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Paraskevas KI, Mukherjee D, Papas TT. Benefits of Statins and Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK-9) Inhibitors for Patients with Peripheral Arterial Disease. Curr Vasc Pharmacol 2024; 22:8-10. [PMID: 38037835 DOI: 10.2174/0115701611292747231129080204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
- Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, U.S.A
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Romano G, Mioni R, Danieli N, Bertoni M, Croatto E, Merla L, Alcaro L, Pedduzza A, Metcalf X, Rigamonti A, Catena C, Sechi LA, Colussi G. Elevated Intrarenal Resistive Index Predicted Faster Renal Function Decline and Long-Term Mortality in Non-Proteinuric Chronic Kidney Disease. J Clin Med 2022; 11:jcm11112995. [PMID: 35683384 PMCID: PMC9181195 DOI: 10.3390/jcm11112995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 12/19/2022] Open
Abstract
Background. Intrarenal resistive index (RI) ≥ 0.80 predicts renal outcomes in proteinuric chronic kidney disease (CKD). However, this evidence in non-proteinuric patients with CKD of unknown etiology is lacking. In this study, we assessed the effect of intrarenal RI on renal function and all-cause mortality in non-proteinuric patients with CKD of unknown etiology despite an extensive diagnostic work-up. Methods. Non-proteinuric CKD patients were evaluated in a retrospective longitudinal study. Progression of renal disease was investigated by checking serum creatinine levels at 1, 3, and 5 years and defined by a creatinine level increase of at least 0.5 mg/dL. The discrimination performance of intrarenal RI in predicting the 5-year progression of renal disease was assessed by calculating the area under the receiver operating characteristic curve (AUROC). Results. One-hundred-thirty-one patients (76 ± 9 years, 56% males) were included. The median follow-up was 7.5 years (interquartile range 4.3−10.5) with a cumulative mortality of 53%, and 5-year renal disease progression occurred in 25%. Patients with intrarenal RI ≥ 0.80 had a faster increase of serum creatinine levels compared to those with RI < 0.80 (+0.06 mg/dL each year, 95% CI 0.02−0.10, p < 0.010). Each 0.1-unit increment of intrarenal RI was an independent determinant of 5-year renal disease progression (odds ratio 4.13, 95% CI 1.45−12.9, p = 0.010) and predictor of mortality (hazards ratio 1.80, 95% CI 1.05−3.09, p = 0.034). AUROCs of intrarenal RI for predicting 5-year renal disease progression and mortality were 0.66 (95% CI 0.57−0.76) and 0.67 (95% CI 0.58−0.74), respectively. Conclusions. In non-proteinuric patients with CKD of unknown etiology, increased intrarenal RI predicted both a faster decline in renal function and higher long-term mortality, but as a single marker, it showed poor discrimination performance.
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Affiliation(s)
- Giulio Romano
- Nephrology, Department of Medicine, University of Udine, 33100 Udine, Italy; (G.R.); (N.D.); (M.B.)
| | - Roberto Mioni
- Division of Nephrology, Academic Hospital of Udine “Santa Maria della Misericordia”, 33100 Udine, Italy;
| | - Nicola Danieli
- Nephrology, Department of Medicine, University of Udine, 33100 Udine, Italy; (G.R.); (N.D.); (M.B.)
| | - Martina Bertoni
- Nephrology, Department of Medicine, University of Udine, 33100 Udine, Italy; (G.R.); (N.D.); (M.B.)
| | - Elisa Croatto
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Lucia Merla
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Lucia Alcaro
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Antonio Pedduzza
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Xenia Metcalf
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Alessandra Rigamonti
- Department of Radiology, Academic Hospital of Udine “Santa Maria della Misericorida”, 33100 Udine, Italy;
| | - Cristiana Catena
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - Leonardo A. Sechi
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
| | - GianLuca Colussi
- Internal Medicine, Department of Medicine, University of Udine, 33100 Udine, Italy; (E.C.); (L.M.); (L.A.); (A.P.); (X.M.); (C.C.); (L.A.S.)
- Correspondence: ; Tel.: +39-0432-559-829; Fax: +39-0432-559-490
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Kosmeri C, Siomou E, Vlahos AP, Milionis H. Review shows that lipid disorders are associated with endothelial but not renal dysfunction in children. Acta Paediatr 2019; 108:19-27. [PMID: 30066344 DOI: 10.1111/apa.14529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/14/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023]
Abstract
AIM We undertook this review to assess the effects of lipid metabolism abnormalities on endothelial and renal function in children. METHODS A search of relevant literature published in English from January 1988 to May 2018 was performed, and this included randomised controlled trials, observational cohort studies, systematic reviews and case reports. RESULTS The search process identified 2324 relevant studies and 29 were finally included. Noninvasive ultrasound markers of endothelial dysfunction, such as flow-mediated dilation and carotid intima-media thickness, were impaired in children with dyslipidaemia. Dietary interventions and statin therapy reversed the effects of dyslipidaemia on endothelial function in children. Most data from adult studies failed to prove a causative relationship between dyslipidaemia and renal disease progression or a beneficial effect of lipid-lowering treatment on renal outcomes. The limited paediatric data did not indicate dyslipidaemia as an independent risk factor for renal dysfunction, which was mainly estimated by cystatin C levels or proteinuria. Therefore, further investigation is needed to clarify a potential relationship. CONCLUSION In view of limited available paediatric evidence, dyslipidaemia may be adversely associated with endothelial function. However, the association between lipid metabolism disorders and renal function in childhood needs to be further investigated.
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Affiliation(s)
- Chrysoula Kosmeri
- Child Health Department School of Health Sciences Faculty of Medicine University of Ioannina Ioannina Greece
| | - Ekaterini Siomou
- Child Health Department School of Health Sciences Faculty of Medicine University of Ioannina Ioannina Greece
| | - Antonios P. Vlahos
- Child Health Department School of Health Sciences Faculty of Medicine University of Ioannina Ioannina Greece
| | - Haralampos Milionis
- Department of Internal Medicine School of Health Sciences Faculty of Medicine University of Ioannina Ioannina Greece
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Katsiki N, Mikhailidis DP. Lipids: a personal view of the past decade. Hormones (Athens) 2018; 17:461-478. [PMID: 30229482 DOI: 10.1007/s42000-018-0058-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/31/2018] [Indexed: 12/27/2022]
Abstract
The past decade has witnessed considerable progress in the field of lipids. New drugs have been "rapidly" developed and some of these drugs have already been evaluated in event-based large trials. This evidence has led to the guidelines recommending new, more aggressive treatment goals for low-density lipoprotein cholesterol (LDL-C) levels. Although LDL-C remains the principal goal for cardiovascular disease (CVD) risk reduction, there has also been considerable interest in other lipid variables, such as high-density lipoprotein cholesterol, triglycerides, and lipoprotein(a). Statin intolerance is now considered a very important topic in daily clinical practice. This has resulted in more attention focusing on non-statin drugs [e.g., ezetimibe and proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors] and statin-related side effects. The latter mainly involve muscles, but there is also a need to consider other adverse effects associated with statin use (e.g., new onset diabetes). New specific areas of statin use have attracted interest. For example, statin-loading before procedures (e.g., coronary stenting), the prevention of stroke, and the treatment of non-alcoholic fatty liver disease (NAFLD). Statins will remain the most widely used drugs to treat dyslipidaemia and decrease CVD risk. However, we also need to briefly consider some other lipid-lowering drugs, including those that may become available in the future.
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Affiliation(s)
- Niki Katsiki
- Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), Pond Street, London, NW3 2QG, UK.
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Atorvastatin dose-dependently promotes mouse lung repair after emphysema induced by elastase. Biomed Pharmacother 2018; 102:160-168. [PMID: 29554594 DOI: 10.1016/j.biopha.2018.03.067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 02/08/2023] Open
Abstract
Emphysema results in a proteinase - antiproteinase imbalance, inflammation and oxidative stress. Our objective was to investigate whether atorvastatin could repair mouse lungs after elastase-induced emphysema. Vehicle (50 μL) or porcine pancreatic elastase (PPE) was administered on day 1, 3, 5 and 7 at 0.6 U intranasally. Male mice were divided into a control group (sham), PPE 32d (sacrificed 24 h after 32 days), PPE 64d (sacrificed 24 h after 64 days), and atorvastatin 1, 5 and 20 mg treated from day 33 until day 64 and sacrificed 24 h later (A1 mg, A5 mg and A20 mg, respectively). Treatment with atorvastatin was performed via inhalation for 10 min once a day. We observed that emphysema at day 32 was similar to emphysema at day 64. The mean airspace chord length (Lm) indicated a recovery of pulmonary morphology in groups A5 mg and A20 mg, as well as recovery of collagen and elastic fibers in comparison to the PPE group. Bronchoalveolar lavage fluid (BALF) leukocytes were reduced in all atorvastatin-treated groups. However, tissue macrophages were reduced only in the A20 mg group compared with the PPE group, while tissue neutrophils were reduced in the A5 mg and A20 mg groups. The redox balance was restored mainly in the A20 mg group compared with the PPE group. Finally, atorvastatin at doses of 5 and 20 mg reduced nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and matrix metalloproteinase-12 (MMP-12) compared with the PPE group. In conclusion, atorvastatin was able to induce lung tissue repair in emphysematous mice.
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Improvement in Renal Function and Reduction in Serum Uric Acid with Intensive Statin Therapy in Older Patients: A Post Hoc Analysis of the SAGE Trial. Drugs Aging 2016; 32:1055-65. [PMID: 26625880 PMCID: PMC4676790 DOI: 10.1007/s40266-015-0328-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Improvement in renal function and decreases in serum uric acid (SUA) have been reported following prolonged high-intensity statin (HMG-CoA reductase inhibitor) therapy. This post hoc analysis of the SAGE trial examined the effect of intensive versus less intensive statin therapy on renal function, safety, and laboratory parameters, including SUA, in elderly coronary artery disease (CAD) patients (65–85 years) with or without chronic kidney disease (CKD). Methods Patients were randomized to atorvastatin 80 mg/day or pravastatin 40 mg/day and treated for 12 months. Patients were stratified using Modification of Diet in Renal Disease (MDRD) estimated glomerular filtration rates (eGFRs) in CKD (eGFR <60 mL/min/1.73 m2) and non-CKD populations. Results Of the 893 patients randomized, 858 had complete renal data and 418 of 858 (49 %) had CKD (99 % Stage 3). Over 12 months, eGFR increased with atorvastatin and remained stable with pravastatin (+2.38 vs. +0.18 mL/min/1.73 m2, respectively; p < 0.0001). MDRD eGFR improved significantly in both CKD treatment arms; however, the increased eGFR in patients without CKD was significantly greater with atorvastatin (+2.08 mL/min/1.73 m2) than with pravastatin (−1.04 mL/min/1.73 m2). Modest reductions in SUA were observed in both treatment arms, but a greater fall occurred with atorvastatin than with pravastatin (−0.52 vs. −0.09 mg/dL, p < 0.0001). Change in SUA correlated negatively with changes in eGFR and positively with changes in low-density lipoprotein cholesterol. Reports of myalgia were rare (3.6 % CKD; 5.7 % non-CKD), and there were no episodes of rhabdomyolysis. Elevated serum alanine and aspartate transaminase to >3 times the upper limit of normal occurred in 4.4 % of atorvastatin- and 0.2 % of pravastatin-treated patients. Conclusion Intensive management of dyslipidemia in older patients with stable coronary heart disease may have beneficial effects on renal function and SUA.
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Kurata M, Tsuboi A, Takeuchi M, Fukuo K, Kazumi T. Association of Metabolic Syndrome with Chronic Kidney Disease in Elderly Japanese Women: Comparison by Estimation of Glomerular Filtration Rate from Creatinine, Cystatin C, and Both. Metab Syndr Relat Disord 2015; 14:40-5. [PMID: 26535975 DOI: 10.1089/met.2015.0085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Associations between metabolic syndrome (MetS) and chronic kidney disease (CKD) has not been extensively studied in elderly Asians, who in general have lower body mass index (BMI) than European populations. METHODS A cross-sectional analysis was conducted including 159 community-living elderly Japanese women. MetS was defined by the modified National Cholesterol Education Program Adult Treatment Panel III criteria, but using a BMI ≥25 kg/m(2) instead of waist circumference and renal function was assessed according to the Kidney Disease Outcomes Quality Initiative CKD classification. Creatinine-based and cystatin C-based estimated glomerular filtration rate (eGFR) and the average of the two eGFRS were used. RESULTS Prevalence of CKD was much higher when creatinine-based eGFR was used than the prevalence obtained when cystatin-C based equations were used (46.5% vs. 12.6%, P < 0.001). Eighteen (11.3%) women met MetS criteria. Both the presence of MetS and the number of MetS components were associated with higher prevalence of CKD using the average eGFR (all P < 0.05) but not using creatinine-based (P = 0.86) and cystatin C-based (P = 0.12) eGFR alone. Lower average eGFR and higher prevalence of CKD using average eGFR were evident in even women with only one MetS component, 89% of whom had elevated blood pressure. CONCLUSIONS Prevalence of CKD varied substantially depending on the used equation. In nonobese, elderly Japanese women, both the presence of MetS and the number of MetS components were associated with higher prevalence of CKD and elevated blood pressure may play an important role in these associations. These findings should be confirmed in studies employing more participants with MetS diagnosed using standard criteria (waist circumference instead of BMI).
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Affiliation(s)
- Miki Kurata
- 1 Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Hyogo, Japan
- 2 Research Institutes for Nutrition Sciences, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Hyogo, Japan
| | - Ayaka Tsuboi
- 2 Research Institutes for Nutrition Sciences, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Hyogo, Japan
| | - Mika Takeuchi
- 1 Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Hyogo, Japan
| | - Keisuke Fukuo
- 1 Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Hyogo, Japan
- 2 Research Institutes for Nutrition Sciences, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Hyogo, Japan
- 3 Postgraduate School of Food Sciences and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Hyogo, Japan
| | - Tsutomu Kazumi
- 2 Research Institutes for Nutrition Sciences, School of Human Environmental Sciences, Mukogawa Women's University , Nishinomiya, Hyogo, Japan
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Gebauer K, Engelbertz C, Malyar NM, Meyborg M, Lüders F, Freisinger E, Reinecke H. Long-Term Mortality After Invasive Angiography and Endovascular Revascularization in Patients With PAD Having Chronic Kidney Disease. Angiology 2015; 67:556-64. [DOI: 10.1177/0003319715603184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Peripheral arterial disease (PAD) and chronic kidney disease (CKD) are associated with increased mortality rates. We assessed long-term outcomes of patients with PAD and CKD. Patients with PAD undergoing invasive angiography and/or endovascular revascularization between 2005 and 2010 were retrospectively classified into 5 CKD stages. A follow-up was performed and 572 patients were included, 116 patients (20%) had normal renal function, 245 were in CKD stage 2 (43%), 156 in CKD stage 3 (27%), and 55 in CKD stages 4 + 5 (10%). Diabetes mellitus, hypertension, and anemia were more frequent in higher CKD stages ( P < .03). During follow-up (mean 1135 days; 95% confidence interval 1159-1259), cumulative mortality was 21% and increased with advanced CKD stages (9%, 16%, 29%, and 47%, respectively, P < .001). In multivariate Cox regression models, higher CKD stages were significantly associated with poor survival. Medication adherence for secondary prevention was significantly lower than recommended but irrespective of CKD stages. Kidney function is an independent predictor of worse long-term survival in patients with PAD. While standard medications were used less often than recommended, no differences between CKD stages were noted.
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Affiliation(s)
- Katrin Gebauer
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Christiane Engelbertz
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Nasser M. Malyar
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Matthias Meyborg
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Florian Lüders
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Eva Freisinger
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Holger Reinecke
- Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
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Paraskevas KI, Phillips MJ, Shearman CP. Screening for Peripheral Arterial Disease Using the Ankle-Brachial Index in Diabetic and Other High-Risk Patients: Pros and Cons. Angiology 2015. [PMID: 26207009 DOI: 10.1177/0003319715597090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mike J Phillips
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Clifford P Shearman
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Athyros VG, Katsiki N, Karagiannis A, Mikhailidis DP. Statins can improve proteinuria and glomerular filtration rate loss in chronic kidney disease patients, further reducing cardiovascular risk. Fact or fiction? Expert Opin Pharmacother 2015; 16:1449-61. [PMID: 26037614 DOI: 10.1517/14656566.2015.1053464] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The prevalence of chronic kidney disease (CKD), a risk factor for cardiovascular disease (CVD), is increasing worldwide. Statin treatment, the cornerstone of prevention or treatment of CVD, might have beneficial effects on urine protein excretion and renal function as determined by the glomerular filtration rate, whereas it might protect from acute kidney injury (AKI), mainly due to contrast-induced AKI. These beneficial effects on CKD may not be drug class effects; specific statins at specific doses may help prevent CKD deterioration and reduce CVD risk. We analysed all statin studies that had renal and CVD endpoints as main outcome measures. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched up to February 2015. AREAS COVERED We consider the effects of statins on microalbuminuria, proteinuria, glomerular filtration rate, AKI associated with angiography or percutaneous coronary intervention and on CVD event rates in patients with CKD. EXPERT OPINION Current evidence points towards the need to prescribe high-potency statins in patients with CKD, before a major decline in kidney function occurs. This may reduce CVD risk and delay the progress of CKD. Administration of either atorvastatin or rosuvastatin can prevent contrast-induced AKI before angiography or percutaneous coronary intervention. The combination of simvastatin + ezetimibe may decrease vascular events in patients with advanced CKD.
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Affiliation(s)
- Vasilios G Athyros
- Aristotle University of Thessaloniki, Hippocration Hospital, Medical School, Second Propedeutic Department of Internal Medicine , Thessaloniki , Greece +30 2310 892606 ; +30 2310 835955 ;
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Shafranskaya KS, Kashtalap VV, Gruzdeva OV, Kutikhin AG, Barbarash OL, Barbarash LS. The Role of Cystatin C in the Prognosis of Adverse Outcomes after the Coronary Artery Bypass Graft Surgery During Hospitalisation. Heart Lung Circ 2015; 24:193-9. [DOI: 10.1016/j.hlc.2014.07.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 07/08/2014] [Accepted: 07/12/2014] [Indexed: 10/25/2022]
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13
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Kouvelos GN, Arnaoutoglou EM, Milionis HJ, Raikou VD, Papa N, Matsagkas MI. The effect of adding ezetimibe to rosuvastatin on renal function in patients undergoing elective vascular surgery. Angiology 2015; 66:128-35. [PMID: 24458801 DOI: 10.1177/0003319713519492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We compared the effects of lipid lowering with rosuvastatin (RSV) monotherapy versus intensified treatment by combining RSV with ezetimibe (EZT) on kidney function in patients undergoing vascular surgery. Patients were randomly assigned to either 10 mg/d RSV (n = 136) or RSV 10 mg/d plus EZT 10 mg/d (RSV/EZT, n = 126). At 12 months, a similar decrease in estimated glomerular filtration rate (eGFR) was noted. Patients who achieved a low-density lipoprotein cholesterol (LDL-C) of <100 mg/dL had less eGFR decrease than those patients having an LDL-C limit of more than 100 mg/dL. There were no significant changes in the urinary total protein to creatinine ratio in either group. Significant microalbuminuria was evident in both the groups. Patients undergoing vascular surgery show deterioration in their renal function during the first year, despite statin therapy. Intensified lipid-lowering therapy by adding EZT does not appear to have any renoprotective effect.
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Affiliation(s)
- George N Kouvelos
- Department of Surgery-Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Eleni M Arnaoutoglou
- Department of Anesthesiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Haralampos J Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Vaia D Raikou
- First Department of Internal Medicine, School of Medicine, University of Athens, Athens, Greece
| | - Nektario Papa
- Department of Surgery-Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Miltiadis I Matsagkas
- Department of Surgery-Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
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Yang Y, Zhao X, Tang X, Lu J, Zhou M, Wang W, Wang L, Guo D, Ding F. Comparison of Serum Cystatin C and Creatinine Level Changes for Prognosis of Patients After Peripheral Arterial Angiography. Angiology 2014; 66:766-73. [PMID: 25344529 DOI: 10.1177/0003319714555431] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared changes in serum cystatin C (Cys C) and creatinine (sCr) levels for detecting contrast-induced acute kidney injury; 350 consecutive patients who underwent peripheral arterial angiography were prospectively enrolled. Serum Cys C and sCr levels were assayed at predefined time points after contrast-media exposure. During 1-year follow-up, major adverse events (MAEs) including all-cause mortality and dialysis were assessed. A sCr increase ≥25% was not associated with MAEs, whereas a serum Cys C increase ≥5% at 24 hours was associated with higher probability of MAEs ( P = .010). The independent predictors of 1-year MAEs were older age ( P = .004), lower prealbumin levels ( P = .022), and serum Cys C increase ≥5%. In patients who underwent peripheral angiography, a serum Cys C increase ≥5% was an independent predictor of 1-year MAEs.
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Affiliation(s)
- Yanjiao Yang
- Division of Nephrology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaojiao Zhao
- Division of Nephrology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Tang
- Division of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianxin Lu
- Division of Nephrology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Minjie Zhou
- Division of Nephrology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wenji Wang
- Division of Nephrology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lixin Wang
- Division of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Division of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Feng Ding
- Division of Nephrology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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18F-fluorodeoxyglucose uptake in abdominal aortic aneurysms: a useful biomarker of AAA rupture risk. BIOMED RESEARCH INTERNATIONAL 2014; 2014:930738. [PMID: 25328893 PMCID: PMC4189845 DOI: 10.1155/2014/930738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022]
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16
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Abstract
Contrast-induced nephropathy (CIN) represents an important adverse effect of contrast media (CM) administration. Contrast-induced nephropathy is associated with prolonged hospitalization as well as increased cardiovascular morbidity, renal morbidity, and all-cause mortality. Several risk factors may predict CIN incidence, and various scores and ratios have been proposed to identify high-risk patients. Novel biomarkers may provide an earlier diagnosis of CIN. A multifactorial approach is required for CIN prevention including hydration, administration of low- or iso-osmolar CM, minimizing CM volume, and statin administration. Renal function may deteriorate after CM administration, even in the absence of CIN. Therefore, this deterioration may not be an “all or none” phenomenon; it may well occur in many patients receiving CM, with/without CIN, and may prove to be an underestimated risk factor. Patients should be followed up for longer periods as outpatients after CM exposure to assess kidney function and predict subsequent increased morbidity and mortality.
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Affiliation(s)
- Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), London, United Kingdom
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17
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Hioki H, Miyashita Y, Miura T, Ebisawa S, Motoki H, Izawa A, Tomita T, Koyama J, Ikeda U. Prognostic Improvement by Multidisciplinary Therapy in Patients With Critical Limb Ischemia. Angiology 2014; 66:187-94. [DOI: 10.1177/0003319714523113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although limb salvage rate has improved in critical limb ischemia (CLI), an improvement in CLI prognosis has been scarcely reported. Multidisciplinary therapy (MT) including revascularization, wound bed preparation, treatment of comorbidity, and education of patients with CLI may improve prognosis. The aim of this study was to investigate the effectiveness of MT in prognostic improvement. We retrospectively analyzed 72 patients with CLI and assessed whether MT improved prognosis. The incidence of amputation-free survival (freedom from major amputation [MA] and death) was significantly different between the MT and conventional groups at 2 years (0% vs 33%; P = .024). After multivariate analysis, transfusion (hazard ratio [HR] 5.778; 95% confidence interval [CI], 2.372-14.073; P < .001), multivessel coronary disease (HR 3.353; 95% CI, 1.309-8.590; P = .012), and C-reactive protein >5 mg/dL (HR 3.958; 95% CI, 1.359-11.531; P = .012) were independent predictors for MA or death. We concluded that MT was effective in improved mortality and limb salvage rate.
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Affiliation(s)
- Hirofumi Hioki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yusuke Miyashita
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Miura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Souichirou Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Izawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeshi Tomita
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Koyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Uichi Ikeda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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18
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Tasal A, Bacaksiz A, Ertas G, Vatankulu MA, Kul S, Sarı S, DÃœZ ME, Erdogan E, Sonmez O, Goktekin O. Association Between Serum Cystatin C Levels and Coronary Slow Flow. Angiology 2013; 65:831-7. [DOI: 10.1177/0003319713505697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We assessed the association between serum cystatin C (CysC) levels and coronary slow flow (CSF) phenomenon in patients who underwent coronary angiography. A total of 210 patients (mean age 55.6 ± 10.9 years; 100 females) were included. Patients were divided into 3 groups, (patients with CSF [group 2], with coronary artery disease [CAD; group 3], and without CAD [group 1]). Serum CysC levels in patients with CSF were significantly lower than those with and without CAD (912.5 ± 135.6, 820.4 ± 104.2, and 1343.4 ± 236.6 ng/mL in groups 1, 2, and 3, respectively; P < .001). Serum CysC levels correlated with the number of vessels with CSF and mean corrected thrombolysis in myocardial infarction frame count (Spearman correlation coefficient [ rs] = .192, P < .001 and rs = .261, P < .001 respectively). In conclusion, patients with CSF have lower CysC levels; this could be a useful biomarker of CSF involvement in patients who undergo diagnostic coronary angiography.
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Affiliation(s)
- Abdurrahman Tasal
- Department of Cardiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Ahmet Bacaksiz
- Department of Cardiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Gokhan Ertas
- Department of Cardiology, Istanbul Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Akif Vatankulu
- Department of Cardiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Seref Kul
- Department of Cardiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Soner Sarı
- Department of Biochemistry, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Emin DÃœZ
- Department of Biochemistry, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Ercan Erdogan
- Department of Cardiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Osman Sonmez
- Department of Cardiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Omer Goktekin
- Department of Cardiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey
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19
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Balta S, Balta I, Demirkol S, Cakar M, Sarlak H, Kurt O. Subclinical peripheral arterial disease and ankle-brachial index. Angiology 2013; 64:395-6. [PMID: 23716726 DOI: 10.1177/0003319712475206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Unlu M, Balta S, Cakar M, Demirkol S, Arslan Z, Sarlak H. Coronary Lesions Complexity in Patients With Stable Coronary Artery Disease. Angiology 2013; 64:310. [DOI: 10.1177/0003319712473636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Murat Unlu
- Department of Cardiology, Beytepe Hospital, Ankara, Turkey
| | - Sevket Balta
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Mustafa Cakar
- Department of Internal Medicine, Gulhane Medical Academy, Ankara, Turkey
| | - Sait Demirkol
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Zekeriya Arslan
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Hakan Sarlak
- Department of Internal Medicine, Gulhane Medical Academy, Ankara, Turkey
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21
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Balta S, Demirkol S, Yesil FG, Cakar M, Sarlak H, Celik T. Only ankle-brachial index may not be an accurate information about the prevalence of peripheral arterial disease. Angiology 2013; 64:481-2. [PMID: 23539614 DOI: 10.1177/0003319713482748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Balta I, Balta S, Demirkol S, Ekiz O. Peripheral arterial disease in patients with Behçet’s disease. Rheumatol Int 2013; 34:589-90. [DOI: 10.1007/s00296-013-2729-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 03/18/2013] [Indexed: 01/30/2023]
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23
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Balta S, Demirkol S, Celik T, Kucuk U, Kucuk HO, Yesil FG. Diastolic dysfunction in patients with peripheral arterial disease: a frequent association. Angiology 2013; 64:544-5. [PMID: 23528937 DOI: 10.1177/0003319713482040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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24
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Balta S, Cakar M, Demirkol S, Kurt O, Unlu M, Kucuk U. The Relationship Between Ankle-Brachial Index and Estimated Glomerular Filtration Rate in Type 2 Diabetes. Angiology 2013; 64:242. [DOI: 10.1177/0003319712470560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sevket Balta
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Mustafa Cakar
- Department of Internal Medicine, Gulhane Medical Academy, Ankara, Turkey
| | - Sait Demirkol
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Omer Kurt
- Department of Internal Medicine, Gulhane Medical Academy, Ankara, Turkey
| | - Murat Unlu
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Ugur Kucuk
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
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25
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Liang KW, Kuo HN, Lee WL, Liu TJ, Lin WW, Tsao CR, Ting CT, Wang KY. Different Mid-Term Prognostic Predictors of Major Adverse Events in Diabetic and Nondiabetic Peripheral Artery Disease Presenting With Critical Limb Ischemia. Angiology 2013; 67:287-91. [DOI: 10.1177/0003319712475074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared midterm prognostic predictors of peripheral artery disease (PAD) with or without diabetes mellitus (DM) presenting with critical lower limb ischemia (CLI). A total of 172 patients with PAD (109 DM; 63 non-DM) were enrolled. The major adverse events (MAEs) were death or amputation. The diabetic group had a higher MAE rate (39% vs 22%, P = .042) with a mean follow-up duration of 30 ± 19 months. In a multivariate binary logistic regression analysis, revascularization (odds ratio = 0.289, P = .006) and higher serum cholesterol (odds ratio=0.988, P = .027) predicted a lower MAE rate in the DM group. In contrast, the presence of severe chronic kidney disease (stage 4 or 5, odds ratio = 5.238, P = .025) was a positive predictor of MAEs in the nondiabetic group. In conclusion, the prognostic predictors of MAE in diabetic and nondiabetic patients with PAD and CLI were different.
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Affiliation(s)
- Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
- Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
| | - Hsun-Nan Kuo
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Wei-Wen Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
- Department of Life Science, Tung-Hai University, Taichung, Taiwan
| | - Chen-Rong Tsao
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Chih-Tai Ting
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, Cardiovascular Research Center and Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
- Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
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26
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O’Sullivan S, Healy DA, Moloney MC, Grace PA, Walsh SR. The Role of N--Acetylcysteine in the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Peripheral Angiography. Angiology 2012. [DOI: 10.1177/0003319712467223] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Contrast-induced nephropathy (CIN) is a leading cause of hospital-acquired acute kidney injury (AKI). N-acetylcysteine (NAC) was proposed as an effective preventative measure. As data in relation to the use of NAC for the prevention of CIN in peripheral angiography are lacking, a systematic review and meta-analysis were undertaken. A comprehensive search for the published and unpublished data was performed. Data were extracted from the eligible studies. Pooled odds ratios (ORs) were used to calculate the effect of NAC on CIN incidence. Pooled effect size estimates were used to calculate the effect of NAC on serum creatinine (SCr) postcontrast. Our results showed that NAC did not reduce CIN incidence (pooled OR 1.05; 95% confidence interval [CI] 0.38-2.88; P = .92) or the mean SCr levels (pooled weighted mean difference, 4.38; 95% CI 10.4-1.65; P = .15). In conclusion, insufficient evidence exists to recommend NAC for the prevention of CIN in patients undergoing peripheral angiography.
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Affiliation(s)
- S. O’Sullivan
- Department of Vascular Surgery, 4i Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School, University of Limerick, Ireland
| | - D. A. Healy
- Department of Vascular Surgery, 4i Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School, University of Limerick, Ireland
| | - Mary Clarke Moloney
- Department of Vascular Surgery, 4i Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School, University of Limerick, Ireland
| | - P. A. Grace
- Department of Vascular Surgery, 4i Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School, University of Limerick, Ireland
| | - S. R. Walsh
- Department of Vascular Surgery, 4i Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School, University of Limerick, Ireland
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27
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Jin X, Ma JH, Shen Y, Luo Y, Su XF, Chen YY, Qi SK, Wu JD. An analysis of the relationship between ankle-brachial index and estimated glomerular filtration rate in type 2 diabetes. Angiology 2012; 64:237-41. [PMID: 23162006 DOI: 10.1177/0003319712464515] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the relationship between peripheral arterial disease (PAD) and renal function in patients with type 2 diabetes mellitus (T2DM). We enrolled 2057 hospitalized patients with T2DM and measured kidney function and ankle-brachial index (ABI). The estimated glomerular filtration rate (eGFR) was derived using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and ABI was grouped as low (<0.9), low-normal (0.9-1.09), normal (1.1-1.3), and high (>1.3). Logistic regression was used to evaluate the associations of eGFR with ABI. Generally speaking, the ABI was negatively correlated with systolic blood pressure, fasting C-peptide, total cholesterol, and low-density lipoprotein cholesterol while positively correlated with body mass index (P < .05 to <.01). Only a low ABI was positively correlated with eGFR (P < .01). In addition to the association of the ABI with cardiovascular events, stroke, and PAD, ABI may also predict the change in renal function in patients with T2DM.
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Affiliation(s)
- Xing Jin
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing Hospital, Nanjing, China
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28
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Abstract
PURPOSE OF REVIEW To discuss the beneficial effects of statin treatment in patients with peripheral arterial disease (PAD), abdominal aortic aneurysms (AAAs), atherosclerotic renal artery stenosis (ARAS) and carotid artery disease. RECENT FINDINGS Evidence suggests that statins may reduce the progression (or even reverse the development) of carotid artery stenosis and AAAs. Statins also improve several indices (e.g. serum creatinine) and preserve renal function in ARAS. In patients with PAD, statins are associated with improved claudication distance and time, reduced cardiovascular events, and improved graft patency rates should these patients undergo surgery. Finally, statins are associated with improved perioperative and long-term morbidity and mortality rates in all vascular patients whether they undergo surgery or endovascular procedures. SUMMARY Routine statin treatment should be implemented for all vascular patients to ensure a reduced progression of their disease, as well as a reduction in cardiovascular events.
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29
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Paraskevas KI, Mikhailidis DP. Carotid artery stenosis and heart valve surgery: a complex scenario. Angiology 2011; 62:597-600. [PMID: 21990547 DOI: 10.1177/0003319711412049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Sheen YJ, Lin JL, Lee IT, Hsu YN, Li TC, Sheu WHH. Low estimated glomerular filtration rate is a major determinant of low ankle-brachial index and toe-brachial index in type 2 diabetes. Angiology 2011; 63:55-61. [PMID: 21642287 DOI: 10.1177/0003319711406709] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We enrolled 1461 Taiwanese type 2 diabetic outpatients with ankle-brachial index (ABI) and toe-brachial index (TBI) examinations, excluding participants with history of stroke, end-stage renal disease, malignancy, acute myocardial infarction, amputation, and overt calcification of the lower limbs (ABI > 1.3). Ankle-brachial index values <0.9 were found in 2.8% of the patients and 5.7% had TBI < 0.6. Estimated glomerular filtration rate (eGFR; 90 ± 33 mL/min per 1.73 m2) obtained from 473 patients correlated significantly with both ABI and TBI. Progressive eGFR decline was observed in 419 participants with normal ABI and TBI, 35 with normal ABI but low TBI, and 19 with low ABI and normal or low TBI (P for trend < .001). After adjusting for confounding factors, age and eGFR were significantly associated with TBI and ABI. Low eGFR is associated with peripheral arterial disease in type 2 diabetes with mild to moderate renal insufficiency.
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Affiliation(s)
- Yi-Jing Sheen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Hospital Department of Health, Executive Yuan, Taichung, Taiwan, Republic of China
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31
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Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures. Int Urol Nephrol 2011; 43:143-5. [PMID: 21210222 DOI: 10.1007/s11255-010-9892-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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32
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Sadat U, Walsh SR, Norden AG, Gillard JH, Boyle JR. Does oral N-acetylcysteine reduce contrast-induced renal injury in patients with peripheral arterial disease undergoing peripheral angiography? A randomized-controlled study. Angiology 2010; 62:225-30. [PMID: 20682612 DOI: 10.1177/0003319710377078] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The nephroprotective role of N-acetylcysteine (NAC) against contrast-induced nephropathy (CIN) in patients undergoing peripheral arterial angiography remains unclear. A total of 40 patients undergoing peripheral arterial angiography were randomized to receive intravenous (iv) hydration only (group 1) or oral NAC in addition to iv hydration (group 2; ISRCTN: 35882618). Primary outcome was reduction in the elevation of urinary retinol binding protein (RBP), albumin-creatinine ratio (ACR), and serum creatinine (serC). Groups 1 and 2 had equivocal percentage reduction in RBP and ACR levels from baseline (P = .80 and .30). A significant reduction in serC was, however, observed with NAC by third postprocedure day (P = .04). One patient in the treatment arm developed CIN compared with 3 patients in the control group (P = .33). Equivocal changes in RBP and ACR levels by both treatments seem to indicate that either is equally effective in affording renal protection.
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Affiliation(s)
- Umar Sadat
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, UK.
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33
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Paraskevas KI, Giannoukas AD, Kotsikoris I, Mikhailidis DP. Contrast-Induced Nephropathy and the Vascular Patient. Angiology 2010; 61:721-3. [DOI: 10.1177/0003319710379110] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK,
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34
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Cianci R, Martina P, Borghesi F, di Donato D, Polidori L, Lai S, Ascoli G, de Francesco I, Zaccaria A, Gigante A, Barbano B. Revascularization Versus Medical Therapy for Renal Artery Stenosis: Antihypertensive Drugs and Renal Outcome. Angiology 2010; 62:92-9. [DOI: 10.1177/0003319710371615] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rosario Cianci
- Department of Nephrology, Sapienza, University of Rome,
Italy,
| | - Paola Martina
- Department of Nephrology, Sapienza, University of Rome,
Italy
| | | | | | - Lelio Polidori
- Department of Nephrology, Sapienza, University of Rome,
Italy
| | - Silvia Lai
- Department of Nephrology, Sapienza, University of Rome,
Italy
| | - Giada Ascoli
- Department of Nephrology, Sapienza, University of Rome,
Italy
| | | | - Alvaro Zaccaria
- Department of Vascular and Endovascular Surgery, San
Pietro-Fatebenefratelli Hospital, Rome, Italy
| | - Antonietta Gigante
- Department of Vascular and Endovascular Surgery, San
Pietro-Fatebenefratelli Hospital, Rome, Italy
| | - Biagio Barbano
- Department of Nephrology, Sapienza, University of Rome,
Italy
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35
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Paraskevas KI, Tzovaras AA, Stathopoulos V, Mikhailidis DP. Statin use in patients with chronic kidney disease stages 2–4: targeting beyond improved mortality rates. Int Urol Nephrol 2010; 42:711-3. [DOI: 10.1007/s11255-009-9677-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 11/05/2009] [Indexed: 10/20/2022]
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36
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Paraskevas KI, Giannoukas AD, Mikhailidis DP. Renal Function Impairment in Peripheral Arterial Disease: An Important Parameter that Should not Be Neglected. Ann Vasc Surg 2009; 23:690-9. [DOI: 10.1016/j.avsg.2009.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 02/15/2009] [Accepted: 06/04/2009] [Indexed: 11/30/2022]
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37
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Tziomalos K, Ganotakis ES, Gazi IF, Nair DR, Mikhailidis DP. Kidney function and estimated vascular risk in patients with primary dyslipidemia. Open Cardiovasc Med J 2009; 3:57-68. [PMID: 19572030 PMCID: PMC2703830 DOI: 10.2174/1874192400903010057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 05/22/2009] [Accepted: 05/25/2009] [Indexed: 01/30/2023] Open
Abstract
Background: Chronic kidney disease (CKD) is associated with increased vascular risk. Some studies suggested that considering markers of CKD might improve the predictive accuracy of the Framingham risk equation. Aim: To evaluate the links between kidney function and risk stratification in patients with primary dyslipidemia. Methods: Dyslipidemic patients (n = 156; 83 men) who were non-smokers, did not have diabetes mellitus or evident vascular disease and were not on lipid-lowering or antihypertensive agents were recruited. Creatinine clearance (CrCl) was estimated using the Cockcroft-Gault equation. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. We estimated vascular risk using the Framingham equation. Results: In both men and women, there was a significant negative correlation between estimated Framingham risk and both eGFR and CrCl (p < 0.001 for all correlations). When men were divided according to creatinine tertiles, there were no significant differences in any parameter between groups. When men were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined (p<0.001 for all trends). When women were divided according to creatinine tertiles, all estimated Framingham risks except for stroke significantly increased as creatinine levels increased. When women were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined. Conclusions: Estimated vascular risk increases as renal function declines. The possibility that incorporating kidney function in the Framingham equation will improve risk stratification requires further evaluation.
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Affiliation(s)
- Konstantinos Tziomalos
- Department of Clinical Biochemistry (Vascular Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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38
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Karagiannis A, Tziomalos K, Anagnostis P, Gossios T, Athyros VG. Atherosclerotic renal artery stenosis: medical therapy alone or in combination with revascularization? Angiology 2009; 60:397-402. [PMID: 19505885 DOI: 10.1177/0003319709334262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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39
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Liu JH, Chang CC, Wang SM, Chou CY, Yang YF, Liu YL, Lin HH, Huang CC. Peripheral arterial disease and clinical risks in Taiwanese hemodialysis patients. Angiology 2009; 61:66-73. [PMID: 19398418 DOI: 10.1177/0003319709333867] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripheral arterial disease (PAD) is associated with significant morbidity and mortality and is an important marker of systemic atherosclerosis. However, little is known about the associated risk factors for PAD in patients on maintenance hemodialysis (HD). We collected the basic data and possible risk factors associated with PAD for 277 patients on maintenance HD. Furthermore, we measured ankle-brachial blood pressure index (ABI) in these patients. PAD was defined as an ABI value less than 0.90. The prevalence of PAD in our HD center was 22.8% (61/268). Advanced age (P = 0.006), longer history of HD (P < 0.001), diabetes (P = 0.002) and presence of PAD symptoms (P < 0.001) were independent predictors of PAD. PAD patients with diabetes had shorter history of HD (P = 0.001). 2-vessel PAD had higher serum cholesterol in HD patients (>or= 200 vs < 200 mg/dL; Odds ratio, 12.12, 95% confidence interval, 2.199-67.79; P < 0.004).
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Affiliation(s)
- Jiung-Hsiun Liu
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
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40
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Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP. JUPITER: major implications for vascular risk assessment. Curr Med Res Opin 2009; 25:133-7. [PMID: 19210146 DOI: 10.1185/03007990802643557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This Editorial comments on the recently published JUPITER trial (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), the further evidence it provides for supporting the role of statins in primary prevention and the major implications this may hold for vascular risk assessment and clinical practice guidelines.
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41
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Samson RH. Author Response. Vasc Endovascular Surg 2008. [DOI: 10.1177/15385744090420061702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Russell H. Samson
- Florida State University Medical School and Mote Vascular Foundation, Inc Sarasota, Florida
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42
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Paraskevas KI, Bessias N, Tzorbatzoglou J, Mikhailidis DP, Andrikopoulos V. Effect of Statins on Renal Function in Patients With Peripheral Arterial Disease. Vasc Endovascular Surg 2008; 42:620-1; author reply 621. [DOI: 10.1177/1538574408326183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Nikolaos Bessias
- Department of Vascular Surgery "" Cross" Hospital Athens, Greece
| | | | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics) Royal Free Hospital Campus University College London (UCL) London, United Kingdom
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43
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Paraskevas KI, Papas TT, Pavlidis P, Bessias N, Andrikopoulos V. The Importance of Conservative Measures in Peripheral Arterial Disease: An Update. Angiology 2008; 59:529-33. [DOI: 10.1177/0003319708318381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | - Nikolaos Bessias
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
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44
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Ramel A, Jonsson PV, Bjornsson S, Thorsdottir I. Differences in the Glomerular Filtration Rate Calculated by Two Creatinine-Based and Three Cystatin-C-Based Formulae in Hospitalized Elderly Patients. ACTA ACUST UNITED AC 2007; 108:c16-22. [DOI: 10.1159/000112477] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 07/08/2007] [Indexed: 11/19/2022]
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45
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Alnaeb ME, Crabtree VP, Boutin A, Mikhailidis DP, Seifalian AM, Hamilton G. Prospective assessment of lower-extremity peripheral arterial disease in diabetic patients using a novel automated optical device. Angiology 2007; 58:579-85. [PMID: 18024941 DOI: 10.1177/0003319707305685] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A new optical device based on the photoplethysmograph (PPG) method and an innovative algorithm for the assessment of lower-extremity peripheral arterial disease was investigated prospectively in patients with type II diabetes. This new functional PPG (fPPG) technique uses a cuffless functional test to assess diabetic peripheral arterial disease without operator dependency and the incompressible arteries, issues associated with ankle brachial pressure index (ABPI) measurement. Diabetic patients (n = 24; 47 legs; age, 70 +/- 3 years) were recruited from the vascular clinic, and controls (n = 15; 30 legs; age, 66 +/- 5 years) were recruited from the orthopedic outpatient clinic. All underwent resting ABPI, fPPG, and duplex angiography (DA) as "gold standard." fPPG requires the placement of an optical probe on the toe for acquisition of pulsatile arterial perfusion for a period of 30 seconds with the leg in supine and raised at 45 degrees positions. The data were analyzed, and indices were generated by an automated computer system. In those with diabetes, fPPG correlated significantly with DA (r = -.68, P < .01) and ABPI (r = -.65, P < .01). We also found a significant correlation between ABPI and DA (r = .81, P < .01). The analysis of the receiver operator curve showed that optimum sensitivity and specificity for ABPI and fPPG were 80% and 93% and 83% and 71%, respectively, against DA. This method uses changes in pulsatile arterial blood volume using a simple cuffless functional test. The fPPG investigation period was much shorter (5 minutes) with independence of operator skills, whereas ABPI took longer (10-15 minutes) and required operator experience. Although the fPPG results are promising, further improvement (eg, by incorporation of functional skin color and temperature changes) is required to improve the sensitivity and specificity of the system.
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Affiliation(s)
- Mohamad E Alnaeb
- Vascular Unit, Royal Free Hampstead NHS Trust Hospital, London, United Kingdom
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46
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Papalambros E, Sigala F, Georgopoulos S, Paraskevas KI, Andreadou I, Menenakos X, Sigalas P, Papalambros AL, Vourliotakis G, Giannopoulos A, Bakoyiannis C, Bastounis E. Malondialdehyde as an indicator of oxidative stress during abdominal aortic aneurysm repair. Angiology 2007; 58:477-82. [PMID: 17875961 DOI: 10.1177/0003319707305246] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ischemia-reperfusion injury significantly contributes to abdominal aortic aneurysm (AAA)- related mortality and morbidity; therefore, we measured oxidative stress during open AAA repair and investigated any potential associations with intraoperative or perioperative events (aortic clamping time, blood loss, and the need to transfer to the intensive care unit). Blood samples were collected at specific time points from 53 patients undergoing open AAA repair: (1) before induction of anesthesia; (2) 15, 30, 60, and 120 minutes after aortic clamping; (3) 15 and 60 minutes after clamp removal; and (4) 24 hours postoperatively. Malondialdehyde (MDA) levels were measured by a spectrophotometric method. Baseline MDA values in patients with AAA were significantly higher than in controls (P < .0001). A positive correlation was found between preoperative MDA levels and the size of AAAs (Pearson correlation = 0.578, P < .001). No difference was observed in MDA levels between ruptured and nonruptured AAAs; however, when all symptomatic patients (ruptured and elective symptomatic AAAs, n = 18) were considered, there was a significant elevation in MDA levels (P < .001). There was also a significant increase in MDA values in patients transferred postoperatively to the intensive care unit (P < .001). Finally, a positive association was found between the duration of aortic clamping with MDA values at 15 and 60 minutes after declamping, but not after 24 hours (Pearson correlation = 0.467, P < .001). MDA levels may predict the postoperative course of elective and ruptured AAAs.
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Affiliation(s)
- Efstathios Papalambros
- Division of Vascular Surgery, First Department of Surgery, University of Athens, Medical School, Greece.
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47
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Paraskevas KI, Hamilton G, Mikhailidis DP. Statins: An essential component in the management of carotid artery disease. J Vasc Surg 2007; 46:373-386. [PMID: 17664116 DOI: 10.1016/j.jvs.2007.03.035] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2006] [Accepted: 03/10/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We aimed to define the role of treatment using statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) in the management of patients with carotid artery disease. LITERATURE SEARCH METHODS We searched PubMed for studies evaluating the effect of statins on carotid IMT and the occurrence of cerebrovascular events. LITERATURE SEARCH RESULTS Current evidence indicates that routine statin therapy reduces carotid intima-media thickness progression and stroke risk. Additionally, statin treatment significantly reduces perioperative as well as long-term morbidity and mortality in patients undergoing carotid surgery or endovascular interventions. It would also be expected that statins would reduce coronary events in this high-risk population. CONCLUSIONS Statins should be considered as an essential component of the therapeutic approach of patients with carotid artery stenosis.
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Affiliation(s)
- Kosmas I Paraskevas
- Department of Clinical Biochemistry, Royal Free Hospital, London, United Kingdom
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48
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Fatourou EM, Paraskevas KI, Seifalian AM, Hamilton G, Mikhailidis DP. The role of established and emerging risk factors in peripheral vascular graft occlusion. Expert Opin Pharmacother 2007; 8:901-11. [PMID: 17472536 DOI: 10.1517/14656566.8.7.901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several studies have evaluated the association between established as well as emerging vascular risk factors with peripheral graft occlusion. There is evidence for a link between the risk for graft occlusion and total serum cholesterol, low-density lipoprotein cholesterol and triglyceride levels. The overall effect of smoking shows a 2.35-fold increase in risk of graft failure. Studies involving diabetic patients undergoing peripheral bypass may have failed to detect higher occlusion rates, possibly due to increased morbidity and mortality as well as higher amputation rates even if the graft is patent. Both antiplatelet agents and anticoagulation seem to be effective in the prevention of graft occlusion. Unconvincing data have been published with regards to the effect of hypertension on graft patency. Emerging factors such as fibrinogen, lipoprotein (a), C-reactive protein and homocysteine levels should also be considered when assessing the risk of graft occlusion. More research is needed to prevent graft occlusion due to the obvious clinical relevance, quality of life and cost issues.
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Affiliation(s)
- E M Fatourou
- Department of Clinical Biochemistry, Royal Free Hospital and Royal Free University College Medical School, London, UK
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49
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Gazi IF, Mikhailidis DP. Non-low-density lipoprotein cholesterol-associated actions of ezetimibe: an overview. Expert Opin Ther Targets 2006; 10:851-66. [PMID: 17105372 DOI: 10.1517/14728222.10.6.851] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Ezetimibe, an intestinal cholesterol absorption inhibitor, lowers circulating low-density lipoprotein cholesterol (LDL-C) levels both when administered as monotherapy and in combination with other hypolipidaemic drugs, mostly statins. This review focuses on the effects of ezetimibe on non-LDL-C-associated variables. In most studies, ezetimibe effectively reduced triglyceride and increased high density lipoprotein cholesterol levels. The authors also consider the effect of ezetimibe on other variables such as C-reactive protein levels, insulin sensitivity and endothelial function. Ezetimibe is useful in patients with sitosterolaemia (a rare inherited disorder) as it significantly reduces plasma phytosterol concentrations. Ezetimibe fulfils two of the three essential characteristics of any drug (efficacy and safety). However, clinical studies are required to provide evidence of its ability to reduce vascular events.
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Affiliation(s)
- Irene F Gazi
- Royal Free Hospital, Department of Clinical Biochemistry, Royal Free and University College of Medicine, University of London, Pond Street, London NW3 2QG, UK
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50
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Paraskevas KI, Liapis CD, Hamilton G, Mikhailidis DP. Can Statins Reduce Perioperative Morbidity and Mortality in Patients Undergoing Non-Cardiac Vascular Surgery? Eur J Vasc Endovasc Surg 2006; 32:286-93. [PMID: 16690330 DOI: 10.1016/j.ejvs.2006.03.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 03/26/2006] [Indexed: 11/27/2022]
Abstract
AIMS To determine whether statins can reduce perioperative morbidity and mortality in patients undergoing non-cardiac vascular surgery. METHODS A search using Pubmed was performed to identify reports in English. The search terms were: "statins", "perioperative morbidity", "perioperative mortality" and "vascular surgery". We excluded studies dealing with the effect of statins in cardiac surgery. Retrieved articles were manually searched. RESULTS Current evidence shows that statins decrease perioperative morbidity and mortality in patients undergoing non-cardiac vascular surgery. Any benefit probably occurs soon (within a month) after initiating treatment. CONCLUSIONS Appropriately designed trials need to confirm the beneficial effect of perioperative statin therapy in various patient categories. The optimal duration and dose of perioperative statin therapy should be defined.
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Affiliation(s)
- K I Paraskevas
- Department of Vascular Surgery, Athens University Medical School, Athens, Greece
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