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Rodrigues AF, Bader M. The contribution of the AT1 receptor to erythropoiesis. Biochem Pharmacol 2023; 217:115805. [PMID: 37714274 DOI: 10.1016/j.bcp.2023.115805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023]
Abstract
The renin-angiotensin system (RAS) comprises a broad set of functional peptides and receptors that play a role in cardiovascular homeostasis and contribute to cardiovascular pathologies. Angiotensin II (Ang II) is the most potent peptide hormone produced by the RAS due to its high abundance and its strong and pleiotropic impact on the cardiovascular system. Formation of Ang II takes place in the bloodstream and additionally in tissues in the so-called local RAS. Of the two Ang II receptors (AT1 and AT2) that Ang II binds to, AT1 is the most expressed throughout the mammalian body. AT1 expression is not restricted to cells of the cardiovascular system but in fact AT1 protein is found in nearly all organs, hence, Ang II takes part in several modulatory physiological processes one of which is erythropoiesis. In this review, we present multiple evidence supporting that Ang II modulates physiological and pathological erythropoiesis processes trough the AT1 receptor. Cumulative evidence indicates that Ang II by three distinct mechanisms influences erythropoiesis: 1) stimulation of renal erythropoietin synthesis; 2) direct action on bone marrow precursor cells; and 3) modulation of sympathetic nerve activity to the bone marrow. The text highlights clinical and preclinical evidence focusing on mechanistic studies using rodent models.
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Affiliation(s)
- André F Rodrigues
- Max Delbrück Center (MDC), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany.
| | - Michael Bader
- Max Delbrück Center (MDC), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany; Charité Universitätsmedizin Berlin, Berlin, Germany; Institute for Biology, University of Lübeck, Lübeck, Germany.
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Nakhaie S, Yazdani R, Shakibi M, Torabian S, Pezeshki S, Bazrafshani MS, Azimi M, Salajegheh F. The effects of antihypertensive medications on severity and outcomes of hypertensive patients with COVID-19. J Hum Hypertens 2023; 37:511-518. [PMID: 35790875 PMCID: PMC9255835 DOI: 10.1038/s41371-022-00716-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/19/2022] [Accepted: 06/14/2022] [Indexed: 02/03/2023]
Abstract
In Covid-19 pandemic, specific comorbidities are associated with the increased risk of worse outcomes and increased severity of lung injury and mortality. the aim of this study was to investigate the effects of antihypertensive medications on the severity and outcomes of hypertensive patients with COVID-19. This retrospective observational study conducted on patients with COVID-19 who referred to Afzalipour Hospital, Kerman, Iran during the six months from 19 February 2020 to 20 July 2020. The data were collected through medical chart reviews. We assessed 265 patients with Covid-19 and they stratified based on hypertension and type of antihypertension medications. The data were described and Student's t-test, Mann-Whitney U and Fisher exact test were run to compare the patients 'demographical and clinical information. The qualitative variables were compared using the by SPSS software version 23. The results of the present study showed that hypertension was a prevalent comorbidity among patients with COVID-19 and hypertensive patients compared to other patients without any comorbidity who were older (P-value: 0.03). The oxygen saturation was higher for the patients in the control group than hypertensive patients (P-value: 0.01). The severity of COVID-19 and its outcome were not different between the patients who took or did not take antihypertensive medications and also the type of antihypertensive medications. Hypertensive patients did not show any significant difference in survival, hospital stay, ICU admission, disease severity, and invasive medical ventilation in other normotensive patients with COVID-19.
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Affiliation(s)
- Samira Nakhaie
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Rostam Yazdani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammadreza Shakibi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheila Torabian
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Pezeshki
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Maliheh Sadat Bazrafshani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Azimi
- Department of Traditional Medicine, School of Traditional Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Faranak Salajegheh
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
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3
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Takeuchi S, Takahashi Y, Asai S. Comparison of pleiotropic effects of statins vs fibrates on laboratory parameters in patients with dyslipidemia: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e23427. [PMID: 33327270 PMCID: PMC7738156 DOI: 10.1097/md.0000000000023427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Differences in the mechanism of action and potential pleiotropic effects between statins and fibrates would potentially drive a different effect on various laboratory parameters, but this remains controversial because of a paucity of reports comparing them. Therefore, the aim of this study was to compare the effects of statins and fibrates on laboratory parameters in Japanese patients in routine clinical practice.This retrospective cohort study included patients with dyslipidemia who had been newly treated with statin or fibrate monotherapy between January 2005 and December 2017. Patients were randomly matched into two sets of pairs by sex, age, and baseline triglyceride (TG) or low-density lipoprotein (LDL) cholesterol level. The 830 patients in TG-matched pairs (415 fibrate users and 415 matched statin users) and 1172 patients in LDL cholesterol-matched pairs (586 fibrate users and 586 matched statin users) were included in this study. Generalized estimating equations were used to estimate the effects of the drugs on serum creatinine level, estimated glomerular filtration rate (eGFR), urea nitrogen, hemoglobin A1c, aspartate aminotransferase, and alanine aminotransferase (ALT), in addition to LDL cholesterol and TG levels, and red blood cell (RBC) and platelet (PLT) counts, up to 12 months after the start of study drug administration.In TG-matched pairs, the increases in creatinine and urea nitrogen levels (P = .010 and P < .001, respectively) and the decreases in eGFR, ALT level and RBC count (P < .001, P = .003, and P = .014, respectively) were greater in fibrate users than in statin users. The decrease in PLT count was greater in statin users than in fibrate users (P < .001). The mean changes in aspartate aminotransferase and hemoglobin A1c levels were not significantly different between statin users and fibrate users. In LDL cholesterol-matched pairs, the differences in changes of all laboratory parameter levels between statin users and fibrate users were similar to those in TG-matched pairs.We demonstrate here that fibrates have a greater effect of increasing creatinine and urea nitrogen levels and of reducing eGFR, ALT level, and RBC count than statins, and that the lowering effect on PLT count is greater with statins than with fibrates.
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Affiliation(s)
- Satoshi Takeuchi
- Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine
| | - Yasuo Takahashi
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, 30-1 Oyaguchi-Kami Machi, Itabashi-ku, Tokyo, Japan
| | - Satoshi Asai
- Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine
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Wang X, Zhao W, Ke J, Zhao D. Comparison and analyses of therapeutic effects between metabolic management center (MMC) and conventional management modes. Acta Diabetol 2020; 57:1049-1056. [PMID: 32248347 DOI: 10.1007/s00592-020-01518-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
AIMS The past 3 decades witnessed the rapid growth of diabetes in China. To better serve large numbers of patients, the Chinese Medical Doctor Association launched metabolic management center (MMC) program which is featured with a one-stop and comprehensive diabetes management mode in 2016. It is worth exploring whether MMC model is better than conventional models in management. METHODS In this study, 228 patients with type 2 diabetes were recruited, and 193 patients completed the study. Therapeutic effects and health care costs were analyzed. RESULTS AND CONCLUSIONS Our results showed that decreases in HbA1C and TG/HDL-C values were significantly greater in the MMC group than in the control group. The increase in HDL-C was significantly higher in the MMC group than in the control group. The percentage of patients whose HbA1C lower than 7% was significantly higher in the MMC group. The results of the UKPDS model simulation showed that within 30 years, with the slight increases in treatment costs, the average life expectancy and total QALE of the MMC group are higher than those of the control group by 0.61 and 0.51 year, respectively. Further study showed that the drug intervention in the MMC group was significantly stronger. In addition, the questionnaires revealed that MMC group performed better in diabetes knowledge tests and have higher patient satisfaction rates of medical services. More patients in the MMC group adopted a more favorable diet strategy. These advantages enable MMC to achieve more short-term and long-term benefits in diabetes treatment than conventional mode.
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Affiliation(s)
- Xiaojing Wang
- Beijing Key Laboratory of Diabetes Mellitus Prevention and Research, Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, 113 Xinhua South Road, Tongzhou District, Beijing City, 101100, China
| | - Wenying Zhao
- Beijing Key Laboratory of Diabetes Mellitus Prevention and Research, Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, 113 Xinhua South Road, Tongzhou District, Beijing City, 101100, China
| | - Jing Ke
- Beijing Key Laboratory of Diabetes Mellitus Prevention and Research, Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, 113 Xinhua South Road, Tongzhou District, Beijing City, 101100, China
| | - Dong Zhao
- Beijing Key Laboratory of Diabetes Mellitus Prevention and Research, Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, 113 Xinhua South Road, Tongzhou District, Beijing City, 101100, China.
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Greenhall GHB, Mansfield KE, Nitsch D, Iwagami M, Leyrat C, Johnston R, Smeeth L, Tomlinson LA. The effect of initiation of renin-angiotensin system inhibitors on haemoglobin: A national cohort study. Br J Clin Pharmacol 2020; 87:622-631. [PMID: 32530524 DOI: 10.1111/bcp.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022] Open
Abstract
AIMS To determine whether initiation of treatment with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARBs) is associated with a subsequent reduction in haemoglobin in the general population. METHODS We undertook a national cohort study over a 13-year period (2004-2016), using routine primary healthcare data from the UK Clinical Practice Research Datalink. We compared ACEI/ARB initiation with calcium channel blocker (CCB) initiation, to minimise confounding by indication. We included all first ACEI/ARB or CCB prescriptions in adults with at least 1 haemoglobin result in the 12 months before and 6 months after drug initiation. Our primary outcome was a ≥1 g/dL haemoglobin reduction in the 6 months after drug initiation. RESULTS We examined 146 610 drug initiation events in 136 655 patients. Haemoglobin fell by ≥1 g/dL after drug initiation in 19.5% (16 936/86 652) of ACEI/ARB initiators and 15.9% (9521/59 958) of CCB initiators. The adjusted odds ratio of a ≥1 g/dL haemoglobin reduction in ACEI/ARB initiators vs CCB initiators was 1.15 (95% confidence interval 1.12-1.19). CONCLUSION ACEI/ARBs are associated with a modest increase in the risk of a haemoglobin reduction. For every 100 patients in our study that initiated a CCB, 16 experienced a ≥1 g/dL haemoglobin decline. If the effect is causal, 3 additional patients would have experienced this outcome if they had received an ACEI/ARB. This may have implications for drug choice and monitoring for many patients in primary care. Further research could identify patients at higher risk of this outcome, who may benefit from closer monitoring.
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Affiliation(s)
- George H B Greenhall
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Clémence Leyrat
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosalynd Johnston
- Department of Haematology, Brighton and Sussex Universities Hospital NHS Trust, Brighton, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Laurie A Tomlinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Yamazaki K, Takahashi Y, Teduka K, Nakayama T, Nishida Y, Asai S. Assessment of effect modification of statins on new-onset diabetes based on various medical backgrounds: a retrospective cohort study. BMC Pharmacol Toxicol 2019; 20:34. [PMID: 31138326 PMCID: PMC6540416 DOI: 10.1186/s40360-019-0314-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/20/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the association between statin use and new-onset diabetes in clinical settings and to assess its effect modification (heterogeneity) among patients with various medical histories and current medications. METHODS In a total of 12,177 Japanese patients without diabetes, from December 2004 to November 2012, we identified 500 statin users and 500 matched non-users using propensity-score matching. Patients were followed until December 2017. We estimated the hazard ratios of new-onset diabetes associated with statin use. We also tested the heterogeneity of the treatment effect by evaluating subgroup interactions in subgroups according to sex, age, medical history, and current medication. RESULTS New-onset diabetes had occurred in 71 patients (13.6%) with statin use and 43 patients (8.3%) with non-use at 5 years (hazard ratio, 1.66; 95% confidence interval [CI], 1.11 to 2.48; P = 0.0143), and in 78 patients (15.6%) with statin use and 48 patients (9.6%) with non-use at 10 years (hazard ratio, 1.61; 95% CI, 1.10 to 2.37; P = 0.0141). There were no significant treatment-by-subgroup interactions in all subgroups defined according to sex, age, medical history, and current medication. CONCLUSIONS In patients with various clinical backgrounds, those who received statin therapy had a higher risk of new-onset diabetes at 5 and 10 years than those who did not receive it. Effect modification of statins on new-onset diabetes was not found in patient populations defined according to various comorbid diseases or concomitant drugs.
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Affiliation(s)
- Keiko Yamazaki
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, 30-1 Oyaguchi-Kami Machi, Itabashi-ku, Tokyo, 173-8610 Japan
| | - Yasuo Takahashi
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, 30-1 Oyaguchi-Kami Machi, Itabashi-ku, Tokyo, 173-8610 Japan
| | - Kotoe Teduka
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, 30-1 Oyaguchi-Kami Machi, Itabashi-ku, Tokyo, 173-8610 Japan
| | - Tomohiro Nakayama
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kami Machi, Itabashi-ku, Tokyo, 173-8610 Japan
| | - Yayoi Nishida
- Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kami Machi, Itabashi-ku, Tokyo, 173-8610 Japan
| | - Satoshi Asai
- Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kami Machi, Itabashi-ku, Tokyo, 173-8610 Japan
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Araújo VDO, Andreotti CEL, Reis MDP, de Lima DA, Pauli KB, Nunes BC, Gomes C, Germano RDM, Cardozo Junior EL, Gasparotto Junior A, Lourenço ELB. 90-Day Oral Toxicity Assessment of Tropaeolum majus L. in Rodents and Lagomorphs. J Med Food 2018; 21:823-831. [PMID: 29565700 DOI: 10.1089/jmf.2017.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tropaeolum majus L., popularly known as nasturtium, is a species widely used in the form of infusions and salads. In the last years, the antihypertensive, diuretic, and calcium and potassium sparing activities of T. majus preparations were shown. Moreover, no preclinical 90-day oral toxicity studies were conducted. Thus, this study evaluated the toxicity of the hydroethanolic extract obtained from T. majus (HETM) leaves in female and male mice, rats, and rabbits. Swiss mice and Wistar rats were treated with HETM (75, 375, and 750 mg/kg). The doses of rabbits (30, 150, and 300 mg/kg) were calculated by allometric extrapolation. The control groups received vehicle. The animals were orally treated, daily, for 90 days. At the end, the animals were anesthetized, and body weight gain, relative weight of liver, kidney, and spleen, and histopathological changes were evaluated. Serum hematological and biochemical parameters were also analyzed. No alterations were found in body and organ weights or in histopathological and biochemical evaluation. Hematological analyses revealed small changes in lymphocytes and neutrophil counts in rats after administration of 750 mg/kg of HETM. These results showed that 90-day use of T. majus is safe in rodents and lagomorphs.
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Affiliation(s)
| | | | - Michelle de Paula Reis
- 1 Laboratory of Preclinical Research of Natural Products, Paranaense University , Umuarama, Paraná, Brazil
| | - Daniely Alves de Lima
- 1 Laboratory of Preclinical Research of Natural Products, Paranaense University , Umuarama, Paraná, Brazil
| | - Karoline Bach Pauli
- 1 Laboratory of Preclinical Research of Natural Products, Paranaense University , Umuarama, Paraná, Brazil
| | - Bruna Caroline Nunes
- 1 Laboratory of Preclinical Research of Natural Products, Paranaense University , Umuarama, Paraná, Brazil
| | - Caroline Gomes
- 2 Laboratory of Reproductive Toxicology, Department of Pharmacology, Federal University of Paraná , Curitiba, Paraná, Brazil
| | | | | | - Arquimedes Gasparotto Junior
- 4 Laboratory of Electrophysiology and Cardiovascular Pharmacology, Faculty of Health Sciences, Federal University of Grande Dourados , Dourados, Mato Grosso do Sul, Brazil
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Mohn ES, Kern HJ, Saltzman E, Mitmesser SH, McKay DL. Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics 2018; 10:E36. [PMID: 29558445 PMCID: PMC5874849 DOI: 10.3390/pharmaceutics10010036] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/18/2022] Open
Abstract
The long-term use of prescription and over-the-counter drugs can induce subclinical and clinically relevant micronutrient deficiencies, which may develop gradually over months or even years. Given the large number of medications currently available, the number of research studies examining potential drug-nutrient interactions is quite limited. A comprehensive, updated review of the potential drug-nutrient interactions with chronic use of the most often prescribed medications for commonly diagnosed conditions among the general U.S. adult population is presented. For the majority of the interactions described in this paper, more high-quality intervention trials are needed to better understand their clinical importance and potential consequences. A number of these studies have identified potential risk factors that may make certain populations more susceptible, but guidelines on how to best manage and/or prevent drug-induced nutrient inadequacies are lacking. Although widespread supplementation is not currently recommended, it is important to ensure at-risk patients reach their recommended intakes for vitamins and minerals. In conjunction with an overall healthy diet, appropriate dietary supplementation may be a practical and efficacious way to maintain or improve micronutrient status in patients at risk of deficiencies, such as those taking medications known to compromise nutritional status. The summary evidence presented in this review will help inform future research efforts and, ultimately, guide recommendations for patient care.
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Affiliation(s)
- Emily S Mohn
- Jean Mayer USDA Human Nutrition Research Center on Aging, and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | - Hua J Kern
- Nutrition & Scientific Affairs, Nature's Bounty Co., Ronkonkoma, NY 11779, USA.
| | - Edward Saltzman
- Jean Mayer USDA Human Nutrition Research Center on Aging, and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | - Susan H Mitmesser
- Nutrition & Scientific Affairs, Nature's Bounty Co., Ronkonkoma, NY 11779, USA.
| | - Diane L McKay
- Jean Mayer USDA Human Nutrition Research Center on Aging, and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
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Ramanathan N, Tan E, Loh LJ, Soh BS, Yap WN. Tocotrienol is a cardioprotective agent against ageing-associated cardiovascular disease and its associated morbidities. Nutr Metab (Lond) 2018; 15:6. [PMID: 29387138 PMCID: PMC5775572 DOI: 10.1186/s12986-018-0244-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/15/2018] [Indexed: 02/07/2023] Open
Abstract
Ageing is a nonmodifiable risk factor that is linked to increased likelihood of cardiovascular morbidities. Whilst many pharmacological interventions currently exist to treat many of these disorders such as statins for hypercholesterolemia or beta-blockers for hypertension, the elderly appear to present a greater likelihood of suffering non-related side effects such as increased risk of developing new onset type 2 diabetes (NODM). In some cases, lower efficacy in the elderly have also been reported. Alternative forms of treatment have been sought to address these issues, and there has been a growing interest in looking at herbal remedies or plant-based natural compounds. Oxidative stress and inflammation are implicated in the manifestation of ageing-related cardiovascular disease. Thus, it is natural that a compound that possesses both antioxidative and anti-inflammatory bioactivities would be considered. This review article examines the potential of tocotrienols, a class of Vitamin E compounds with proven superior antioxidative and anti-inflammatory activity compared to tocopherols (the other class of Vitamin E compounds), in ameliorating ageing-related cardiovascular diseases and its associated morbidities. In particular, the potential of tocotrienols in improving inflammaging, dyslipidemia and mitochondrial dysfunction in ageing-related cardiovascular diseases are discussed.
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Affiliation(s)
- Nardev Ramanathan
- Department of R&D, Davos Life Science Pte Ltd, 3 Biopolis Drive, #04-19, Davos, 138623 Singapore
- Department of R&D, Level 8, Menara KLK 1,Jalan Pju 7/6,Mutiara Damansara, 47810, 47800 Petaling Jaya, Selangor Malaysia
| | - Esther Tan
- Disease Modeling and Therapeutics Laboratory, Institute of Molecular and Cell Biology, 61 Biopolis Drive Proteos, Singapore, 138673 Singapore
| | - Li Jun Loh
- Disease Modeling and Therapeutics Laboratory, Institute of Molecular and Cell Biology, 61 Biopolis Drive Proteos, Singapore, 138673 Singapore
| | - Boon Seng Soh
- Disease Modeling and Therapeutics Laboratory, Institute of Molecular and Cell Biology, 61 Biopolis Drive Proteos, Singapore, 138673 Singapore
- Department of Biological Sciences, National University of Singapore, Singapore, 117543 Singapore
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 China
| | - Wei Ney Yap
- Department of R&D, Davos Life Science Pte Ltd, 3 Biopolis Drive, #04-19, Davos, 138623 Singapore
- Department of R&D, Level 8, Menara KLK 1,Jalan Pju 7/6,Mutiara Damansara, 47810, 47800 Petaling Jaya, Selangor Malaysia
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10
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Nishida Y, Takahashi Y, Tezuka K, Takeuchi S, Nakayama T, Asai S. A Comparative Effectiveness Study of Renal Parameters Between Imidapril and Amlodipine in Patients with Hypertension: A Retrospective Cohort Study. Cardiol Ther 2017; 6:69-80. [PMID: 28044266 PMCID: PMC5446813 DOI: 10.1007/s40119-016-0080-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Indexed: 01/13/2023] Open
Abstract
Introduction Imidapril is an angiotensin converting enzyme inhibitor (ACEI) that is frequently used as an antihypertensive drug in Japan. Although ACEIs are known to have adverse effects of decreasing glomerular filtration rate (GFR) and causing hyperkalemia, there are very few clinical data on the long-term effect of imidapril on glomerular function. We conducted a retrospective cohort study using a clinical database to evaluate and compare the long-term effects of imidapril and amlodipine on renal parameters in Japanese hypertensive patients in routine clinical practice. Methods We identified cohorts of new users of imidapril (n = 57) and a propensity score-matched group with an equal number of new users of amlodipine (n = 57). We used a multivariable regression model to evaluate and compare the effects of the drugs on laboratory parameters including serum levels of creatinine, potassium, sodium, blood urea nitrogen, and estimated GFR (eGFR) between imidapril users and amlodipine users up to 12 months after the initiation of study drug administration. The mean exposure of imidapril and amlodipine was 226.2 and 235.2 days, respectively. Results We found a significant increase of serum creatinine and potassium levels and a decrease of eGFR in imidapril users from the baseline period to the exposure period. The reduction of eGFR and the increase of serum creatinine and potassium levels in imidapril users were significantly greater than those in amlodipine users. Conclusions Our study showed that imidapril decreased eGFR and increases the serum levels of creatinine and potassium compared with amlodipine, at least during 1 year of administration.
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Affiliation(s)
- Yayoi Nishida
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Takahashi
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Kotoe Tezuka
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Satoshi Takeuchi
- Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tomohiro Nakayama
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
- Division of Companion Diagnostics, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Satoshi Asai
- Division of Pharmacology, Department of Biomedical Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
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Ortakoyluoglu A, Boz B, Dizdar OS, Avcı D, Cetinkaya A, Baspınar O. The association of serum gamma-glutamyl transpeptidase level and other laboratory parameters with blood pressure in hypertensive patients under ambulatory blood pressure monitoring. Ther Clin Risk Manag 2016; 12:1395-401. [PMID: 27660457 PMCID: PMC5019468 DOI: 10.2147/tcrm.s116603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hypertension is a very important cause of morbidity and mortality. Serum gamma-glutamyl transpeptidase (GGT) is a biomarker of oxidative stress and associated with increased risk of hypertension and diabetes. The aim of this study was to evaluate the association of serum GGT level, which is an early marker of inflammation and endothelial dysfunction, with the deterioration of the diurnal rhythm of the blood pressure. METHODS A total of 171 patients with hypertension were included in this study. Patients whose nighttime mean blood pressure, measured via ambulatory blood pressure monitoring, decreased between 10% and 20% compared with the daytime mean blood pressure were defined as "dippers", whereas patients with a nighttime blood pressure decrease lower than 10% were defined as "non-dippers". RESULTS A total of 99 hypertensive patients (65 females/34 males) were classified as dippers and 72 patients (48 females/24 males) as non-dippers. The mean age of the non-dipper group was significantly greater than the dipper group. Serum GGT, C-reactive protein and uric acid levels were significantly higher among patients in the non-dipper group. Negative correlations were detected between GGT levels and diurnal systolic and diastolic blood pressure decreases. CONCLUSION Our findings revealed that GGT level was higher in the non-dipper group, and was negatively correlated with the nighttime decrease of diurnal blood pressure. C-reactive protein and uric acid levels were also higher in the non-dipper group. However, future randomized controlled prospective studies with larger patient populations are necessary to confirm our findings.
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Affiliation(s)
- Adile Ortakoyluoglu
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Betul Boz
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Oguzhan Sıtkı Dizdar
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Deniz Avcı
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ali Cetinkaya
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Osman Baspınar
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
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12
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Feasibility study for removing calcified material using a planar rectangular ultrasound transducer. J Ultrasound 2016; 19:115-23. [PMID: 27298649 DOI: 10.1007/s40477-015-0191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The aim of the proposed study was to conduct a feasibility study using a flat rectangular (3 mm × 10 mm) MRI compatible transducer operating at 5.3 MHz for destroying calcified material in an in vitro model. The proposed method can be used in the future for treating atherosclerosis plaques of the coronary, carotid or peripheral arteries. METHODS The system was tested initially on calcium rods. Another test was performed in a hydroxyapatite-polylactide model. RESULTS A parametric study was performed where the mass of calcified material removed was studied as a function of intensity, pulse repetition frequency (PRF), duty factor (DF) and presence of bubbles. CONCLUSIONS The amount of calcified material removed is directly related to the intensity, PRF and DF. It was found that the presence of bubbles accelerates the removal of calcified material. In order to ensure that pure mechanical mode ultrasound was used, the protocols were designed so that the temperature does not exceed 1 °C.
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Susa N, Nishida Y, Yada Y, Nakayama T, Asai S, Takahashi Y. Comparative effect of fixed-dose combination tablets of candesartan cilexetil/amlodipine versus olmesartan medoxomil/azelnidipine on laboratory parameters in patients with hypertension: a retrospective cohort study. Clin Exp Hypertens 2015; 38:173-9. [PMID: 26453437 DOI: 10.3109/10641963.2015.1081214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We conducted a retrospective cohort study to evaluate and compare the long-term effects of two single-pill fixed-dose combinations (FDCs), candesartan/amlodipine and olmesartan/azelnidipine, on laboratory parameters in patients in routine clinical practice. We identified an equal number of new users (n = 182) of a candesartan/amlodipine (8/5 mg/day) FDC tablet (CAN/AML users) and a propensity-score matched cohort (n = 182) receiving an olmesartan/azelnidipine (20/16 mg/day) FDC tablet (OLM/AZ users). Generalized estimating equations were used to estimate and compare the effects of the drugs on serum levels of creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), uric acid, sodium, potassium, aspartate aminotransferase, and alanine aminotransferase levels up to 12 months after the start of study drug administration. There was a significant increase of serum creatinine level and a significant decrease of eGFR from the baseline period to during the exposure period in both CAN/AML and OLM/AZ users, and a significant increase of BUN level in CAN/AML users. However, there were no significant differences in the mean changes of laboratory parameters between CAN/AML and OLM/AZ users. Our findings suggested that the effects of CAN/AML and OLM/AZ on laboratory parameters, including an unfavorable effect on renal function, were similar at least during 1 year of administration.
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Affiliation(s)
- Norio Susa
- a Division of Genomic Epidemiology and Clinical Trials , Clinical Trials Research Center, Nihon University School of Medicine , Tokyo , Japan
| | - Yayoi Nishida
- a Division of Genomic Epidemiology and Clinical Trials , Clinical Trials Research Center, Nihon University School of Medicine , Tokyo , Japan
| | - Yoichi Yada
- b Division of Pharmacology , Department of Biomedical Sciences, Nihon University School of Medicine , Tokyo , Japan
| | - Tomohiro Nakayama
- c Division of Laboratory Medicine , Department of Pathology and Microbiology, Nihon University School of Medicine , Tokyo , Japan , and.,d Division of Companion Diagnosis , Department of Pathology of Microbiology, Nihon University School of Medicine , Tokyo , Japan
| | - Satoshi Asai
- b Division of Pharmacology , Department of Biomedical Sciences, Nihon University School of Medicine , Tokyo , Japan
| | - Yasuo Takahashi
- a Division of Genomic Epidemiology and Clinical Trials , Clinical Trials Research Center, Nihon University School of Medicine , Tokyo , Japan .,d Division of Companion Diagnosis , Department of Pathology of Microbiology, Nihon University School of Medicine , Tokyo , Japan
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14
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Mohamed Yahaya NF, Rahman MA, Abdullah N. Therapeutic potential of mushrooms in preventing and ameliorating hypertension. Trends Food Sci Technol 2014. [DOI: 10.1016/j.tifs.2014.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Pozzobon CR, Gismondi RAOC, Bedirian R, Ladeira MC, Neves MF, Oigman W. Functional vascular study in hypertensive subjects with type 2 diabetes using losartan or amlodipine. Arq Bras Cardiol 2014; 103:51-9. [PMID: 25014057 PMCID: PMC4126761 DOI: 10.5935/abc.20140089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/14/2014] [Indexed: 12/24/2022] Open
Abstract
Background Antihypertensive drugs are used to control blood pressure (BP) and reduce
macro- and microvascular complications in hypertensive patients with
diabetes. Objectives The present study aimed to compare the functional vascular changes in
hypertensive patients with type 2 diabetes mellitus after 6 weeks of
treatment with amlodipine or losartan. Methods Patients with a previous diagnosis of hypertension and type 2 diabetes
mellitus were randomly divided into 2 groups and evaluated after 6 weeks of
treatment with amlodipine (5 mg/day) or losartan (100 mg/day). Patient
evaluation included BP measurement, ambulatory BP monitoring, and assessment
of vascular parameters using applanation tonometry, pulse wave velocity
(PWV), and flow-mediated dilation (FMD) of the brachial artery. Results A total of 42 patients were evaluated (21 in each group), with a predominance
of women (71%) in both groups. The mean age of the patients in both groups
was similar (amlodipine group: 54.9 ± 4.5 years; losartan group: 54.0 ± 6.9
years), with no significant difference in the mean BP [amlodipine group: 145
± 14 mmHg (systolic) and 84 ± 8 mmHg (diastolic); losartan group: 153 ± 19
mmHg (systolic) and 90 ± 9 mmHg (diastolic)]. The augmentation index (30% ±
9% and 36% ± 8%, p = 0.025) and augmentation pressure (16 ± 6 mmHg and 20 ±
8 mmHg, p = 0.045) were lower in the amlodipine group when compared with the
losartan group. PWV and FMD were similar in both groups. Conclusions Hypertensive patients with type 2 diabetes mellitus treated with amlodipine
exhibited an improved pattern of pulse wave reflection in comparison with
those treated with losartan. However, the use of losartan may be associated
with independent vascular reactivity to the pressor effect.
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Affiliation(s)
| | | | - Ricardo Bedirian
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Wille Oigman
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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16
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Chang CH, Chang YC, Wu LC, Lin JW, Chuang LM, Lai MS. Different angiotensin receptor blockers and incidence of diabetes: a nationwide population-based cohort study. Cardiovasc Diabetol 2014; 13:91. [PMID: 24886542 PMCID: PMC4039330 DOI: 10.1186/1475-2840-13-91] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/07/2014] [Indexed: 12/12/2022] Open
Abstract
Background Angiotensin receptor blockers (ARBs) have been shown to exert various peroxisome proliferator-activated receptor gamma (PPARγ) binding activities and insulin-sensitizing effects. The objective of this study was to investigate the association of different ARBs with new-onset diabetes mellitus. Methods In the respective cohort, a total of 492,530 subjects who initiated ARB treatment between January 2004 and December 2009 were identified from Taiwan National Health Insurance Database. The primary outcome was newly diagnosed diabetes, defined as at least one hospital admission or two or more outpatient visits within a year with an ICD-9-CM code 250. Cox proportional regression was used to estimate the risk of diabetes associated with each ARB, using losartan as the reference. Results A total of 65,358 incident diabetes cases were identified out of 1,771,173 person-years. Olmesartan initiators had a small but significantly increased risk of developing diabetes after adjusting for baseline characteristics and mean daily dose (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03-1.12). After excluding those followed for less than one year, the increase in diabetes risk are more pronounced (HR, 1.09; 95% CI, 1.05-1.14). This association was consistent across all subgroup analyses. Similar results were observed when a more strict definition of diabetes combining both diabetes diagnosis and anti-diabetic treatment was used. On the other hand, there was no difference in diabetes risk between telmisartan and losartan. Conclusions Among all ARBs, olmesartan might be associated with a slightly increased risk of diabetes mellitus. Our data suggest differential diabetes risks associated with ARBs beyond a class effect.
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Affiliation(s)
| | | | | | - Jou-Wei Lin
- Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Nakamura M, Sasai N, Hisatome I, Ichida K. Effects of irbesartan on serum uric acid levels in patients with hypertension and diabetes. Clin Pharmacol 2014; 6:79-86. [PMID: 24833923 PMCID: PMC4014383 DOI: 10.2147/cpaa.s61462] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hyperuricemia has been proposed to be a risk factor for cardiovascular disease and chronic kidney disease. Since diabetes is often complicated by hypertension and hyperuricemia, efficient therapeutic strategy against these two complications is very important in diabetic treatment. It has been reported that the antihypertensive drug, irbesartan, inhibits the renal uric acid reabsorptive transporters, URAT1 and GLUT9; this result suggests that irbesartan decreases serum uric acid level (SUA). SUBJECTS AND METHODS A retrospective study of 107 patients with hypertension and diabetes was performed to analyze the effects of irbesartan on blood pressure, estimated glomerular filtration rate (eGFR), and SUA. The follow-up period was 6-12 months. Seventy percent of the patients were diagnosed with diabetic nephropathy stage II-IV. We excluded patients treated with drugs that influenced SUA. The multiple logistic regression analysis was introduced to identify the relative factors for SUA decline. The time-dependent SUA changes were examined in a mixed-linear model. RESULTS Irbesartan reduced blood pressure significantly after 1, 6, and 12 months' treatment. No subject showed significant change in eGFR from baseline level throughout the period. The multiple logistic regression analysis revealed that SUA baseline significantly influenced SUA decline after 6-12 months. In patients whose SUA baseline was ≥5.9 mg/dL, the SUA was significantly decreased from 6.6±0.16 mg/dL to 6.2±0.16 mg/dL (P=0.010), after 12 months' irbesartan treatment. In the SUA baseline <5.9 mg/dL group, the SUA did not show significant change over the monitoring period. CONCLUSION Our results demonstrate that irbesartan reduces the risk of hyperuricemia. No decline in renal function was observed after the initiation of irbesartan treatment. The present report determines the criteria of SUA baseline for introducing an antihyperuricemic effect using irbesartan. Its antihypertensive effect coupled with SUA decline would be effective for the treatment of hypertension complicated by hyperuricemia.
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Affiliation(s)
- Makiko Nakamura
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | | | - Ichiro Hisatome
- Division of Regenerative Medicine and Therapeutics, Institute of Regenerative Medicine and Biofunction, Graduate School of Medical Sciences, Tottori University, Tottori, Japan
| | - Kimiyoshi Ichida
- Department of Pathophysiology, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
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Nishida Y, Takahashi Y, Susa N, Kanou N, Nakayama T, Asai S. Comparative effect of angiotensin II type I receptor blockers on serum uric acid in hypertensive patients with type 2 diabetes mellitus: a retrospective observational study. Cardiovasc Diabetol 2013; 12:159. [PMID: 24180232 PMCID: PMC4176752 DOI: 10.1186/1475-2840-12-159] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/29/2013] [Indexed: 01/17/2023] Open
Abstract
Background Angiotensin II type 1 receptor blockers (ARB) are a frequently used class of antihypertensive drug. The ARB losartan is known to decrease the serum uric acid (SUA) level. However, there are very few clinical data comparing the effects of other ARBs on SUA level under the conditions of clinical practice. This study evaluated and compared the long-term effects of monotherapy with five ARBs on SUA level in Japanese hypertensive patients with type 2 diabetes mellitus (DM). Methods We identified hypertensive patients with type 2 DM who had been treated with monotherapy with losartan (n = 214), valsartan (n = 266), telmisartan (n = 185), candesartan (n = 458), or olmesartan (n = 192), in whom laboratory data of SUA between November 1, 2004 and July 31, 2011 were available, from the Nihon University School of Medicine’s Clinical Data Warehouse (NUSM’s CDW). We used a propensity-score weighting method and a multivariate regression model to adjust for differences in the background among ARB users, and compared the SUA level. The mean exposure of losartan was 264.7 days, valsartan 245.3 days, telmisartan 235.9 days, candesartan 248.9 days, and olmesartan 234.5 days. Results In losartan users, mean SUA level was significantly decreased from baseline, while it was conversely increased in users of other ARBs; valsartan, telmisartan, candesartan, and olmesartan. The mean reduction of SUA level from baseline was significantly greater in losartan users compared with that in other ARB users. Comparison of ARBs other than losartan showed no significant difference in mean change in SUA level from baseline. Conclusions Our study showed that losartan had the most beneficial effect on SUA level among five ARBs, and that there was no significant difference in the unfavorable effects on SUA level among four ARBs other than losartan, at least during one year. These findings provide evidence of an effect of ARBs on SUA level, and support the benefit of the use of losartan in hypertensive patients with type 2 DM.
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Affiliation(s)
| | - Yasuo Takahashi
- Division of Genomic Epidemiology and Clinical Trials, Clinical Trials Research Center, Nihon University School of Medicine, 30-1 Oyaguchi-Kami Machi, Itabashi-ku, Tokyo 173-8610, Japan.
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Takahashi Y, Nishida Y, Nakayama T, Asai S. Comparative effect of clopidogrel and aspirin versus aspirin alone on laboratory parameters: a retrospective, observational, cohort study. Cardiovasc Diabetol 2013; 12:87. [PMID: 23767412 PMCID: PMC3687565 DOI: 10.1186/1475-2840-12-87] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/09/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clopidogrel and aspirin are antiplatelet agents that are recommended to reduce the risk of recurrent stroke and other cardiovascular events. Combination therapy of clopidogrel and aspirin has been shown to increase the risk of hemorrhage, but the effects of the drugs on laboratory parameters have not been well studied in patients in routine clinical practice. Therefore, we evaluated and compared the effects of combination therapy with clopidogrel plus aspirin and aspirin monotherapy on laboratory parameters using a clinical database. METHODS We used data from the Clinical Data Warehouse of Nihon University School of Medicine obtained between November 2004 and April 2011, to identify cohorts of new users (n = 159) of clopidogrel (75 mg/day) plus aspirin (100 mg/day) and new users (n = 834) of aspirin alone (100 mg/day). We used a multivariable regression model and regression adjustment with the propensity score to adjust for differences in baseline covariates between settings, and compare the mean changes in serum levels of creatinine, aspartate aminotransferase, alanine aminotransferase and hematological parameters, including hemoglobin level, hematocrit, and white blood cell (WBC), red blood cell and platelet counts up to two months after the start of study drug administration. RESULTS After adjustment, the reduction of WBC count in clopidogrel plus aspirin users was significantly greater than that in aspirin alone users. All other tests showed no statistically significant difference in the mean change from baseline to during the exposure period between clopidogrel plus aspirin users and aspirin alone users. The combination of clopidogrel and aspirin increased the risk of gastrointestinal bleeding compared with aspirin alone, with a relative risk ranging from 2.06 (95% CI, 1.02 to 4.13; p = 0.043) for the multivariate model and 2.61 (95% CI, 1.18 to 5.80; p = 0.0184) for propensity adjustment. CONCLUSION Our findings suggested that hematological adverse effects may be greater with combination therapy of clopidogrel plus aspirin than with aspirin monotherapy.
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Tiyerili V, Becher UM, Aksoy A, Lütjohann D, Wassmann S, Nickenig G, Mueller CFH. AT1-receptor-deficiency induced atheroprotection in diabetic mice is partially mediated via PPARγ. Cardiovasc Diabetol 2013; 12:30. [PMID: 23374104 PMCID: PMC3667017 DOI: 10.1186/1475-2840-12-30] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 01/28/2013] [Indexed: 11/24/2022] Open
Abstract
Objective Peroxisome-proliferator–activated-receptor-γ (PPARγ) acts as a transcriptional regulator of multiple genes involved in glucose and lipid metabolism. In vitro studies showed that activated PPARγ suppresses AT1R-gene expression and vice versa. However, it has not yet been determined in vivo, whether AT1R-PPARγ-interactions play a relevant role in the pathogenesis of diabetic complications and specifically in accelerated atherosclerosis. Methods and results ApoE−/− and ApoE−/−/AT1R−/−-mice were rendered diabetic by intraperitoneal injections of streptozotocin. Diabetic and non-diabetic ApoE−/−-mice were further randomized to receive the AT1R antagonist telmisartan, the selective PPARγ antagonist GW9662, telmisartan and GW9662 or vehicle for 18 weeks. Diabetic and non-diabetic ApoE−/−/AT1R−/−-mice were randomized to receive either GW9662 or vehicle. GW9662 treatment in diabetic ApoE−/− and diabetic ApoE−/−/AT1−/−-mice resulted in the highest elevation of fasting blood glucose levels, whereas telmisartan treatment and AT1 deficiency in ApoE−/−-mice showed the lowest fasting blood glucose levels. Diabetic ApoE−/−-mice displayed severe impairment of endothelial function, enhanced oxidative stress and increased atherosclerotic lesion formation. ApoE−/−/AT1R−/− and telmisartan-treated ApoE−/−-mice showed a significantly better endothelial function, decreased oxidative stress and reduced atherosclerotic lesion formation. Treatment of diabetic ApoE−/− and ApoE−/−/AT1R−/−-mice with the selective PPARγ antagonist GW9662 omitted the atheroprotective effects of AT1R deficiency or AT1 antagonism. Conclusion Genetic disruption or pharmacological inhibition of the AT1R attenuates atherosclerosis and improves endothelial function in diabetic ApoE−/−-mice via the PPARγ pathway.
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Affiliation(s)
- Vedat Tiyerili
- Medizinische Klinik und Poliklinik II, Innere Medizin, Universitätsklinikum Bonn, Sigmund Freud Str, 25, 53105, Bonn, Germany.
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