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Wang R, Zhu L, Gao H, Zhang M, Fan Y, Lin C, Shen P, Gao H. Dorsomedial hypothalamus-raphe pallidus-cardiac sympathetic pathway mediates electroacupuncture intervention of stress-induced tachycardia. J Neurophysiol 2024; 131:589-597. [PMID: 38416698 DOI: 10.1152/jn.00036.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/01/2024] Open
Abstract
Electroacupuncture at Neiguan point (PC6) effectively ameliorates tachycardia. However, very little is known about the neural pathway mechanism underlying the effect of electroacupuncture at PC6 in stress-induced tachycardia. Here, we investigate whether there exists a dorsomedial hypothalamus (DMH)-raphe pallidus (RP)-heart pathway to mediate the effect of electroacupuncture at PC6. The virus tracing results show that the heart is innervated by the neurons in DMH and RP, and the neurons of DMH project to RP. Chemogenetic inhibition of RP projecting DMH neurons reverses the cardiac autonomic imbalance and tachycardia induced by stress. Of note, immunofluorescence results show that the neural activity of DMH and RP is inhibited by electroacupuncture at PC6 accompanied with improved cardiac autonomic imbalance and tachycardia under stress. Moreover, chemogenetic inhibition of RP projecting DMH neurons cannot affect autonomic nervous activity and heart rate of stress rats after administrating electroacupuncture at PC6.NEW & NOTEWORTHY Our study suggests that this dorsomedial hypothalamus (DMH)-raphe pallidus (RP)-cardiac sympathetic pathway involves in the improvement of cardiac dysfunction associated with stress by administrating electroacupuncture at PC6, thus providing beneficial information for the development of therapeutic strategies to prevent stress-induced cardiovascular diseases, and insight into neural pathway basis for electroacupuncture at PC6 intervention of cardiac dysfunction.
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Affiliation(s)
- Ruwen Wang
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Li Zhu
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Heyuan Gao
- Department of Pediatrics, The First Hospital of Qinhuangdao, Qinhuangdao, People's Republic of China
| | - Mengting Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, People's Republic of China
- CAS Key Laboratory of Brain Function and Disease, and School of Life Sciences, University of Science Technology of China, Hefei, People's Republic of China
| | - Yuyang Fan
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Chuanbo Lin
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Ping Shen
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Heren Gao
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
- Research Institute of Acupuncture and Meridian, Anhui Academy of Chinese Medicine, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Meridian Viscera Correlationship, Hefei, People's Republic of China
- CAS Key Laboratory of Brain Function and Disease, and School of Life Sciences, University of Science Technology of China, Hefei, People's Republic of China
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Kakaletsis N, Ntaios G, Milionis H, Karagiannaki A, Chouvarda I, Dourliou V, Ladakis I, Kaiafa G, Vemmos K, Savopoulos C. Midday Dipping and Circadian Blood Pressure Patterns in Acute Ischemic Stroke. J Clin Med 2023; 12:4816. [PMID: 37510931 PMCID: PMC10381256 DOI: 10.3390/jcm12144816] [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: 05/16/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
The purpose of this study was to investigate the alterations in blood pressure (BP) during midday and the changes in circadian BP patterns in the acute phase of ischemic stroke (AIS) with the severity of stroke and their predictive role outcomes within 3 months. A total of 228 AIS patients (a prospective multicenter follow-up study) underwent 24 h ambulatory blood pressure monitoring (ABPM). Mean BP parameters during the day (7:00-22:59), the midday (13:00-16:59), and the night (23:00-6:59), and midday and nocturnal dipping were calculated. Midday SBP dippers had less severe stroke, lower incidence of hypertension and SBP/DBP on admission, lower levels of serum glucose and WBCs, and delayed initiation of ABPM compared to risers. There was a reverse relation between midday SBP dipping and both nocturnal dipping and stroke severity. The "double dippers" (midday and nocturnal dipping) had the least severe stroke, the lowest SBP/DBP on admission, the lowest heart rate from ABPM, and a lower risk of an unfavorable outcome, while the "double risers" had the opposite results, by an approximately five-fold risk of death/disability at 3 months. These findings indicate different circadian BP patterns during the acute phase of AIS, which could be considered a marker of stroke severity and prognosis.
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Affiliation(s)
- Nikolaos Kakaletsis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 35100 Larissa, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Anastasia Karagiannaki
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 35100 Larissa, Greece
| | - Ioanna Chouvarda
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Vasiliki Dourliou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Ioannis Ladakis
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | | | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
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Kang Q, Luo A. The efficacy of mindfulness-based intervention for heart diseases: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e29649. [PMID: 36181030 PMCID: PMC9524963 DOI: 10.1097/md.0000000000029649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The efficacy of mindfulness-based intervention for heart diseases remains controversial. We conduct a systematic review and meta-analysis to explore the impact of mindfulness-based intervention on heart diseases. METHODS We have search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2020 for randomized controlled trials (RCTs) assessing the effect of mindfulness-based intervention versus usual care on heart diseases. This meta-analysis is performed using the random-effect model. RESULTS Five RCTs involving 458 patients are included in the meta-analysis. Overall, compared with control group for heart diseases, mindfulness-based intervention is associated with significantly increased 6 minute walking test [mean difference (MD) = 14.74; 95% confidence interval (95% CI) = 2.50-26.97; P = .02], decreased heart rate (MD = -2.54; 95% CI = -4.76 to -0.31; P = .03) and stress score (MD = -2.31; 95% CI = -4.23 to -0.38; P = .02), but shows no obvious impact on anxiety score (MD = -3.48; 95% CI = -7.98 to 1.03; P = .13) or respiratory rate (MD = -0.42; 95% CI = -1.31 to 0.46; P = .35). CONCLUSIONS Mindfulness-based intervention can provide additional benefits to heart diseases.
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Affiliation(s)
- Qingxia Kang
- Department of Cardiology, Yongchuan Hospital of Chongqing Medical University, Chongqing City, China
| | - Aihua Luo
- Department of Cardiology, Yongchuan Hospital of Chongqing Medical University, Chongqing City, China
- *Correspondence: Aihua Luo, Department of Cardiology, Yongchuan Hospital of Chongqing Medical University, No. 1 Youyi Street, Yongchuan District, Chongqing City 400453, China (e-mail: )
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Ni R, Liu M, Huang S, Yang J. Effects of eHealth Interventions on Quality of Life and Psychological Outcomes in Cardiac Surgery Patients: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40090. [PMID: 35972792 PMCID: PMC9428777 DOI: 10.2196/40090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients undergoing heart surgery may experience a range of physiological changes, and the postoperative recovery time is long. Patients and their families often have concerns about quality of life (QoL) after discharge. eHealth interventions may improve patient participation, ensure positive and effective health management, improve the quality of at-home care and the patient's quality of life, and reduce rates of depression. OBJECTIVE The purpose of this study was to evaluate the effects of eHealth interventions on the physiology, psychology, and compliance of adult patients after cardiac surgery to provide a theoretical basis for clinical practice. METHODS We conducted systematic searches of the following 4 electronic databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Mean (SD) values were used to calculate the pooled effect sizes for all consecutive data, including QoL, anxiety, and depression. Where the same results were obtained using different instruments, we chose the standardized mean difference with a 95% CI to represent the combined effect size; otherwise, the mean difference (MD) with a 95% CI was used. Odds ratios were used to calculate the combined effect size for all dichotomous data. The Cohen Q test for chi-square distribution and an inconsistency index (I2) were used to test for heterogeneity among the studies. We chose a fixed-effects model to estimate the effect size if there was no significant heterogeneity in the data (I2≤50%); otherwise, a random-effects model was used. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS The search identified 3632 papers, of which 19 met the inclusion criteria. In terms of physical outcomes, the score of the control group was lower than that of the intervention group (MD 0.15, 95% CI 0.03-0.27, I2=0%, P=.02). There was no significant difference in the mental outcomes between the intervention and control groups (MD 0.10, 95% CI -0.03 to 0.24, I2=46.4%, P=.14). The control group's score was lower than that of the intervention group for the depression outcomes (MD -0.53, 95% CI -0.89 to -0.17, I2=57.1%, P=.004). Compliance outcomes improved in most intervention groups. The results of the sensitivity analysis were robust. Nearly half of the included studies (9/19, 47%) had a moderate to high risk of bias. The quality of the evidence was medium to low. CONCLUSIONS eHealth improved the physical component of quality of life and depression after cardiac surgery; however, there was no statistical difference in the mental component of quality of life. The effectiveness of eHealth on patient compliance has been debated. Further high-quality studies on digital health are required. TRIAL REGISTRATION PROSPERO CRD42022327305; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327305.
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Affiliation(s)
- Ruping Ni
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Shunmin Huang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Jing Yang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- College of Pharmacy, Fujian Medical University, Fuzhou, China
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Sara JDS, Toya T, Ahmad A, Clark MM, Gilliam WP, Lerman LO, Lerman A. Mental Stress and Its Effects on Vascular Health. Mayo Clin Proc 2022; 97:951-990. [PMID: 35512885 PMCID: PMC9058928 DOI: 10.1016/j.mayocp.2022.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 01/13/2023]
Abstract
Coronary artery disease continues to be a major cause of morbidity and mortality despite significant advances in risk stratification and management. This has prompted the search for alternative nonconventional risk factors that may provide novel therapeutic targets. Psychosocial stress, or mental stress, has emerged as an important risk factor implicated in a higher incidence of cardiovascular events, and although our understanding of this far ranging and interesting phenomenon has developed greatly over recent times, there is still much to be learned regarding how to measure mental stress and how it may impact physical health. With the current coronavirus disease 2019 global pandemic and its incumbent lockdowns and social distancing, understanding the potentially harmful biological effects of stress related to life-changing events and social isolation has become even more important. In the current review our multidisciplinary team discusses stress from a psychosocial perspective and aims to define psychological stress as rigorously as possible; discuss the pathophysiologic mechanisms by which stress may mediate cardiovascular disease, with a particular focus to its effects on vascular health; outline existing methods and approaches to quantify stress by means of a vascular biomarker; outline the mechanisms whereby psychosocial stressors may have their pathologic effects ultimately transduced to the vasculature through the neuroendocrine immunologic axis; highlight areas for improvement to refine existing approaches in clinical research when studying the consequences of psychological stress on cardiovascular health; and discuss evidence-based therapies directed at reducing the deleterious effects of mental stress including those that target endothelial dysfunction. To this end we searched PubMed and Google Scholar to identify studies evaluating the relationship between mental or psychosocial stress and cardiovascular disease with a particular focus on vascular health. Search terms included "myocardial ischemia," "coronary artery disease," "mental stress," "psychological stress," "mental∗ stress∗," "psychologic∗ stress∗," and "cardiovascular disease∗." The search was limited to studies published in English in peer-reviewed journals between 1990 and the present day. To identify potential studies not captured by our database search strategy, we also searched studies listed in the bibliography of relevant publications and reviews.
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Key Words
- cad, coronary artery disease
- cbt, cognitive behavioral therapy
- cvd, cardiovascular disease
- fmd, flow-mediated dilatation
- il, interleukin
- mi, myocardial infarction
- ms, mental stress
- msimi, mental stress induced myocardial ischemia
- pat, peripheral arterial tonometry
- ped, peripheral endothelial dysfunction
- pet, positron emission tomography
- rh, reactive hyperemia
- ses, socioeconomic status
- tnf, tumor necrosis factor
- vsmc, vascular smooth muscle cells
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Affiliation(s)
| | - Takumi Toya
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Ali Ahmad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Wesley P Gilliam
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Lliach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
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Morais-Silva G, Gomes-de-Souza L, Costa-Ferreira W, Pavan JC, Crestani CC, Marin MT. Cardiovascular Reactivity to a Novel Stressor: Differences on Susceptible and Resilient Rats to Social Defeat Stress. Front Physiol 2022; 12:781447. [PMID: 35250603 PMCID: PMC8889071 DOI: 10.3389/fphys.2021.781447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Prolonged and heightened responses to stress are known factors that influence the development of mood disorders and cardiovascular diseases. Moreover, the coping strategies related to the experience of adverse events, i.e., resilience or the susceptibility to stress, are determinants for the individual risk of developing such diseases. Susceptible rats to the social defeat stress (SDS), identified by the social interaction test (SIT), show behavioral and cardiovascular alterations after SDS exposure that are not found in resilient rats. However, it is not elucidated yet how the cardiovascular system of susceptible and resilient phenotypes responds to a new stressor after SDS exposure. Thus, using the SDS exposure followed by the SIT, we evaluated heart rate, blood pressure (BP), tail skin temperature, and circulating corticosterone responses to an acute session of restraint stress in susceptible and resilient rats to SDS. Susceptible rats showed resting tachycardia and exaggerated BP response to restraint stress, while resilient rats did not present such alterations. In contrast, both phenotypes showed increased plasma corticosterone and a drop in tail skin temperature to restraint stress, which was similar to that observed in control animals. Our results revealed an increased cardiovascular reactivity in response to a new stressful stimulus in susceptible rats, which might be related to a greater risk for the development of cardiovascular diseases.
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Affiliation(s)
- Gessynger Morais-Silva
- Laboratory of Pharmacology, School of Pharmaceutical Sciences of Araraquara, São Paulo State University, Araraquara, Brazil
- Joint Graduate Program in Physiological Sciences (PIPGCF), UFSCar/UNESP, Araraquara, Brazil
| | - Lucas Gomes-de-Souza
- Laboratory of Pharmacology, School of Pharmaceutical Sciences of Araraquara, São Paulo State University, Araraquara, Brazil
- Joint Graduate Program in Physiological Sciences (PIPGCF), UFSCar/UNESP, Araraquara, Brazil
| | - Willian Costa-Ferreira
- Laboratory of Pharmacology, School of Pharmaceutical Sciences of Araraquara, São Paulo State University, Araraquara, Brazil
- Joint Graduate Program in Physiological Sciences (PIPGCF), UFSCar/UNESP, Araraquara, Brazil
| | - Jacqueline C. Pavan
- Laboratory of Pharmacology, School of Pharmaceutical Sciences of Araraquara, São Paulo State University, Araraquara, Brazil
| | - Carlos C. Crestani
- Laboratory of Pharmacology, School of Pharmaceutical Sciences of Araraquara, São Paulo State University, Araraquara, Brazil
- Joint Graduate Program in Physiological Sciences (PIPGCF), UFSCar/UNESP, Araraquara, Brazil
| | - Marcelo T. Marin
- Laboratory of Pharmacology, School of Pharmaceutical Sciences of Araraquara, São Paulo State University, Araraquara, Brazil
- Joint Graduate Program in Physiological Sciences (PIPGCF), UFSCar/UNESP, Araraquara, Brazil
- *Correspondence: Marcelo T. Marin,
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Tao X, Wu S, Tang W, Li L, Huang L, Mo D, Liu C, Song T, Wang S, Wang J, He J. Alleviative effects of foraging exercise on depressive-like behaviors in chronic mild stress-induced ischemic rat model. Brain Inj 2022; 36:127-136. [PMID: 35138197 DOI: 10.1080/02699052.2022.2034949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Poststroke depression (PSD) is a common complication that seriously affects the functional recovery and prognosis of an individual. As some patients with PSD fail to respond to drug therapy, it is urgent to find a viable alternative treatment. METHODS An active exercise program known as foraging exercise (FE), using food as bait, was designed. First, focal ischemia and chronic unpredictable mild stress (CUMS) were used to establish a PSD model in rats. FE was then performed for 4 weeks. Body weight and behavioral assessments were conducted at the end of the 4th and 8th weeks. RESULTS After 8 weeks, the results revealed that, compared with the PSD group, the behavioral scores of the rats in the PSD/FE group were significantly improved, the expression of Iba-1 in the affected frontal lobe and striatum was decreased, and serum levels of IL-6 and the IL-6/IL-10 ratio were downregulated. However, the ratio of residual brain volume in rats that had experienced CUMS was significantly less than that in the stroke group. CONCLUSION FE can alleviate the behavioral scores of PSD rats, and its mechanism may be related to a modulation of the immune-inflammation response of microglia. Furthermore, chronic, persistent stress may increase the volume of cerebral infarction after stroke.
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Affiliation(s)
- Xi Tao
- Department of Neurological Rehabilitation, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China
| | - Siyuan Wu
- Department of Neurological Rehabilitation, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China
| | - Wenjing Tang
- Department of Neurological Rehabilitation, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China
| | - Lu Li
- Department of Neurological Rehabilitation, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China
| | - Lijun Huang
- Department of Neurological Rehabilitation, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China
| | - Danheng Mo
- Department of Neurology, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China
| | - Chujuan Liu
- Department of Neurological Rehabilitation, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China
| | - Tao Song
- Department of Neurological Rehabilitation, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China
| | - Shuling Wang
- Hunan Provincial Institute of Geriatrics, Hunan Provincial People's Hospital, Hunan Normal University, Changsha, Hunan Province, China
| | - Jia Wang
- Department of Scientific Research, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China
| | - Juan He
- Department of Neurosurgery, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, China
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Nano-ivabradine averts behavioral anomalies in Huntington's disease rat model via modulating Rhes/m-tor pathway. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110368. [PMID: 34087391 DOI: 10.1016/j.pnpbp.2021.110368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 01/24/2023]
Abstract
Huntington's disease (HD) is characterized by abnormal involuntary movements together with cognitive impairment and disrupted mood changes. 3-nitropropionic acid (3-NP) is one of the chemo-toxic models used to address the striatal neurotoxicity pattern encountered in HD. This study aims to explain the neuroprotective effect of nano-formulated ivabradine (nano IVA) in enhancing behavioral changes related to 3-NP model and to identify the involvement of ras homolog enriched striatum (Rhes)/mammalian target of rapamycin (m-Tor) mediated autophagy pathway. Rats were divided into 6 groups, the first 3 groups received saline (control), ivabradine (IVA), nano IVA respectively, the fourth received a daily dose of 3-NP (20 mg/kg, s.c) for 2 weeks, the fifth received 3-NP + IVA (1 mg/kg, into the tail vein, every other day for 1 week) and the last group received 3-NP + nano IVA (1 mg/kg, i.v, every other day for 1 week). Interestingly, nano IVA reversed motor disabilities, improved memory function and overcame the psychiatric changes. It boosted expression of autophagy markers combined with down regulation of Rhes, m-Tor and b-cell lymphoma 2 protein levels. Also, it restored the normal level of neurotransmitters and myocardial function related-proteins. Histopathological examination revealed a preserved striatal structure with decreased number of darkly-degenerated neurons. In conclusion, the outcomes of this study provide a well-recognized clue for the promising neuroprotective effect of IVA and the implication of autophagy and Rhes/m-Tor pathways in the 3-NP induced HD and highlight the fact that nano formulations of IVA would be an auspicious approach in HD therapy.
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Lee JD, Kuo YW, Lee CP, Huang YC, Lee M, Lee TH. Initial in-hospital heart rate is associated with long-term survival in patients with acute ischemic stroke. Clin Res Cardiol 2021; 111:651-662. [PMID: 34687320 PMCID: PMC9151537 DOI: 10.1007/s00392-021-01953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022]
Abstract
Aims Increased heart rate has been associated with stroke risk and outcomes. The purpose of this study was to explore the long-term prognostic value of initial in-hospital heart rate in patients with acute ischemic stroke (AIS). Methods We analyzed data from 21,655 patients with AIS enrolled (January 2010–September 2018) in the Chang Gung Research Database. Mean initial in-hospital heart rates were averaged and categorized into 10-beat-per-minute (bpm) increments. The primary and secondary outcomes were all-cause mortality and cardiovascular death. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable adjusted Cox proportional hazard models, using the heart rate < 60 bpm subgroup as the reference. Results The adjusted HRs for all-cause mortality were 1.23 (95% CI 1.08–1.41) for heart rate 60–69 bpm, 1.74 (95% CI 1.53–1.97) for heart rate 70–79 bpm, 2.16 (95% CI 1.89–2.46) for heart rate 80–89 bpm, and 2.83 (95% CI 2.46–3.25) for heart rate ≥ 90 bpm compared with the reference group. Likewise, heart rate ≥ 60 bpm was also associated with an increased risk of cardiovascular death (adjusted HR 1.18 [95% CI 0.95–1.46] for heart rate 60–69 bpm, 1.57 [95% CI 1.28–1.93] for heart rate 70–79 bpm, 1.98 [95% CI 1.60–2.45] for heart rate 80–89 bpm, and 2.36 [95% CI 1.89–2.95] for heart rate ≥ 90 bpm). Conclusions High initial in-hospital heart rate is an independent predictor of all-cause mortality and cardiovascular death in patients with AIS. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01953-5.
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Affiliation(s)
- Jiann-Der Lee
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Wen Kuo
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng Lee
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Sara JDS, Ahmad A, Toya T, Suarez Pardo L, Lerman LO, Lerman A. Anxiety Disorders Are Associated With Coronary Endothelial Dysfunction in Women With Chest Pain and Nonobstructive Coronary Artery Disease. J Am Heart Assoc 2021; 10:e021722. [PMID: 34459240 PMCID: PMC8649259 DOI: 10.1161/jaha.121.021722] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Anxiety disorders are the most prevalent mental disorders and are an emerging risk factor for coronary artery disease and its complications. We determine the relationship between having a clinical diagnosis of an anxiety disorder and coronary endothelial dysfunction (CED) using invasive coronary reactivity testing across both sexes. Methods and Results Patients presenting with chest pain and nonobstructive coronary artery disease (stenosis <40%) at coronary angiography underwent an invasive assessment of CED. Patients were categorized as having a clinical diagnosis of an anxiety disorder at the time of coronary angiography by chart review. The frequency of CED was compared between patients with versus without an anxiety disorder and after stratifying patients by sex. Between 1992 and 2020, 1974 patients (mean age, 51.3 years; 66.2% women) underwent invasive coronary reactivity testing, of which 550 (27.9%) had a documented anxiety disorder at the time of angiography. There was a significantly higher proportion of patients with any type of CED in those with an anxiety disorder in all patients (343 [62.7%] versus 790 [56.4%]; P=0.011) that persisted in women but not in men. After adjusting for covariables, anxiety was significantly associated with any CED among all patients (odds ratio [95% CI], 1.36 [1.10–1.68]; P=0.004), and after stratifying by sex in women but not in men. Conclusions Anxiety disorders are significantly associated with CED in women presenting with chest pain and nonobstructive coronary artery disease. Thus, CED may represent a mechanism underpinning the association between anxiety disorders and coronary artery disease and its complications, highlighting the role of anxiety as a potential therapeutic target to prevent cardiovascular events.
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Affiliation(s)
- Jaskanwal D S Sara
- Department of Cardiovascular Medicine Mayo College of Medicine Rochester MN
| | - Ali Ahmad
- Department of Cardiovascular Medicine Mayo College of Medicine Rochester MN
| | - Takumi Toya
- Department of Cardiovascular Medicine Mayo College of Medicine Rochester MN
| | | | - Lilach O Lerman
- Department of Psychiatry and Psychology Mayo Clinic Rochester MN.,Division of Nephrology and Hypertension Mayo Clinic Rochester MN
| | - Amir Lerman
- Department of Cardiovascular Medicine Mayo College of Medicine Rochester MN
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11
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Kuo YW, Lee M, Huang YC, Lee JD. Initial in-hospital heart rate is associated with three-month functional outcomes after acute ischemic stroke. BMC Neurol 2021; 21:222. [PMID: 34116663 PMCID: PMC8194208 DOI: 10.1186/s12883-021-02252-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/19/2021] [Indexed: 12/27/2022] Open
Abstract
Background Increased heart rate (HR) has been associated with stroke risk and outcomes. Material and methods We analyzed 1,420 patients from a hospital-based stroke registry with acute ischemic stroke (AIS). Mean initial in-hospital HR and the coefficient of variation of HR (HR-CV) were derived from the values recorded during the first 3 days of hospitalization. The study outcome was the 3-month functional outcome. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using multivariable logistic regression analysis. Results A higher mean HR level was significantly and continuously associated with a higher probability of unfavorable functional outcomes. Compared with the reference group (mean HR < 70 beats per minute), the multivariate-adjusted OR for an unfavorable outcome was 1.81 (95% CI, 1.25–2.61) for a mean HR ≥ 70 and < 80 beats per minute, 2.52 (95% CI, 1.66 − 3.52) for a mean HR ≥ 80 and < 90 beats per minute, and 3.88 (95% CI, 2.20–6.85) for mean HR ≥ 90 beats per minute. For stroke patients with a history of hypertension, the multivariate-adjusted OR for patients with a HR-CV ≥ 0.12 (versus patients with a HR-CV < 0.08 as a reference) was 1.73 (95% CI, 1.11–2.70) for an unfavorable outcome. Conclusions Our results indicated that a high initial in-hospital HR was significantly associated with unfavorable 3-month functional outcomes in patients with AIS. In addition, stroke patients with a HR-CV ≥ 0.12 also had unfavorable outcomes compared with those with a HR-CV < 0.08 if they had a history of hypertension. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02252-2.
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Affiliation(s)
- Ya-Wen Kuo
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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12
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Li C, Meng X, Pan Y, Li Z, Wang M, Wang Y. The Association Between Heart Rate Variability and 90-Day Prognosis in Patients With Transient Ischemic Attack and Minor Stroke. Front Neurol 2021; 12:636474. [PMID: 34122296 PMCID: PMC8193569 DOI: 10.3389/fneur.2021.636474] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Low heart rate variability (HRV) is known to be associated with increased all-cause, cardiovascular, and cerebrovascular mortality but its association with clinical outcomes in patients with transient ischemic attack (TIA) or minor stroke is unclear. Methods: We selected TIA and minor stroke patients from a prospective registration study. From each continuous electrocardiograph (ECG) record, each QRS complex was detected and normal-to-normal (N-N) intervals were determined. The standard deviation of all N-N intervals (SDNN) and the square root of the mean squared differences of successive N-N intervals (RMSSD) were calculated. Logistic regression analysis and Cox regression analysis were performed to assess the outcomes of patients at 90 days, and the odds and risk ratios (OR/HR) of each index quartile were compared. Results: Compared with SDNN patients in the lowest quartile, neurological disability was significantly reduced in other quartile groups at 90 days, with significant differences [OR of group Q2 was 0.659; 95% confidence interval (CI), 0.482–0.900; p = 0.0088; OR of group Q3 was 0.662; 95% CI, 0.478–0.916; p = 0.0127; OR of group Q4 was 0.441; 95% CI, 0.305–0.639; p <0.0001]. Compared with the lowest quartile, the recurrence rate of TIA or minor stroke in patients of the two higher quartiles (Q3 and Q4) of SDNN was significantly reduced at 90 days (HR of Q3 group was 0.732; 95% CI, 0.539–0.995; p = 0.0461; HR of Q4 group was 0.528; 95% CI, 0.374–0.745; p = 0.0003). Conclusions: Based on our findings, autonomic dysfunction is an adverse indicator for neurological function prognosis and stroke recurrence 90 days after TIA or minor stroke.
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Affiliation(s)
- Changhong Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Haidian Hospital, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Mengxing Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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13
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Xu J, Chen W. Impact of Water Temperature on Heart Rate Variability during Bathing. Life (Basel) 2021; 11:life11050378. [PMID: 33922202 PMCID: PMC8145520 DOI: 10.3390/life11050378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Heart rate variability (HRV) is affected by many factors. This paper aims to explore the impact of water temperature (WT) on HRV during bathing. Methods: The bathtub WT was preset at three conditions: i.e., low WT (36–38 °C), medium WT (38–40 °C), and high WT (40–42 °C), respectively. Ten subjects participated in the data collection. Each subject collected five electrocardiogram (ECG) recordings at each preset bathtub WT condition. Each recording was 18 min long with a sampling rate of 200 Hz. In total, 150 ECG recordings and 150 WT recordings were collected. Twenty HRV features were calculated using 1-min ECG segments each time. The k-means clustering analysis method was used to analyze the rough trends based on the preset WT. Analyses of the significant differences were performed using the multivariate analysis of variance of t-tests, and the mean and standard deviation (SD) of each HRV feature based on the WT were calculated. Results: The statistics show that with increasing WT, 11 HRV features are significantly (p < 0.05) and monotonously reduced, four HRV features are significantly (p < 0.05) and monotonously rising, two HRV features are rising first and then reduced, two HRV features (fuzzy and approximate entropy) are almost unchanged, and vLF power is rising. Conclusion: The WT has an important impact on HRV during bathing. The findings in the present work reveal an important physiological factor that affects the dynamic changes of HRV and contribute to better quantitative analyses of HRV in future research works.
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14
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You S, Wang Y, Lu Z, Chu D, Han Q, Xu J, Liu CF, Cao Y, Zhong C. Dynamic change of heart rate in the acute phase and clinical outcomes after intracerebral hemorrhage: a cohort study. J Intensive Care 2021; 9:28. [PMID: 33736711 PMCID: PMC7971394 DOI: 10.1186/s40560-021-00540-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dynamic change of heart rate in the acute phase and clinical outcomes after intracerebral hemorrhage (ICH) remains unknown. We aimed to investigate the associations of heart rate trajectories and variability with functional outcome and mortality in patients with acute ICH. METHODS This prospective study was conducted among 332 patients with acute ICH. Latent mixture modeling was used to identify heart rate trajectories during the first 72 h of hospitalization after ICH onset. Mean and coefficient of variation of heart rate measurements were calculated. The study outcomes included unfavorable functional outcome, ordinal shift of modified Rankin Scale score, and all-cause mortality. RESULTS We identified 3 distinct heart rate trajectory patterns (persistent-high, moderate-stable, and low-stable). During 3-month follow-up, 103 (31.0%) patients had unfavorable functional outcome and 46 (13.9%) patients died. In multivariable-adjusted model, compared with patients in low-stable trajectory, patients in persistent-high trajectory had the highest odds of poor functional outcome (odds ratio 15.06, 95% CI 3.67-61.78). Higher mean and coefficient of variation of heart rate were also associated with increased risk of unfavorable functional outcome (P trend < 0.05), and the corresponding odds ratios (95% CI) comparing two extreme tertiles were 4.69 (2.04-10.75) and 2.43 (1.09-5.39), respectively. Likewise, similar prognostic effects of heart rate dynamic changes on high modified Rankin Scale score and all-cause mortality were observed. CONCLUSIONS Persistently high heart rate and higher variability in the acute phase were associated with increased risk of unfavorable functional outcome in patients with acute ICH.
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Affiliation(s)
- Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China
| | - Yupin Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, Jiangsu, China
| | - Zian Lu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, Jiangsu, China
| | - Dandan Chu
- Department of Neurology, The People's Hospital of Xuan Cheng City, Xuancheng, China
| | - Qiao Han
- Department of Neurology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jiaping Xu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China.,Institutes of Neuroscience, Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China. .,Institutes of Neuroscience, Soochow University, Suzhou, China.
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, Jiangsu, China.
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15
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Simko F, Baka T. Ivabradine and Blood Pressure Reduction: Underlying Pleiotropic Mechanisms and Clinical Implications. Front Cardiovasc Med 2021; 8:607998. [PMID: 33644129 PMCID: PMC7902523 DOI: 10.3389/fcvm.2021.607998] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/07/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Fedor Simko
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,3rd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Tomas Baka
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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16
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Shah SM, Meadows JL, Burg MM, Pfau S, Soufer R. Effects of Psychological Stress on Vascular Physiology: Beyond the Current Imaging Signal. Curr Cardiol Rep 2020; 22:156. [PMID: 33037500 DOI: 10.1007/s11886-020-01406-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW This review describes the effects of psychological stress on the physiology of the entire vascular system, from individual cellular components to macrovascular and microvascular responses, and highlights the importance of the vascular system in the context of current limitations in cardiac imaging for evaluation of the cardiovascular response to mental stress. RECENT FINDINGS The physiological responses that mediate vascular changes are based on evolutionary needs, but there is increasing evidence that the long-term consequences of psychological stress can precipitate the development and progression of cardiovascular disease (CVD). While there is an extensive body of literature describing localized physiological responses or overt cardiovascular manifestations, often framed within the organ-specific scope of cardiovascular imaging, there has not been a comprehensive description of the global vascular effects of psychological stress. Given the global nature of these processes, targeted cardiovascular imaging modalities may be insufficient. Here we approach the vascular response to mental stress systematically, describing the effects on the endothelium, vascular smooth muscle, and adventitia. We then address the mental stress effects on large vessels and the microvascular compartment, with a discussion of the role of microvascular resistance in the pathophysiology of mental stress-induced myocardial ischemia. Vascular responses to psychological stress involve complex physiological processes that are not fully characterized by routine cardiovascular imaging assessments. Future research incorporating standardized psychological assessments targeted toward vascular mechanisms of stress responses is required to guide the development of behavioral and therapeutic interventions.
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Affiliation(s)
- Samit M Shah
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Judith L Meadows
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Steven Pfau
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave./111B, West Haven, CT, 06516, USA. .,VA Connecticut Healthcare System, West Haven, CT, USA.
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17
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Valenzuela PL, Carrera-Bastos P, Gálvez BG, Ruiz-Hurtado G, Ordovas JM, Ruilope LM, Lucia A. Lifestyle interventions for the prevention and treatment of hypertension. Nat Rev Cardiol 2020; 18:251-275. [PMID: 33037326 DOI: 10.1038/s41569-020-00437-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
Hypertension affects approximately one third of the world's adult population and is a major cause of premature death despite considerable advances in pharmacological treatments. Growing evidence supports the use of lifestyle interventions for the prevention and adjuvant treatment of hypertension. In this Review, we provide a summary of the epidemiological research supporting the preventive and antihypertensive effects of major lifestyle interventions (regular physical exercise, body weight management and healthy dietary patterns), as well as other less traditional recommendations such as stress management and the promotion of adequate sleep patterns coupled with circadian entrainment. We also discuss the physiological mechanisms underlying the beneficial effects of these lifestyle interventions on hypertension, which include not only the prevention of traditional risk factors (such as obesity and insulin resistance) and improvements in vascular health through an improved redox and inflammatory status, but also reduced sympathetic overactivation and non-traditional mechanisms such as increased secretion of myokines.
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Affiliation(s)
| | - Pedro Carrera-Bastos
- Centre for Primary Health Care Research, Lund University/Region Skane, Skane University Hospital, Malmö, Sweden
| | - Beatriz G Gálvez
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Research Institute of the Hospital Universitario 12 de Octubre (imas12), Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José M Ordovas
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.,IMDEA Alimentacion, Madrid, Spain
| | - Luis M Ruilope
- Research Institute of the Hospital Universitario 12 de Octubre (imas12), Madrid, Spain.,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain. .,Research Institute of the Hospital Universitario 12 de Octubre (imas12), Madrid, Spain.
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18
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Abstract
Heart rate is a parameter that is very easy to measure and is widely used both in clinic and during daily life activities. Its value gained more relevance with the evidence, in prospective studies and meta-analysis, of association between elevated heart rate values and diseases and outcomes.The increased knowledge of physiological mechanisms of heart rate control and the pathophysiological mechanisms responsible for its dysfunction allows to identify the cut-off value of normalcy providing info for non-pharmacological and pharmacological treatments to reduce the cardiovascular risk both in general population and in pathophysiological conditions. This paper overviews the knowledges of the role of resting heart rate as predictor of cardiovascular risk.
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Affiliation(s)
- Gino Seravalle
- Department of Cardiology, Italian Auxological Institute S. Luca Hospital, Milan, Italy -
| | | | - Guido Grassi
- Department of Health Science, Milano-Bicocca University, Milan, Italy
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19
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Huang YQ, Shen G, Huang JY, Zhang B, Feng YQ. A nonlinear association between resting heart rate and ischemic stroke among community elderly hypertensive patients. Postgrad Med 2020; 132:215-219. [PMID: 31829063 DOI: 10.1080/00325481.2019.1704544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, Guangzhou 510080, China
| | - Geng Shen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, Guangzhou 510080, China
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, Guangzhou 510080, China
| | - Bin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, Guangzhou 510080, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, Guangzhou 510080, China
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20
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Models of poststroke depression and assessments of core depressive symptoms in rodents: How to choose? Exp Neurol 2019; 322:113060. [DOI: 10.1016/j.expneurol.2019.113060] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/09/2019] [Accepted: 09/05/2019] [Indexed: 01/22/2023]
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21
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Wegner S, Uhlemann R, Boujon V, Ersoy B, Endres M, Kronenberg G, Gertz K. Endothelial Cell-Specific Transcriptome Reveals Signature of Chronic Stress Related to Worse Outcome After Mild Transient Brain Ischemia in Mice. Mol Neurobiol 2019; 57:1446-1458. [PMID: 31758402 PMCID: PMC7060977 DOI: 10.1007/s12035-019-01822-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/23/2019] [Indexed: 12/29/2022]
Abstract
Vascular mechanisms underlying the adverse effects that depression and stress-related mental disorders have on stroke outcome are only partially understood. Identifying the transcriptomic signature of chronic stress in endothelium harvested from the ischemic brain is an important step towards elucidating the biological processes involved. Here, we subjected male 129S6/SvEv mice to a 28-day model of chronic stress. The ischemic lesion was quantified after 30 min filamentous middle cerebral artery occlusion (MCAo) and 48 h reperfusion by T2-weighted MRI. RNA sequencing was used to profile transcriptomic changes in cerebrovascular endothelial cells (ECs) from the infarct. Mice subjected to the stress procedure displayed reduced weight gain, increased adrenal gland weight, and increased hypothalamic FKBP5 mRNA and protein expression. Chronic stress conferred increased lesion volume upon MCAo. Stress-exposed mice showed a higher number of differentially expressed genes between ECs isolated from the ipsilateral and contralateral hemisphere than control mice. The genes in question are enriched for roles in biological processes closely linked to endothelial proliferation and neoangiogenesis. MicroRNA-34a was associated with nine of the top 10 biological process Gene Ontology terms selectively enriched in ECs from stressed mice. Moreover, expression of mature miR-34a-5p and miR-34a-3p in ischemic brain tissue was positively related to infarct size and negatively related to sirtuin 1 (Sirt1) mRNA transcription. In conclusion, this study represents the first EC-specific transcriptomic analysis of chronic stress in brain ischemia. The stress signature uncovered relates to worse stroke outcome and is directly relevant to endothelial mechanisms in the pathogenesis of stroke.
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Affiliation(s)
- Stephanie Wegner
- Klinik für Neurologie, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ria Uhlemann
- Klinik für Neurologie, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Valérie Boujon
- Klinik für Neurologie, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Burcu Ersoy
- Klinik für Neurologie, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Endres
- Klinik für Neurologie, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner site Berlin, 10115, Berlin, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), 10117, Berlin, Germany
| | - Golo Kronenberg
- Klinik für Neurologie, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,University of Leicester and Leicestershire Partnership NHS Trust, Leicester, UK
| | - Karen Gertz
- Klinik für Neurologie, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,DZHK (German Center for Cardiovascular Research), Partner site Berlin, 10115, Berlin, Germany.
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22
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Morais-Silva G, Costa-Ferreira W, Gomes-de-Souza L, Pavan JC, Crestani CC, Marin MT. Cardiovascular outcomes related to social defeat stress: New insights from resilient and susceptible rats. Neurobiol Stress 2019; 11:100181. [PMID: 31236438 PMCID: PMC6582241 DOI: 10.1016/j.ynstr.2019.100181] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022] Open
Abstract
Stress exposure is an important risk factor for psychiatric and cardiovascular disorders. Two phenotypes related to coping with stress can be observed in rodents that experience chronic social defeat stress (SDS): susceptible, showing social avoidance and behavioral changes related to depression, and resilient, showing none of these alterations. Moreover, a strong correlation exists between depression and the development of or mortality due to cardiovascular diseases. Nevertheless, little is known about cardiovascular alterations related to SDS exposure in those phenotypes or their correlation with depressive-like behaviors. Using a chronic SDS protocol followed by the social interaction test, we identified Wistar rats as resilient or susceptible to SDS. Susceptible animals showed increased depressive-like behaviors with resting tachycardia and decreased heart rate variability (HRV) due to increased sympathetic tone in the heart and a less effective baroreflex. In contrast, resilient rats were protected from these alterations by increased vagal tone, resulting in greater HRV values. To our knowledge, our study is the first to indicate that harmful cardiovascular outcomes are related to depressive-like behaviors in susceptible rats and to suggest a mechanism by which resilient rats are protected from these changes. Also, our results suggest that enhanced HRV and vagal tone may be an important trait in resilient individuals. Cardiovascular alterations are correlated to depressive-like behaviors. Susceptible rats show increased sympathetic tone to the heart and lower HRV. Baroreflex effectiveness in susceptible rats is impaired. Resilient rats show an increased vagal tone to the heart and greater values of HRV.
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Affiliation(s)
- Gessynger Morais-Silva
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Laboratory of Pharmacology, Araraquara, SP, Brazil.,Joint Graduate Program in Physiological Sciences (PIPGCF), UFSCar/UNESP, São Carlos/Araraquara, SP, Brazil
| | - Willian Costa-Ferreira
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Laboratory of Pharmacology, Araraquara, SP, Brazil.,Joint Graduate Program in Physiological Sciences (PIPGCF), UFSCar/UNESP, São Carlos/Araraquara, SP, Brazil
| | - Lucas Gomes-de-Souza
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Laboratory of Pharmacology, Araraquara, SP, Brazil.,Joint Graduate Program in Physiological Sciences (PIPGCF), UFSCar/UNESP, São Carlos/Araraquara, SP, Brazil
| | - Jacqueline C Pavan
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Laboratory of Pharmacology, Araraquara, SP, Brazil
| | - Carlos C Crestani
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Laboratory of Pharmacology, Araraquara, SP, Brazil.,Joint Graduate Program in Physiological Sciences (PIPGCF), UFSCar/UNESP, São Carlos/Araraquara, SP, Brazil
| | - Marcelo T Marin
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Laboratory of Pharmacology, Araraquara, SP, Brazil.,Joint Graduate Program in Physiological Sciences (PIPGCF), UFSCar/UNESP, São Carlos/Araraquara, SP, Brazil
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23
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Yao BC, Meng LB, Hao ML, Zhang YM, Gong T, Guo ZG. Chronic stress: a critical risk factor for atherosclerosis. J Int Med Res 2019; 47:1429-1440. [PMID: 30799666 PMCID: PMC6460614 DOI: 10.1177/0300060519826820] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chronic stress refers to the non-specific systemic reaction that occurs when the body is stimulated by various internal and external negative factors over a long time. The physiological response to chronic stress exposure has long been recognized as a potent modulator in the occurrence of atherosclerosis. Furthermore, research has confirmed the correlation between atherosclerosis and cardiovascular events. Chronic stress is pervasive during negative life events and may lead to the formation of plaque. Several epidemiological studies have shown that chronic stress is an independent risk factor for the development of vascular disease and for increased morbidity and mortality in patients with pre-existing coronary artery disease. One possible mechanism for this process is that chronic stress causes endothelial injury, directly activating macrophages, promoting foam cell formation and generating the formation of atherosclerotic plaque. This mechanism involves numerous variables, including inflammation, signal pathways, lipid metabolism and endothelial function. The mechanism of chronic stress in atherosclerosis should be further investigated to provide a theoretical basis for efforts to eliminate the effect of chronic stress on the cardiocerebral vascular system.
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Affiliation(s)
- Bo-Chen Yao
- 1 Graduate College, Tianjin Medical University, Tianjin, China.,2 Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Ling-Bing Meng
- 3 Neurology Department, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P. R. China
| | - Meng-Lei Hao
- 4 Department of geriatric medicine, Qinghai University, Xining, Qinghai, China
| | - Yuan-Meng Zhang
- 5 Internal medicine, Jinzhou Medical University, Linghe District, Jinzhou City, Liaoning Province, China
| | - Tao Gong
- 1 Graduate College, Tianjin Medical University, Tianjin, China
| | - Zhi-Gang Guo
- 2 Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
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24
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Krajcirovicova K, Aziriova S, Baka T, Repova K, Adamcova M, Paulis L, Simko F. Ivabradine does not impair anxiety-like behavior and memory in both healthy and L-NAME-induced hypertensive rats. Physiol Res 2019; 67:S655-S664. [PMID: 30607972 DOI: 10.33549/physiolres.934048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cardiovascular pathologies are frequently associated with anxiety and other behavioral disturbances. Ivabradine, an inhibitor of the hyperpolarization-activated cyclic nucleotide-gated channels in the sinoatrial node, decreases heart rate and provides cardiovascular protection. Although ivabradine is increasingly used in cardiovascular medicine, the data on its behavioral effects are lacking. The aim of this work was to show ivabradine's potential effect on behavior in healthy and hypertensive rats. After a four-week treatment period, systolic blood pressure was increased in the N(G)-nitro-L-arginine methyl ester (L-NAME)-group and ivabradine significantly reduced it. Furthermore, it reduced the heart rate in both the control and L-NAME-group. In the control group, ivabradine enhanced the time spent in and transition to the open arms of the elevated plus maze test (EPM). In the L-NAME-group, ivabradine does not show a significant effect on the time spent in the EPM open arms and the number of transitions into them. Furthermore, ivabradine has no impact on cognitive function in both control and L-NAME groups. We conclude that ivabradine showed no undesirable effects on anxiety, locomotion or learning; in fact, some of these parameters were even improved. For the first time it has been shown that ivabradine is a safe cardiovascular drug regarding its effect on psycho-behavioral manifestations.
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Affiliation(s)
- K Krajcirovicova
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic.
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25
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The cytoskeleton in ‘couch potato-ism’: Insights from a murine model of impaired actin dynamics. Exp Neurol 2018; 306:34-44. [DOI: 10.1016/j.expneurol.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 03/19/2018] [Accepted: 04/06/2018] [Indexed: 01/22/2023]
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26
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Tadic M, Cuspidi C, Grassi G. Heart rate as a predictor of cardiovascular risk. Eur J Clin Invest 2018; 48. [PMID: 29355923 DOI: 10.1111/eci.12892] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Heart rate (HR) is a predictor of cardiovascular, cerebrovascular and all-cause mortality in the general population, as well as in patients with cardio- and cerebrovascular diseases. We aimed to summarize current knowledge regarding the influence of HR on cardio- and cerebrovascular morbidity and mortality. MATERIALS AND METHODS PubMed, MEDLINE, Ovid and EMBASE databases were searched for large follow-up studies or meta-analysis published between January 1990 and September 2017 in the English language using the following keyword "heart rate," "resting heart rate," "mortality," "outcome," "hypertension," "heart failure," "ischaemic heart disease," "coronary heart disease" and "stroke." RESULTS The relationship between increased HR and cardio- and cerebrovascular morbidity and mortality has been reported in a large number of studies, and the results regarding this association are concurrent. This connection is generally stronger in men than in women. The increase in HR usually occurs in parallel with elevation of blood pressure and metabolic disturbances (insulin resistance, dyslipidaemia). However, even after adjustment for the most important cardiovascular risk factors, HR remained an independent predictor of adverse events in global population or in patients with cardio- and cerebrovascular diseases. CONCLUSION HR has an important negative effect on cardio- and cerebrovascular morbidity and mortality. Future longitudinal investigations should clarify HR significance and optimal HR reduction for primary and secondary prevention in cardio- and cerebrovascular events.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Guido Grassi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy.,IRCCS Multimedica, Sesto San Giovanni, Milano, Italy
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27
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Mengesha HG, Tafesse TB, Bule MH. If Channel as an Emerging Therapeutic Target for Cardiovascular Diseases: A Review of Current Evidence and Controversies. Front Pharmacol 2017; 8:874. [PMID: 29225577 PMCID: PMC5705549 DOI: 10.3389/fphar.2017.00874] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/13/2017] [Indexed: 01/09/2023] Open
Abstract
In 2015, non-communicable diseases accounted for 39.5 million (70%) of the total 56.4 million deaths that occurred globally, of which 17.7 million (45%) were due to cardiovascular diseases. An elevated heart rate is considered to be one of the independent predictors and markers of future cardiovascular diseases. A variety of experimental and epidemiological studies have found that atherosclerosis, heart failure, coronary artery disease, stroke, and arrhythmia are linked to elevated heart rate. Although there are established drugs to reduce the heart rate, these drugs have undesirable side effects. Hence, the development of new drugs that selectively inhibit the heart rate is considered necessary. In the search for such drugs, almost four decades ago the If channel, also known as the “funny channel,” emerged as a novel site for the selective inhibition of heart rate. These If channels, with a mixed sodium and potassium inward current, have been identified in the sinoatrial node of the heart, which mediates the slow diastolic depolarization of the pacemaker of the spontaneous rhythmic cells. The hyperpolarization-activated cyclic nucleotide-gated (HCN) subfamily is primarily articulated in the heart and neurons that are encoded by a family of four genes (HCN1-4) and they identify the funny channel. Of these, HCN-4 is the principal protein in the sinoatrial node. Currently, funny channel inhibition is being targeted for the treatment and prevention of cardiovascular diseases such as atherosclerosis and stroke. A selective If channel inhibitor named ivabradine was discovered for clinical use in treating heart failure and coronary artery disease. However, inconsistencies regarding the clinical effects of ivabradine have been reported in the literature, suggesting the need for a rigorous analysis of the available evidence. The objective of this review is therefore to assess the current advances in targeting the If channel associated with ivabradine and related challenges.
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Affiliation(s)
- Hayelom G Mengesha
- Pharmacology and Toxicology Research Unit, School of Pharmacy, Mekelle University, Mekelle, Ethiopia.,College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia
| | - Tadesse B Tafesse
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mohammed H Bule
- Department of Pharmacy, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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28
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Yu J, Dai L, Zhao Q, Liu X, Chen S, Wang A, Su Z, Wu S. Association of Cumulative Exposure to Resting Heart Rate with Risk of Stroke in General Population: The Kailuan Cohort Study. J Stroke Cerebrovasc Dis 2017; 26:2501-2509. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/22/2017] [Accepted: 05/28/2017] [Indexed: 01/29/2023] Open
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29
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Nikolovska Vukadinović A, Vukadinović D, Borer J, Cowie M, Komajda M, Lainscak M, Swedberg K, Böhm M. Heart rate and its reduction in chronic heart failure and beyond. Eur J Heart Fail 2017. [DOI: 10.1002/ejhf.902] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Davor Vukadinović
- Klinik für Innere Medizin III; der Universität des Saarlandes; Homburg/Saar Germany
| | - Jeffrey Borer
- Division of Cardiovascular Medicine and the Howard Gilman Institute for Heart Valve Disease and the Schiavone Institute for Cardiovascular Translational Research; State University of New York Downstate Medical Center; New York NY USA
| | | | | | - Mitja Lainscak
- Department of Cardiology, Department of Research and Education; Celje Slovenia
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy; University of Gothenburg; Göteborg Sweden
| | - Michael Böhm
- Klinik für Innere Medizin III; der Universität des Saarlandes; Homburg/Saar Germany
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30
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Gotink RA, Younge JO, Wery MF, Utens EMWJ, Michels M, Rizopoulos D, van Rossum LFC, Roos-Hesselink JW, Hunink MMG. Online mindfulness as a promising method to improve exercise capacity in heart disease: 12-month follow-up of a randomized controlled trial. PLoS One 2017; 12:e0175923. [PMID: 28486559 PMCID: PMC5423609 DOI: 10.1371/journal.pone.0175923] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/31/2017] [Indexed: 11/18/2022] Open
Abstract
There is increasing evidence that mindfulness can reduce stress, and thereby affect other psychological and physiological outcomes as well. Earlier, we reported the direct 3-month results of an online modified mindfulness-based stress reduction training in patients with heart disease, and now we evaluate the effect at 12-month follow-up. 324 patients (mean age 43.2 years, 53.7% male) were randomized in a 2:1 ratio to additional 3-month online mindfulness training or to usual care alone. The primary outcome was exercise capacity measured with the 6 minute walk test (6MWT). Secondary outcomes were blood pressure, heart rate, respiratory rate, NT-proBNP, cortisol levels (scalp hair sample), mental and physical functioning (SF-36), anxiety and depression (HADS), perceived stress (PSS), and social support (PSSS12). Differences between groups on the repeated outcome measures were analyzed with linear mixed models. At 12-months follow-up, participants showed a trend significant improvement exercise capacity (6MWT: 17.9 meters, p = 0.055) compared to UC. Cohen's D showed significant but small improvement on exercise capacity (d = 0.22; 95%CI 0.05 to 0.39), systolic blood pressure (d = 0.19; 95%CI 0.03 to 0.36), mental functioning (d = 0.22; 95%CI 0.05 to 0.38) and depressive symptomatology (d = 0.18; 95%CI 0.02 to 0.35). All other outcome measures did not change statistically significantly. In the as-treated analysis, systolic blood pressure decreased significantly with 5.5 mmHg (p = 0.045; d = 0.23 (95%CI 0.05-0.41)). Online mindfulness training shows favorable albeit small long-term effects on exercise capacity, systolic blood pressure, mental functioning, and depressive symptomatology in patients with heart disease and might therefore be a beneficial addition to current clinical care. TRIAL REGISTRATION www.trialregister.nl NTR3453.
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Affiliation(s)
- Rinske A. Gotink
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - John O. Younge
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Machteld F. Wery
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Elisabeth M. W. J. Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | - Myriam M. G. Hunink
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
- Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, United States of America
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31
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Schöner J, Heinz A, Endres M, Gertz K, Kronenberg G. Post-traumatic stress disorder and beyond: an overview of rodent stress models. J Cell Mol Med 2017; 21:2248-2256. [PMID: 28374949 PMCID: PMC5618668 DOI: 10.1111/jcmm.13161] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/13/2017] [Indexed: 11/26/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric disorder of high prevalence and major socioeconomic impact. Patients suffering from PTSD typically present intrusion and avoidance symptoms and alterations in arousal, mood and cognition that last for more than 1 month. Animal models are an indispensable tool to investigate underlying pathophysiological pathways and, in particular, the complex interplay of neuroendocrine, genetic and environmental factors that may be responsible for PTSD induction. Since the 1960s, numerous stress paradigms in rodents have been developed, based largely on Seligman's seminal formulation of 'learned helplessness' in canines. Rodent stress models make use of physiological or psychological stressors such as foot shock, underwater trauma, social defeat, early life stress or predator-based stress. Apart from the brief exposure to an acute stressor, chronic stress models combining a succession of different stressors for a period of several weeks have also been developed. Chronic stress models in rats and mice may elicit characteristic PTSD-like symptoms alongside, more broadly, depressive-like behaviours. In this review, the major existing rodent models of PTSD are reviewed in terms of validity, advantages and limitations; moreover, significant results and implications for future research-such as the role of FKBP5, a mediator of the glucocorticoid stress response and promising target for therapeutic interventions-are discussed.
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Affiliation(s)
- Johanna Schöner
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Heinz
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karen Gertz
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Golo Kronenberg
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Nervenheilkunde, Universitätsmedizin Rostock, Rostock, Germany
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32
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Kronenberg G, Schöner J, Nolte C, Heinz A, Endres M, Gertz K. Charting the perfect storm: emerging biological interfaces between stress and stroke. Eur Arch Psychiatry Clin Neurosci 2017; 267:487-494. [PMID: 28393267 PMCID: PMC5561158 DOI: 10.1007/s00406-017-0794-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/25/2017] [Indexed: 12/20/2022]
Abstract
A growing body of evidence demonstrates that psychosocial stress is an important and often underestimated risk factor for cardiovascular disease such as myocardial infarction and stroke. In this article, we map out major biological interfaces between stress, stress-related psychiatric disorders, and stroke, placing special emphasis on the fact that stress and psychiatric disorders may be both cause and consequence of cardiovascular disease. Apart from high-risk lifestyle habits such as smoking and lack of exercise, neuroendocrine dysregulation, alterations of the hemostatic system, increased oxidative stress, and inflammatory changes have been implicated in stress-related endothelial dysfunction. Heart rate provides another useful and easily available measure that reflects the complex interplay of vascular morbidity and psychological distress. Importantly, heart rate is emerging as a valuable predictor of stroke outcome and, possibly, even a target for therapeutic intervention. Furthermore, we review recent findings highlighting the role of FK506-binding protein 51 (FKBP5), a co-chaperone of the glucocorticoid receptor, and of perturbations in telomere maintenance, as potential mediators between stress and vascular morbidity. Finally, psychiatric sequelae of cardiovascular events such as post-stroke depression or posttraumatic stress disorder are highly prevalent and may, in turn, exert far-reaching effects on recovery and outcome, quality of life, recurrent ischemic events, medication adherence, and mortality.
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Affiliation(s)
- G. Kronenberg
- 0000 0000 9737 0454grid.413108.fKlinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsmedizin Rostock, Rostock, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J. Schöner
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C. Nolte
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A. Heinz
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - M. Endres
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany ,0000 0004 0438 0426grid.424247.3German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany ,grid.452396.fGerman Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Karen Gertz
- Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.
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33
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Kronenberg G, Uhlemann R, Schöner J, Wegner S, Boujon V, Deigendesch N, Endres M, Gertz K. Repression of telomere-associated genes by microglia activation in neuropsychiatric disease. Eur Arch Psychiatry Clin Neurosci 2017; 267:473-477. [PMID: 27896432 PMCID: PMC5509772 DOI: 10.1007/s00406-016-0750-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/18/2016] [Indexed: 12/18/2022]
Abstract
Microglia senescence may promote neuropsychiatric disease. This prompted us to examine the relationship between microglia activation states and telomere biology. A panel of candidate genes associated with telomere maintenance, mitochondrial biogenesis, and cell-cycle regulation were investigated in M1- and M2-polarized microglia in vitro as well as in MACS-purified CD11b+ microglia/brain macrophages from models of stroke, Alzheimer's disease, and chronic stress. M1 polarization, ischemia, and Alzheimer pathology elicited a strikingly similar transcriptomic profile with, in particular, reduced expression of murine Tert. Our results link classical microglia activation with repression of telomere-associated genes, suggesting a new mechanism underlying microglia dysfunction.
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Affiliation(s)
- Golo Kronenberg
- grid.440244.2Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin, Berlin, Germany ,0000000121858338grid.10493.3fKlinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsmedizin Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Ria Uhlemann
- 0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin, Berlin, Germany
| | - Johanna Schöner
- grid.440244.2Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin, Berlin, Germany
| | - Stephanie Wegner
- 0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin, Berlin, Germany
| | - Valérie Boujon
- 0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin, Berlin, Germany
| | - Nikolas Deigendesch
- 0000 0001 2218 4662grid.6363.0Institut für Neuropathologie, Charité - Universitätsmedizin, Berlin, Germany
| | - Matthias Endres
- 0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin, Berlin, Germany ,0000 0004 0438 0426grid.424247.3German Center for Neurodegenerative Diseases (DZNE), Charitéplatz 1, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Cluster of Excellence NeuroCure, Charité - Universitätsmedizin, Berlin, Germany ,grid.452396.fDZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Karen Gertz
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany. .,Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin, Berlin, Germany.
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34
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[Posttraumatic stress disorder : Trigger and consequence of vascular diseases]. DER NERVENARZT 2016; 88:234-246. [PMID: 27752723 DOI: 10.1007/s00115-016-0231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) was previously thought to be a psychological reaction precipitated by exposure to war, sexual and physical violence; however, PTSD is also prevalent after life-threatening medical events, such as stroke and myocardial infarction. After such events PTSD is often underdiagnosed despite the fact that it is clearly associated with adverse clinical outcomes including recurrence of cardiac events and increased mortality. Moreover, PTSD increases the risk of vascular events. This review summarizes the bidirectional relationship between PTSD and vascular diseases and outlines current knowledge regarding clinical features, prevalence and the putative underlying pathophysiological mechanisms.
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Böhm M. Heart rate as emerging risk indicator in stroke - the beat goes on. Eur J Neurol 2016; 23:1698-1699. [DOI: 10.1111/ene.13122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. Böhm
- Department of Internal Medicine III - Cardiology, Angiology and Internal Intensive Care; Saarland University Medical Center; University of the Saarland; Homburg Germany
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Nolte CH, Erdur H, Grittner U, Schneider A, Piper SK, Scheitz JF, Wellwood I, Bath PMW, Diener HC, Lees KR, Endres M. Impact of heart rate on admission on mortality and morbidity in acute ischaemic stroke patients - results from VISTA. Eur J Neurol 2016; 23:1750-1756. [DOI: 10.1111/ene.13115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/27/2016] [Indexed: 01/24/2023]
Affiliation(s)
- C. H. Nolte
- Department of Neurology; Center for Stroke Research; Berlin Institute of Health; Charite-Universitätsmedzin; Berlin Germany
- Centre for Stroke Research; Berlin Germany
| | - H. Erdur
- Department of Neurology; Center for Stroke Research; Berlin Institute of Health; Charite-Universitätsmedzin; Berlin Germany
| | | | | | | | - J. F. Scheitz
- Department of Neurology; Center for Stroke Research; Berlin Institute of Health; Charite-Universitätsmedzin; Berlin Germany
- Centre for Stroke Research; Berlin Germany
| | - I. Wellwood
- Department of Public Health and Primary Care; University of Cambridge; Cambridge UK
| | - P. M. W. Bath
- School of Medicine; University of Nottingham; Nottingham UK
| | - H.-C. Diener
- Klinik für Neurologie und Schlaganfall-Zentrum Universitätsklinikum; Essen Germany
| | - K. R. Lees
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | - M. Endres
- Department of Neurology; Center for Stroke Research; Berlin Institute of Health; Charite-Universitätsmedzin; Berlin Germany
- Centre for Stroke Research; Berlin Germany
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Qiu M, Sato S, Zheng D, Wang X, Carcel C, Hirakawa Y, Sandset EC, Delcourt C, Arima H, Wang J, Chalmers J, Anderson CS. Admission Heart Rate Predicts Poor Outcomes in Acute Intracerebral Hemorrhage. Stroke 2016; 47:1479-85. [DOI: 10.1161/strokeaha.115.012382] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/14/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Miaoyan Qiu
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - Shoichiro Sato
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - Danni Zheng
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - Xia Wang
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - Cheryl Carcel
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - Yoichiro Hirakawa
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - Else C. Sandset
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - Candice Delcourt
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - Hisatomi Arima
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - Jiguang Wang
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - John Chalmers
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
| | - Craig S. Anderson
- From the Neurological and Mental Health Division, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia (M.Q., S.S., D.Z., X.W., C.C., Y.H., E.C.S., C.D., J.C., C.S.A.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (M.Q., J.W.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (S.S.); Neurology Department, Royal Prince Alfred Hospital, Sydney, New
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Zhou Y, Tian Y, Zhong C, Batu B, Xu T, Li H, Zhang M, Wang A, Zhang Y. Combined effects of family history of CVD and heart rate on ischemic stroke incidence among Inner Mongolians in China. Neurol Res 2016; 38:441-7. [PMID: 27101478 DOI: 10.1080/01616412.2016.1155816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to evaluate the combined effects of family history of cardiovascular diseases (FHCVD) and heart rate on ischemic stroke incidence among Inner Mongolians in China. METHODS A prospective cohort study was conducted among 2589 participants aged 20 years and older from Inner Mongolia, China. The participants were divided into four groups according to status of FHCVD and heart rate and followed up from June 2002 to July 2012. Cox proportional hazards models were used to evaluate the combined effects of FHCVD and heart rate on the incidence of ischemic stroke. RESULTS A total of 76 ischemic stroke occurred during the follow-up period. The observed ischemic stroke cases tended to be older and male, and had higher prevalence of smoking, drinking, hypertension and FHCVD as well as higher systolic and diastolic blood pressures at baseline compared with those who did not experience ischemic stroke. Age- and gender-adjusted hazard ratio (95% confidence interval) of ischemic stroke in the participants with both FHCVD and heart rate ≥ 80 were 2.89 (1.51-5.53), compared with those without FHCVD and heart rate < 80. After multiple adjustment, the association between ischemic stroke risk and both FHCVD and heart rate ≥ 80 remained statistically significant (hazard ratio, 2.47; 95% confidence interval: 1.22-5.01). DISCUSSION Our main finding that participants with both FHCVD and faster heart rate have the highest risk of ischemic stroke suggests that faster heart rate may increase the risk of ischemic stroke among people with FHCVD.
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Affiliation(s)
- Yipeng Zhou
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Department of Epidemiology, School of Public Health , Medical College of Soochow University , Suzhou , China
| | - Yunfan Tian
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Department of Epidemiology, School of Public Health , Medical College of Soochow University , Suzhou , China
| | - Chongke Zhong
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Department of Epidemiology, School of Public Health , Medical College of Soochow University , Suzhou , China
| | - Buren Batu
- b Department of Epidemiology , Tongliao Center for Disease Prevention and Control , Tongliao , China
| | - Tian Xu
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Department of Epidemiology, School of Public Health , Medical College of Soochow University , Suzhou , China.,c Department of Neurology , Affiliated Hospital of Nantong University , Nantong , China
| | - Hongmei Li
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Department of Epidemiology, School of Public Health , Medical College of Soochow University , Suzhou , China
| | - Mingzhi Zhang
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Department of Epidemiology, School of Public Health , Medical College of Soochow University , Suzhou , China
| | - Aili Wang
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Department of Epidemiology, School of Public Health , Medical College of Soochow University , Suzhou , China
| | - Yonghong Zhang
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Department of Epidemiology, School of Public Health , Medical College of Soochow University , Suzhou , China
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Ingberg E, Dock H, Theodorsson E, Theodorsson A, Ström JO. Method parameters' impact on mortality and variability in mouse stroke experiments: a meta-analysis. Sci Rep 2016; 6:21086. [PMID: 26876353 PMCID: PMC4753409 DOI: 10.1038/srep21086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/13/2016] [Indexed: 12/17/2022] Open
Abstract
Although hundreds of promising substances have been tested in clinical trials,
thrombolysis currently remains the only specific pharmacological treatment for
ischemic stroke. Poor quality, e.g. low statistical power, in the preclinical
studies has been suggested to play an important role in these failures. Therefore,
it would be attractive to use animal models optimized to minimize unnecessary
mortality and outcome variability, or at least to be able to power studies more
exactly by predicting variability and mortality given a certain experimental setup.
The possible combinations of methodological parameters are innumerous, and an
experimental comparison of them all is therefore not feasible. As an alternative
approach, we extracted data from 334 experimental mouse stroke articles and, using a
hypothesis-driven meta-analysis, investigated the method parameters’
impact on infarct size variability and mortality. The use of Swiss and C57BL6 mice
as well as permanent occlusion of the middle cerebral artery rendered the lowest
variability of the infarct size while the emboli methods increased variability. The
use of Swiss mice increased mortality. Our study offers guidance for researchers
striving to optimize mouse stroke models.
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Affiliation(s)
- Edvin Ingberg
- Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Linköping University, Department of Clinical Chemistry, Center for Diagnostics, Region Östergötland, Sweden
| | - Hua Dock
- Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Linköping University, Department of Clinical Chemistry, Center for Diagnostics, Region Östergötland, Sweden
| | - Elvar Theodorsson
- Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Linköping University, Department of Clinical Chemistry, Center for Diagnostics, Region Östergötland, Sweden
| | - Annette Theodorsson
- Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Linköping University, Department of Clinical Chemistry, Center for Diagnostics, Region Östergötland, Sweden.,Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University, Department of Neurosurgery, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Sweden
| | - Jakob O Ström
- Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Linköping University, Department of Clinical Chemistry, Center for Diagnostics, Region Östergötland, Sweden.,Vårdvetenskapligt Forskningscentrum/Centre for Health Sciences, Örebro University Hospital, County Council of Örebro, Örebro, Sweden.,School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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Resting heart rate is an independent predictor of all-cause mortality in the middle aged general population. Clin Res Cardiol 2016; 105:601-12. [PMID: 26803646 DOI: 10.1007/s00392-015-0956-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/21/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND High resting heart rate (RHR) predicts cardiovascular outcomes in patients with vascular disease and heart failure. We evaluated the prognostic value of RHR in a large contemporary population-based, prospective cohort of individuals without known coronary artery disease. METHODS AND RESULTS Resting heart rate (RHR) was determined in 4091 individuals (mean age 59.2 ± 7.7; 53 % women) from the Heinz Nixdorf RECALL study, of whom, 3348 were free of heart rate lowering medication. During 10.5 years of follow-up (median), 159 (3.9 %) individuals developed a coronary event and 398 (9.7 %) died of any cause. Persons without any event (n = 3603) had similar heart rates as persons with coronary events (69.5 ± 11 versus 69.9 ± 11 bpm, p = 0.51) but lower heart rates than persons who died (72.3 ± 13 bpm, p < 0.0001). In individuals without heart rate lowering medication, an increase in heart rate by 5 bpm was associated with an increased hazard ratio (HR) for all-cause mortality of 13 % in unadjusted analysis and also upon adjustment for traditional cardiovascular risk factors, including coronary artery calcification [full model: HR (95 % CI) 1.13 (1.07-1.20), p < 0.0001], but not for coronary events [HR 1.02 (0.94-1.11), p = 0.60]. In individuals without heart rate lowering medication, the HR (full model) for heart rate ≥70 versus <70 bpm with regard to all-cause mortality and coronary events was 1.68 (1.30-2.18), p < 0.0001, and 1.20 (0.82-1.77), p = 0.35. Analysis of the entire cohort revealed a continuous relationship of heart rate with all-cause mortality [HR for lowest to highest heart rate quartile 1.64 (1.22-2.22), p = 0.001, full model] but not with coronary events [HR 1.04 (0.65-1.66), p = 0.86]. CONCLUSIONS In the general population without known coronary artery disease and heart rate lowering medication, elevated RHR is an independent risk marker for all-cause mortality but not for coronary events.
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Lee S, Kang BM, Shin MK, Min J, Heo C, Lee Y, Baeg E, Suh M. Chronic Stress Decreases Cerebrovascular Responses During Rat Hindlimb Electrical Stimulation. Front Neurosci 2015; 9:462. [PMID: 26778944 PMCID: PMC4688360 DOI: 10.3389/fnins.2015.00462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/23/2015] [Indexed: 12/21/2022] Open
Abstract
Repeated stress is one of the major risk factors for cerebrovascular disease, including stroke, and vascular dementia. However, the functional alterations in the cerebral hemodynamic response induced by chronic stress have not been clarified. Here, we investigated the in vivo cerebral hemodynamic changes and accompanying cellular and molecular changes in chronically stressed rats. After 3 weeks of restraint stress, the elicitation of stress was verified by behavioral despair in the forced swimming test and by physical indicators of stress. The evoked changes in the cerebral blood volume and pial artery responses following hindpaw electrical stimulation were measured using optical intrinsic signal imaging. We observed that, compared to the control group, animals under chronic restraint stress exhibited a decreased hemodynamic response, with a smaller pial arterial dilation in the somatosensory cortex during hindpaw electrical stimulation. The effect of chronic restraint stress on vasomodulator enzymes, including neuronal nitric oxide synthase (nNOS) and heme oxygenase-2 (HO-2), was assessed in the somatosensory cortex. Chronic restraint stress downregulated nNOS and HO-2 compared to the control group. In addition, we examined the subtypes of cells that can explain the environmental changes due to the decreased vasomodulators. The expression of parvalbumin in GABAergic interneurons and glutamate receptor-1 in neurons were decreased, whereas the microglial activation was increased. Our results suggest that the chronic stress-induced alterations in cerebral vascular function and the modulations of the cellular expression in the neuro-vasomodulatory system may be crucial contributing factors in the development of various vascular-induced conditions in the brain.
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Affiliation(s)
- Sohee Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science Suwon, South Korea
| | - Bok-Man Kang
- Center for Neuroscience Imaging Research, Institute for Basic Science Suwon, South Korea
| | - Min-Kyoo Shin
- Department of Biological Science, Sungkyunkwan University Suwon, South Korea
| | - Jiwoong Min
- Department of Biomedical Engineering, Sungkyunkwan University Suwon, South Korea
| | - Chaejeong Heo
- Center for Neuroscience Imaging Research, Institute for Basic Science Suwon, South Korea
| | - Yubu Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science Suwon, South Korea
| | - Eunha Baeg
- Center for Neuroscience Imaging Research, Institute for Basic Science Suwon, South Korea
| | - Minah Suh
- Center for Neuroscience Imaging Research, Institute for Basic ScienceSuwon, South Korea; Department of Biological Science, Sungkyunkwan UniversitySuwon, South Korea; Department of Biomedical Engineering, Sungkyunkwan UniversitySuwon, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan UniversitySeoul, South Korea
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Younge JO, Wery MF, Gotink RA, Utens EMWJ, Michels M, Rizopoulos D, van Rossum EFC, Hunink MGM, Roos-Hesselink JW. Web-Based Mindfulness Intervention in Heart Disease: A Randomized Controlled Trial. PLoS One 2015; 10:e0143843. [PMID: 26641099 PMCID: PMC4671576 DOI: 10.1371/journal.pone.0143843] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/08/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Evidence is accumulating that mindfulness training has favorable effects on psychological outcomes, but studies on physiological outcomes are limited. Patients with heart disease have a high incidence of physiological and psychological problems and may benefit from mindfulness training. Our aim was to determine the beneficial physiological and psychological effects of online mindfulness training in patients with heart disease. METHODS The study was a pragmatic randomized controlled single-blind trial. Between June 2012 and April 2014 we randomized 324 patients (mean age 43.2 years, 53.7% male) with heart disease in a 2:1 ratio (n = 215 versus n = 109) to a 12-week online mindfulness training in addition to usual care (UC) compared to UC alone. The primary outcome was exercise capacity measured with the 6 minute walk test (6MWT). Secondary outcomes were other physiological parameters (heart rate, blood pressure, respiratory rate, and NT-proBNP), subjective health status (SF-36), perceived stress (PSS), psychological well-being (HADS), social support (PSSS12) and a composite endpoint (all-cause mortality, heart failure, symptomatic arrhythmia, cardiac surgery, and percutaneous cardiac intervention). Linear mixed models were used to evaluate differences between groups on the repeated outcome measures. RESULTS Compared to UC, mindfulness showed a borderline significant improved 6MWT (effect size, meters: 13.2, 95%CI: -0.02; 26.4, p = 0.050). There was also a significant lower heart rate in favor of the mindfulness group (effect size, beats per minute: -2.8, 95%CI: -5.4;-0.2, p = 0.033). No significant differences were seen on other outcomes. CONCLUSIONS Mindfulness training showed positive effects on the physiological parameters exercise capacity and heart rate and it might therefore be a useful adjunct to current clinical therapy in patients with heart disease. TRIAL REGISTRATION Dutch Trial Register 3453.
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Affiliation(s)
- John O Younge
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Machteld F Wery
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rinske A Gotink
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Psychiatry (Section Medical Psychology and Psychotherapy), Erasmus MC Rotterdam, University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Adolescent Psychiatry/Psychology, Erasmus MC Rotterdam, University Medical Center, Rotterdam, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M G Myriam Hunink
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Zhong C, Zhong X, Xu T, Peng H, Li H, Zhang M, Wang A, Xu T, Sun Y, Zhang Y. Combined effects of hypertension and heart rate on the risk of stroke and coronary heart disease: a population-based prospective cohort study among Inner Mongolians in China. Hypertens Res 2015; 38:883-8. [DOI: 10.1038/hr.2015.90] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/04/2015] [Accepted: 06/23/2015] [Indexed: 12/21/2022]
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Böhm M, Schumacher H, Schmieder RE, Mann JFE, Teo K, Lonn E, Sleight P, Mancia G, Linz D, Mahfoud F, Ukena C, Sliwa K, Bakris G, Yusuf S. Resting heart rate is associated with renal disease outcomes in patients with vascular disease: results of the ONTARGET and TRANSCEND studies. J Intern Med 2015; 278:38-49. [PMID: 25431275 DOI: 10.1111/joim.12333] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Resting heart rate (RHR) is associated with cardiovascular disease outcomes in high-risk patients. It is not known whether RHR is predictive of renal outcomes such as albuminuria, end-stage renal disease (ESRD) or doubling of creatinine. We evaluated whether RHR could predict renal endpoints in patients at a high risk of cardiovascular disease. We also tested the effects of RHR at different levels of systolic blood pressure (SBP). METHODS We analysed data from 28 757 patients in the ONTARGET and TRANSCEND trials. RHR and SBP were available for a mean of 4.9 ± 0.4 visits (range 3-5) within the first 2 years of the studies. Albuminuria was determined at baseline, at 2 years and at study end. RESULTS Mean RHR was predictive of incident micro-albuminuria [hazard ratio (HR) for RHR ≥80 vs. <60 beats min(-1) 1.49, 95% confidence interval (CI) 1.29-1.71, P < 0.0001], incident macro-albuminuria (HR 1.84, 95% CI 1.39-2.42, P < 0.0001), doubling of creatinine (HR 1.47, 95% CI 1.00-2.17, P = 0.050) and ESRD (HR 1.78, 95% CI 1.00-3.16, P = 0.050), and the combined renal end-point (HR 1.51, 95% CI 1.32-1.74, P < 0.0001). Associations were robust at SBPs from <120 to ≥150 mmHg, with the lowest risk at a SBP of 130-140 mmHg. CONCLUSION Resting heart rate is a potent predictor of these renal outcomes, as well as their combination, in patients with cardiovascular disease. RHR at all SBP levels should be considered as a possible renal disease risk predictor and should be investigated as a treatment target with RHR-reducing agents.
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Affiliation(s)
- M Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - R E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany
| | - J F E Mann
- Department of Nephrology and Hypertension, Klinikum Schwabing, Munich, Germany
| | - K Teo
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - E Lonn
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - P Sleight
- Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
| | - G Mancia
- IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy
| | - D Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - F Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - C Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - K Sliwa
- Hatter Institute for Cardiovascular Research in Africa and IIDMM, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - G Bakris
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - S Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
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Abstract
Lifestyle modifications and environmental factors are important for stroke prevention and rehabilitation after stroke. The individual stroke risk may be modified by factors like physical activity, body weight and nutrition, special dietary supplements such as vitamins, smoking, consumption of tea, coffee and alcohol, psychological factors and by keeping a pet. The focus of this article lies on measures for stroke prevention. For certain topics, it also comments on factors that are important during rehabilitation after stroke.
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Affiliation(s)
- L M Gerischer
- Klinik und Hochschulambulanz für Neurologie, Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Deutschland
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Kallmünzer B, Bobinger T, Kopp M, Kurka N, Arnold M, Hilz MJ, Schwab S, Köhrmann M. Impact of Heart Rate Dynamics on Mortality in the Early Phase after Ischemic Stroke: A Prospective Observational Trial. J Stroke Cerebrovasc Dis 2015; 24:946-51. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/05/2014] [Indexed: 11/28/2022] Open
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Böhm M, Reil JC, Deedwania P, Kim JB, Borer JS. Resting heart rate: risk indicator and emerging risk factor in cardiovascular disease. Am J Med 2015; 128:219-28. [PMID: 25447617 DOI: 10.1016/j.amjmed.2014.09.016] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/10/2014] [Accepted: 09/17/2014] [Indexed: 12/14/2022]
Abstract
Resting heart rate is central to cardiac output and is influenced by changes occurring in numerous diseases. It predicts longevity and cardiovascular diseases, and current evidence suggests that it is also an important marker of outcome in cardiovascular disease, including heart failure. Beta-blockers improve outcomes in heart failure; however, they have effects outside reducing heart rate. Ivabradine has demonstrated efficacy in reducing rehospitalizations and mortality in heart failure and in improving exercise tolerance and reducing angina attacks in patients with coronary artery disease, whereas selective heart rate reduction may also prove to be beneficial in therapeutic areas outside those in which ivabradine has already demonstrated clinical efficacy. This review provides an update on the associations between heart rate and cardiovascular outcomes in various conditions, the experimental effects of heart rate reduction with ivabradine, and the potential new indications in cardiovascular disease.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
| | - Jan-Christian Reil
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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49
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Böhm M, Schumacher H, Leong D, Mancia G, Unger T, Schmieder R, Custodis F, Diener HC, Laufs U, Lonn E, Sliwa K, Teo K, Fagard R, Redon J, Sleight P, Anderson C, O'Donnell M, Yusuf S. Systolic blood pressure variation and mean heart rate is associated with cognitive dysfunction in patients with high cardiovascular risk. Hypertension 2015; 65:651-61. [PMID: 25583157 DOI: 10.1161/hypertensionaha.114.04568] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
UNLABELLED Elevated systolic blood pressure (SBP) correlates to cognitive decline and incident dementia. The effects of heart rate (HR), visit to visit HR variation, and visit to visit SBP variation are less well established. Patients without preexisting cognitive dysfunction (N=24 593) were evaluated according to mean SBP, SBP visit to visit variation (coefficient of variation [standard deviation/mean×100%], CV), mean HR, and visit to visit HR variation (HR-CV) in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease. Cognitive function was assessed with mini mental state examination. Cognitive dysfunction (fall in mini mental state examination ≤24 points), important cognitive decline (drop of ≥5 points), and cognitive deterioration (drop of >1 point per year or decline to <24 points) were assessed. SBP and HR were measured over 10.7±2.2 (mean±SD) visits. Mean SBP, mean HR, and SBP-CV were associated with cognitive decline, dysfunction, and deterioration (all P<0.01, unadjusted). After adjustment, only SBP-CV (P=0.0030) and mean HR (P=0.0008) remained predictors for cognitive dysfunction (odds ratios [95% confidence intervals], 1.32 [1.10-1.58] for 5th versus 1st quintile of SBP-CV and 1.40 [1.18-1.66] for 5th versus 1st quintile of mean HR). Similar effects were observed for cognitive decline and deterioration. SBP-CV and mean HR showed additive effects. In conclusion, SBP-CV and mean HR are independent predictors of cognitive decline and cognitive dysfunction in patients at high CV risk. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT 00153101.
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Affiliation(s)
- Michael Böhm
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.).
| | - Helmut Schumacher
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Darryl Leong
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Giuseppe Mancia
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Thomas Unger
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Roland Schmieder
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Florian Custodis
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Hans-Christoph Diener
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Ulrich Laufs
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Eva Lonn
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Karen Sliwa
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Koon Teo
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Robert Fagard
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Josep Redon
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Peter Sleight
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Craig Anderson
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Martin O'Donnell
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
| | - Salim Yusuf
- From the Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B., F.C., U.L.); Boehringer Ingelheim, Pharma GmbH & Co. KG, Ingelheim, Germany (H.S.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (D.L., E.L., K.T., S.Y.); Centro di Fisiologica Clinica e Ipertensione, Universita Milano-Bicocca, Istituto Auxologico, Milan, Italy (G.M.); CARIM-School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands (T.U.); Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen, Germany (R.S.); Department of Neurology, University Hospital Essen, Essen, Germany (H.-C.D.); Hatter Institute for Cardiovascular Research in Africa & IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.); Hypertension Unit, KU Leuven University, Leuven, Belgium (R.F.); University of Valencia, Spain (J.R.); Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (P.S.); The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia (C.A.); and HRB Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland (M.O'D.)
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Sandset EC, Berge E, Kjeldsen SE, Julius S, Holzhauer B, Krarup LH, Hua TA. Heart rate as a predictor of stroke in high-risk, hypertensive patients with previous stroke or transient ischemic attack. J Stroke Cerebrovasc Dis 2014; 23:2814-2818. [PMID: 25304725 DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/07/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Risk factors for first stroke are well established, but less is known about risk factors for recurrent stroke. In the present analysis, we aimed to assess the effect of heart rate and other possible predictors of stroke in a hypertensive population with previous stroke or transient ischemic attack (TIA). METHODS The Valsartan Antihypertensive Long-Term Use Evaluation trial was a multicentre, double-masked, randomized controlled, parallel group trial comparing the effects of an angiotensin receptor blocker (valsartan) and a calcium channel blocker (amlodipine) in patients with hypertension and high cardiovascular risk. We used Cox proportional hazard models to investigate the effect of baseline variables on the risk of stroke. Quadratic terms of the continuous variables were entered in the models to test for linearity. RESULTS Of 15,245 patients included in the trial, 3014 had a previous stroke or TIA at baseline and were included in the present analysis. Stroke recurrence occurred in 239 patients (7.9%) during a median of 4.5 years of follow-up. Resting heart rate (per 10 beats per minute; hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.18-6.58) and diabetes mellitus at baseline (HR, 1.47; 95% CI, 1.03-2.10) were significantly associated with an increased risk of stroke recurrence in the multivariable analysis. CONCLUSIONS In high-risk, hypertensive patients with previous stroke or TIA, resting heart rate was the strongest predictor of recurrent stroke.
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Affiliation(s)
| | - Eivind Berge
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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