1
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Wellens’ Syndrome from COVID-19 Infection Assessed by Enhanced Transthoracic Coronary Echo Doppler: A Case Report. Diagnostics (Basel) 2022; 12:diagnostics12040804. [PMID: 35453852 PMCID: PMC9029647 DOI: 10.3390/diagnostics12040804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 12/26/2022] Open
Abstract
Wellens’ syndrome (WS) is a preinfarction state caused by a sub-occlusion of the proximal left anterior descending coronary artery (LAD). In this case report, for the first time, we describe how this syndrome can be caused by COVID-19 infection and, most importantly, that it can be assessed bedside by enhanced transthoracic coronary echo Doppler (E-Doppler TTE). This seasoned technique allows blood flow Doppler to be recorded in the coronaries and at the stenosis site but has never been tested in an acute setting. Two weeks after clinical recovery from bronchitis allegedly caused by COVID-19 infection on the basis of epidemiologic criteria (no swab performed during the acute phase but only during recovery, at which time it was negative), our patient developed typical angina for the first time, mainly during effort but also at rest. He was admitted to our tertiary center, where pharyngeal swabs tested positive for COVID-19. A typical EKG finding supporting WS prompted an assessment of the left main coronary artery (LMCA) and the whole LAD blood flow velocity by E-Doppler TTE. Localized high velocity (transtenotic velocity) (100 cm/s) was recorded in the proximal LAD, with the reference velocity being 20 cm/s. This indicated severe stenosis with 90% area narrowing according to the continuity equation, as confirmed by coronary angiography. During follow-up after successful stenting, E-Doppler TTE showed a decrease in the transtenotic acceleration, confirming stent patency and a normal coronary flow reserve (3.2) and illustrating a normal microcirculatory function. Conclusion: COVID infection can trigger a coronary syndrome like WS. E-Doppler TTE, an ionizing radiation-free method, allows safe and rapid bedside management of the syndrome. This new strategy can be pivotal in distinguishing true WS from pseudo-WS. In cases of pseudo-WS, coronary angiography can be avoided. If E-Doppler TTE confirms the stenosis and PCI (percutaneous coronary intervention) is performed, the same method can allow assessment over time of the precise residual stenosis after stenting and verify the microvasculature status by evaluating coronary flow reserve.
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2
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Chen CC, Lin CH, Hao WR, Yeh JS, Chiang KH, Fang YA, Chiu CC, Yang TY, Wu YW, Liu JC. Influenza Vaccination and the Risk of Ventricular Arrhythmias in Patients With Chronic Obstructive Pulmonary Disease: A Population-Based Longitudinal Study. Front Cardiovasc Med 2021; 8:731844. [PMID: 34722665 PMCID: PMC8551488 DOI: 10.3389/fcvm.2021.731844] [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: 06/28/2021] [Accepted: 09/15/2021] [Indexed: 01/11/2023] Open
Abstract
Backgrounds: Influenza vaccination could decrease the risk of major cardiac events in patients with chronic obstructive pulmonary disease (COPD). However, the effects of the vaccine on decreasing the risk of ventricular arrhythmia (VA) development in such patients remain unclear. Methods: We retrospectively analyzed the data of 18,658 patients with COPD (≥55 years old) from the National Health Insurance Research Database from January 1, 2001, to December 31, 2012. After a 1:1 propensity score matching by the year of diagnosis, we divided the patients into vaccinated and unvaccinated groups. Time-varying Cox proportional hazards regression was applied to assess the time to event hazards of influenza vaccination exposure. Results: The risk of VA occurrence was significantly lower in the vaccinated group during influenza season and all seasons [adjusted hazard ratio (aHR): 0.62, 95% CI: 0.41-0.95; aHR: 0.69, 95% CI: 0.44-1.08; and aHR: 0.65, 95% CI: 0.48-0.89, in the influenza season, non-influenza season, and all seasons, respectively]. Among patients with CHA2DS2-VASc scores (conditions and characteristics included congestive heart failure, hypertension, diabetes, stroke, vascular disease, age, and sex) of 2-3, receiving one time and two to three times of influenza vaccination were associated with lower risk of VA occurrence in all seasons (aHR: 0.28, 95% CI: 0.10-0.80; aHR: 0.27, 95% CI: 0.10-0.68, respectively). Among patients without stroke, peripheral vascular disease, and diabetes, a lower risk of VA occurrence after receiving one and two to three times vaccination was observed in all seasons. Among patients with a history of asthma and patients without a history of heart failure, ischemic heart disease, angina hypertension, or renal failure, a significantly lower risk of VA occurrence was observed after the first time of vaccination in all seasons. Conclusions: Influenza vaccination may be associated with lower risks of VA among patients with COPD aged 55-74. Further investigation is still needed to resolve this clinical question.
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Affiliation(s)
- Chun-Chao Chen
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Hsin Lin
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Rui Hao
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jong-Shiuan Yeh
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
| | - Kuang-Hsing Chiang
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Yu-Ann Fang
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chih Chiu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Tsung Yeh Yang
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Yu-Wei Wu
- College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.,Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ju-Chi Liu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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3
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Buicu AL, Cernea S, Benedek I, Buicu CF, Benedek T. Systemic Inflammation and COVID-19 Mortality in Patients with Major Noncommunicable Diseases: Chronic Coronary Syndromes, Diabetes and Obesity. J Clin Med 2021; 10:jcm10081545. [PMID: 33916917 PMCID: PMC8067631 DOI: 10.3390/jcm10081545] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 02/07/2023] Open
Abstract
COVID-19 is currently considered an inflammatory disease affecting the entire organism. In severe forms, an augmented inflammatory response leads to the fulminant “cytokine storm”, which may result in severe multisystemic end-organ damage. Apart from the acute inflammatory response, it seems that chronic inflammation also plays a major role in the clinical evolution of COVID-19 patients. Pre-existing inflammatory conditions, such as those associated with chronic coronary diseases, type 2 diabetes mellitus or obesity, may be associated with worse clinical outcomes in the context of COVID-19 disease. These comorbidities are reported as powerful predictors of poor outcomes and death following COVID-19 disease. Moreover, in the context of chronic coronary syndrome, the cytokine storm triggered by SARS-CoV-2 infection may favor vulnerabilization and rupture of a silent atheromatous plaque, with consequent acute coronary syndrome, leading to a sudden deterioration of the clinical condition of the patient. This review aims to present the current status of knowledge regarding the link between COVID-19 mortality, systemic inflammation and several major diseases associated with poor outcomes, such as cardiovascular diseases, diabetes and obesity.
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Affiliation(s)
- Andreea-Luciana Buicu
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, 540139 Târgu Mureș, Romania;
| | - Simona Cernea
- Department M3/Internal Medicine I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, 38 Gheorghe Marinescu street, 540139 Târgu Mureș, Romania
- Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, 540136 Târgu Mureș, Romania
- Correspondence: or
| | - Imre Benedek
- Clinical Department of Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, 540139 Târgu Mureș, Romania; (I.B.); (T.B.)
- Clinic of Cardiology, Emergency County Clinical Hospital, 540136 Târgu Mureș, Romania
| | - Corneliu-Florin Buicu
- Public Health and Management Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, 540139 Târgu Mureș, Romania;
| | - Theodora Benedek
- Clinical Department of Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, 540139 Târgu Mureș, Romania; (I.B.); (T.B.)
- Clinic of Cardiology, Emergency County Clinical Hospital, 540136 Târgu Mureș, Romania
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4
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Kang Y, Fang XY, Wang D, Wang XJ. Factors associated with acute myocardial infarction in older patients after hospitalization with community-acquired pneumonia: a cross-sectional study. BMC Geriatr 2021; 21:113. [PMID: 33563232 PMCID: PMC7871537 DOI: 10.1186/s12877-021-02056-6] [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: 09/28/2020] [Accepted: 01/31/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) and acute myocardial infarction cardiovascular (AMI) are two important health issues in older patients. Little is known regarding characteristics of AMI in older patients hospitalized for CAP. Therefore, we investigated the prevalence, characteristics compared with younger patients, impact on clinical outcomes and risk factors of AMI during hospitalization for CAP in geriatric patients. METHODS Eleven thousand nine adult inpatients consisted of 5111 patients≥65 years and 5898 patients< 65 years in respiratory ward diagnosed with CAP were retrospectively analyzed by electronic medical records. RESULTS 159 (3.1%) older patients in respiratory ward experienced AMI during hospitalization for CAP. AMI were more frequently seen in patients≥65 years compared with patients< 65 years (3.1% vs. 1.0%). Patients≥65 years who experienced AMI during hospitalization for CAP had higher percentage of respiratory failure (P = 0.001), hypertension (P = 0.008), dyspnea (P = 0.046), blood urea nitrogen (BUN) ≥7 mmol/L (P < 0.001), serum sodium< 130 mmol/L (P = 0.005) and had higher in-hospital mortality compared to patients< 65 years (10.1% vs. 6.6%). AMI was associated with increased in-hospital mortality (odds ratio, OR, with 95% confidence interval: 1.49 [1.24-1.82]; P < 0.01). Respiratory failure (OR, 1.34 [1.15-1.54]; P < 0.01), preexisting coronary artery disease (OR, 1.31[1.07-1.59]; P = 0.02), diabetes (OR, 1.26 [1.11-1.42]; P = 0.02) and BUN (OR, 1.23 [1.01-1.49]; P = 0.04) were correlated with the occurrence of AMI in the older patients after hospitalization with CAP. CONCLUSIONS The incidence of AMI during CAP hospitalization in geriatric patients is notable and have an impact on in-hospital mortality. Respiratory failure, preexisting coronary artery disease, diabetes and BUN was associated with the occurrence of AMI in the older patients after hospitalization with CAP. Particular attention should be paid to older patients with risk factors for AMI.
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Affiliation(s)
- Yu Kang
- Department of Geriatric Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiang-Yang Fang
- Department of Geriatric Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Dong Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Juan Wang
- Department of Geriatric Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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5
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Possible Correlations between Atherosclerosis, Acute Coronary Syndromes and COVID-19. J Clin Med 2020; 9:jcm9113746. [PMID: 33233333 PMCID: PMC7700642 DOI: 10.3390/jcm9113746] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
An outbreak of SARS-CoV-2 infection in December 2019 became a major global concern in 2020. Since then, several articles analyzing the course, complications and mechanisms of the infection have appeared. However, there are very few papers explaining the possible correlations between COVID-19, atherosclerosis and acute coronary syndromes. We performed an analysis of PubMed, Cochrane, Google Scholar, and MEDLINE databases. As of September 15, 2020, the results were as follows: for "COVID-19" and "cardiovascular system" we obtained 687 results; for "COVID-19" and "myocardial infarction" together with "COVID-19" and "acute coronary syndrome" we obtained 328 results; for "COVID-19" and "atherosclerosis" we obtained 57 results. Some of them did not fulfill the search criteria or concerned the field of neurology. Only articles written in English, German and Polish were analyzed for a total number of 432 papers. While the link between inflammatory response, COVID- 19 and atherosclerosis still remains unclear, there is evidence that suggests a more likely correlation between them. Practitioners' efforts should be focused on the prevention of excessive inflammatory response and possible complications, while there are limited specific therapeutic options against SARS-CoV-2. Furthermore, special attention should be paid to cardioprotection during the pandemic.
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6
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Sheth AR, Grewal US, Patel HP, Thakkar S, Garikipati S, Gaddam J, Bawa D. Possible mechanisms responsible for acute coronary events in COVID-19. Med Hypotheses 2020; 143:110125. [PMID: 32763657 PMCID: PMC7371587 DOI: 10.1016/j.mehy.2020.110125] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 01/08/2023]
Abstract
The novel coronavirus (SARS-CoV-2) is primarily a respiratory pathogen and its clinical manifestations are dominated by respiratory symptoms, the most severe of which is acute respiratory distress syndrome (ARDS). However, COVID-19 is increasingly recognized to cause an overwhelming inflammatory response and cytokine storm leading to end organ damage. End organ damage to heart is one of the most severe complications of COVID-19 that increases the risk of death. We proposed a two-fold mechanism responsible for causing acute coronary events in patients with COVID-19 infection: Cytokine storm leading to rapid onset formation of new coronary plaques along with destabilization of pre-existing plaques and direct myocardial injury secondary to acute systemic viral infection. A well-coordinated immune response is the first line innate immunity against a viral infection. However, an uncoordinated response and hypersecretion of cytokines and chemokines lead to immune related damage to the human body. Human Coronavirus (HCoV) infection causes infiltration of inflammatory cells that cause excessive production of cytokines, proteases, coagulation factors, oxygen radicals and vasoactive molecules causing endothelial damage, disruption of fibrous cap and initiation of formation of thrombus. Systemic viral infections also cause vasoconstriction leading to narrowing of vascular lumen and stimulation of platelet activation via shear stress. The resultant cytokine storm causes secretion of hypercoagulable tissue factor without consequential increase in counter-regulatory pathways such as AT-III, activated protein C and plasminogen activator type 1. Lastly, influx of CD4+ T-cells in cardiac vasculature results in an increased production of cytokines that stimulate smooth muscle cells to migrate into the intima and generate collagen and other fibrous products leading to advancement of fatty streaks to advanced atherosclerotic lesions. Direct myocardial damage and cytokine storm leading to destabilization of pre-existing plaques and accelerated formation of new plaques are the two instigating mechanisms for acute coronary syndromes in COVID-19.
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Affiliation(s)
- Aakash R Sheth
- The Department of Internal Medicine, LSU Health Sciences Center, Shreveport, LA, United States.
| | - Udhayvir S Grewal
- The Department of Internal Medicine, LSU Health Sciences Center, Shreveport, LA, United States
| | - Harsh P Patel
- The Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, United States
| | - Samarthkumar Thakkar
- The Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States
| | - Subhash Garikipati
- The Department of Internal Medicine, LSU Health Sciences Center, Shreveport, LA, United States
| | - Jashwanth Gaddam
- The Department of Internal Medicine, LSU Health Sciences Center, Shreveport, LA, United States
| | - Danish Bawa
- The Department of Internal Medicine, LSU Health Sciences Center, Shreveport, LA, United States
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7
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Singh M, Khan K, Fisch E, Frey C, Mathias K, Jneid H, Musher DM, Barshes NR. Acute Cardiac Events in Patients With Severe Limb Infection. INT J LOW EXTR WOUND 2018; 17:261-267. [PMID: 30461325 DOI: 10.1177/1534734618810944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Recent studies have shown an association between infections, such as influenza, pneumonia, or bacteremia, and acute cardiac events. We studied the association between foot infection and myocardial infarction, arrhythmia, and/or congestive heart failure. We analyzed the records of 318 consecutive episodes of deep soft tissue infection, gangrene, and/or osteomyelitis in 274 patients referred to a vascular surgery service at a tertiary center. We identified 24 acute cardiac events in 21 of 318 (6.6%) episodes of foot infection or foot gangrene. These 24 events included 11 new myocardial infarctions (3.5%), 8 episodes of new onset or worsening congestive heart failure (2.5%), and 5 new arrhythmias (1.6%). Tachycardia and systemic inflammatory response syndrome were associated with acute cardiac events ( P < .05 for each). The 1-year survival of patients with acute cardiac events was 50.4%, significantly lower than the 91.7% 1-year survival of patients without acute cardiac events ( P < .0015). Acute cardiac complications are not uncommon among patients presenting with severe foot infection and are associated with a high 1-year mortality. Primary care physicians, cardiologists, and vascular and orthopedic surgeons must keep a high index of suspicion for the occurrence of an acute cardiac event.
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Affiliation(s)
| | | | - Evan Fisch
- 2 Baylor College of Medicine, Houston, TX, USA
| | | | | | - Hani Jneid
- 2 Baylor College of Medicine, Houston, TX, USA.,3 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Daniel M Musher
- 2 Baylor College of Medicine, Houston, TX, USA.,3 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Neal R Barshes
- 2 Baylor College of Medicine, Houston, TX, USA.,3 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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8
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Poulsen AH, Raaschou-Nielsen O, Peña A, Hahmann AN, Nordsborg RB, Ketzel M, Brandt J, Sørensen M. Short-term nighttime wind turbine noise and cardiovascular events: A nationwide case-crossover study from Denmark. ENVIRONMENT INTERNATIONAL 2018; 114:160-166. [PMID: 29505969 DOI: 10.1016/j.envint.2018.02.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/01/2018] [Accepted: 02/17/2018] [Indexed: 06/08/2023]
Abstract
AIMS The number of people exposed to wind turbine noise (WTN) is increasing. WTN is reported as more annoying than traffic noise at similar levels. Long-term exposure to traffic noise has consistently been associated with cardiovascular disease, whereas effects of short-term exposure are much less investigated due to little day-to-day variation of e.g. road traffic noise. WTN varies considerably due to changing weather conditions allowing investigation of short-term effects of WTN on cardiovascular events. METHODS AND RESULTS We identified all hospitalisations and deaths from stroke (16,913 cases) and myocardial infarction (MI) (17,559 cases) among Danes exposed to WTN between 1982 and 2013. We applied a time-stratified, case-crossover design. Using detailed data on wind turbine type and hourly wind data at each wind turbine, we simulated mean nighttime outdoor (10-10,000 Hz) and nighttime low frequency (LF) indoor WTN (10-160 Hz) over the 4 days preceding diagnosis and reference days. For indoor LF WTN between 10 and 15 dB(A) and above 15 dB(A), odds ratios (ORs) for MI were 1.27 (95% confidence interval (CI): 0.97-1.67; cases = 198) and 1.62 (95% CI: 0.76-3.45; cases = 21), respectively, when compared to indoor LF WTN below 5 dB(A). For stroke, corresponding ORs were 1.17 (95% CI: 0.95-1.69; cases = 166) and 2.30 (95% CI: 0.96-5.50; cases = 15). The elevated ORs above 15 dB(A) persisted across sensitivity analyses. When looking at specific lag times, noise exposure one day before MI events and three days before stroke events were associated with the highest ORs. For outdoor WTN at night, we observed both increased and decreased risk estimates. CONCLUSION This study did not provide conclusive evidence of an association between WTN and MI or stroke. It does however suggest that indoor LF WTN at night may trigger cardiovascular events, whereas these events seemed largely unaffected by nighttime outdoor WTN. These findings need reproduction, as they were based on few cases and may be due to chance.
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Affiliation(s)
- Aslak Harbo Poulsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.
| | - Ole Raaschou-Nielsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Alfredo Peña
- DTU Wind Energy, Technical University of Denmark, Roskilde, Denmark
| | - Andrea N Hahmann
- DTU Wind Energy, Technical University of Denmark, Roskilde, Denmark
| | | | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
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9
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Ding Y, Pedersen ER, Svingen GF, Helgeland Ø, Gregory JF, Løland KH, Meyer K, Tell GS, Ueland PM, Nygård OK. Methylenetetrahydrofolate Dehydrogenase 1 Polymorphisms Modify the Associations of Plasma Glycine and Serine With Risk of Acute Myocardial Infarction in Patients With Stable Angina Pectoris in WENBIT (Western Norway B Vitamin Intervention Trial). ACTA ACUST UNITED AC 2016; 9:541-547. [DOI: 10.1161/circgenetics.116.001483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 10/21/2016] [Indexed: 02/07/2023]
Abstract
Background—
Serine and glycine interconversion and methylenetetrahydrofolate dehydrogenase 1 (MTHFD1)–mediated 1-carbon transfer are the major sources of methyl groups for 1-carbon metabolism. Recently, plasma glycine and a common polymorphism in MTHFD1 have been associated with risk of acute myocardial infarction (AMI). It is, therefore, of interest to explore if these 2 pathways interact in relation to AMI.
Methods and Results—
A total of 2571 participants in the WENBIT (Western Norway B Vitamin Intervention Trial) undergoing coronary angiography for stable angina pectoris were studied. Associations of plasma serine and glycine concentrations with risk of AMI across 2 common and functional MTHFD1 polymorphisms (
rs2236225
and
rs1076991
) were explored in Cox regression models. During a median follow-up of 4.7 years, 212 patients (8.2%) experienced an AMI. In age- and sex-adjusted analyses, plasma glycine (
P
<0.01), but not serine (
P
=0.52), showed an overall association with AMI. However, interactions of MTHFD1
rs2236225
polymorphism with both plasma serine and glycine were observed (
P
interaction
=0.03 for both). Low plasma serine and glycine were associated with an increased risk of AMI among patients carrying the
rs2236225
minor A allele. Similarly, low plasma glycine showed stronger risk relationship with AMI in the
rs1076991
CC genotype carriers but weaker associations in patients carrying the minor T allele (
P
interaction
=0.02).
Conclusions—
Our results showed that 2 common and functional polymorphisms in the
MTHFD1
gene modulate the risk associations of plasma serine and glycine with AMI. These findings emphasize the possible role of the MTHFD1 in regulating serine and glycine metabolism in relation to atherosclerotic complications.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique Identifier: NCT00354081.
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Affiliation(s)
- Yunpeng Ding
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Eva R. Pedersen
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Gard F.T. Svingen
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Øyvind Helgeland
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Jesse F. Gregory
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Kjetil H. Løland
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Klaus Meyer
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Grethe S. Tell
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Per M. Ueland
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Ottar K. Nygård
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
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10
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Ding YP, Pedersen EKR, Johansson S, Gregory JF, Ueland PM, Svingen GFT, Helgeland Ø, Meyer K, Fredriksen Å, Nygård OK. B vitamin treatments modify the risk of myocardial infarction associated with a MTHFD1 polymorphism in patients with stable angina pectoris. Nutr Metab Cardiovasc Dis 2016; 26:495-501. [PMID: 26803590 DOI: 10.1016/j.numecd.2015.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/24/2015] [Accepted: 12/15/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Methylenetetrahydrofolate dehydrogenase (MTHFD1) catalyzes three sequential reactions that metabolize derivatives of tetrahydrofolate (THF) in folate-dependent one-carbon metabolism. Impaired MTHFD1 flux has been linked to disturbed lipid metabolism and oxidative stress. However, limited information is available on its relation to the development of atherothrombotic cardiovascular disease. METHODS AND RESULTS We explored the association between a MTHFD1 polymorphism (rs1076991 C > T) and acute myocardial infarction (AMI), and potential effect modifications by folic acid/B12 and/or vitamin B6 treatment in suspected stable angina pectoris patients (n = 2381) participating in the randomized Western Norway B Vitamin Intervention Trial (WENBIT). During the median follow-up of 4.9 years 204 participants (8.6%) suffered an AMI. After adjusting for established CVD risk factors, the MTHFD1 polymorphism was significantly associated with AMI (HR: 1.49; 95% CI, 1.23-1.81). A similar association was observed among patients allocated to treatment with vitamin B6 alone (HR: 1.53; 95% CI, 1.01-2.31), and an even stronger relationship was seen in patients treated with both vitamin B6 and folic acid/B12 (HR: 2.35; 95% CI, 1.55-3.57). However, no risk association between the MTHFD1 polymorphism and AMI was seen in patients treated with placebo (HR: 1.29; 95% CI, 0.86-1.93) or folic acid/B12 (1.17; 95% CI, 0.83-1.65). CONCLUSION A common and functional MTHFD1 polymorphism is associated with increased risk of AMI, although the risk seems to be dependent on specific B vitamin treatment. Further studies are warranted to elucidate the possible mechanisms, also in order to explore potential effect modifications by nutritional factors.
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Affiliation(s)
- Y P Ding
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway.
| | - E K R Pedersen
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
| | - S Johansson
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway; Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen 5021, Norway
| | - J F Gregory
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| | - P M Ueland
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway; Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen 5021, Norway
| | - G F T Svingen
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
| | - Ø Helgeland
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
| | - K Meyer
- Bevital AS, Bergen 5020, Norway
| | - Å Fredriksen
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
| | - O K Nygård
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen 5021, Norway; KG Jebsen Center for Diabetes Research, Haukeland University Hospital, Bergen 5021, Norway
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11
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White H. Targeting Therapy to the Fibrin-Mediated Pathophysiology of Acute Coronary Syndrome. Clin Appl Thromb Hemost 2013; 20:516-23. [DOI: 10.1177/1076029612472551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Acute coronary syndrome (ACS) encompasses a spectrum of diseases, ranging from ST-elevation myocardial infarction to non-ST-elevation myocardial infarction and unstable angina. A key initiating event in the pathology of ACS is atheromatous plaque disruption, in which the exposure of thrombogenic material triggers simultaneous activation of primary and secondary hemostatic pathways. Targeting platelet-mediated thrombus formation with dual antiplatelet therapy comprising acetylsalicylic acid and a P2Y12 antagonist is the current mainstay for management of ACS. However, a significant proportion of patients remain at risk of cardiovascular events. Fibrin is an important contributor to thrombogenesis and may account for the residual event rates. This review examines evidence for the role of the coagulation cascade in thrombus formation in ACS, which provides a rationale for the use of anticoagulation therapy. The current status of research with novel oral anticoagulants in combination with dual antiplatelet therapy for the secondary prevention of ACS is also discussed.
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Affiliation(s)
- Harvey White
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
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12
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Bazaz R, Marriott HM, Francis SE, Dockrell DH. Mechanistic links between acute respiratory tract infections and acute coronary syndromes. J Infect 2013; 66:1-17. [DOI: 10.1016/j.jinf.2012.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 09/22/2012] [Accepted: 09/26/2012] [Indexed: 12/27/2022]
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13
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Correlation of Coronary Plaque Phenotype and Carotid Atherosclerotic Plaque Composition. Am J Med Sci 2011; 342:480-5. [DOI: 10.1097/maj.0b013e31821caa88] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Gambardella I, Blair PH, McKinley A, Baker R, Harkin DW. Triglyceride to HDL ratio is a reliable predictor of adverse outcomes in risk stratification for candidates undergoing abdominal aortic surgery. Eur J Vasc Endovasc Surg 2010; 41:249-55. [PMID: 21183369 DOI: 10.1016/j.ejvs.2010.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 07/24/2010] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to establish if an elevated triglyceride to high-density lipoprotein (HDL) ratio (THR) is not only a risk factor for cardiovascular and overall morbidity as the updated evidence shows, but could also be employed as a significant predictor for surgical adverse outcomes and hence be a valid tool for risk stratification of candidates undergoing abdominal aortic surgery. METHODS This is a single-centre retrospective analysis of 2224 patients who underwent open abdominal aortic surgery between January 1996 and 2009. This cohort was divided into quartiles of THR. A list of covariates has been entered with THR into a multiple logistic model with forwards stepwise selection. The obtained result is an adjusted model, conceived to establish the association between THR and perioperative adverse events. Discrimination of the model so obtained and comparison with vascular-specific risk stratification scoring systems were evaluated using the area under the receiver operating characteristic (AUROC). RESULTS THR had the highest predictive value for the outcomes of interest. The adjusted odds ratios (ORs) per every 0.1 augmentation of THR were 1.41 (1.08-1.88) for cardiac, 1.38 (1.09-1.84) for respiratory, 1.27 (1.06-1.54) for renal adverse events and 1.02 (0.84-1.23) for mortality. Regarding mortality, either of the scoring systems Vascular Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and customised probability index (CPI) and the THR ranked as moderate discriminators, with THR performing the worst (AUROC 0.71) compared with Vascular POSSUM (AUROC 0.76) and CPI (AUROC 0.78). THR performed as a very strong predictor of morbidity (AUROC 0.86), ranking above Vascular POSSUM (AUROC 0.72). CONCLUSIONS THR is a significant predictor of perioperative morbidity and mortality. THR offers a broad outlook on the metabolic state of patients undergoing major abdominal aortic surgery and hence their propensity to adverse events, allowing us to risk-stratify the prognostic outcome of surgical intervention and possibly intervene preoperatively to optimise results.
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Affiliation(s)
- I Gambardella
- Department of Vascular and Endovascular Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA,United Kingdom.
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15
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Corrales-Medina VF, Madjid M, Musher DM. Role of acute infection in triggering acute coronary syndromes. THE LANCET. INFECTIOUS DISEASES 2010; 10:83-92. [PMID: 20113977 DOI: 10.1016/s1473-3099(09)70331-7] [Citation(s) in RCA: 315] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Acute coronary syndromes are a leading cause of morbidity and mortality worldwide. The mechanisms underlying the triggering of these events are diverse and include increased coronary and systemic inflammatory activity, dominant prothrombotic conditions, increased biomechanical stress on coronary arteries, variations in the coronary arterial tone, disturbed haemodynamic homoeostasis, and altered myocardial metabolic balance. There is experimental evidence that acute infections can promote the development of acute coronary syndromes, and clinical data strongly support a role for acute infections in triggering these events. In our Review, we summarise the pathogenesis of coronary artery disease and present the evidence linking acute infections with the development of acute coronary syndromes. Greater awareness of this association is likely to encourage research into ways of protecting patients who are at high risk.
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