is a strong risk for MIS and subsequent vascular events (SVE). Methods A retrospective cohort study was performed examining symptomatic MIS in a Chinese neurologic outpatient population aged over 25 years without history of stroke. MetS was defined using the International Diabetes Federation criteria. MIS was diagnosed by magnetic resonance imaging-diffusion weighted images or fluid-attenuated inversion recovery. Results Of 1361 outpatients, a total of 753 (55.3%) patients were diagnosed with MIS; of them, 80% had a score of 0 using the MIS had a 0 score on the National Institutes of Health Stroke Scale. Among these, 303 (40.2%) individuals with MIS were diagnosed with MetS. Diagnosed of MIS with MetS significantly correlated with abdominal obesity (30.7% v.s 18.0%), hypertension (91.1% v.s 81.6%), increased blood glucose (6.9±2.4 v.s 5.0±0.4), dyslipidemia (78.2% v.s 48.2%), and SVE (50.5% v.s 11.3%) when compared with the controls group. On adjusted analysis, the risk of SVE was also significantly associated with three additional MetS criterion (RR,9.0; 95% CI, 5.677–14.46). Using Cox proportional analysis, risk of SVE in patient with MIS was significantly associated with MetS (RR, 3.3; 95% CI, 1.799–6.210), older age (RR, 1.0; 95% CI, 1.001–1.048), and high blood glucose (RR,1.1; 95%CI, 1.007–1.187). Conclusions The MetS is a strong risk factor for MIS, and patients presenting with MIS and MetS are at a high risk of SVE. Further studies are required to determine the improvement of Mets prevention in the reduction of MIS and SVE.
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Affiliation(s)
- Guang-Sheng Wang
- Department of Neurology, Affiliated Shu Yang People′s Hospital, XuZhou Medical University, XuZhou, China
| | - Dao-Ming Tong
- Department of Neurology, Affiliated Shu Yang People′s Hospital, XuZhou Medical University, XuZhou, China
- * E-mail:
| | - Xiao-Dong Chen
- Department of Neurology, Affiliated Shu Yang People′s Hospital, XuZhou Medical University, XuZhou, China
| | - Tong-Hui Yang
- Department of Neurology, Affiliated Shu Yang People′s Hospital, XuZhou Medical University, XuZhou, China
| | - Ye-Ting Zhou
- Department of Clinical Research, Affiliated Shu Yang People's Hospital, XuZhou Medical University, XuZhou, China
| | - Xiao-Bo Ma
- Department of science and education, Affiliated Shu Yang People′s Hospital, XuZhou Medical University, XuZhou, China
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Chang JJ, Stanfill A, Pourmotabbed T. The Role of Matrix Metalloproteinase Polymorphisms in Ischemic Stroke. Int J Mol Sci 2016; 17:ijms17081323. [PMID: 27529234 PMCID: PMC5000720 DOI: 10.3390/ijms17081323] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 12/17/2022] Open
Abstract
Stroke remains the fifth leading cause of mortality in the United States with an annual rate of over 128,000 deaths per year. Differences in incidence, pathogenesis, and clinical outcome have long been noted when comparing ischemic stroke among different ethnicities. The observation that racial disparities exist in clinical outcomes after stroke has resulted in genetic studies focusing on specific polymorphisms. Some studies have focused on matrix metalloproteinases (MMPs). MMPs are a ubiquitous group of proteins with extensive roles that include extracellular matrix remodeling and blood-brain barrier disruption. MMPs play an important role in ischemic stroke pathophysiology and clinical outcome. This review will evaluate the evidence for associations between polymorphisms in MMP-1, 2, 3, 9, and 12 with ischemic stroke incidence, pathophysiology, and clinical outcome. The role of polymorphisms in MMP genes may influence the presentation of ischemic stroke and be influenced by racial and ethnic background. However, contradictory evidence for the role of MMP polymorphisms does exist in the literature, and further studies will be necessary to consolidate our understanding of these multi-faceted proteins.
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Affiliation(s)
- Jason J Chang
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38104, USA.
| | - Ansley Stanfill
- Department of Nursing and Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, TN 38104, USA.
| | - Tayebeh Pourmotabbed
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN 38104, USA.
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The Effects of “Physical Activity on Prescription” in Persons With Transient Ischemic Attack: A Randomized Controlled Study. J Neurol Phys Ther 2016; 40:176-83. [DOI: 10.1097/npt.0000000000000134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Mellendijk L, Wiesmann M, Kiliaan AJ. Impact of Nutrition on Cerebral Circulation and Cognition in the Metabolic Syndrome. Nutrients 2015; 7:9416-39. [PMID: 26580647 PMCID: PMC4663605 DOI: 10.3390/nu7115477] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/12/2015] [Accepted: 11/03/2015] [Indexed: 12/12/2022] Open
Abstract
The increasing prevalence of Metabolic Syndrome (MetS), defined as the clustering of abdominal obesity, dyslipidemia, hypertension, and hyperglycemia, appears to be driving the global epidemics cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Nutrition has a major impact on MetS and plays an important role in the prevention, development, and treatment of its features. Structural and functional alterations in the vasculature, associated with MetS, might form the link between MetS and the increased risk of developing CVD and T2DM. Not only does the peripheral vasculature seem to be affected, but the syndrome has a profound impact on the cerebral circulation and thence brain structure as well. Furthermore, strong associations are shown with stroke, cognitive impairment, and dementia. In this review the impact of nutrition on the individual components of MetS, the effects of MetS on peripheral and cerebral vasculature, and its consequences for brain structure and function will be discussed.
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Affiliation(s)
- Laura Mellendijk
- Department of Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6500 HB, The Netherlands.
| | - Maximilian Wiesmann
- Department of Anatomy & Geriatric Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6500 HB, The Netherlands.
| | - Amanda J Kiliaan
- Department of Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen 6500 HB, The Netherlands.
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Conteduca V, Caffo O, Derosa L, Veccia A, Petracci E, Chiuri VE, Santoni M, Santini D, Fratino L, Maines F, Testoni S, De Giorgi U. Metabolic syndrome in castration-resistant prostate cancer patients treated with abiraterone. Prostate 2015; 75:1329-38. [PMID: 25982919 DOI: 10.1002/pros.23014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/16/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) has not yet been studied in castration-resistant prostate cancer (CRPC) men treated with novel hormonal therapies. The study aims to assess the impact of MS on outcome from time starting abiraterone. PATIENTS AND METHODS We retrospectively evaluated a consecutive series of metastatic CRPC patients treated with abiraterone after docetaxel failure. MS, as defined by modified Adult Treatment Panel (ATP) III criteria, was assessed at the time of initiation of abiraterone, during treatment and follow-up. RESULTS Sixty-seven of 178 patients evaluated (37.6%) met MS criteria at baseline, before abiraterone initiation, whereas for 11 (9.9%) without MS before treatment with abiraterone this occurred during treatment. Median PFS was equal to 4.7 months for patients with MS versus 9 months for those without MS. Patients with MS had an increased risk of 71% of progression or death for all causes than patients without MS (HR = 1.7, 95% CI [1.2-2.4], P = 0.03). Median OS was 14.7 months and 22.3 months in patients with and without MS, respectively. After adjusting for covariates, MS resulted not significantly associated to OS (HR = 1.42, 95% CI [0.91-2.22], P = 0.073). CONCLUSIONS The presence of MS is a significant risk factor for shorter PFS in CRPC patients treated with abiraterone, even if it does not show a significant impact on OS. A prospective evaluation is warranted.
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Affiliation(s)
- Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Lisa Derosa
- Medical Oncology Department, Santa Chiara Hospital, Pisa, Italy
| | - Antonello Veccia
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Elisabetta Petracci
- Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Matteo Santoni
- Medical Oncology Department, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Santini
- Medical Oncology Department, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Lucia Fratino
- Medical Oncology Department, National Cancer Institute, Aviano, Italy
| | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Sara Testoni
- Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Intravenous Thrombolysis with Recombinant Tissue-type Plasminogen Activator for Acute Ischemic Stroke in Patients with Metabolic Syndrome. J Stroke Cerebrovasc Dis 2015; 24:1787-92. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/21/2022] Open
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Chantler PD, Shrader CD, Tabone LE, d’Audiffret AC, Huseynova K, Brooks SD, Branyan KW, Grogg KA, Frisbee JC. Cerebral Cortical Microvascular Rarefaction in Metabolic Syndrome is Dependent on Insulin Resistance and Loss of Nitric Oxide Bioavailability. Microcirculation 2015; 22:435-45. [PMID: 26014499 PMCID: PMC4551443 DOI: 10.1111/micc.12209] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/20/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Chronic presentation of the MS is associated with an increased likelihood for stroke and poor stroke outcomes following occlusive cerebrovascular events. However, the physiological mechanisms contributing to compromised outcomes remain unclear, and the degree of cerebral cortical MVD may represent a central determinant of stroke outcomes. METHODS This study used the OZR model of MS and clinically relevant, chronic interventions to determine the impact on cerebral cortical microvascular rarefaction via immunohistochemistry with a parallel determination of cerebrovascular function to identify putative mechanistic contributors. RESULTS OZR exhibited a progressive rarefaction (to ~80% control MVD) of the cortical microvascular networks vs. lean Zucker rats. Chronic treatment with antihypertensive agents (captopril/hydralazine) had limited effectiveness in blunting rarefaction, although treatments improving glycemic control (metformin/rosiglitazone) were superior, maintaining ~94% control MVD. Chronic treatment with the antioxidant TEMPOL severely blunted rarefaction in OZR, although this ameliorative effect was prevented by concurrent NOS inhibition. CONCLUSIONS Further analyses revealed that the maintenance of glycemic control and vascular NO bioavailability were stronger predictors of cerebral cortical MVD in OZR than was prevention of hypertension, and this may have implications for chronic treatment of CVD risk under stroke-prone conditions.
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Affiliation(s)
- Paul D. Chantler
- Division of Exercise Physiology, West Virginia University Health Sciences Center, Morgantown, WV
- Clinical and Translational Sciences Institute, West Virginia University Health Sciences Center, Morgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, WV
| | - Carl D. Shrader
- Department of Family Medicine, West Virginia University Health Sciences Center, Morgantown, WV
- Clinical and Translational Sciences Institute, West Virginia University Health Sciences Center, Morgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, WV
| | - Lawrence E. Tabone
- Division of Bariatric Surgery, West Virginia University Health Sciences Center, Morgantown, WV
- Clinical and Translational Sciences Institute, West Virginia University Health Sciences Center, Morgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, WV
| | - Alexandre C. d’Audiffret
- Division of Vascular Surgery, West Virginia University Health Sciences Center, Morgantown, WV
- Clinical and Translational Sciences Institute, West Virginia University Health Sciences Center, Morgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, WV
| | - Khumara Huseynova
- Division of Vascular Surgery, West Virginia University Health Sciences Center, Morgantown, WV
- Clinical and Translational Sciences Institute, West Virginia University Health Sciences Center, Morgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, WV
| | - Steven D. Brooks
- Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, WV
| | - Kayla W. Branyan
- Division of Exercise Physiology, West Virginia University Health Sciences Center, Morgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, WV
| | - Kristin A. Grogg
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, WV
| | - Jefferson C. Frisbee
- Department of Physiology and Pharmacology, West Virginia University Health Sciences Center, Morgantown, WV
- Clinical and Translational Sciences Institute, West Virginia University Health Sciences Center, Morgantown, WV
- Center for Cardiovascular and Respiratory Sciences, West Virginia University Health Sciences Center, Morgantown, WV
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Vujnic M, Peric S, Popovic S, Raseta N, Ralic V, Dobricic V, Novakovic I, Rakocevic-Stojanovic V. Metabolic syndrome in patients with myotonic dystrophy type 1. Muscle Nerve 2015; 52:273-7. [PMID: 25487787 DOI: 10.1002/mus.24540] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2014] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The aim of this study was to assess the frequency and features of metabolic syndrome (MetS) in myotonic dystrophy type 1 (DM1). METHODS We studied 66 DM1 patients (50% men, aged 41.9 ± 10.5 years, disease duration of 19.3 ± 8.6 years). New worldwide consensus criteria for MetS from 2009 were used. RESULTS Components of MetS were present at the following frequencies: hypertriglyceridemia 67%; low HDL cholesterol 35%; hypertension 18%; central obesity 14%; and hyperglycemia 9%. MetS was present in 11 (17%) patients. The presence of MetS was not associated with patients' gender, age, disease severity, disease duration, or CTG repeat length (P > 0.05). Patients with MetS had significantly lower total SF-36 scores as a measure of quality of life in comparison to patients without MetS (P < 0.05). CONCLUSION Although certain components of MetS were very frequent in patients with DM1, only 17% met the criteria for MetS.
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Affiliation(s)
- Milorad Vujnic
- Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotica 6, 11 000, Belgrade, Serbia
| | - Srdjan Popovic
- Endocrinology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nela Raseta
- Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Vesna Ralic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotica 6, 11 000, Belgrade, Serbia
| | - Valerija Dobricic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotica 6, 11 000, Belgrade, Serbia
| | - Ivana Novakovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotica 6, 11 000, Belgrade, Serbia
| | - Vidosava Rakocevic-Stojanovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Dr Subotica 6, 11 000, Belgrade, Serbia
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Sari-Sarraf V, Aliasgarzadeh A, Naderali MM, Esmaeili H, Naderali EK. A combined continuous and interval aerobic training improves metabolic syndrome risk factors in men. Int J Gen Med 2015; 8:203-10. [PMID: 26056487 PMCID: PMC4445945 DOI: 10.2147/ijgm.s81938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Individuals with metabolic syndrome have significantly higher risk of cardiovascular disease and type 2 diabetes leading to premature death mortality. Metabolic syndrome has a complex etiology; thus, it may require a combined and multi-targeted aerobic exercise regimen to improve risk factors associated with it. Therefore, the aim of this study was to evaluate the effect of combined continuous and interval aerobic training on patients with metabolic syndrome. Thirty adult male with metabolic syndrome (54±8 years) were randomly divided into two groups: test training group (TTG; n=15) and control group (CG; n=15). Subjects in TTG performed combined continuous and interval aerobic training using a motorized treadmill three times per week for 16 weeks. Subjects in CG were advised to continue with their normal activities of life. Twenty-two men completed the study (eleven men in each group). At the end of the study, in TTG, there were significant (for all, P<0.05) reductions in total body weight (−3.2%), waist circumference (−3.43 cm), blood pressure (up to −12.7 mmHg), and plasma insulin, glucose, and triacylglyceride levels. Moreover, there were significant (for all, P<0.05) increases VO2max (−15.3%) and isometric strength of thigh muscle (28.1%) and high-density lipoprotein in TTG. None of the above indices were changed in CG at the end of 16-week study period. Our study suggests that adoption of a 16-week combined continuous and interval aerobic training regimen in men with metabolic syndrome could significantly reduce cardiovascular risk factors in these patients.
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Affiliation(s)
- Vahid Sari-Sarraf
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Akbar Aliasgarzadeh
- Bone Research Centre, Endocrine Unit, Department of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad-Mahdi Naderali
- The School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Hamid Esmaeili
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
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van Rooy MJ, Pretorius E. Metabolic syndrome, platelet activation and the development of transient ischemic attack or thromboembolic stroke. Thromb Res 2015; 135:434-42. [PMID: 25601172 DOI: 10.1016/j.thromres.2014.12.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/26/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
Stroke is the second most common cause of mortality in the world today, where transient ischemic attack (TIA) is a period of focal ischemia, the symptoms of which resemble a thromboembolic stroke. Contrary to stroke, TIA symptoms typically last less than one hour and necrosis is absent. Stroke is often preceded by TIA, making it an important predictor of future ischemic events. The causal role of atherosclerosis in the development of TIA is well established, however, research indicates that the atherosclerotic process begins years earlier with the development of metabolic syndrome, which affects approximately 45% of the adult population worldwide. Metabolic syndrome is present if three or more of the following is present: increased waist circumference, increased triglycerides, decreased HDL, increased fasting glucose and hypertension. This syndrome causes systemic inflammation that activates the coagulation system and may cause the formation of pathological thrombi. The role of platelets in stroke has been studied and platelet activation pathways identified. ADP and thromboxane A(2) are the most common activators of platelets in normal physiology. Several pharmacological treatments have been employed to prevent the activation of platelets, the most common of which include aspirin and P2Y(12)-inhibitors. Although treatment is administered strokes and subsequent TIAs are very common in individuals that suffered an initial event. This indicates that research needs to be done in order to elucidate new therapeutic targets, but also to better treat ischemic events to not only decrease the amount of recurring events but also decrease stroke mortality worldwide.
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Affiliation(s)
- Mia-Jeanne van Rooy
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia 0007, South Africa
| | - Etheresia Pretorius
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia 0007, South Africa.
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Naruse T, Tsuchiya R, Yamamoto N, Nagata S. Identifying Characteristics of Adults Absent from a Metabolic Syndrome Checkup in Japan Using CHAID Dendrograms and Insurance Claim Data. Health (London) 2015. [DOI: 10.4236/health.2015.714202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mighdoll MI, Tao R, Kleinman JE, Hyde TM. Myelin, myelin-related disorders, and psychosis. Schizophr Res 2015; 161:85-93. [PMID: 25449713 DOI: 10.1016/j.schres.2014.09.040] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 12/14/2022]
Abstract
The neuropathological basis of schizophrenia and related psychoses remains elusive despite intensive scientific investigation. Symptoms of psychosis have been reported in a number of conditions where normal myelin development is interrupted. The nature, location, and timing of white matter pathology seem to be key factors in the development of psychosis, especially during the critical adolescent period of association area myelination. Numerous lines of evidence implicate myelin and oligodendrocyte function as critical processes that could affect neuronal connectivity, which has been implicated as a central abnormality in schizophrenia. Phenocopies of schizophrenia with a known pathological basis involving demyelination or dysmyelination may offer insights into the biology of schizophrenia itself. This article reviews the pathological changes in white matter of patients with schizophrenia, as well as demyelinating diseases associated with psychosis. In an attempt to understand the potential role of dysmyelination in schizophrenia, we outline the evidence from a number of both clinically-based and post-mortem studies that provide evidence that OMR genes are genetically associated with increased risk for schizophrenia. To further understand the implication of white matter dysfunction and dysmyelination in schizophrenia, we examine diffusion tensor imaging (DTI), which has shown volumetric and microstructural white matter differences in patients with schizophrenia. While classical clinical-neuropathological correlations have established that disruption in myelination can produce a high fidelity phenocopy of psychosis similar to schizophrenia, the role of dysmyelination in schizophrenia remains controversial.
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Affiliation(s)
- Michelle I Mighdoll
- Lieber Institute for Brain Development, Johns Hopkins Medical Institutions, 855 N. Wolfe Street, Suite 300, Baltimore, MD 21205, USA.
| | - Ran Tao
- Lieber Institute for Brain Development, Johns Hopkins Medical Institutions, 855 N. Wolfe Street, Suite 300, Baltimore, MD 21205, USA.
| | - Joel E Kleinman
- Lieber Institute for Brain Development, Johns Hopkins Medical Institutions, 855 N. Wolfe Street, Suite 300, Baltimore, MD 21205, USA.
| | - Thomas M Hyde
- Lieber Institute for Brain Development, Johns Hopkins Medical Institutions, 855 N. Wolfe Street, Suite 300, Baltimore, MD 21205, USA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins Medical School, Baltimore, MD 21205, USA; Department of Neurology, Johns Hopkins Medical School, Baltimore, MD 21205, USA.
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Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MSV, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:3754-832. [PMID: 25355838 PMCID: PMC5020564 DOI: 10.1161/str.0000000000000046] [Citation(s) in RCA: 993] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.
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Metabolic components and recurrence in early-stage cervical cancer. Tumour Biol 2014; 36:2201-7. [PMID: 25398694 DOI: 10.1007/s13277-014-2831-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/07/2014] [Indexed: 12/11/2022] Open
Abstract
Epidemiological evidence suggests that the metabolic syndrome (MetS) is associated with increased risk of cervical cancer. However, research on the impact of MetS on prognosis in cervical cancer is lacking. This study investigated the association between MetS and recurrence-free survival (RFS) in patients with early-stage cervical cancer. This is a retrospective study of patients diagnosed with the International Federation of Gynecology and Obstetrics (FIGO) stage I-II cervical cancer in three tertiary hospitals during 2006-2009. Cox proportional hazards model was used to estimate the association between MetS or MetS components and RFS. We were able to evaluate MetS status in 84 patients out of 127. Forty patients had MetS. RFS was not significantly different according to MetS status; however, there was no further event of recurrence in non-MetS group after 2 years from primary surgical treatment. Hypertriglyceridemia (HR 3.67, 95% CI 1.18-11.43) and impaired fasting glucose (HR 4.30, 95% CI 1.23-15.03) were independent risk factors for shorter RFS, after adjustment for age, lymph node involvement, tumor involvement of resection margin, parametrial invasion, FIGO stage at diagnosis, and adjuvant treatment. Hypertriglyceridemia and impaired fasting glucose were associated with higher risk of recurrence in patients with early-stage cervical cancer. Prospective validation in large populations and further studies on the impact of MetS treatment in patients with cervical cancer are warranted.
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Tiehuis AM, van der Graaf Y, Mali WPTM, Vincken K, Muller M, Geerlings MI. Metabolic syndrome, prediabetes, and brain abnormalities on mri in patients with manifest arterial disease: the SMART-MR study. Diabetes Care 2014; 37:2515-21. [PMID: 24947788 DOI: 10.2337/dc14-0154] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors leading to atherosclerosis and diabetes. Diabetes is associated with both structural and functional abnormalities of the brain. MetS, even before diabetes is diagnosed, may also predispose to cerebral changes, probably through shared mechanisms. We examined the association of MetS with cerebral changes in patients with manifest arterial disease. RESEARCH DESIGN AND METHODS Cross-sectional data on MetS and brain MRI were available in 1,232 participants with manifest arterial disease (age 58.6 ± 10.1 years; 37% MetS). Volumes of brain tissue, ventricles, and white matter hyperintensities (WMH) were obtained by automated segmentation and expressed relative to intracranial volume. Infarcts were distinguished into lacunar and nonlacunar infarcts. RESULTS The presence of MetS (n = 451) was associated with smaller brain tissue volume (B -0.72% [95% CI -0.97, -0.47]), even in the subgroup of patients without diabetes (B -0.42% [95% CI -0.71, -0.13]). MetS was not associated with an increased occurrence of WMH or cerebral infarcts. Impaired glucose metabolism, abdominal obesity, and elevated triglycerides were individual components associated with smaller brain volume. Obesity and hypertriglyceridemia remained associated with smaller brain volume when patients with diabetes were excluded. Hypertension was associated with an increased occurrence of WMH and infarcts. CONCLUSIONS In patients with manifest arterial disease, presence of MetS is associated with smaller brain volume, even in patients without diabetes. Screening for MetS and treatment of its individual components, in particular, hyperglycemia, hypertriglyceridemia, and obesity, may prevent progression of cognitive aging in patients with MetS, even in a prediabetic stage.
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Affiliation(s)
| | | | | | - Koen Vincken
- University Medical Center Utrecht, Utrecht, the Netherlands
| | - Majon Muller
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SCC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160-236. [PMID: 24788967 DOI: 10.1161/str.0000000000000024] [Citation(s) in RCA: 2863] [Impact Index Per Article: 286.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.
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Influence of Criteria Used in Determining Prevalence of Metabolic Syndrome (NCEP-ATPIII versus IDF) in Patients with Intermittent Claudication. Ann Vasc Surg 2014; 28:640-3. [DOI: 10.1016/j.avsg.2013.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 04/22/2013] [Indexed: 11/20/2022]
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Voils SA, Cooper-DeHoff RM. Association between high sensitivity C-reactive protein and metabolic syndrome in subjects completing the National Health and Nutrition Examination Survey (NHANES) 2009-10. Diabetes Metab Syndr 2014; 8:88-90. [PMID: 24907172 DOI: 10.1016/j.dsx.2014.04.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Metabolic syndrome and elevated high-sensitivity (hs) C-reactive protein (CRP) have been associated with an increase in risk of coronary artery disease, stroke, and diabetes but the relationship between the two is unclear. The purpose of this study is to identify any association between metabolic syndrome and hs-CRP concentrations. METHODS Subjects 20 years or older completing the 2009-10 National Health and Nutrition Examination Survey (NHANES) were included. Metabolic syndrome was defined as having at least 3 of the following: hypertension, insulin resistance, hypertriglyceridemia, low high-density lipoprotein cholesterol, or high waist circumference. Elevated hs-CRP was defined as >3 mg/L. Multivariate logistic regression modeling was used to assess the relationship between hs-CRP and metabolic syndrome while controlling for potential confounders. RESULTS A total of 5728 subjects met the inclusion criteria, of which 69% were 20-55 years old, and 52% were female. Overall prevalence of metabolic syndrome was 34% and hs-CRP concentrations were elevated in 32% of subjects. Number of metabolic syndrome conditions was significantly associated with increasing odds of elevated hs-CRP concentrations. Subjects with one, two, three, four, or five metabolic syndrome conditions had 2.4, 3.3, 5.1, 10.7 and 11.1 times greater odds of elevated hs-CRP as compared to subjects with no metabolic syndrome conditions (p<0.05 for all comparisons). CONCLUSIONS Presence of metabolic syndrome was common in subjects from NHANES 2009-10 and a significant "dose-related" association was confirmed between number of metabolic syndrome conditions and increasing odds of elevated hs-CRP concentration.
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Affiliation(s)
- Stacy A Voils
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, 1225 Center Drive, HPNP Building, Room 3315, P.O. Box 100486, Gainesville, FL 32610-0486, United States.
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine, Colleges of Pharmacy and Medicine, Center for Pharmacogenomics, University of Florida, Health Science Center, Room PG-25, P.O. Box 100486, Gainesville, FL 32610-0486, United States.
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Kul S, Uyarel H, Gul M, Kucukdaglı OT, Bacaksiz A, Erdogan E, Ekmekci A. Metabolic syndrome and long-term cardiovascular outcomes in NSTEMI with unstable angina. Nutr Metab Cardiovasc Dis 2014; 24:176-182. [PMID: 24439842 DOI: 10.1016/j.numecd.2013.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/15/2013] [Accepted: 07/08/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Metabolic syndrome (MS) is associated with cardiovascular mortality and morbidity in patients with acute coronary syndrome. The purpose of this study was to evaluate the impact of MS on long-term clinical outcomes in patients with pure non-ST segment myocardial infarction (NSTEMI) or unstable angina pectoris (USAP). METHODS AND RESULTS We prospectively enrolled 310 consecutive NSTEMI/USAP patients (74 females; mean age, 59.3 ± 11.9 years). The study population was divided into two groups: MS(+) and MS(-). The clinical outcomes of the patients were followed for up to 3 years. Increased 3-year cardiovascular mortality and reinfarction were observed in the MS(+) group, as compared to the MS(-) group (15 vs. 3.4%, p = 0.001, and 22.2 vs. 8.3%, p = 0.001, respectively). Hospitalization rates for heart failure and stroke were not significantly different between the two groups on follow-up. By a Cox multivariate analysis, a significant association was noted between MS and the adjusted risk of 3-year cardiovascular mortality (odds ratio 3.4, 95% confidence interval, 1.24-9.1, p = 0.02). CONCLUSION These results suggest that MS is associated with an increased risk of 3-year cardiovascular mortality and reinfarction in patients with NSTEMI/USAP.
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Affiliation(s)
- S Kul
- Department of Cardiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
| | - H Uyarel
- Department of Cardiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - M Gul
- Department of Cardiology, Mehmet Akif Ersoy Thoracic-Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - O T Kucukdaglı
- Department of Emergency, Faculty Of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - A Bacaksiz
- Department of Cardiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - E Erdogan
- Department of Cardiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - A Ekmekci
- Department of Cardiology, Siyami Ersek Thoracic-Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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