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Zeng MT, Huang LY, Zheng XH, Fu YQ, Weng CF. Ethanolic Extracts of Cupressaceae Species Conifers Provide Rapid Protection against Barium Chloride-Induced Cardiac Arrhythmia. Pharmaceuticals (Basel) 2024; 17:1003. [PMID: 39204108 PMCID: PMC11356987 DOI: 10.3390/ph17081003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 09/03/2024] Open
Abstract
Sudden cardiac death (SCD) is responsible for a high percentage of cardiovascular fatalities, with ventricular arrhythmias being the most common cause. Despite numerous clinically available antiarrhythmic drugs (AADs), AADs retain some undesirable arrhythmic effects, and their inappropriate use can lead to severe adverse reactions. The exploration of new therapeutic options against arrhythmias with fewer unreceptive effects is of utmost importance. The ethanolic extracts of seven Cupressaceae species, namely, Chamaecyparis obtusa, Juniperus chinensis (L.) Ant., Sabina chinensis (L.) Ant. cv. Kaizuca, Platycladus orientalis (L.) Franco, Juniperus sabina L., Fokienia hodginsii, and Juniperus chinensis 'Pyramidalis' were investigated for their pharmacological effects on barium chloride (BaCl2)-induced arrhythmia using normal II lead electrocardiogram (ECG) measurements in a mouse model. According to the ECG profiles, pretreatment with C. obtusa, P. orientalis, and J. sabina extracts provoked dose-dependent protection against BaCl2-induced arrhythmia, while pretreatment with the other four species and amiodarone did not exert cardioprotective effects. The treatment effects were confirmed using a rat model. The therapeutic effects of C. obtusa, P. orientalis, and J. sabina extracts on the M2 and M3 receptors but not the M1 receptor were mediated by the inhibition of the M2 receptor blocker (methoctramine tetrahydrochloride), M3 antagonist (4-DAMP), or M1 receptor blocker (pirenzepine dihydrochloride). This first-line evidence illustrates that certain Cupressaceae species possess active antiarrhythmic components. The first line of key findings revealed that active components of certain Cupressaceae species have cardioprotective effects, suggesting that these innovative phytochemicals have promising potential for preventing the occurrence of cardiac arrhythmia and reducing sudden cardiac death.
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Affiliation(s)
- Meng-Ting Zeng
- Functional Physiology Section, Department of Basic Medical Science, Xiamen Medical College, Xiamen 361023, China; (M.-T.Z.); (L.-Y.H.); (X.-H.Z.); (Y.-Q.F.)
| | - Li-Yue Huang
- Functional Physiology Section, Department of Basic Medical Science, Xiamen Medical College, Xiamen 361023, China; (M.-T.Z.); (L.-Y.H.); (X.-H.Z.); (Y.-Q.F.)
| | - Xiao-Hui Zheng
- Functional Physiology Section, Department of Basic Medical Science, Xiamen Medical College, Xiamen 361023, China; (M.-T.Z.); (L.-Y.H.); (X.-H.Z.); (Y.-Q.F.)
| | - Yan-Qi Fu
- Functional Physiology Section, Department of Basic Medical Science, Xiamen Medical College, Xiamen 361023, China; (M.-T.Z.); (L.-Y.H.); (X.-H.Z.); (Y.-Q.F.)
| | - Ching-Feng Weng
- Functional Physiology Section, Department of Basic Medical Science, Xiamen Medical College, Xiamen 361023, China; (M.-T.Z.); (L.-Y.H.); (X.-H.Z.); (Y.-Q.F.)
- Institute of Respiratory Disease, Department of Basic Medical Science, Xiamen Medical College, Xiamen 361023, China
- LEADTEK Research, Inc., New Taipei City 235603, Taiwan
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Wang C, Du Z, Ye N, Liu S, Geng D, Sun Y. Prevalence and prognosis of atrial fibrillation in a hypertensive population: A prospective cohort study. J Clin Hypertens (Greenwich) 2023; 25:335-342. [PMID: 36866435 PMCID: PMC10085811 DOI: 10.1111/jch.14643] [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: 11/04/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 03/04/2023]
Abstract
Identifying risk factors for atrial fibrillation (AF) and evaluating their impact are essential to avoid the occurrence of adverse events. However, few studies to date have explored the prevalence, risk factors, and prognosis of AF in hypertensive patients. The objective of this study was to investigate the epidemiology of AF in a hypertensive population and determine the relationship between AF and all-cause mortality. At baseline, a total of 8541 Chinese patients with hypertension were enrolled from the Northeast Rural Cardiovascular Health Study. A logistic regression model was established to assess the relationship between blood pressure and AF, and Kaplan-Meier survival curve analysis and multivariate Cox regression were used to explore the relationship between AF and all-cause mortality. Meanwhile, subgroup analyses illustrated the robustness of results. This study found that the overall prevalence rate of AF was 1.4% in its Chinese hypertensive population. After adjusting for the confounding factors, every standard deviation increase in diastolic blood pressure (DBP) was associated with a 37% increase in the prevalence of AF (95% confidence interval: 1.152-1.627, p < .001). Compared to hypertensive patients without AF, those with AF had an increased risk of all-cause mortality (hazard ratio = 1.866, 95% confidence interval: 1.117-3.115, p = .017) in the adjusted model. The results show that the burden of AF is quite large in rural-dwelling Chinese hypertensive patients. Focusing on the control of DBP to prevent the occurrence of AF can be helpful. Meanwhile, AF increases risk of all-cause mortality in hypertensive patients. Our results indicated a huge burden of AF. Considering that most of the risk factors of AF were unmodifiable in hypertensive individuals and given their high risk of mortality, long-term interventions, including AF education, timely screening, and widespread use of anticoagulant drugs, should be emphasized in hypertensive populations.
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Affiliation(s)
- Chang Wang
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhi Du
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ning Ye
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Songyue Liu
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Danxi Geng
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yingxian Sun
- Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Du Z, Lin M, Tian Y, Jing L, Liu S, Li G, Jia T, Sun Q, Shi L, Sun J, Tian W, Xing L. Epidemiology of atrial fibrillation and risk of CVD mortality among hypertensive population: A prospective cohort study in Northeast China. Front Cardiovasc Med 2022; 9:955685. [PMID: 35966526 PMCID: PMC9366344 DOI: 10.3389/fcvm.2022.955685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDetermining risk factors of cardiovascular disease (CVD)-related mortality and evaluating their influence are important for effectively reducing corresponding mortality. However, few research findings have estimated the relationship between atrial fibrillation (AF) and CVD-related mortality among hypertension individuals.ObjectiveThe objective of this study was to investigate the epidemiology of AF in a hypertension population and determine the relationship between AF and CVD-related mortality.MethodsUsing a multistage, stratified, and cluster random sampling method, the prospective cohort study with a median follow-up of 3.51 years enrolled 10,678 hypertensive participants at baseline. The prevalence, awareness, and anticoagulation data of AF in this focal population were carefully assessed. Stepwise logistic regression and Cox regression analysis were respectively performed to evaluate the determinants of AF and the association between AF and CVD-related mortality.ResultsThe overall prevalence of AF was 1.3% (95% CI, 1.1%−1.6%) in the hypertensive population, and it was higher in men than in women (1.8% vs. 1.0%, respectively; p=0.001). The awareness of AF was 53.1%, and the rate of oral anticoagulant (OAC) therapy was only 4.2%, although all AF participants should have required according to the European Society of Cardiology guidelines. The determinants of AF included elder, male, and history of coronary heart disease in the hypertensive population. Besides, compared with individuals without AF, the risk of CVD-related mortality significantly increased in the hypertensive population with AF (HR 3.37, 95% CI 2.10–5.40).ConclusionOur results indicated a huge burden of AF and underuse of OAC therapy for them in a community-based hypertensive population. Considering that most of the risk factors of AF were unmodifiable in hypertensive individuals, as well as its high risk of mortality, long-term interventions including AF education, timely screening, and widespread use of OACs should be emphasized in the focal populations.
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Affiliation(s)
- Zhi Du
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Lin
- Department of Cardiovascular Medicine, Benxi Central Hospital, Benxi, China
| | - Yuanmeng Tian
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Department of Chronic Disease Preventive and Control, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Li Jing
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Department of Chronic Disease Preventive and Control, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Shuang Liu
- Department of Ultrasound, The Fourth Hospital of China Medical University, Shenyang, China
| | - Guangxiao Li
- Department of Medical Record Management Center, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Tong Jia
- College of Information Science and Engineering, Northeastern University, Shenyang, China
| | - Qun Sun
- Department of Chronic Disease, Disease Control and Prevention of Chaoyang City, Chaoyang, China
| | - Lei Shi
- Department of Chronic Disease, Disease Control and Prevention of Liaoyang City, Liaoyang, China
| | - Jixu Sun
- Department of Chronic Disease, Disease Control and Prevention of Dandong City, Dandong, China
| | - Wen Tian
- Department of Geriatric Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Wen Tian
| | - Liying Xing
- Institute of Preventive Medicine, China Medical University, Shenyang, China
- Department of Chronic Disease Preventive and Control, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
- *Correspondence: Liying Xing
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Nine-Year Trends in Atrial Fibrillation Prevalence among Romanian Adult Hypertensives: A Post-Hoc Analysis of SEPHAR II-IV Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159250. [PMID: 35954602 PMCID: PMC9368716 DOI: 10.3390/ijerph19159250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022]
Abstract
Objectives: There are limited epidemiological data regarding atrial fibrillation (AF) in hypertensive (HT) Romanian adults. We sought to evaluate AF prevalence trends in the SEPHAR surveys (Study for Evaluation of Prevalence of Hypertension and Cardiovascular Risk in an Adult Population in Romania) during a nine-year interval (2012−2016−2021). Methods: Three consecutive editions of a national epidemiological survey regarding HT included representative samples of subjects stratified by age, gender and area of residence (SEPHAR II-IV—in total, 5422 subjects, mean age 48.69 ± 16.65 years, 57.5% (n = 3116) females). A post-hoc analysis of AF prevalence and oral anticoagulation (OAC) rates was performed. AF definition was based on a documented medical history of AF and/or AF documentation by study electrocardiogram. Results: General AF prevalence was 5.5% (n = 297). AF prevalence in HT subjects was 8.9% (n = 209) and has risen since SEPHAR II—7.2% (n = 57) and SEPHAR III—8.1% (n = 72) to SEPHAR IV—11.8% (n = 80), respectively (p = 0.001). AF prevalence has increased in HT males (SEPHAR II—5.3% (n = 19), SEPHAR III—7.6% (n = 26) and SEPHAR IV—11.7% (n = 35) (p = 0.010)) and in HT from urban areas (SEPHAR II—7.8% (n = 37), SEPHAR III—7.8% (n = 40), SEPHAR IV—14.7% (n = 50), p < 0.001). In SEPHAR III-IV, only 19.3% (n = 23) of HT AF patients with OAC indication were anticoagulated. Conclusions: AF prevalence has increased by ~64% in hypertensive Romanian adults between 2012 and 2021. However, anticoagulation strategies may be suboptimal in patients with cardioembolic risk.
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Bukata IT, Tegene E, Gobena T, Woldesenbet YM. Prevalence and determinants of cardiac arrhythmias and conduction anomalies in adults aged ≥ 40 years in Jimma Town, Southwest of Ethiopia: a cross-sectional study. Afr Health Sci 2022; 22:236-246. [PMID: 36407368 PMCID: PMC9652622 DOI: 10.4314/ahs.v22i2.27] [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] [Indexed: 11/29/2022] Open
Abstract
Background The prevalence of cardiac arrhythmia (CA) in the Ethiopian population is unknown. A community study was conducted to assess the magnitude and predictors of CAs in adults aged≥40 years in Jimma Town. Methods A community-based cross-sectional study was conducted in Jimma town from May to July 2017. A total of 634 adults aged 40 years or older were selected using a systematic sampling technique from six kebeles of the Town. Study participants were screened for CA using a 12-lead ECG machine. Face-to-face interviews, anthropometric, important clinical measurements were performed. Data analysis was done using SPSS for windows version 21.0. Results A total of 634 study participants, significant CA occurred in 217 individuals (34.2%). Conduction abnormalities and sinus bradycardia were the commonest findings (25.4%). Premature beats (ventricular 1.9%, atrial 1.1%) and atrioventricular nodal reentrant tachycardia (2.1%) were the next most frequent arrhythmias. Arrhythmias were independently associated with smoking(AOR=1.9;P=.047), hypertension(AOR=1.5;P=.02), heart failure(AOR=2.06;P=.023), prior stroke(AOR=4.9;P=.001), previous history of MI(AOR=1.78;P=.039), vigorous intensity activities(AOR=0.56;P=.024), solidified vegetable oil consumption(AOR=3.5;P=.004), and occupation(pensioner, none)[AOR=1.7;P=.017]. Conclusions CA is highly prevalent in Jimma. Hypertension and history of heart diseases are the most potent predictors of cardiac arrhythmia. Large-scale screening for early detection of arrhythmia has important implications for treatment.
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Affiliation(s)
- Iyasu Tadesse Bukata
- Lecturer of medical physiology, Department of Medical Physiology, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251912492329; P.O.Box: 378, Jimma, Ethiopia
| | - Elsa Tegene
- Assistant professor of internal medicine, Department of internal medicine, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251911769176; P.O.Box: 378, Jimma, Ethiopia
| | - Teshome Gobena
- Assistant professor of medical physiology, Department of Medical Physiology, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251911487658; P.O.Box: 378, Jimma, Ethiopia
| | - Yohannes Markos Woldesenbet
- Lecturer of medical physiology, School of Medicine, College of Medicine and Health Sciences, Wolaita Sodo University, WolaitaSodo, Ethiopia: , phone: +251911016539; P.O.Box: 138, WolaitaSodo, Ethiopia
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Xia Z, Dang W, Yang X, Sun Q, Sun J, Shi L, Sun S, An L, Li X, Peng H, Liu S, Yue L, Chen H. Prevalence of atrial fibrillation and the risk of cardiovascular mortality among hypertensive elderly population in northeast China. J Clin Hypertens (Greenwich) 2022; 24:630-637. [PMID: 35434909 PMCID: PMC9106073 DOI: 10.1111/jch.14483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
Little is known about the epidemiology and impact of atrial fibrillation (AF) on cardiovascular diseases (CVD) mortality among hypertensive elderly population in northeast China. The community‐based study included 4497 hypertensive elderly residents aged ≥65 years who lived in northeast China from September 2017 to March 2019. Information on CVD deaths was obtained from baseline until July 31, 2021. Cox proportional hazard regression models were performed in the evaluation of CVD mortality. We identified 101 persons with AF. The prevalence of AF was 2.2% among elderly hypertensive population, which increased significantly with age. The prevalence of AF was higher in men than in women. The awareness rate was 51.5%, higher in urban areas than in rural areas (68.8% vs 43.5%, P = .018). Only 4.0% patients received oral anticoagulant (OAC) therapy among AF patients. Moreover, diabetes (26.7%) and dyslipidemia (37.6%) were highly prevalent in AF patients. Furthermore, 212 persons died due to CVD (14.7/1000 person‐years) during a median follow‐up of 3.2 years. AF patients had a 3.42 (95% CI: 2.07‐5.63) times higher risk of CVD mortality than the patients without AF in the fully adjusted model. Therefore, the burden of AF among hypertensive elderly population in northeast China was considerable. Long‐term screening and management strategies for AF and related risk factors are required among hypertensive elderly in northeast China.
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Affiliation(s)
- Zhenwei Xia
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Wei Dang
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Xue Yang
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Qun Sun
- Department of Chronic Disease Disease Control and Prevention of Chaoyang City Chaoyang Liaoning China
| | - Jixu Sun
- Department of Chronic Disease Disease Control and Prevention of Dandong City Dandong Liaoning China
| | - Lei Shi
- Department of Chronic Disease Disease Control and Prevention of Liaoyang City Liaoyang Liaoning China
| | - Shize Sun
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Le An
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Xiaojing Li
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Hongbo Peng
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
| | - Shuang Liu
- Department of Ultrasound The Fourth Hospital of China Medical University Shenyang Liaoning China
| | - Ling Yue
- Department of Ultrasound The Fourth Hospital of China Medical University Shenyang Liaoning China
| | - Hongyun Chen
- Department of Cardiology Dalian Municipal Central Hospital Dalian Liaoning China
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Bukata IT, Tegene E, Gobena T, Woldesenbet YM. Prevalence and determinants of cardiac arrhythmias and conduction anomalies in adults aged ≥ 40 years in Jimma Town, Southwest of Ethiopia: a cross-sectional study. Afr Health Sci 2022; 22:210-219. [PMID: 36032455 PMCID: PMC9382499 DOI: 10.4314/ahs.v22i1.27] [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] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of cardiac arrhythmia (CA) in the Ethiopian population is unknown. A community study was conducted to assess the magnitude and predictors of CAs in adults aged≥40 years in Jimma Town. Methods A community-based cross-sectional study was conducted in Jimma town from May to July 2017. A total of 634 adults aged 40 years or older were selected using a systematic sampling technique from six kebeles of the Town. Study participants were screened for CA using a 12-lead ECG machine. Face-to-face interviews, anthropometric, important clinical measurements were performed. Data analysis was done using SPSS for windows version 21.0. Results A total of 634 study participants, significant CA occurred in 217 individuals (34.2%). Conduction abnormalities and sinus bradycardia were the commonest findings (25.4%). Premature beats (ventricular 1.9%, atrial 1.1%) and atrioventricular nodal reentrant tachycardia (2.1%) were the next most frequent arrhythmias. Arrhythmias were independently associated with smoking(AOR=1.9;P=.047), hypertension(AOR=1.5;P=.02), heart failure(AOR=2.06;P=.023), prior stroke(AOR=4.9;P=.001), previous history of MI(AOR=1.78;P=.039), vigorous intensity activities(AOR=0.56;P=.024), solidified vegetable oil consumption(AOR=3.5;P=.004), and occupation(pensioner, none)[AOR=1.7;P=.017]. Conclusion CA is highly prevalent in Jimma. Hypertension and history of heart diseases are the most potent predictors of cardiac arrhythmia. Large-scale screening for early detection of arrhythmia has important implications for treatment.
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Affiliation(s)
- Iyasu Tadesse Bukata
- Lecturer of medical physiology, Department of Medical Physiology, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251912492329; P.O.Box: 378, Jimma, Ethiopia
| | - Elsa Tegene
- Assistant professor of internal medicine, Department of internal medicine, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251911769176; P.O.Box: 378, Jimma, Ethiopia
| | - Teshome Gobena
- Assistant professor of medical physiology, Department of Medical Physiology, Faculty of medical sciences, Institute of Health, Jimma University, Jimma, Ethiopia: , phone: +251911487658; P.O.Box: 378, Jimma, Ethiopia
| | - Yohannes Markos Woldesenbet
- Lecturer of medical physiology, School of Medicine, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia: , phone: +251911016539; P.O.Box: 138, Wolaita Sodo, Ethiopia
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Yang J, Lou L, Zhang X, Chen Y, Zhou W, Zhang C, Guo X, Hu S. The Relationship between Uric Acid and the Development, Complication, and Prognosis of Atrial Fibrillation: The Views from a Clinical Study. Int J Endocrinol 2022; 2022:9355504. [PMID: 36340931 PMCID: PMC9633180 DOI: 10.1155/2022/9355504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
A large number of studies suggest that uric acid (UA) is related to the occurrence, complications, and prognosis of atrial fibrillation (AF). However, the guidelines did not clearly elaborate on this issue. The current research results need to be summarized to analyze the association between UA and AF. This study found that in the current clinical research on the relationship between UA and AF, studies mainly focus on the development or complications of AF. A lot of repetitive work does not deepen awareness of this question. In contrast, studies investigating the effects of UA-lowering therapy on the management of AF are limited. The only reports deny the protective effect of UA-lowering therapy. For now, we suggest that UA is close to the occurrence and progression of AF; therefore, it may have important significance as a clinical marker. The role of UA-lowering therapy in the management of AF is one of the next key issues to be explored. It will be a meaningful topic to focus on the latest research on AF ablation and to conduct a secondary analysis to explore the prognostic impact of UA on the latest treatment methods for AF. Multiomics techniques may allow us to have a deeper understanding of the role of UA in AF management in the future.
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Affiliation(s)
- Jian Yang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lian Lou
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuan Zhang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxiao Chen
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weier Zhou
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chi Zhang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaogang Guo
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shenjiang Hu
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Troisi F, Guida P, Di Monaco A, Quadrini F, Vitulano N, Grimaldi M. Gender-specific association of risk factors in patients who underwent catheter ablation of atrial fibrillation. J Cardiovasc Med (Hagerstown) 2021; 22:901-908. [PMID: 34747926 DOI: 10.2459/jcm.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Atrial fibrillation (AF) has been highlighted as a growing epidemic. Evidence is lacking on the role of different risk factors within both genders especially in AF patients referred for catheter ablation (CA). The objective was the evaluation of differences between men and women in the associations with aging, obesity and hypertension as the most highly contributing factors to AF onset and progression. METHODS Cases selected among patients scheduled for CA as a rhythm-control strategy and controls from a recent Italian national survey on the population's health conditions were analysed to quantify the strength of association and to assess the existence of gender differences. To reduce the effect of possible confounding factors, both cases and controls were selected without preexisting comorbidities other than hypertension. RESULTS At multivariate logistic regression analysis, cases (534 patients, 166 women) were significantly associated with the male sex, higher age, presence of obesity and hypertension in comparison to controls (17,983 subjects, 9,409 women). At analyses gender-stratified, age and obesity had a significant greater association in women than men. On the contrary, hypertension was relatively more frequent in men than women. CONCLUSION Although mechanisms linking risk factors and AF are complex, this study suggests the existence of differences mediated by gender in AF drug-refractory patients who underwent CA. A tailored public health programme to reduce the growing burden of AF needs to be designed to prevent and counter the increasing epidemic of the most common cardiac arrhythmia as well as its progression in more resistant forms.
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Affiliation(s)
- Federica Troisi
- Cardiology Department, Regional General Hospital 'F. Miulli', Acquaviva delle Fonti, Bari, Italy
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Yang NJ, Liu YR, Tang ZS, Duan JA, Yan YF, Song ZX, Wang MG, Zhang YR, Chang BJ, Zhao ML, Zhao YT. Poria cum Radix Pini Rescues Barium Chloride-Induced Arrhythmia by Regulating the cGMP-PKG Signalling Pathway Involving ADORA1 in Zebrafish. Front Pharmacol 2021; 12:688746. [PMID: 34393777 PMCID: PMC8360851 DOI: 10.3389/fphar.2021.688746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/19/2021] [Indexed: 11/15/2022] Open
Abstract
The traditional Chinese medicine Poria cum Radix Pini (PRP) is a fungal medicinal material that has been proven to play an important role in the treatment of arrhythmia. However, the mechanism of its effect on arrhythmia is still unclear. In this study, network pharmacology and metabolomics correlation analysis methods were used to determine the key targets, metabolites and potential pathways involved in the effects of PRP on arrhythmia. The results showed that PRP can significantly improve cardiac congestion, shorten the SV-BA interval and reduce the apoptosis of myocardial cells induced by barium chloride in zebrafish. By upregulating the expression of the ADORA1 protein and the levels of adenosine and cGMP metabolites in the cGMP-PKG signalling pathway, PRP can participate in ameliorating arrhythmia. Therefore, we believe that PRP shows great potential for the treatment of arrhythmia.
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Affiliation(s)
- Ning-Juan Yang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yan-Ru Liu
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Zhi-Shu Tang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jin-Ao Duan
- Key Laboratory for High Technology Research of TCM Formulae and Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ya-Feng Yan
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Zhong-Xing Song
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang, China
| | | | - Yu-Ru Zhang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Bai-Jin Chang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang, China.,Changchun University of Chinese Medicine, Changchun, China
| | - Meng-Li Zhao
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yan-Ting Zhao
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Shaanxi Collaborative Innovation Center Medicinal Resources Industrialization, Shaanxi University of Chinese Medicine, Xianyang, China
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11
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Suwanwela NC, Chutinet A, Autjimanon H, Ounahachok T, Decha-umphai C, Chockchai S, Indrabhakti S, Kijpaisalratana N, Akarathanawat W, Travanichakul S, Kitjavijitre T, Vongvasinkul P, Kanacharoen I, Bunlikitkul TO, Charnwut S, Lowres N, Freedman B. Atrial fibrillation prevalence and risk profile from novel community-based screening in Thailand: A prospective multi-centre study. IJC HEART & VASCULATURE 2021; 32:100709. [PMID: 33490362 PMCID: PMC7811109 DOI: 10.1016/j.ijcha.2020.100709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/23/2020] [Accepted: 12/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In Thailand, almost one-quarter of strokes are related to atrial fibrillation (AF), and many could be prevented if AF were diagnosed and treated prior to the stroke. Therefore, we tested a novel strategy to screen large numbers of community residents using village health volunteers and primary care nurses. METHODS Local primary care nurses and village health volunteers in Phetchaburi and Lopburi provinces, Thailand were trained to perform AF screening using a blood pressure device with AF algorithm (Microlife A200 AFib). 10% of residents aged ≥ 65 years were randomly selected for screening during home-visits. Participants with possible AF were given follow-up appointments for further testing, including 12-lead ECG and echocardiogram. RESULTS Over two-months, 9.7% (13,864/143,478) of the target population were screened: mean age 73.2 ± 6.4 years, 32.4% male. The estimated AF prevalence (detected by Microlife A200 AFib) was 2.8% (95% CI, 2.6-3.1%) for age ≥ 65 years (i.e. 393/13,864 participants). Prevalence increased with age from 1.9% (65-69 years) to 5.0% (≥85 years) (p < 0.001). Only 58% (226/393) of participants with suspected AF attended the follow-up appointment (1-3 months after initial screen): mean CHA2DS2-VASc score 3.2 ± 1.2; 86.3% (195/226) had Class-1 oral anticoagulation recommendation, and 33% (75/226) had AF on 12-lead ECG. CONCLUSIONS In Thailand, large-scale AF screening in the community is feasible using trained volunteer health workers, allowing screening of large numbers in a short time-period. Further investigation of this strategy is warranted, ensuring mechanisms to obtain a timely rhythm strip or 12-lead ECG locally, and a designated pathway to treatment.
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Affiliation(s)
- Nijasri C. Suwanwela
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Stroke Center, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Aurauma Chutinet
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | - Tanawat Ounahachok
- Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | | | | | | | - Naruchorn Kijpaisalratana
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Wasan Akarathanawat
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Suporn Travanichakul
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Teeraparp Kitjavijitre
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pakkawan Vongvasinkul
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | - Tanyaluk O. Bunlikitkul
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Supparat Charnwut
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nicole Lowres
- Heart Research Institute, Sydney Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ben Freedman
- Heart Research Institute, Sydney Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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12
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Ding WY, Protty MB, Davies IG, Lip GYH. Relationship between lipoproteins, thrombosis and atrial fibrillation. Cardiovasc Res 2021; 118:716-731. [PMID: 33483737 PMCID: PMC8859639 DOI: 10.1093/cvr/cvab017] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/14/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022] Open
Abstract
The prothrombotic state in atrial fibrillation (AF) occurs as a result of multifaceted interactions, known as Virchow’s triad of hypercoagulability, structural abnormalities, and blood stasis. More recently, there is emerging evidence that lipoproteins are implicated in this process, beyond their traditional role in atherosclerosis. In this review, we provide an overview of the various lipoproteins and explore the association between lipoproteins and AF, the effects of lipoproteins on haemostasis, and the potential contribution of lipoproteins to thrombogenesis in AF. There are several types of lipoproteins based on size, lipid composition, and apolipoprotein category, namely: chylomicrons, very low-density lipoprotein, low-density lipoprotein (LDL), intermediate-density lipoprotein, and high-density lipoprotein. Each of these lipoproteins may contain numerous lipid species and proteins with a variety of different functions. Furthermore, the lipoprotein particles may be oxidized causing an alteration in their structure and content. Of note, there is a paradoxical inverse relationship between total cholesterol and LDL cholesterol (LDL-C) levels, and incident AF. The mechanism by which this occurs may be related to the stabilizing effect of cholesterol on myocardial membranes, along with its role in inflammation. Overall, specific lipoproteins may interact with haemostatic pathways to promote excess platelet activation and thrombin generation, as well as inhibiting fibrinolysis. In this regard, LDL-C has been shown to be an independent risk factor for thromboembolic events in AF. The complex relationship between lipoproteins, thrombosis and AF warrants further research with an aim to improve our knowledge base and contribute to our overall understanding of lipoprotein-mediated thrombosis.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Majd B Protty
- Systems Immunity University Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Ian G Davies
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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13
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Bahloul A, Bouattour N, Triki F, Hammami R, Charfeddine S, Ellouze T, Mhiri C, Abid L, Kammoun S. [Observational study of the prevalence of non-valvular atrial fibrillation and ischemic stroke and the factors associated with non-valvular atrial fibrillation in hypertensive patients: about 2887 cases]. Pan Afr Med J 2021; 38:31. [PMID: 33777299 PMCID: PMC7955596 DOI: 10.11604/pamj.2021.38.31.25569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/20/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction high blood pressure (HBP), atrial fibrillation (AF) and ischemic stroke are three public health problems. The purpose of this study was to determine the prevalence of AF and ischemic stroke in hypertensive patients and the factors associated with the occurrence of non-valvular AF in these patients. Methods we used data collected in the Department of Cardiology at the University Hospital of Sfax as a part of National Tunisian Registry of Hypertension. We examined the associations between different socio-demographic, clinical, paraclinical, and therapeutic variables and AF in hypertensive patients using logistic regression models. Results our sample consisted of 2887 patients with a sex ratio of 0.95. The average age of patients was 65 years (±11). AF was found in 230 patients (8%), while ischemic stroke was found in 152 patients (5.3%). Multivariate analysis highlighted that independent factors associated with an increase in the prevalence of AF were: advanced age (p = 0,001, Odds Ratio (OR) = 1,647, 95% confidence interval ( CI): 1,1227-2,213), the detection of left ventricular hypertrophy (LVH) on cardiac ultrasound (p= 0,004, OR= 2,140, 5%CI 9: 1,281-3,576), and left ventricular ejection fraction (LVEF) < 50% (p<0,001, OR=4,677, 95% CI: 2,715 and 8.057). Conclusion this study confirms that there is a direct and independent relationship between high blood pressure, advanced age, LVH and AF. AF in patients with high blood pressure is a disease progression leading to an increased risk of ischemic stroke. Optimal high blood pressure control is a priority in hypertensive patients, especially in the elderly, aiming at preventing the risk of AF and ischemic stroke.
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Affiliation(s)
- Amine Bahloul
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Nadia Bouattour
- Service de Neurologie, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax, Tunisie
| | - Faten Triki
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Rania Hammami
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Selma Charfeddine
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Tarek Ellouze
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Chokri Mhiri
- Service de Neurologie, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax, Tunisie
| | - Leila Abid
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Samir Kammoun
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
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14
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Zhang J, Zheng R, Li H, Guo J. Serum uric acid and incident atrial fibrillation: A systematic review and dose-response meta-analysis. Clin Exp Pharmacol Physiol 2020; 47:1774-1782. [PMID: 32621546 DOI: 10.1111/1440-1681.13374] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
Abstract
The exposure-effect association between serum uric acid and atrial fibrillationis not well known. We conduct a meta-analysis to quantitatively examine the exposure-effect relationship between serum uric acid and atrial fibrillation. Prospective studies (including cohort or nested case-control) that reported the serum uric acid and atrial fibrillation were identified through electronic searches using EMBASE, PubMed, and the Cochrane Library database. The exposure-effect analysis was performed using a stage robust error meta-regression. Eleven studies were included, with a total of 6831 cases of atrial fibrillation among 527 908 individuals. Both the highest (risk ratio (RR), 1.9; 95% confidence interval (CI), 1.64-2.23; I2 = 0%) and intermediate (RR, 1.36; 95% CI, 1.16-1.59; I2 = 36%) level of serum uric acid were associated with increased risks of atrial fibrillation compared to the patients with the lowest level of serum uric acid. In the exposure-effect analysis, for each 1 mg/dL increase in serum uric acid level, the incidence of atrial fibrillation increased by 21% (RR, 1.21; 95% CI, 1.12-1.32; I2 = 78%). Furthermore, a significant positive linear relationship between serum uric acid and the risk of atrial fibrillation, Pnonlinearity = 0.47 was found. The exposure-effect analysis demonstrated that serum uric acid over 5.0 mg/dL significantly increased the risk of atrial fibrillation. There was a positive linear association between serum uric acid and risk of atrial fibrillation, both in subjects with noruricaemia and hyperuricaemia. More studies are needed to explore the impact of serum uric acid reduction on the incidence of atrial fibrillation.
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Affiliation(s)
- Jiayong Zhang
- Department of Rheumatology and Immunology, Mindong Hospital Affiliated to Fujian Medical University, Fu'an, China
| | - Ruiping Zheng
- Department of Integrated TCM & Western Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an, China
| | - Hejun Li
- Department of Rheumatology and Immunology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jin Guo
- Department of Integrated TCM & Western Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an, China
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15
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Bhalia S, Pallangyo P, Dalidali A, Salum S, Kawajika R, Kajuna E, Kusiima H, Kifai E, Kisenge P, Waane T, Janabi M. Burden and correlates of atrial fibrillation among hypertensive patients attending a tertiary hospital in Tanzania. BMC Cardiovasc Disord 2020; 20:235. [PMID: 32429855 PMCID: PMC7236463 DOI: 10.1186/s12872-020-01517-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common supra ventricular cardiac arrhythmia, which presents with variety of clinical symptoms. Hypertension increases risk of developing Atrial fibrillation by 1.5 fold. Together Atrial fibrillation and hypertension doubles the risk of morbidity and mortality. We aimed to determine the prevalence of AF and describe associated factors among hypertensive patients attending tertiary hospital in Tanzania. Methods A cross-sectional hospital-based study, involving 391 hypertensive patients visiting the Jakaya Kikwete Cardiac Institute was conducted between October to December 2017. Categorical variables were analyzed using chi square while student t- test was used to analyze continuous variables. Multivariate logistic regression analysis was performed to determine factors associated with AF. All analysis was two sided and p- value of < 0.05 was used to be not significant. Results AF was detected in 40 (10.2%) patients. Atrial fibrillation was associated with BMI ≥ 25 (OR 4.4, 95% CI 1.1–7.7, p-value 0.02), ejection fraction < 50% (OR 3.0, 95%CI 1.1–8.2, p-value 0.03), Left Atrial diameter > 40 mm (OR 9.4,95%CI 2.1–43.2, p-value < 0.01) and eGFR< 60 (OR 2.9, 95%CI 1.1–7.8, p-value 0.04). Conclusion Atrial fibrillation is considerably prevalent among the hypertensive sub-population. Prompt diagnosis and timely management is vital to prevent complications and premature mortality.
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Affiliation(s)
- Smita Bhalia
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania.
| | - Pedro Pallangyo
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Abuu Dalidali
- Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Saada Salum
- Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Richard Kawajika
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Edna Kajuna
- Department of Nursing, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Happiness Kusiima
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Engerasiya Kifai
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania.,Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Peter Kisenge
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Tatizo Waane
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
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16
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Li S, Cheng J, Cui L, Gurol ME, Bhatt DL, Fonarow GC, Benjamin EJ, Xing A, Xia Y, Wu S, Gao X. Cohort Study of Repeated Measurements of Serum Urate and Risk of Incident Atrial Fibrillation. J Am Heart Assoc 2019; 8:e012020. [PMID: 31213103 PMCID: PMC6662349 DOI: 10.1161/jaha.119.012020] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Current evidence on the association between serum urate and risk of atrial fibrillation ( AF ) is limited by cross-sectional designs and 1-time measurement of serum urate. The roles of serum urate, gout-related inflammation, and systemic inflammation in the etiology of AF are currently unknown. This gap is important, given that systemic inflammation is a recognized risk factor for AF . Methods and Results We conducted a prospective cohort study of 123 238 Chinese patients from 2006 to 2014. Serum urate concentrations were measured in 2006, 2008, 2010, and 2012. Incident AF cases were identified via biennial 12-lead ECG assessment. We used a Cox proportional hazards model to examine the sex-specific associations of cumulative average serum urate and changes in serum urate accounting for baseline level with risk of incident AF . We also assessed the joint associations of serum urate and high-sensitivity C-reactive protein levels. Comparing extreme categories, participants with the highest quintile of serum urate had 1.91-fold higher risk of AF (adjusted hazard ratio: 1.91; 95% CI, 1.32-2.76; P=0.001 for trend). Participants with both high serum urate and high-sensitivity C-reactive protein had 2.6-fold elevated risk of incident AF compared with those with normal levels of serum urate and high-sensitivity C-reactive protein (adjusted hazard ratio: 2.63; 95% CI, 1.63-4.23). Conclusions High serum urate levels and increases in serum urate over time were associated with increased risk of incident AF . Patients with high levels of both serum urate and high-sensitivity C-reactive protein had substantially higher risk of AF .
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Affiliation(s)
- Shanshan Li
- 1 Boston University School of Medicine Boston MA
| | - Jin Cheng
- 2 Department of Cardiology Kailuan General Hospital Tangshan People's Republic of China
| | - Liufu Cui
- 3 Department of Rheumatology and Immunology Kailuan General Hospital Tangshan People's Republic of China
| | - M Edip Gurol
- 4 Massachusetts General Hospital Harvard Medical School Boston MA
| | - Deepak L Bhatt
- 5 Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Gregg C Fonarow
- 6 David Geffen School of Medicine University of California Los Angeles CA
| | | | - Aijun Xing
- 2 Department of Cardiology Kailuan General Hospital Tangshan People's Republic of China
| | - YunLong Xia
- 7 Department of Cardiology First Affiliated Hospital of Dalian Medical University Dailian People's Republic of China
| | - Shouling Wu
- 2 Department of Cardiology Kailuan General Hospital Tangshan People's Republic of China
| | - Xiang Gao
- 8 Department of Nutritional Sciences Pennsylvania State University State College PA
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17
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Deng H, Shantsila A, Xue Y, Bai Y, Guo P, Potpara TS, Zhan X, Fang X, Liao H, Wu S, Lip GYH. Renal function and outcomes after catheter ablation of patients with atrial fibrillation: The Guangzhou atrial fibrillation ablation registry. Arch Cardiovasc Dis 2019; 112:420-429. [PMID: 31133543 DOI: 10.1016/j.acvd.2019.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/15/2019] [Accepted: 02/26/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) has been associated with incident atrial fibrillation (AF) and its complications, but data from Asian cohorts are limited. AIM To explore the relationship of AF recurrence after catheter ablation (CA) with eGFR as a continuous variable, and with different renal function categories (normal: estimated glomerular filtration rate [eGFR] ≥90mL/min/1.73 m2; mild CKD: eGFR 60-89mL/min/1.73 m2; moderate CKD: eGFR 45-59mL/min/1.73 m2; severe CKD: <45mL/min/1.73 m2), using data from the Guangzhou Atrial Fibrillation Ablation Registry. METHODS We studied consecutive symptomatic adult patients with non-valvular AF, refractory to at least one antiarrhythmic drug and eligible for CA, in Guangdong General Hospital between June 2011 and August 2015. RESULTS Data were available from 1407 consecutive patients (mean age 57.3±11.5 years; 68% men) with non-valvular AF undergoing radiofrequency or cryoballoon ablation. During a mean follow-up of 20.7±8.8 months, 18.6% of patients with paroxysmal AF and 50.5% with non-paroxysmal AF had AF recurrence. On multivariable analysis, eGFR (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.96-0.97) was an independent risk factor for AF recurrence, with a good predictive value (area under the curve 0.74, 95% CI 0.72-0.77; P<0.01). In the normal renal function, and mild, moderate and severe CKD categories, AF recurrence rates were 11.5%, 29.3%, 72.0% and 93.3%, respectively. Compared with normal renal function, there were stepwise increased risks of AF recurrence with mild CKD (HR 3.30, 95% CI 2.55-4.26; P<0.01), moderate CKD (HR 9.43, 95% CI 6.76-13.16; P<0.01) and severe CKD (HR 12.35, 95% CI 6.93-21.99; P<0.01). CONCLUSIONS In a large cohort of Asian patients with AF, renal dysfunction increased the risk of AF recurrence after CA. AF recurrence gradually increased with worsening kidney function in this cohort.
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Affiliation(s)
- Hai Deng
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, 510100 Guangzhou, China
| | - Alena Shantsila
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, 510100 Guangzhou, China
| | - Ying Bai
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; Cardiovascular Centre, Beijing Tongren Hospital, Capital Medical University, 100730 Beijing, China
| | - Pi Guo
- Department of Public Health, Shantou University Medical College, 515100 Guangdong Sheng, China
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, 11000 Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Xianzhang Zhan
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, 510100 Guangzhou, China
| | - Xianhong Fang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, 510100 Guangzhou, China
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, 510100 Guangzhou, China
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, 510100 Guangzhou, China.
| | - Gregory Y H Lip
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK; School of Medicine, Belgrade University, 11000 Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, 11000 Belgrade, Serbia; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark.
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18
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Tegene E, Tadesse I, Markos Y, Gobena T. Prevalence and risk factors for atrial fibrillation and its anticoagulant requirement in adults aged ≥40 in Jimma Town, Southwest Ethiopia: A community based cross-sectional study. IJC HEART & VASCULATURE 2019; 22:199-204. [PMID: 30963095 PMCID: PMC6437289 DOI: 10.1016/j.ijcha.2019.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is no information on the prevalence and incidence of atrial fibrillation in Ethiopia. We aimed to investigate the prevalence, risk factors and anticoagulant requirements of atrial fibrillation in an elderly Jimma population. METHODS In a community-based cross-sectional study in 634 adult (≥40 years) Jimma population, we performed cardiovascular health examinations including a 12-lead electrocardiogram to estimate AF prevalence. A standardized questionnaire was used to collect information on medical history, lifestyle and use of medications. Stroke risk stratification was done using CHA2DS2-VASc score. We used logistic regressions to determine the potential risk factors of AF. RESULTS The overall prevalence of AF was 4.3%. AF was associated with sex, current smoking, hypertension and BMI. Nineteen out of twenty seven participants with AF were in need of anticoagulation to prevent risk of stroke. CONCLUSION The prevalence of AF is high and common risk factors were sex, current smoking, hypertension, and higher BMI in this cohort. More than two-third of study participants with AF were at higher need of oral anticoagulants.
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Affiliation(s)
- Elsah Tegene
- Department of Internal Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Iyasu Tadesse
- Department of Medical Physiology, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Yohannes Markos
- Department of Medical Physiology, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teshome Gobena
- Department of Medical Physiology, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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19
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Cameli M, Mandoli GE, Ambrosio G, Cerbai E, Coiro S, Emdin M, Marcucci R, Morrone D, Palazzuoli A, Savino K, Padeletti L, Mondillo S, Pedrinelli R. Arterial hypertension and atrial fibrillation: standard and advanced echocardiography from diagnosis to prognostication. J Cardiovasc Med (Hagerstown) 2018; 19:51-61. [PMID: 29251696 DOI: 10.2459/jcm.0000000000000607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
: Structural changes in left and right cardiac chambers that occur in arterial hypertension (AH) may lead to an increased risk of atrial fibrillation. Considering that AH is currently the most common cardiovascular disease in the general population, it represents a major risk factor for atrial fibrillation development. This review explores the complex relationship between atrial fibrillation and AH, starting from its pathophysiological basis. It focuses on the role of echocardiography in the management of hypertensive and atrial fibrillation patients, with emphasis on what should be evaluated about left ventricular remodeling, diastolic and systolic function, left atrial (LA) size and function and right ventricular deformation in patients with AH.
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Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena
| | - Giulia E Mandoli
- Department of Cardiovascular Diseases, University of Siena, Siena
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia
| | - Elisabetta Cerbai
- Department of NeuroFarBa, C.I.M.M.B.A., University of Florence, Florence
| | - Stefano Coiro
- Division of Cardiology, University of Perugia School of Medicine, Perugia
| | - Michele Emdin
- Scuola Superiore Sant'Anna.,Fondazione Toscana G. Monasterio, Pisa
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Doralisa Morrone
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa
| | - Alberto Palazzuoli
- Department of Internal Medicine, Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena, Siena
| | - Ketty Savino
- Division of Cardiology, University of Perugia School of Medicine, Perugia
| | - Luigi Padeletti
- Institute of Internal Medicine and Cardiology, Careggi Hospital, University of Florence, Florence.,IRCCS Multimedica, Milan, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa
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20
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Atrial Fibrillation Manifestations Risk Factors and Sex Differences in a Population-Based Cohort (From the Gutenberg Health Study). Am J Cardiol 2018; 122:76-82. [PMID: 29706202 DOI: 10.1016/j.amjcard.2018.03.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/14/2018] [Accepted: 03/19/2018] [Indexed: 11/20/2022]
Abstract
Sex differences in cardiovascular risk factors, cardiac structure and function, and disease and symptom burden in the common arrhythmia atrial fibrillation (AF) have not been investigated systematically at the population level. Cross-sectional data of 14,796 subjects (age range 35 to 74 years, 50.5% men) from the population-based Gutenberg Health Study were examined to show the distribution of cardiovascular risk factors by AF status and sex, and to determine sex-specific predictors for AF. The prevalence of AF was higher in men (4.3%) than in women (1.9%). Men had a worse cardiovascular risk factor profile, a higher prevalence of cardiovascular disease, but fewer symptoms than women. Age-adjusted Cox regressions showed sex interactions in the association of high-density lipoprotein-cholesterol, triglycerides, diabetes mellitus, coronary artery disease, myocardial infarction, generalized anxiety disorder, and heart rate with AF. After multivariable adjustment, sex interactions were seen for thickness of interventricular end-diastolic septum, odds ratio (OR) per standard deviation (SD), 95% confidence interval women: 0.9 (0.8, 1.1), men: 1.2 (1.1, 1.4), interaction p value = 0.02; left atrial diameter index, OR per SD women: 1.5 (1.3, 1.8), men: 1.9 (1.7, 2.1), interaction p value = 0.03; and myocardial infarction, OR women: 2.7 (1.3, 5.6), men: 0.7 (0.5, 1.1), interaction p value = 0.002. In conclusion, in our large cohort, we observed substantial sex differences in AF distribution and clinical characteristics including comorbidities, symptom burden, and structural cardiac changes.
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Choi KH, Yu YM, Ah YM, Chang MJ, Lee JY. Persistence with antihypertensives in uncomplicated treatment-naïve very elderly patients: a nationwide population-based study. BMC Cardiovasc Disord 2017; 17:232. [PMID: 28836946 PMCID: PMC5571581 DOI: 10.1186/s12872-017-0665-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/16/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Limited studies have evaluated the medication-taking behavior in very elderly hypertensive patients. The aim of this study was to evaluate the persistence and adherence with antihypertensive agents in treatment-naïve patients, along with other related factors, according to age. METHODS Adult (19-64 years), elderly (65-79 years), and very elderly (≥80 years) uncomplicated hypertensive patients starting antihypertensive monotherapy were identified from the National Health Insurance claims database. The first-year treatment persistence and adherence rates measured using the medication possession ratio were assessed and compared in these three age cohorts. RESULTS After propensity score matching, three age cohorts with 6689 patients each were assembled from 228,925 uncomplicated hypertensive patients who began antihypertensive monotherapy in 2012. The treatment persistence and adherence rates over the first year were the lowest in the very elderly (59.5% and 62.8%, respectively) and highest in the elderly (65.2% and 67.9%, respectively) patients among the three age cohorts (p < 0.001). The adjusted risk for treatment non-persistence was significantly higher in the very elderly (adjusted hazard ratio, 1.20; 95% confidence interval, 1.13-1.27) compared with the elderly. Having more comorbidities, being a beneficiary of medical aid, and having a diagnosis of dementia were unique positive predictors for treatment persistence in the very elderly, along with common predictors such as female sex, dyslipidemia, and an initially chosen antihypertensive therapeutic class other than beta blockers and thiazide diuretics. CONCLUSIONS Very elderly patients were less likely to continue antihypertensive therapy over the first year compared with their younger counterparts. Our findings suggest that a low comorbidity index and lack of medical aid support negatively affect the treatment persistence in this population.
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Affiliation(s)
- Kyung Hee Choi
- College of Pharmacy, Sunchon National University, 255 Jungang-ro, Suncheon, Jeollanam-do, 57922, South Korea.,College of Pharmacy, Chonnam National University, Gwang-Ju, 61186, South Korea
| | - Yun Mi Yu
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Young-Mi Ah
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, South Korea
| | - Min Jung Chang
- College of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, 21983, South Korea
| | - Ju-Yeun Lee
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, South Korea.
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22
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Galli F, Borghi L, Carugo S, Cavicchioli M, Faioni EM, Negroni MS, Vegni E. Atrial fibrillation and psychological factors: a systematic review. PeerJ 2017; 5:e3537. [PMID: 28828233 PMCID: PMC5555290 DOI: 10.7717/peerj.3537] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/12/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Psychological factors have been suggested to have an influence in Atrial Fibrillation (AF) onset, progression, severity and outcomes, but their role is unclear and mainly focused on anxiety and depression. METHODS A systematic electronic search had been conducted to identify studies exploring different psychological factors in AF. The search retrieved 832 articles that were reviewed according to inclusion criteria: observational study with a control/comparison group; use of standardized and validated instruments for psychological assessment. Results were summarized qualitatively and quantitatively by effect size measure (Cohen's d and its 95% confidence interval). Cochrane Collaboration guidelines and the PRISMA Statement were adopted. RESULTS Eight studies were included in the systematic review. Depression was the most studied construct/ but only one study showed a clear link with AF. The remaining studies showed small and non-significant (95% CI [-0.25-1.00]) differences between AF and controls, no differences in frequency of depression history (95% CI [-0.14-0.22]) or in case frequency (95% CI [-0.50-0.04]). Miscellaneous results were found as far as anxiety: AF patients showed higher levels when compared to healthy subjects (95% CI [2.05-2.95]), but findings were inconsistent when compared to other heart diseases. Considering personality and life-events preceding AF, we respectively found a large (95% CI [1.87-2.49]) and a moderate to large effect (95% CI [0.48-0.98]). DISCUSSION The small number of studies does not allow to draw clear-cut conclusions on the involvement of psychological factors in AF. Promising lines of research are related to personality and adverse life-events, and to the increase of longitudinal design studies. Some methodological problems could be overcome by including clinical psychologists in the implementation of research protocols.
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Affiliation(s)
- Federica Galli
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Lidia Borghi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Stefano Carugo
- Department of Health Sciences, University of Milan, Milan, Italy
- Cardiology Unit and UTIC, UOC Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Elena Maria Faioni
- Department of Health Sciences, University of Milan, Milan, Italy
- SIMT, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Silvia Negroni
- Cardiology Unit and UTIC, UOC Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
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23
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Molnar AO, Eddeen AB, Ducharme R, Garg AX, Harel Z, McCallum MK, Perl J, Wald R, Zimmerman D, Sood MM. Association of Proteinuria and Incident Atrial Fibrillation in Patients With Intact and Reduced Kidney Function. J Am Heart Assoc 2017; 6:e005685. [PMID: 28684642 PMCID: PMC5586292 DOI: 10.1161/jaha.117.005685] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 05/17/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Early evidence suggests proteinuria is independently associated with incident atrial fibrillation (AF). We sought to investigate whether the association of proteinuria with incident AF is altered by kidney function. METHODS AND RESULTS Retrospective cohort study using administrative healthcare databases in Ontario, Canada (2002-2015). A total of 736 666 patients aged ≥40 years not receiving dialysis and with no previous history of AF were included. Proteinuria was defined using the urine albumin-to-creatinine ratio (ACR) and kidney function by the estimated glomerular filtration rate (eGFR). The primary outcome was time to AF. Cox proportional models were used to determine the hazard ratio for AF censored for death, dialysis, kidney transplant, or end of follow-up. Fine and Grey models were used to determine the subdistribution hazard ratio for AF, with death as a competing event. Median follow-up was 6 years and 44 809 patients developed AF. In adjusted models, ACR and eGFR were associated with AF (P<0.0001). The association of proteinuria with AF differed based on kidney function (ACR × eGFR interaction, P<0.0001). Overt proteinuria (ACR, 120 mg/mmol) was associated with greater AF risk in patients with intact (eGFR, 120) versus reduced (eGFR, 30) kidney function (adjusted hazard ratios, 4.5 [95% CI, 4.0-5.1] and 2.6 [95% CI, 2.4-2.8], respectively; referent ACR 0 and eGFR 120). Results were similar in competing risk analyses. CONCLUSIONS Proteinuria increases the risk of incident AF markedly in patients with intact kidney function compared with those with decreased kidney function. Screening and preventative strategies should consider proteinuria as an independent risk factor for AF.
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Affiliation(s)
- Amber O Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Robin Ducharme
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
- Epidemiology, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Ziv Harel
- Nephrology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Megan K McCallum
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Jeffrey Perl
- Nephrology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Ron Wald
- Nephrology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Deborah Zimmerman
- Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada
| | - Manish M Sood
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada
- Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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24
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Target Organ Damage and the Long Term Effect of Nonadherence to Clinical Practice Guidelines in Patients with Hypertension: A Retrospective Cohort Study. Int J Hypertens 2017; 2017:2637051. [PMID: 28695006 PMCID: PMC5485479 DOI: 10.1155/2017/2637051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/22/2017] [Accepted: 04/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background There was limited published data on target organ damage (TOD) and the effect of nonadherence to practice guidelines in Ethiopia. This study determined TOD and the long term effect of nonadherence to clinical guidelines on hypertensive patients. Methods An open level retrospective cohort study has been employed at cardiac clinic of Gondar university hospital for a mean follow-up period of 78 months. Multivariate Cox regression was conducted to test associating factors of TOD. Results Of the total number of 612 patients examined, the overall prevalence of hypertensive TOD was 40.3%. The presence of comorbidities, COR = 1.073 [1.01–1.437], AOR = 1.196 [1.174–1.637], and nonadherence to clinical practice guidelines, COR = 1.537 [1.167–2.024], AOR = 1.636 [1.189–2.251], were found to be predicting factors for TOD. According to Kaplan-Meier analysis patients who were initiated on appropriate medication tended to develop TOD very late: Log Rank [11.975 (p = 0.01)]. Conclusion More than forty percent of patients acquired TOD which is more significant. Presence of comorbidities and nonadherence to practice guidelines were correlated with the incidence of TOD. Appropriate management of hypertension and modification of triggering factors are essential to prevent complications.
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