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Mahmoud DM, El-Ela FIA, Fouad AG, Belal A, Ali MAM, Ghoneim MM, Almeheyawi RN, Attia ME, Mahmoud TM. Improving the bioavailability and therapeutic efficacy of felodipine for the control of diabetes-associated atherosclerosis: In vitro and in vivo characterization. Int J Pharm 2024; 661:124395. [PMID: 38945465 DOI: 10.1016/j.ijpharm.2024.124395] [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: 04/30/2024] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/02/2024]
Abstract
Felodipine has proven to be effective as an atherosclerosis therapy because it increases blood flow to the vessel wall. However, the poor solubility, low bioavailability, and hepatic first-pass metabolism of oral felodipine compromise its therapeutic effectiveness. The study's goal is to create a nasal pH-sensitive hydrogel of felodipine-loaded invasomes (IPHFI) that will improve felodipine's release, permeation, bioavailability, and efficacy as a potential diabetes-associated atherosclerosis therapy. According to the pre-formulation study, the felodipine-loaded invasomes formulation composed of phospholipid (3%w/v), cholesterol (0.16%w/v), ethanol (3%v/v) and cineole (1%v/v) was chosen as the optimum formulation. The optimum formulation was characterized in vitro and then mixed with a mixture of chitosan and glyceryl monooleate to make the IPHFI formulation. The IPHFI formulation enhanced the release and permeation of felodipine by 2.99 and 3-fold, respectively. To assess the efficacy and bioavailability of the IPHFI formulation, it was studied in vivo using an experimental atherosclerosis rat model. Compared to oral free felodipine, the nasal administration of the IPHFI formulation increased the bioavailability by 3.37-fold and decreased the serum cholesterol, triglycerides, LDL, and calcification score by 1.56, 1.53, 1.80, and 1.18 ratios, respectively. Thus, nasal IPHFI formulation may represent a promising diabetes-associated atherosclerosis therapy.
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Affiliation(s)
- Dina M Mahmoud
- Department of Pharmaceutics, Faculty of Pharmacy, El Saleheya El Gadida University, El Saleheya El Gadida, Sharkia, Egypt; Department of Pharmaceutics, Faculty of Pharmacy, Nahda University, Beni-Suef, Egypt.
| | - Fatma I Abo El-Ela
- Department of Pharmacology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, Egypt.
| | - Amr Gamal Fouad
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt.
| | - Amany Belal
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Mohamed A M Ali
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11623, Riyadh, Saudi Arabia; Department of Biochemistry, Faculty of Science, Ain Shams University, Abbassia 11566, Cairo, Egypt.
| | - Mohammed M Ghoneim
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Ad Diriyah, Riyadh 13713, Saudi Arabia.
| | - Rania N Almeheyawi
- Department of Physical therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.
| | - Mary Eskander Attia
- Pharmacology department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
| | - Tamer M Mahmoud
- Department of Pharmaceutics and Drug Manufacturing, Faculty of Pharmacy, Modern University for Technology and Information, Cairo, Egypt.
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Behdani B, Kazemi T, Zardast M, Khosravi Bizhaem S, Jafari S. Adherence to the 2018 AHA cholesterol management guideline in hyperlipidemia treatment among adults in an outpatient setting. Front Cardiovasc Med 2024; 11:1340311. [PMID: 39081369 PMCID: PMC11288196 DOI: 10.3389/fcvm.2024.1340311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/23/2024] [Indexed: 08/02/2024] Open
Abstract
Background Although evidence-based guidelines and effective treatments exist for dyslipidemia, a significant disparity remains between guidelines and clinical practice. In this study, we investigated adherence to statin therapy per the 2018 ACC/AHA Guideline recommendations. Methods This is a retrospective, descriptive-analytical study involving 1,224 individuals who presented to the laboratories located in Birjand, Eastern Iran, from June 2022 to March 2023. Analyses were conducted on 700 patients. Data collection utilized a checklist and serum value measurements of laboratory factors deemed necessary for the study. Results Treatment was administered per the guidelines for 348 out of the 700 patients (49.7%). With 60.7%, the diabetes group exhibited the highest level of adherence to guidelines. In the atherosclerotic cardiovascular disease (ASCVD) group, 31.7% followed the recommendations. The lowest adherence rates were in groups with a 10-year ASCVD risk score of ≥20% and severe hypercholesterolemia, respectively (0% and 2.8%). In our study, atorvastatin was the most frequently prescribed statin, with the majority of patients consuming a moderate-intensity statin. None of the severely hypercholesterolemic patients achieved the LDL goal. Moreover, LDL-C goal achievement was low among the ASCVD group and those with an ASCVD risk score of ≥20%. Conclusion Patients with hypercholesterolemia adhere inadequately to the AHA Guideline. Consequently, training courses are needed to inform medical doctors, particularly general practitioners, of the latest dyslipidemia treatment recommendations as the AHA advises.
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Affiliation(s)
- Bahere Behdani
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Toba Kazemi
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahmood Zardast
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeede Khosravi Bizhaem
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Shima Jafari
- Department of Clinical Pharmacy, School of Pharmacy, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Dženkevičiūtė V, Adomavičius T, Tarutytė G, Rinkūnienė E, Kasiulevičius V, Badarienė J. Carotid Plaques and Hypertension as Risk Factors for Cardiovascular Disease and All-Cause Mortality in Middle-Aged Adults. J Clin Med 2024; 13:2804. [PMID: 38792345 PMCID: PMC11121814 DOI: 10.3390/jcm13102804] [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: 04/08/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Both hypertension and carotid atherosclerosis are independent risk factors for cardiovascular disease. We aim to investigate the synergistic effects of hypertension and carotid plaques on cardiovascular events and all-cause mortality. Methods: A follow-up study was conducted at the Preventive Cardiology Department of Vilnius University Hospital Santaros Klinikos between 2012 and 2021. The study recruited participants aged 40-65 who did not have overt cardiovascular disease (CVD) and were part of the Lithuanian High Cardiovascular Risk primary preventive program. The study collected demographic and clinical data, including an ultrasound assessment of carotid plaque. Results: The participants were monitored for 4-10 years for CVD events and all-cause mortality. Among 6138 participants, 954 (16%) experienced CVD events. The presence of carotid plaque on both sides was significantly associated with CVD events, myocardial infarction, and all-cause mortality. However, the combination of hypertension and carotid plaque did not significantly increase the risk for CVD events or all-cause mortality. Conclusions: The risk of CVD events or all-cause mortality was not significantly increased by the combination of hypertension and carotid plaque. Cardiovascular events depend on the extent of atherosclerosis in the carotid arteries.
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Affiliation(s)
- Vilma Dženkevičiūtė
- Clinic of Internal and Family Medicine, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (T.A.); (V.K.)
| | - Tadas Adomavičius
- Clinic of Internal and Family Medicine, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (T.A.); (V.K.)
| | - Gabrielė Tarutytė
- Department of Research and Innovation, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | - Egidija Rinkūnienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (E.R.); (J.B.)
| | - Vytautas Kasiulevičius
- Clinic of Internal and Family Medicine, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (T.A.); (V.K.)
| | - Jolita Badarienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (E.R.); (J.B.)
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Yoon CY, Lee J, Kong TH, Seo YJ. Importance of small vessel disease as a possible cause of sudden sensorineural hearing loss. PLoS One 2024; 19:e0302447. [PMID: 38713651 DOI: 10.1371/journal.pone.0302447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/29/2024] [Indexed: 05/09/2024] Open
Abstract
OBJECTIVE Vascular disease like small-vessel disease (SVD) is the most likely cause among the potential causes of Sudden sensorineural hearing loss (SSNHL). Understanding the relationship between SVD and SSNHL is crucial for developing effective prevention and treatment strategies. To confirm the relationship between SVD and SSNHL, the effect of SVD is confirmed by focusing on the duration and recurrence of SSNHL. METHODS This article reports a retrospective observational study that investigated the relationship between SVD and SSNHL using the South Korea Health Insurance Review and Assessment Service (HIRA) database from 2010 to 2020. This retrospective observational study included 319,569 SSNHL patients between 2010 and 2020. RESULTS Participant demographics were controlled using Propensity Score Matching. The hazard ratios (HR) for the effect of SVD on the duration of SSNHL were 1.045 for the group with SVD before the onset of SSNHL and 1.234 for the group with SVD after the onset of SSNHL. SVD was statistically significant for the recurrence of SSNHL, with an odds ratio of 1.312 in the group with SVD compared to the group without SVD. The HR for the period until a recurrence in the group with SVD was 1.062. CONCLUSIONS The study identified SVD as a possible cause of SSNHL and found that the duration of SSNHL increased only in the presence of SVD. SVD also affected the recurrence of SSNHL, with the recurrence rate being 1.312 times higher in the group with SVD.
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Affiliation(s)
- Chul Young Yoon
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, South Korea
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Junhun Lee
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, South Korea
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Tae Hoon Kong
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, South Korea
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, South Korea
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Young Joon Seo
- Research Institute of Hearing Enhancement, Yonsei University Wonju College of Medicine, Wonju, South Korea
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, South Korea
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Choi E, Lee J, Choo E, Jang EJ, Lee IH. Continuity of care between dyslipidemia patients and multiple providers: A cohort study. PLoS One 2024; 19:e0300745. [PMID: 38696494 PMCID: PMC11065238 DOI: 10.1371/journal.pone.0300745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the impacts of continuity of care (COC) between patients and multiple providers, i.e., doctors and community pharmacists, on clinical and economic outcomes. METHODS This is a retrospective cohort study and analyzed Korean national claims data for ambulatory care setting between 2007 and 2018. Patients with dyslipidemia newly diagnosed in 2008 were identified. COC between providers and patients was computed using the continuity of care index (COCI). Based on COCIs, the study patients were allocated to four groups: HM/HP, HM/LP, LM/HP, and LM/LP. Each symbol represents H for high, L for low, M for doctor, and P for pharmacist. The primary study outcome was the incidence of atherosclerotic cardiovascular disease (ASCVD). RESULTS 126,710 patients were included. Percentages of patients in the four study groups were as follows: HM/HP 35%, HM/LP 19%, LM/HP 12%, and LM/LP 34%. During the seven-year outcome period, 8,337 patients (6.6%) developed an ASCVD, and percentages in the study groups were as follows; HM/HP 6.2%, HM/LP 6.3%, LM/HP 6.8%, and LM/LP 7.1%. After adjusting for confounding covariates, only the LM/LP group had a significantly higher risk of ASCVD than the reference group, HM/HP (aHR = 1.16 [95% confidence interval = 1.10~1.22]). The risk of inappropriate medication adherence gradually increased 1.03-fold in the HM/LP group, 1.67-fold in the LM/HP, and 2.26-fold in the LM/LP group versus the HM/HP group after adjusting for covariates. Disease-related costs were lower in the HM/HP and LM/HP groups. CONCLUSIONS The study shows that patients with high relational care continuity with doctors and pharmacists achieved better clinical results and utilized health care less, resulting in reduced expenses. Further exploration for the group that exhibits an ongoing relationship solely with pharmacists is warranted.
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Affiliation(s)
- Eunyoung Choi
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
- Department of Pharmacy, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Juhee Lee
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, United States of America
| | - Eunjung Choo
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Eun Jin Jang
- Department of Informational Statistics, Andong National University, Andong, Republic of Korea
| | - Iyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
- Department of Health Sciences, University of York, York, United Kingdom
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Orji R, Morgans A, Jahangir E, Markson F, Ilelaboye A, Tan A, Okwuosa TM. Androgen Deprivation Therapy/Androgen Receptor Signaling Inhibitor Treatments for Prostate Cancer: Pathophysiology and Review of Effects on Cardiovascular Disease. South Med J 2024; 117:245-253. [PMID: 38701845 DOI: 10.14423/smj.0000000000001687] [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: 05/05/2024]
Abstract
Androgen deprivation therapy is the cornerstone of systemic management for prostate cancer but is associated with multiple adverse effects that must be considered during treatment. These effects occur because of the profound hypogonadism that is induced from lack of testosterone or due to the medications used in the treatment or in combination with androgen receptor signaling inhibitors. This article critically reviews the associations between androgen deprivation therapy, androgen receptor signaling inhibitors, and cardiovascular complications such as prolonged QT interval, atrial fibrillation, heart failure, atherosclerosis, coronary heart disease, venous thromboembolism, and peripheral arterial occlusive disease. These unfavorable outcomes reinforce the need for regular cardiovascular screening of patients undergoing androgen deprivation for the management of prostate cancer.
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Affiliation(s)
| | - Alicia Morgans
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eiman Jahangir
- Division of Cardiovascular Medicine, Section of Cardio-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Favor Markson
- Department of Internal Medicine, Lincoln Medical Center, Bronx, New York
| | - Ayodeji Ilelaboye
- Department of Internal Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Alan Tan
- Division of Hematology-Oncology, Rush University Medical Center, Chicago, Illinois
| | - Tochukwu M Okwuosa
- Division of Cardiovascular Medicine, Section of Cardio-Oncology, Rush University Medical Center, Chicago, Illinois
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7
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Park J, Park S. Association of Handgrip Strength and Cardiovascular Disease Risk Among Middle-Aged Postmenopausal Women: An Analysis of the Korea National Health and Nutrition Examination Survey 2014-2019. Vasc Health Risk Manag 2024; 20:183-194. [PMID: 38628618 PMCID: PMC11020303 DOI: 10.2147/vhrm.s442277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose Handgrip strength is an indicator of overall muscle strength and has been associated with an increased risk of cardiovascular disease. Evidence suggests that menopause is a risk factor for cardiovascular disease in women, and muscle strength decreases progressively after menopause. Despite the prognostic importance of the decline in muscle strength and increased cardiovascular disease risk among postmenopausal women, evidence of their association is limited. This study aimed to investigate the relationship between handgrip strength and cardiovascular disease risk among postmenopausal, middle-aged Korean women. Patients and Methods Using pooled cohort equations, we calculated the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) among postmenopausal women (N = 2019) aged 50-64 years without cardiovascular disease history from the 2014-2019 Korea National Health and Nutrition Examination Survey. Relative grip strength was defined as measured grip strength divided by body mass index. Logistic regression analysis of a complex sampling design was performed to evaluate the association between relative grip strength and a predicted 10-year ASCVD risk ≥7.5%. Results The average handgrip strength was 24.8 kg, and 5.2% of women were considered for sarcopenia (<18 kg). The quartile-stratified relative grip strength was negatively associated with 10-year ASCVD risk (p < 0.001). In the multiple logistic regression analysis, the adjusted odds ratio for the highest relative grip strength quartile was 0.53 (95% confidence interval [CI]: 0.36-0.78), and that of the group who breastfed for more than 12 months was 1.75 (95% CI: 1.36-2.25) for 10-year ASCVD risk. Conclusion Increased handgrip strength may be associated with lower cardiovascular disease risk among middle-aged postmenopausal women in Korea. Our findings provide critical evidence regarding the importance of increasing handgrip strength among postmenopausal, middle-aged women to reduce cardiovascular disease risk. Handgrip strength measurement might be a valuable screening tool for cardiovascular disease prevention.
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Affiliation(s)
- Jinkyung Park
- College of Nursing, Chonnam National University, Gwangju, 61469, Republic of Korea
| | - Sooyeon Park
- College of Nursing, Konyang University, Daejeon, 35365, Republic of Korea
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Ashrafee A, Yashfe SMS, Khan NS, Islam MT, Azam MG, Arafat MT. Design of experiment approach to identify the dominant geometrical feature of left coronary artery influencing atherosclerosis. Biomed Phys Eng Express 2024; 10:035008. [PMID: 38430572 DOI: 10.1088/2057-1976/ad2f59] [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: 09/06/2023] [Accepted: 03/01/2024] [Indexed: 03/04/2024]
Abstract
Background and Objective. Coronary artery geometry heavily influences local hemodynamics, potentially leading to atherosclerosis. Consequently, the unique geometrical configuration of an individual by birth can be associated with future risk of atherosclerosis. Although current researches focus on exploring the relationship between local hemodynamics and coronary artery geometry, this study aims to identify the order of influence of the geometrical features through systematic experiments, which can reveal the dominant geometrical feature for future risk assessment.Methods. According to Taguchi's method of design of experiment (DoE), the left main stem (LMS) length (lLMS), curvature (kLMS), diameter (dLMS) and the bifurcation angle between left anterior descending (LAD) and left circumflex (LCx) artery (αLAD-LCx) of two reconstructed patient-specific left coronary arteries (LCA) were varied in three levels to create L9 orthogonal array. Computational fluid dynamic (CFD) simulations with physiological boundary conditions were performed on the resulting eighteen LCA models. Average helicity intensity (h2) and relative atheroprone area (RAA) of near-wall hemodynamic descriptors were analyzed.Results. The proximal LAD (LADproximal) was identified to be the most atheroprone region of the left coronary artery due to higherh2,large RAA of time averaged wall shear stress (TAWSS < 0.4 Pa), oscillatory shear index (OSI ∼ 0.5) and relative residence time (RRT > 4.17 Pa-1). In both patient-specific cases, based onh2and TAWSS,dlmsis the dominant geometric parameter while based on OSI and RRT,αLAD-LCxis the dominant one influencing hemodynamic condition in proximal LAD (p< 0.05). Based on RRT, the rank of the geometrical factors is:αLAD-LCx>dLMS>lLMS>kLMS, indicating thatαLAD-LCxis the most dominant geometrical factor affecting hemodynamics at proximal LAD which may influence atherosclerosis.Conclusion. The proposed identification of the rank of geometrical features of LCA and the dominant feature may assist clinicians in predicting the possibility of atherosclerosis, of an individual, long before it will occur. This study can further be translated to be used to rank the influence of several arterial geometrical features at different arterial locations to explore detailed relationships between the arterial geometrical features and local hemodynamics.
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Affiliation(s)
- Adiba Ashrafee
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
| | - Syed Muiz Sadat Yashfe
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
| | - Nusrat S Khan
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, United States of America
| | - Md Tariqul Islam
- Department of Radiology and Imaging, Sheikh Hasina National Institute of Burn & Plastic Surgery, Dhaka - 1205, Bangladesh
| | - M G Azam
- Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka - 1207, Bangladesh
| | - M Tarik Arafat
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
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Woo K, Lim JE, Lee EY. Influence of blood pressure polygenic risk scores and environmental factors on coronary artery disease in the Korean Genome and Epidemiology Study. J Hum Hypertens 2024; 38:221-227. [PMID: 37985823 DOI: 10.1038/s41371-023-00878-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 10/19/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
The present study aimed to investigate the association of blood pressure polygenic risk scores (BP PRSs) with coronary artery disease (CAD) in a Korean population and the interaction effects between PRSs and environmental factors on CAD. Data were derived from the Cardiovascular Disease Association Study (CAVAS; N = 5100) and the Health Examinee Study (HEXA; N = 58,623) within the Korean Genome and Epidemiology Study. PRSs for systolic and diastolic BP were calculated with the weighted allele sum of >200 single-nucleotide polymorphisms. Multivariable logistic regression models were used. BP PRSs were strongly associated with systolic BP (SBP), diastolic BP (DBP), and hypertension in both CAVAS and HEXA (p < 0.0001). PRSSBP was significantly associated with CAD in CAVAS, while PRSSBP and PRSDBP were significantly associated with CAD in HEXA. There was an interaction effect between the BP PRSs and environmental factors on CAD. The odds ratios (ORs) for CAD were 1.036 (95% confidence interval [CI], 1.016-1.055) for obesity, 1.028 (95% CI, 1.011-1.045) for abdominal obesity, 1.030 (95% CI, 1.009-1.050) for triglyceride, 1.024 (95% CI, 1.008-1.041) for high-density lipoprotein cholesterol, and 1.039 for smoking (95% CI, 1.003-1.077) in CAVAS. There was no significant interaction in HEXA, except between PRSDBP and triglyceride (OR, 1.012; 95% CI, 1.001-1.024). BP PRS was associated with an increased risk of hypertension and CAD. The interactions among PRSs and environmental risk factors increased the risk of CAD. Multi-component interventions to lower BP in the population via healthy behaviors are needed to prevent CAD regardless of genetic predisposition.
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Affiliation(s)
- Kyungsook Woo
- Institute of Health and Society, Hanyang University, Seoul, 04763, Republic of Korea
| | - Ji Eun Lim
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Eun Young Lee
- Department of Nursing, Catholic Kkottongnae University, Cheongju, 28211, Republic of Korea.
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Kotlyarov S. Identification of Important Genes Associated with the Development of Atherosclerosis. Curr Gene Ther 2024; 24:29-45. [PMID: 36999180 DOI: 10.2174/1566523223666230330091241] [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: 09/17/2022] [Revised: 12/06/2022] [Accepted: 01/26/2023] [Indexed: 04/01/2023]
Abstract
Atherosclerosis is one of the most important medical problems due to its prevalence and significant contribution to the structure of temporary and permanent disability and mortality. Atherosclerosis is a complex chain of events occurring in the vascular wall over many years. Disorders of lipid metabolism, inflammation, and impaired hemodynamics are important mechanisms of atherogenesis. A growing body of evidence strengthens the understanding of the role of genetic and epigenetic factors in individual predisposition and development of atherosclerosis and its clinical outcomes. In addition, hemodynamic changes, lipid metabolism abnormalities, and inflammation are closely related and have many overlapping links in regulation. A better study of these mechanisms may improve the quality of diagnosis and management of such patients.
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Affiliation(s)
- Stanislav Kotlyarov
- Department of Nursing, Ryazan State Medical University Named After Academician I.P. Pavlov, Russian Federation
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Jędrzejczak K, Orciuch W, Wojtas K, Kozłowski M, Piasecki P, Narloch J, Wierzbicki M, Makowski Ł. Prediction of Hemodynamic-Related Hemolysis in Carotid Stenosis and Aiding in Treatment Planning and Risk Stratification Using Computational Fluid Dynamics. Biomedicines 2023; 12:37. [PMID: 38255144 PMCID: PMC10813079 DOI: 10.3390/biomedicines12010037] [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: 11/09/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Atherosclerosis affects human health in many ways, leading to disability or premature death due to ischemic heart disease, stroke, or limb ischemia. Poststenotic blood flow disruption may also play an essential role in artery wall impairment linked with hemolysis related to shear stress. The maximum shear stress in the atherosclerotic plaque area is the main parameter determining hemolysis risk. In our work, a 3D internal carotid artery model was built from CT scans performed on patients qualified for percutaneous angioplasty due to its symptomatic stenosis. The obtained stenosis geometries were used to conduct a series of computer simulations to identify critical parameters corresponding to the increase in shear stress in the arteries. Stenosis shape parameters responsible for the increase in shear stress were determined. The effect of changes in the carotid artery size, length, and degree of narrowing on the change in maximum shear stress was demonstrated. Then, a correlation for the quick initial diagnosis of atherosclerotic stenoses regarding the risk of hemolysis was developed. The developed relationship for rapid hemolysis risk assessment uses information from typical non-invasive tests for treated patients. Practical guidelines have been developed regarding which stenosis shape parameters pose a risk of hemolysis, which may be adapted in medical practice.
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Affiliation(s)
- Krystian Jędrzejczak
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland
| | - Wojciech Orciuch
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland
| | - Krzysztof Wojtas
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland
| | - Michał Kozłowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 47, 40-635 Katowice, Poland
| | - Piotr Piasecki
- Interventional Radiology Department, Military Institute of Medicine—National Research Institute, Szaserów 128, 04-141 Warsaw, Poland
| | - Jerzy Narloch
- Interventional Radiology Department, Military Institute of Medicine—National Research Institute, Szaserów 128, 04-141 Warsaw, Poland
| | - Marek Wierzbicki
- Interventional Radiology Department, Military Institute of Medicine—National Research Institute, Szaserów 128, 04-141 Warsaw, Poland
| | - Łukasz Makowski
- Faculty of Chemical and Process Engineering, Warsaw University of Technology, Waryńskiego 1, 00-645 Warsaw, Poland
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12
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Kale D, Fatangare A, Phapale P, Sickmann A. Blood-Derived Lipid and Metabolite Biomarkers in Cardiovascular Research from Clinical Studies: A Recent Update. Cells 2023; 12:2796. [PMID: 38132115 PMCID: PMC10741540 DOI: 10.3390/cells12242796] [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: 09/01/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
The primary prevention, early detection, and treatment of cardiovascular disease (CVD) have been long-standing scientific research goals worldwide. In the past decades, traditional blood lipid profiles have been routinely used in clinical practice to estimate the risk of CVDs such as atherosclerotic cardiovascular disease (ASCVD) and as treatment targets for the primary prevention of adverse cardiac events. These blood lipid panel tests often fail to fully predict all CVD risks and thus need to be improved. A comprehensive analysis of molecular species of lipids and metabolites (defined as lipidomics and metabolomics, respectively) can provide molecular insights into the pathophysiology of the disease and could serve as diagnostic and prognostic indicators of disease. Mass spectrometry (MS) and nuclear magnetic resonance (NMR)-based lipidomics and metabolomics analysis have been increasingly used to study the metabolic changes that occur during CVD pathogenesis. In this review, we provide an overview of various MS-based platforms and approaches that are commonly used in lipidomics and metabolomics workflows. This review summarizes the lipids and metabolites in human plasma/serum that have recently (from 2018 to December 2022) been identified as promising CVD biomarkers. In addition, this review describes the potential pathophysiological mechanisms associated with candidate CVD biomarkers. Future studies focused on these potential biomarkers and pathways will provide mechanistic clues of CVD pathogenesis and thus help with the risk assessment, diagnosis, and treatment of CVD.
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Affiliation(s)
- Dipali Kale
- Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., 44139 Dortmund, Germany; (A.F.); (P.P.)
| | | | | | - Albert Sickmann
- Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., 44139 Dortmund, Germany; (A.F.); (P.P.)
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13
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Khan H, Shaikh F, Syed MH, Mamdani M, Saposnik G, Qadura M. Current Biomarkers for Carotid Artery Stenosis: A Comprehensive Review of the Literature. Metabolites 2023; 13:919. [PMID: 37623863 PMCID: PMC10456624 DOI: 10.3390/metabo13080919] [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: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
Carotid artery stenosis (CAS), an atherosclerotic disease of the carotid artery, is one of the leading causes of transient ischemic attacks (TIA) and cerebrovascular attacks (CVA). The atherogenic process of CAS affects a wide range of physiological processes, such as inflammation, endothelial cell function, smooth muscle cell migration and many more. The current gold-standard test for CAS is Doppler ultrasound; however, there is yet to be determined a strong, clinically validated biomarker in the blood that can diagnose patients with CAS and/or predict adverse outcomes in such patients. In this comprehensive literature review, we evaluated all of the current research on plasma and serum proteins that are current contenders for biomarkers for CAS. In this literature review, 36 proteins found as potential biomarkers for CAS were categorized in to the following nine categories based on protein function: (1) Inflammation and Immunity, (2) Lipid Metabolism, (3) Haemostasis, (4) Cardiovascular Markers, (5) Markers of Kidney Function, (6) Bone Health, (7) Cellular Structure, (8) Growth Factors, and (9) Hormones. This literature review is the most up-to-date and current comprehensive review of research on biomarkers of CAS, and the only review that demonstrated the several pathways that contribute to the initiation and progression of the disease. With this review, future studies can determine if any new markers, or a panel of the proteins explored in this study, may be contenders as diagnostic or prognostic markers for CAS.
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Affiliation(s)
- Hamzah Khan
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (H.K.); (F.S.); (M.H.S.)
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada; (M.M.); (G.S.)
| | - Farah Shaikh
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (H.K.); (F.S.); (M.H.S.)
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada; (M.M.); (G.S.)
| | - Muzammil H. Syed
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (H.K.); (F.S.); (M.H.S.)
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada; (M.M.); (G.S.)
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada; (M.M.); (G.S.)
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Gustavo Saposnik
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada; (M.M.); (G.S.)
- Division of Neurology, Department of Medicine, St. Michael’s Hospital, University of Toronto, 55 Queen St E, Toronto, ON M5C 1R6, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (H.K.); (F.S.); (M.H.S.)
- Division of Neurology, Department of Medicine, St. Michael’s Hospital, University of Toronto, 55 Queen St E, Toronto, ON M5C 1R6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
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14
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Bebo A, Jarmul JA, Pletcher MJ, Hasbani NR, Couper D, Nambi V, Ballantyne CM, Fornage M, Morrison AC, Avery CL, de Vries PS. Coronary heart disease and ischemic stroke polygenic risk scores and atherosclerotic cardiovascular disease in a diverse, population-based cohort study. PLoS One 2023; 18:e0285259. [PMID: 37327218 PMCID: PMC10275447 DOI: 10.1371/journal.pone.0285259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/18/2023] [Indexed: 06/18/2023] Open
Abstract
The predictive ability of coronary heart disease (CHD) and ischemic stroke (IS) polygenic risk scores (PRS) have been evaluated individually, but whether they predict the combined outcome of atherosclerotic cardiovascular disease (ASCVD) remains insufficiently researched. It is also unclear whether associations of the CHD and IS PRS with ASCVD are independent of subclinical atherosclerosis measures. 7,286 White and 2,016 Black participants from the population-based Atherosclerosis Risk in Communities study who were free of cardiovascular disease and type 2 diabetes at baseline were included. We computed previously validated CHD and IS PRS consisting of 1,745,179 and 3,225,583 genetic variants, respectively. Cox proportional hazards models were used to test the association between each PRS and ASCVD, adjusting for traditional risk factors, ankle-brachial index, carotid intima media thickness, and carotid plaque. The hazard ratios (HR) for the CHD and IS PRS were significant with HR of 1.50 (95% CI: 1.36-1.66) and 1.31 (95% CI: 1.18-1.45) respectively for the risk of incident ASCVD per standard deviation increase in CHD and IS PRS among White participants after adjusting for traditional risk factors. The HR for the CHD PRS was not significant with an HR of 0.95 (95% CI: 0.79-1.13) for the risk of incident ASCVD in Black participants. The HR for the IS PRS was significant with an HR of 1.26 (95%CI: 1.05-1.51) for the risk of incident ASCVD in Black participants. The association of the CHD and IS PRS with ASCVD was not attenuated in White participants after adjustment for ankle-brachial index, carotid intima media thickness, and carotid plaque. The CHD and IS PRS do not cross-predict well, and predict better the outcome for which they were created than the composite ASCVD outcome. Thus, the use of the composite outcome of ASCVD may not be ideal for genetic risk prediction.
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Affiliation(s)
- Allison Bebo
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Jamie A. Jarmul
- Gillings School of Public Health, Department of Health Policy and Management, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States of America
- School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States of America
| | - Mark J. Pletcher
- Departments of Epidemiology and Biostatistics and Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Natalie R. Hasbani
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - David Couper
- Gillings School of Public Health, Department of Biostatistics, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States of America
- Collaborative Studies Coordinating Center, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States of America
| | - Vijay Nambi
- Baylor College of Medicine, Houston, TX, United States of America
- Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | | | - Myriam Fornage
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
- McGovern Medical School Institute of Molecular Medicine Research Center for Human Genetics, Houston, TX, United States of America
| | - Alanna C. Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Christy L. Avery
- Gillings School of Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, University of North Carolina–Chapel Hill, Chapel Hill, NC, United States of America
| | - Paul S. de Vries
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
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15
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Park S, Jeon YJ, Ann SH, Kim YG, Lee Y, Choi SH, Han S, Park GM. Comprehensive Prediction of Subclinical Coronary Atherosclerosis in Subjects Without Traditional Cardiovascular Risk Factors. Am J Cardiol 2023; 198:64-71. [PMID: 37201233 DOI: 10.1016/j.amjcard.2023.04.011] [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: 01/29/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 05/20/2023]
Abstract
It is not uncommon for asymptomatic individuals without identified cardiovascular risk factors to present with atherosclerosis-related adverse events. We aimed to evaluate the predictors of subclinical coronary atherosclerosis in individuals without traditional cardiovascular risk factors. We analyzed 2,061 individuals without identified cardiovascular risk factors who voluntarily underwent coronary computed tomography angiography as part of a general health examination. Subclinical atherosclerosis was defined as the presence of any coronary plaque. Of 2,061 individuals, subclinical atherosclerosis was observed in 337 individuals (16.4%). Clinical variables, such as age, gender, body mass index (BMI), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), were significantly associated with subclinical coronary atherosclerosis. The participants were randomly split into train and validation data sets. In the train set, a prediction model using 6 variables with optimal cutoffs (age >53 years for men and >55 years for women, gender, BMI >22 kg/m2, SBP >120 mm Hg, HDL-C <55 mg/100 ml, and LDL-C >130 mg/100 ml) was derived (area under the curve 0.780, 95% confidence interval 0.751 to 0.809, goodness-of-fit p = 0.693). In the validation set, this model performed well (area under the curve 0.792, 95% confidence interval 0.726 to 0.858, goodness-of-fit p = 0.073). In conclusion, together with nonmodifiable risk factors, such as age and gender, modifiable variables, such as BMI, SBP, LDL-C, and HDL-C, were shown to be associated with subclinical coronary atherosclerosis, even at currently acceptable levels. These results suggest that stricter control of BMI, blood pressure, and cholesterol might be helpful in the primary prevention of future coronary events.
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Affiliation(s)
| | | | | | | | | | - Seong Hoon Choi
- Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seungbong Han
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea.
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16
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S VC, S S, R NK, S N MS, P A A. Association of Serum Cystatin C Level With Carotid Arterial Wall Elastic Resistance as a Potential Marker for Detection of Early Stage Atherosclerosis. Cureus 2023; 15:e38543. [PMID: 37273348 PMCID: PMC10239270 DOI: 10.7759/cureus.38543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Early diagnosis of atherosclerosis is exigent in patients with known cardiovascular disease (CVD) risk factors. During the initial phases of atherosclerosis, appearance of plaques can be detected by the ultrasonic phased tracking method which measures the arterial wall elasticity. However, reliable and easily available biochemical markers are not evaluated in the diagnosis of early-stage atherosclerosis. So the current study was carried out to assess the serum cystatin C level as an atherosclerotic marker, by evaluating its association with carotid arterial elastic modulus using the phased tracking method. MATERIALS AND METHODS A cross-sectional study was conducted on 115 patients having risk factors for atherosclerosis but not meeting carotid intima-media thickness (IMT) criteria. The early-stage atherosclerosis was detected by using the ultrasonic phased tracking method and the patients were divided based on low and high carotid elastic modulus. Serum levels of cystatin-C were measured in association with IMT, and elastic modulus was calculated using a novel method. This study also put forth the evaluation of the sensitivity and specificity of cystatin C for early diagnosis of atherosclerosis. RESULTS Cystatin C was strongly related to carotid elasticity (r=0.650). Based on multi-linear regression analysis, cystatin C showed significant association with carotid elasticity (β=0.509; p<0.001). It also displayed significant positive association with high carotid elastic modulus (β=0.511; p=0.02). Cystatin C showed a sensitivity of 85% in the prediction of high carotid elastic modulus. CONCLUSION For patients who are at risk to evolve atherosclerosis but are not evident with arterial plaques, cystatin C exhibits a significant association with carotid wall elastic modulus, which eases the detection of atherosclerosis. Thus, cystatin C is a potential biochemical marker for early diagnosis of atherosclerosis.
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Affiliation(s)
- Vishnu Chander S
- Department of General Medicine, SRM Institute of Science and Technology, SRM Medical College Hospital and Research Centre, Faculty of Medicine and Health Sciences, Kattankulathur, IND
| | - Sarumathy S
- Department of Pharmacy Practice, SRM Institute of Science and Technology, SRM College of Pharmacy, Faculty of Medicine and Health Sciences, Kattankulathur, IND
| | - Nanda Kumar R
- Department of General Medicine, SRM Institute of Science and Technology, SRM Medical College Hospital and Research Centre, Faculty of Medicine and Health Sciences, Kattankulathur, IND
| | - Meenakshi Sundari S N
- Department of General Medicine, SRM Institute of Science and Technology, SRM Medical College Hospital and Research Centre, Faculty of Medicine and Health Sciences, Kattankulathur, IND
| | - Anuba P A
- Department of Pharmacy Practice, SRM Institute of Science and Technology, SRM College of Pharmacy, Faculty of Medicine and Health Sciences, Kattankulathur, IND
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17
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Keller K, Kohring C, Farmakis IT, Valerio L, Barco S, Bätzing J, Akmatov MK, Konstantinides S, Münzel T, Hobohm L, Holstiege J. Impact of venous thromboembolism on incidence of arterial thromboembolism - An analysis of German outpatient claims data. Thromb Res 2023; 226:9-17. [PMID: 37079980 DOI: 10.1016/j.thromres.2023.04.008] [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: 01/07/2023] [Revised: 03/10/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) and arterial thromboembolism (ATE) are considered as two separate disease-entities. In recent years, studies have reported clear associations between VTE and atherosclerosis. We aimed to evaluate the long-term risk of ATE in VTE patients in comparison to controls without VTE. METHODS Nationwide outpatient claims data of all inhabitants with statutory health insurance in Germany were used for secondary data analysis between the years 2011 and 2020. Patients treated in 2013 were stratified by VTE event, and groups were 1:2-matched by age and sex. The hazard for an ATE event in a 5-year follow-up period between patients with and without VTE was calculated with multivariable Cox regression adjusted for age, sex, cardiovascular risk factors, and comorbidities. RESULTS Of 69,699,277 individuals treated in the year 2013 by German physicians in outpatient care, in total 686,382 individuals (age 59.8 ± 17.5 years, 65.4 % females) were included comprising 228,794 patients with VTE and 457,588 controls without VTE. VTE patients more often had cardiovascular risk factors (81.6 % vs. 62.2 %) and traditional VTE risk factors. The occurrence of ATE events during follow-up was 1.8 %-points higher in VTE patients in comparison to the controls (9.7 % vs. 7.9 %). VTE events were independently associated with increased occurrence of ATE events within follow-up (HRadjusted 1.19 [99%CI 1.16-1.23], p < 0.0001). CONCLUSIONS Patients with a VTE event have an increased long-term risk for subsequent arterial cardiovascular events. Large prospective cohorts are needed to identify patient subgroups with a very high ATE risk after VTE.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany.
| | - Claudia Kohring
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Ioannis T Farmakis
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Luca Valerio
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Jörg Bätzing
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Manas K Akmatov
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Jakob Holstiege
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
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18
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Park KA, Jeon H, Choi DG, Jung JH, Shin HJ, Lee BJ, Moon Y, Lee SY, Lee DC, Cho SY, Kim SJ, Oh SY, Moon S, Oh SY, Choi DD, Choi MY, Kim WJ, Kim US, Lee HJ, Kim Y. Ocular motility disorders following coronavirus disease-19 vaccination. Graefes Arch Clin Exp Ophthalmol 2023; 261:1127-1139. [PMID: 36383278 PMCID: PMC9667443 DOI: 10.1007/s00417-022-05888-z] [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: 06/27/2022] [Revised: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe clinical manifestations and short-term prognosis of ocular motility disorders following coronavirus disease-2019 (COVID-19) vaccination. METHODS Ocular motility disorders were diagnosed by clinical assessment, high-resolution magnetic resonance imaging, and laboratory testing. Clinical manifestations, short-term prognosis, and rate of complete recovery were analyzed. RESULTS Sixty-three patients (37 males, 26 females) with a mean age of 61.6 ± 13.3 years (range, 22-81 years) were included in this study. Among 61 applicable patients with sufficient information regarding medical histories, 38 (62.3%) had one or more significant underlying past medical histories including vasculopathic risk factors. The interval between initial symptoms and vaccination was 8.6 ± 8.2 (range, 0-28) days. Forty-two (66.7%), 14 (22.2%), and 7 (11.1%) patients developed symptoms after the first, second, and third vaccinations, respectively. One case of internuclear ophthalmoplegia, 52 cases of cranial nerve palsy, two cases of myasthenia gravis, six cases of orbital diseases (such as myositis, thyroid eye disease, and IgG-related orbital myopathy), and two cases of comitant vertical strabismus with acute onset diplopia were found. Among 42 patients with follow-up data (duration: 62.1 ± 40.3 days), complete improvement, partial improvement, no improvement, and exacerbation were shown in 20, 15, 3, and 4 patients, respectively. CONCLUSION This study provided various clinical features of ocular motility disorders following COVID-19 vaccination. The majority of cases had a mild clinical course while some cases showed a progressive nature. Close follow-up and further studies are needed to elucidate the underlying mechanisms and long-term prognosis.
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Affiliation(s)
- Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeshin Jeon
- Department of Ophthalmology, Pusan National University Collage of Medicine and Biomedical Research Institute, Busan, Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, College of Medicine Hallym University, Seoul, Korea.
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Jin Shin
- Department of Ophthalmology, Konkuk University Hospital, Seoul, Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeji Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se-Youp Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Cheol Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Soon Young Cho
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sunghyuk Moon
- Department of Ophthalmology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Shin Yeop Oh
- Department of Ophthalmology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Daye Diana Choi
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Mi Young Choi
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Won Jae Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ungsoo Samuel Kim
- Department of Ophthalmology, Chung-Ang University, Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University College of Medicine, Jeonju, Korea
| | - Yikyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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19
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Giannopoulos S, Volteas P, Virvilis D. Specialty Balloons for Vessel Preparation During Infrainguinal Endovascular Revascularization Procedures: A Review of Literature. Vasc Endovascular Surg 2023:15385744231156077. [PMID: 36745906 DOI: 10.1177/15385744231156077] [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: 02/08/2023]
Abstract
Balloon angioplasty with/without utilizing drug eluting technology or stenting constitutes the treatment of choice for a significant percentage of patients with peripheral artery disease requiring an intervention. However, in cases of diffuse disease and plaque complexity, angioplasty may lead to dissection, recoil, and/or early restenosis, making vessel preparation a key component for successful and durable endovascular revascularization outcome. This review of literature aims to present contemporary data for several commercially available specialty balloons that have been designed to minimize the arterial wall stress of conventional balloon angioplasty and facilitate technical success, as well as long-term patency.
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Affiliation(s)
- Stefanos Giannopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, 22161Stony Brook University Hospital, Stony Brook, NY, USA
| | - Panagiotis Volteas
- Division of Vascular and Endovascular Surgery, Department of Surgery, 22161Stony Brook University Hospital, Stony Brook, NY, USA
| | - Dimitrios Virvilis
- Division of Vascular and Endovascular Surgery, Department of Surgery, 22161Stony Brook University Hospital, Stony Brook, NY, USA
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20
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Mavragani A, Kim D, Hwang J, Kang JH, Kwon Y, Kwon JW. Association of Uncontrolled Hypertension or Diabetes Mellitus With Major Adverse Cardiovascular Events and Mortality in South Korea: Population-Based Cohort Study. JMIR Public Health Surveill 2023; 9:e42190. [PMID: 36735297 PMCID: PMC9938442 DOI: 10.2196/42190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/27/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Managing hypertension (HT) and diabetes mellitus (DM) is crucial to preventing cardiovascular diseases. Few studies have investigated the incidence and risk of cardiovascular diseases or mortality in uncontrolled HT or DM in the Asian population. Epidemiological studies of cardiovascular disease should be conducted with continuous consideration of the changing disease risk profiles, lifestyles, and socioeconomic status over time. OBJECTIVE We aimed to examine the association of uncontrolled HT or DM with the incidence of cardiovascular events or deaths from any cause. METHODS This population-based retrospective study was conducted using data from the Korean National Health Insurance Service-National Health Screening Cohort, including patients aged 40-79 years who participated in national screening from 2002 to 2003 and were followed up until 2015. The health screening period from 2002 to 2013 was stratified into 6 index periods in 2-year cycles, and the follow-up period from 2004 to 2015 was stratified accordingly into 6 subsequent 2-year periods. The incidence rates and hazard ratio (HR) for major adverse cardiovascular events (MACE) and death from any cause were estimated according to HT or DM control status. Extended Cox models with time-dependent variables updated every 2 years, including sociodemographic characteristics, blood pressure (BP), fasting blood glucose (FBG), medication prescription, and adherence, were used. RESULTS Among the total cohort of 440,249 patients, 155,765 (35.38%) were in the uncontrolled HT or DM group. More than 60% of the patients with HT or DM who were prescribed medications did not achieve the target BP or FBG. The incidence of MACE was 10.8-15.5 and 9.6-13.3 per 1000 person-years in the uncontrolled DM and uncontrolled HT groups, respectively, and increased with age. In the uncontrolled HT and DM group, the incidence of MACE was high (15.2-17.5 per 1000 person-years) at a relatively young age and showed no age-related trend. Adjusted HR for MACE were 1.28 (95% CI 1.23-1.32) for the uncontrolled DM group, 1.32 (95% CI 1.29-1.35) for the uncontrolled HT group, and 1.54 (95% CI 1.47-1.60) for the uncontrolled HT and DM group. Adjusted HR for death from any cause were 1.05 (95% CI 1.01-1.10) for the uncontrolled DM group, 1.13 (95% CI 1.10-1.16) for the uncontrolled HT group, and 1.17 (95% CI 1.12-1.23) for the uncontrolled HT and DM group. CONCLUSIONS This up-to-date evidence of cardiovascular epidemiology in South Korea serves as the basis for planning public health policies to prevent cardiovascular diseases. The high uncontrolled rates of HT or DM, regardless of medication prescription, have led us to suggest the need for a novel system for effective BP or glycemic control, such as a community-wide management program using mobile health technology.
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Affiliation(s)
| | - Dohyang Kim
- Department of Statistics, Daegu University, Gyeongbuk, Republic of Korea
| | - Jinseub Hwang
- Department of Statistics, Daegu University, Gyeongbuk, Republic of Korea
| | - Jae-Heon Kang
- Department of Family Medicine, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Yeongkeun Kwon
- Centre for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
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Kim YS, Shin SJ, Kim Y, Kim J, Kang HT. Effect of metabolic health and obesity on all-cause death and CVD incidence in Korean adults: a retrospective cohort study. Sci Rep 2023; 13:639. [PMID: 36635350 PMCID: PMC9837041 DOI: 10.1038/s41598-022-27097-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
This study aimed to investigate the risk of all-cause mortality and incidence of CVD according to metabolic health and body mass index (BMI) in Korean adults. This study was retrospectively designed using the National Health Insurance Service-National Health Screening Cohort data. Participants were divided into six groups according to two category of metabolic syndrome and three categories of BMI. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the composite outcome (all-cause mortality and incidence of CVDs) were estimated using multivariable Cox proportional hazards regression models. 151,706 participants aged ≥ 40 years were enrolled; median follow-up period was 9.7 years in the study. Compared to metabolically healthy normal weight, the fully adjusted HRs (95% CIs) of metabolically healthy overweight, metabolically healthy obese, metabolically unhealthy normal weight, metabolically unhealthy overweight, and metabolically unhealthy obese for composite outcome were 1.07 (1.03-1.12), 1.12 (1.07-1.17), 1.33 (1.25-1.41), 1.28 (1.22-1.34), and 1.31 (1.26-1.37), respectively, in men, and 1.10 (1.05-1.16), 1.22 (1.16-1.29), 1.34 (1.26-1.43), 1.27 (1.19-1.34), and, 1.40 (1.34-1.47), respectively, in women. High BMI and metabolic unhealthiness were associated with an increased risk on the composite of all-cause mortality and incidence of CVD in both sexes.
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Affiliation(s)
- Ye-Seul Kim
- grid.411725.40000 0004 1794 4809Department of Family Medicine, Chungbuk National University Hospital, 776 1-Soonwhan-ro, Seowon-gu, Cheongju, 28644 Republic of Korea
| | - Sang-Jun Shin
- grid.15444.300000 0004 0470 5454Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea
| | - Yonghwan Kim
- grid.411725.40000 0004 1794 4809Department of Family Medicine, Chungbuk National University Hospital, 776 1-Soonwhan-ro, Seowon-gu, Cheongju, 28644 Republic of Korea
| | - Joungyoun Kim
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Department of Artificial Intelligence, University of Seoul, 163 Seoulsiripdae-ro, Dongdaemun-gu, Seoul, 02504, Republic of Korea.
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, 776 1-Soonwhan-ro, Seowon-gu, Cheongju, 28644, Republic of Korea. .,Department of Family Medicine, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju, 28644, Chungbuk, Republic of Korea.
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Lee SC, Son KJ, Hoon Han C, Park SC, Jung JY. Cardiovascular and cerebrovascular-associated mortality in patients with preceding bronchiectasis exacerbation. Ther Adv Respir Dis 2022; 16:17534666221144206. [PMID: 36533883 PMCID: PMC9772950 DOI: 10.1177/17534666221144206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Bronchiectasis is associated with an increased incidence of atherosclerotic cardiovascular disease (ASCaVD) and atherosclerotic cerebrovascular disease (ASCeVD). Its effect on associated mortality is unclear. OBJECTIVES This study investigated the effects of bronchiectasis exacerbation prior to ASCaVD or ASCeVD events on mortality in patients with bronchiectasis using a large population-based database. METHODS A retrospective cohort of patients with bronchiectasis who experienced ASCaVD (n = 1066) or ASCeVD (n = 825) was studied for the first time using a nationwide population-based database (National Health Insurance Service-National Sample Cohort, Korea, 2002-2015). We classified each cohort according to the presence of moderate bronchiectasis exacerbation within 1 year before the ASCaVD or ASCeVD event. We evaluated 90-day, 1-year, and all-cause mortalities risk. RESULTS Within 1 year before the index ASCaVD or ASCeVD event, 149 (13.9%) and 112 (13.6%) patients with bronchiectasis experienced moderate exacerbation(s), respectively. Mild exacerbations did not different in frequency between the survivors and nonsurvivors. In both cohorts, more nonsurvivors experienced moderate exacerbations than survivors. The odds ratios of 90-day and 1-year mortalities and hazard ratios of all-cause mortalities on experiencing moderate exacerbations were 2.27 [95% confidence interval (CI) = 1.26-4.10], 3.30 (95% CI = 2.03-5.38), and 1.78 (95% CI = 1.35-2.34) in the bronchiectasis-ASCaVD cohort and 1.73 (95% CI = 0.94-3.19), 1.79 (95% CI = 1.07-3.00), and 1.47 (95% CI = 1.10-1.95), in the bronchiectasis-ASCeVD cohort. CONCLUSION Hospitalization or emergency room visit for bronchiectasis exacerbation within 1 year before ASCaVD or ASCeVD is associated with an increased ASCaVD- or ASCeVD-associated mortality.
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Affiliation(s)
| | | | - Chang Hoon Han
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
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Ryu GW, Park YS, Kim J, Yang YS, Ko YG, Choi M. Incidence and Prevalence of Peripheral Arterial Disease in South Korea: Retrospective Analysis of National Claims Data. JMIR Public Health Surveill 2022; 8:e34908. [PMID: 36399371 PMCID: PMC9719060 DOI: 10.2196/34908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) causes blood vessel narrowing that decreases blood flow to the lower extremities, with symptoms such as leg pain, discomfort, and intermittent claudication. PAD increases risks for amputation, poor health-related quality of life, and mortality. It is estimated that more than 200 million people worldwide have PAD, although the paucity of PAD research in the East detracts from knowledge on global PAD epidemiology. There are few national data-based analyses or health care utilization investigations. Thus, a national data analysis of PAD incidence and prevalence would provide baseline data to enable health promotion strategies for patients with PAD. OBJECTIVE This study aims to identify South Korean trends in the incidence and prevalence of PAD and PAD treatment, in-hospital deaths, and health care utilization. METHODS This was a retrospective analysis of South Korean national claims data from 2009 to 2018. The incidence of PAD was determined by setting the years 2010 and 2011 as a washout period to exclude previously diagnosed patients with PAD. The study included adults aged ≥20 and <90 years who received a primary diagnosis of PAD between 2011 and 2018; patients were stratified according to age, sex, and insurance status for the incidence and prevalence analyses. Descriptive statistics were used to assess incidence, prevalence, endovascular revascularization (EVR) events, amputations, in-hospital deaths, and the health care utilization characteristics of patients with PAD. RESULTS Based on data from 2011 to 2018, there were an average of 124,682 and 993,048 incident and prevalent PAD cases, respectively, in 2018. PAD incidence (per 1000 persons) ranged from 2.68 to 3.09 during the study period. From 2012 to 2018, the incidence rate in both sexes showed an increasing trend. PAD incidence continued to increase with age. PAD prevalence (per 1000 persons) increased steadily, from 3.93 in 2011 to 23.55 in 2018. The number of EVR events varied between 933 and 1422 during the study period, and both major and minor amputations showed a decreasing trend. Health care utilization characteristics showed that women visited clinics more frequently than men, whereas men used tertiary and general hospitals more often than women. CONCLUSIONS The number of incident and prevalent PAD cases generally showed an increasing trend. Visits to tertiary and general hospitals were higher among men than women. These results indicate the need for attention not only to Western and male patients, but also to Eastern and female patients with PAD. The results are generalizable, as they are based on national claims data from the entire South Korean population, and they can promote preventive care and management strategies for patients with PAD in clinical and public health settings.
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Affiliation(s)
- Gi Wook Ryu
- Department of Nursing, Hansei University, Gunpo-si, Republic of Korea
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Young Shin Park
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Jeewuan Kim
- Department of Statistics and Data Science, Yonsei University, Seoul, Republic of Korea
| | - Yong Sook Yang
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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Biological Assessment of the NO-Dependent Endothelial Function. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27227921. [PMID: 36432022 PMCID: PMC9698916 DOI: 10.3390/molecules27227921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
Nitric oxide (NO) is implicated in numerous physiological processes, including vascular homeostasis. Reduced NO bioavailability is a hallmark of endothelial dysfunction, a prequel to many cardiovascular diseases. Biomarkers of an early NO-dependent endothelial dysfunction obtained from routine venous blood sampling would be of great interest but are currently lacking. The direct measurement of circulating NO remains a challenge due by its high reactivity and short half-life. The current techniques measure stable products from the NO signaling pathway or metabolic end products of NO that do not accurately represent its bioavailability and, therefore, endothelial function per se. In this review, we will concentrate on an original technique of low temperature electron paramagnetic resonance spectroscopy capable to directly measure the 5-α-coordinated heme nitrosyl-hemoglobin in the T (tense) state (5-α-nitrosyl-hemoglobin or HbNO) obtained from fresh venous human erythrocytes. In humans, HbNO reflects the bioavailability of NO formed in the vasculature from vascular endothelial NOS or exogenous NO donors with minor contribution from erythrocyte NOS. The HbNO signal is directly correlated with the vascular endothelial function and inversely correlated with vascular oxidative stress. Pilot studies support the validity of HbNO measurements both for the detection of endothelial dysfunction in asymptomatic subjects and for the monitoring of such dysfunction in patients with known cardiovascular disease. The impact of therapies or the severity of diseases such as COVID-19 infection involving the endothelium could also be monitored and their incumbent risk of complications better predicted through serial measurements of HbNO.
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Kang HS, Kim SY, Choi HG, Lim H, Kim JH, Kim JH, Cho SJ, Nam ES, Min KW, Park HY, Kim NY, Choi Y, Kwon MJ. Comparison of the Concordance of Cardiometabolic Diseases and Physical and Laboratory Examination Findings between Monozygotic and Dizygotic Korean Adult Twins: A Cross-Sectional Study Using KoGES HTS Data. Nutrients 2022; 14:nu14224834. [PMID: 36432523 PMCID: PMC9693823 DOI: 10.3390/nu14224834] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/31/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
Abstract
This study investigated the contribution of genetic and environmental factors to cardiometabolic diseases (CMDs) by comparing disease concordance in monozygotic and dizygotic twins. This cross-sectional study analyzed 1294 (1040 monozygotic and 254 dizygotic) twin pairs (>20 years) based on the Korean Genome and Epidemiology Study data (2005−2014). The odds ratios of disease concordance were calculated using binomial and multinomial logistic regression models. The occurrence of CMDs (hypertension, hyperlipidemia, type 2 diabetes, cerebral stroke, transient ischemic attack, and ischemic heart disease) and related physical and laboratory levels did not differ between the monozygotic and dizygotic twin groups. The odds for concordance of the presence/absence of CMDs and the likelihood of incident CMD within monozygotic twins were comparable to that of dizygotic twins. The absolute differences in hemoglobin A1c, insulin, low- and high-density lipoprotein cholesterol, total cholesterol, triglycerides, and systolic blood pressure were lower in monozygotic twins than in dizygotic twins. Absolute differences in fasting glucose and diastolic blood pressure did not differ between groups. Although baseline levels of several laboratory parameters related to CMD showed a strong likelihood of heritability in monozygotic twins, CMD phenotype appears to be largely affected by environmental factors.
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Affiliation(s)
- Ho Suk Kang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam 13488, Republic of Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Seong-Jin Cho
- Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea
| | - Eun Sook Nam
- Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, Republic of Korea
| | - Kyueng-Whan Min
- Department of Pathology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Republic of Korea
| | - Ha Young Park
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea
| | - Younghee Choi
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea
- Research Insititute for Complementary & Alternative Medicine, Hallym University, Hwaseong 18450, Republic of Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
- Correspondence:
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Ryou IS, Kim JY, Park HY, Oh S, Kim S, Kim HJ. Do statins benefit low-risk population for primary prevention of atherosclerotic cardiovascular disease: A retrospective cohort study. Front Med (Lausanne) 2022; 9:1024780. [PMID: 36405617 PMCID: PMC9669657 DOI: 10.3389/fmed.2022.1024780] [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: 08/22/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
The reported beneficial effects of statins on cardiovascular outcome based on risk assessment are inconsistent. Therefore, we investigated statin therapy effectiveness for the primary prevention of cardiovascular disease (CVD), according to the Korean Risk Prediction Model (KRPM). Subjects aged 40–79 years with low density lipoprotein cholesterol (LDL-C) of < 190 mg/dL and without CVD history were categorized as statin users or non-users using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database, Korea, 2002–2015. The 10-year atherosclerotic CVD (ASCVD) risk was calculated using the validated KRPM and categorized as low, borderline, intermediate, or high-risk groups; the incidence of major adverse cardiovascular events (MACEs) was compared over a mean follow-up period of 5.7 years using Cox proportional hazard models. The MACE incidence risk was decreased in statin users [hazard ratio (HR) 0.90, 95% confidence interval (CI) (0.84–0.98)]. However, there was an increased risk of MACE incidence in low-risk statin users [HR 1.80, 95% CI (1.29–2.52)], and no significant relationship was identified between statin use and MACE in the borderline [HR 1.15, 95% CI (0.86–1.54)] and intermediate-risk [HR 0.94, 95% CI (0.85–1.03)] groups. The risk of MACE incidence decreased only in the high CVD risk group among statin users. Statin use is not associated with MACE reduction in low- to intermediate-risk participants. Therefore, individuals with LDL-C level of < 190 mg/dL and low ASCVD risk should consider statin therapy only when CVD risk is proved obvious using an appropriate ASCVD risk tool.
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Affiliation(s)
- In Sun Ryou
- Department of Family Medicine, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Ju Young Kim
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Ju Young Kim
| | - Hwa Yeon Park
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sehun Kim
- Cardiovascular Center, Hallym University Medical Center, Seoul, South Korea
| | - Hwa Jung Kim
- Department of Preventive Medicine, Ulsan University College of Medicine, Seoul, South Korea
- Department of Clinical Epidemiology and Biostatistics, ASAN Medical Center, Seoul, South Korea
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The Link between ANRIL Gene RS4977574 Polymorphism and Common Atherosclerosis Cardiovascular Complications: A Hospital-Based Case-Control Study in Ukrainian Population. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8468202. [PMID: 36246967 PMCID: PMC9556174 DOI: 10.1155/2022/8468202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022]
Abstract
Materials and Methods 195 patients with ACS, 200 patients with LAS, and 234 control subjects were enrolled in this case-control study. Real-time PCR was used for ANRIL rs4977574 genotyping. SPSS software package (version 17.0, IBM, USA) was used for data analysis. Results A significant association between rs4977574 polymorphism and the risk of atherosclerosis and cardiovascular complications was found under the recessive model regardless of adjustment for nongenetic risk factors (OR = 1.551; p = 0.025). Moreover, the link between rs4977574 locus and serum levels of total cholesterol (p = 0.021) and LDL (p = 0.022) was detected. A separate analysis in subgroups demonstrated the association of rs4977574 polymorphism with increased risk of ACS under the recessive model (OR = 1.501; p = 0.048). No relation between rs4977574 site and LAS development was revealed (p > 0.05). Conclusion Obtained data suggested that ANRIL rs4977574-GG genotype can be a possible genetic marker for the development of atherosclerosis and cardiovascular complications in Ukrainian population.
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Diagnostic Predictive Value of Tryptase, Serum Amyloid A and Lipoprotein-Associated Phospholipase A2 Biomarker Groups for Large Atherosclerotic Cerebral Infarction. Emerg Med Int 2022; 2022:5784909. [PMID: 36225714 PMCID: PMC9550468 DOI: 10.1155/2022/5784909] [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: 08/08/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background There has been a gradual trend towards younger ageing of acute cerebral infarction in recent years. Atherosclerotic plaque rupture followed by dislodgement of emboli and resulting arterial embolism is an important mechanism for the development of acute cerebral infarction. Traditional independent risk factors for cerebral infarction have received attention from clinicians, but the risk factors for large artery atherosclerotic cerebral infarction are still unclear. Various blood biomarkers have an important role in the early diagnosis of large artery atherosclerotic cerebral infarction. Objective To assess the diagnostic predictive value of a group of biomarkers for large artery atherosclerotic cerebral infarction. Methods Lipoprotein-associated phospholipase A2 (LP-PLA2), trypsin-like protein (TPS), serum amyloid A (SAA), and supersensitive C-reactive protein (hs-CRP) levels were measured in the case group (30 cases) and control group (54 cases), respectively. Results The differences in the general data between the two groups were not statistically significant (P > 0.05). Logistic regression and ROC curve analysis showed that Lp-PLA2, TPS, and SAA were positively associated with the diagnosis of large atherosclerotic cerebral infarction (P < 0.05). The area under the ROC curve of the multivariate model for the biomarker group reached 0.995. Conclusion Biomarkers are closely associated with the occurrence of large atherosclerotic cerebral infarction and can be used as clinical adjuncts for diagnosis and assessment of prognosis.
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Rankouhi TR, Keulen DV, Tempel D, Venhorst J. Oncostatin M: Risks and Benefits of a Novel Therapeutic Target for Atherosclerosis. Curr Drug Targets 2022; 23:1345-1369. [PMID: 35959619 DOI: 10.2174/1389450123666220811101032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/30/2022] [Accepted: 06/03/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of death worldwide. It is predicted that approximately 23.6 million people will die from CVDs annually by 2030. Therefore, there is a great need for an effective therapeutic approach to combat this disease. The European Cardiovascular Target Discovery (CarTarDis) consortium identified Oncostatin M (OSM) as a potential therapeutic target for atherosclerosis. The benefits of modulating OSM - an interleukin (IL)-6 family cytokine - have since been studied for multiple indications. However, as decades of high attrition rates have stressed, the success of a drug target is determined by the fine balance between benefits and the risk of adverse events. Safety issues should therefore not be overlooked. OBJECTIVE In this review, a risk/benefit analysis is performed on OSM inhibition in the context of atherosclerosis treatment. First, OSM signaling characteristics and its role in atherosclerosis are described. Next, an overview of in vitro, in vivo, and clinical findings relating to both the benefits and risks of modulating OSM in major organ systems is provided. Based on OSM's biological function and expression profile as well as drug intervention studies, safety concerns of inhibiting this target have been identified, assessed, and ranked for the target population. CONCLUSION While OSM may be of therapeutic value in atherosclerosis, drug development should also focus on de-risking the herein identified major safety concerns: tissue remodeling, angiogenesis, bleeding, anemia, and NMDA- and glutamate-induced neurotoxicity. Close monitoring and/or exclusion of patients with various comorbidities may be required for optimal therapeutic benefit.
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Affiliation(s)
- Tanja Rouhani Rankouhi
- Department of Risk Analysis for Products in Development, TNO, Utrechtseweg 48, 3704 HE, Zeist, The Netherlands
| | - Daniëlle van Keulen
- SkylineDx BV, Science and Clinical Development, 3062 ME Rotterdam, The Netherlands
| | - Dennie Tempel
- SkylineDx BV, Science and Clinical Development, 3062 ME Rotterdam, The Netherlands
| | - Jennifer Venhorst
- Department of Risk Analysis for Products in Development, TNO, Utrechtseweg 48, 3704 HE, Zeist, The Netherlands
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Park J, Kim KM, Yoon YE, Hwang IC, Cho GY. Risk of earlier atherosclerotic cardiovascular disease in women with low bone mineral density. Sci Rep 2022; 12:15996. [PMID: 36163227 PMCID: PMC9512928 DOI: 10.1038/s41598-022-19801-5] [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: 02/25/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Low bone mineral density (BMD) is associated with higher risk of atherosclerotic cardiovascular disease (ASCVD) in women. We investigated whether the association between low BMD and ASCVD differs according to the age at ASCVD occurrence. We retrospectively analyzed 7932 women aged 50–65 years who underwent dual-energy X-ray absorptiometry. ASCVD was defined as a composite of ASCVD death, myocardial infarction, and ischemic stroke. When we classified participants into no event (n = 7803), early ASCVD (< 70 years) (n = 97), and late ASCVD (≥ 70 years) (n = 32) groups, age gradually increased across groups (median, 58, 60, and 63 years, respectively). However, the estimated BMD T-score at the age of 65 years was lowest in the early ASCVD group (median − 0.9, − 1.1, and − 0.5, respectively). Lower BMD was an independent predictor for early ASCVD (adjusted hazard ratio [95% confidence interval]: 1.34 [1.08–1.67] per 1-SD decrease in T-score), but not for late ASCVD (0.88 [0.60–1.30]). The inverse trend between early ASCVD risk and BMD T-score was consistent regardless of the number of accompanied clinical risk factors. Thus, low BMD is an independent predictor for early ASCVD in women. BMD evaluation can provide prognostic benefit for risk stratification for early ASCVD.
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Affiliation(s)
- Jiesuck Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Kim
- Division of Endocrinology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea.
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Nasiri-Ansari N, Spilioti E, Kyrou I, Kalotychou V, Chatzigeorgiou A, Sanoudou D, Dahlman-Wright K, Randeva HS, Papavassiliou AG, Moutsatsou P, Kassi E. Estrogen Receptor Subtypes Elicit a Distinct Gene Expression Profile of Endothelial-Derived Factors Implicated in Atherosclerotic Plaque Vulnerability. Int J Mol Sci 2022; 23:ijms231810960. [PMID: 36142876 PMCID: PMC9506323 DOI: 10.3390/ijms231810960] [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: 08/12/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
In the presence of established atherosclerosis, estrogens are potentially harmful. MMP-2 and MMP-9, their inhibitors (TIMP-2 and TIMP-1), RANK, RANKL, OPG, MCP-1, lysyl oxidase (LOX), PDGF-β, and ADAMTS-4 play critical roles in plaque instability/rupture. We aimed to investigate (i) the effect of estradiol on the expression of the abovementioned molecules in endothelial cells, (ii) which type(s) of estrogen receptors mediate these effects, and (iii) the role of p21 in the estrogen-mediated regulation of the aforementioned factors. Human aortic endothelial cells (HAECs) were cultured with estradiol in the presence or absence of TNF-α. The expression of the aforementioned molecules was assessed by qRT-PCR and ELISA. Zymography was also performed. The experiments were repeated in either ERα- or ERβ-transfected HAECs and after silencing p21. HAECs expressed only the GPR-30 estrogen receptor. Estradiol, at low concentrations, decreased MMP-2 activity by 15-fold, increased LOX expression by 2-fold via GPR-30, and reduced MCP-1 expression by 3.5-fold via ERβ. The overexpression of ERα increased MCP-1 mRNA expression by 2.5-fold. In a low-grade inflammation state, lower concentrations of estradiol induced the mRNA expression of MCP-1 (3.4-fold) and MMP-9 (7.5-fold) and increased the activity of MMP-2 (1.7-fold) via GPR-30. Moreover, p21 silencing resulted in equivocal effects on the expression of the abovementioned molecules. Estradiol induced different effects regarding atherogenic plaque instability through different ERs. The balance of the expression of the various ER subtypes may play an important role in the paradoxical characterization of estrogens as both beneficial and harmful.
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Affiliation(s)
- Narjes Nasiri-Ansari
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eliana Spilioti
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Laboratory of Toxicological Control of Pesticides, Scientific Directorate of Pesticides’ Control and Phytopharmacy, Benaki Phytopathological Institute, 14561 Athens, Greece
| | - Ioannis Kyrou
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK
| | - Vassiliki Kalotychou
- Department of Internal Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Antonios Chatzigeorgiou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Despina Sanoudou
- Clinical Genomics and Pharmacogenomics Unit, 4th Department of Internal Medicine, Attikon Hospital Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for New Biotechnologies and Precision Medicine, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Karin Dahlman-Wright
- Department of Biosciences and Nutrition, Novum, Karolinska Institute, SE-14183 Huddinge, Sweden
| | - Harpal S. Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Athanasios G. Papavassiliou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Paraskevi Moutsatsou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eva Kassi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Endocrine Unit, 1st Department of Propaedeutic Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-21-0746-2699; Fax: +30-21-0746-2703
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Gilani STA, Khan DA, Rauf A, Haroon ZH, Khan KA, Hassan FU. Early Diagnosis of Coronary Artery Disease by Inflammatory Biomarkers of Atherosclerosis in Patients with Angina. J Interferon Cytokine Res 2022; 42:493-500. [PMID: 36121373 DOI: 10.1089/jir.2022.0110] [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: 01/08/2023] Open
Abstract
Early diagnosis of coronary artery disease (CAD) in patients with chest pain is a challenge. Currently diagnosis of CAD is confirmed by coronary angiography, which is invasive and not easily available in developing countries. Therefore, it is imperative to establish noninvasive biomarker for early diagnosis of CAD in patients with angina and determine the diagnostic accuracy of inflammatory biomarkers of atherosclerosis in comparison to angiography and correlate with severity of CAD in patients with angina. Diagnostic accuracy study was carried out in tertiary care hospitals, Rawalpindi, Pakistan. Total of 58 patients aged 55.24 ± 11.61 years, with chest pain and troponin-I -ve, having coronary artery stenosis ≥50% were included as cases of CAD and 55 subjects having stenosis <50% were included as controls. Nuclear factor kappa-B (NF-κB), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were analyzed on immunoassay analyzers. The receiver operating characteristic curve analysis revealed significant (P < 0.05) high area under curve (95% confidence interval) with sensitivity and specificity of NF-κB 0.76 (0.65-0.85), 73% and 65%; TNF-α 0.72 (0.61-0.81), 71% and 69%; IL-6 0.62 (0.52-0.71), 64% and 53% and hs-CRP 0.62 (0.52-0.71), and 53% and 56% in CAD patients compared to controls. There was significant positive correlation between NF-κB (r = 0.44), TNF-α (r = 0.37), IL-6 (r = 0.23), and hs-CRP (r = 0.23) with severity of CAD by Gensini score. The inflammatory biomarkers, especially NF-κB and TNF-α, have highest diagnostic accuracy and indicate severity of atherosclerosis in patients with angina. These markers may be used as noninvasive biomarkers to exclude healthy individuals before undergoing angiography.
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Affiliation(s)
- Sayed Tanveer Abbas Gilani
- Armed Forces Institute of Cardiology (AFIC) & National Institute of Heart Diseases (NIHD), National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
| | - Dilshad Ahmed Khan
- Armed Forces Institute of Pathology (AFIP), National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
| | - Amer Rauf
- Armed Forces Institute of Cardiology (AFIC) & National Institute of Heart Diseases (NIHD), National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
| | - Zujaja Hina Haroon
- Armed Forces Institute of Pathology (AFIP), National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
| | - Kumail Abbas Khan
- Armed Forces Institute of Cardiology (AFIC) & National Institute of Heart Diseases (NIHD), National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
| | - Faheem Ul Hassan
- Armed Forces Institute of Cardiology (AFIC) & National Institute of Heart Diseases (NIHD), National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
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Kotlyarov S. Immune Function of Endothelial Cells: Evolutionary Aspects, Molecular Biology and Role in Atherogenesis. Int J Mol Sci 2022; 23:ijms23179770. [PMID: 36077168 PMCID: PMC9456046 DOI: 10.3390/ijms23179770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Atherosclerosis is one of the key problems of modern medicine, which is due to the high prevalence of atherosclerotic cardiovascular diseases and their significant share in the structure of morbidity and mortality in many countries. Atherogenesis is a complex chain of events that proceeds over many years in the vascular wall with the participation of various cells. Endothelial cells are key participants in vascular function. They demonstrate involvement in the regulation of vascular hemodynamics, metabolism, and innate immunity, which act as leading links in the pathogenesis of atherosclerosis. These endothelial functions have close connections and deep evolutionary roots, a better understanding of which will improve the prospects of early diagnosis and effective treatment.
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Affiliation(s)
- Stanislav Kotlyarov
- Department of Nursing, Ryazan State Medical University, 390026 Ryazan, Russia
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Genetic and Epigenetic Regulation of Lipoxygenase Pathways and Reverse Cholesterol Transport in Atherogenesis. Genes (Basel) 2022; 13:genes13081474. [PMID: 36011386 PMCID: PMC9408222 DOI: 10.3390/genes13081474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Atherosclerosis is one of the most important medical and social problems of modern society. Atherosclerosis causes a large number of hospitalizations, disability, and mortality. A considerable amount of evidence suggests that inflammation is one of the key links in the pathogenesis of atherosclerosis. Inflammation in the vascular wall has extensive cross-linkages with lipid metabolism, and lipid mediators act as a central link in the regulation of inflammation in the vascular wall. Data on the role of genetics and epigenetic factors in the development of atherosclerosis are of great interest. A growing body of evidence is strengthening the understanding of the significance of gene polymorphism, as well as gene expression dysregulation involved in cross-links between lipid metabolism and the innate immune system. A better understanding of the genetic basis and molecular mechanisms of disease pathogenesis is an important step towards solving the problems of its early diagnosis and treatment.
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Won MH, Choi J, Son YJ. Multiple mediating effects of self-efficacy and physical activity on the relationship between frailty and health-related quality of life in adults with CVD. Eur J Cardiovasc Nurs 2022; 22:382-391. [PMID: 35974670 DOI: 10.1093/eurjcn/zvac074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/12/2022]
Abstract
AIMS Poor health-related quality of life is prevalent among individuals with cardiovascular disease (CVD) and may be associated with frailty as well as low levels of self-efficacy and physical activity. This study aimed to identify the multiple mediating effects of exercise self-efficacy and physical activity on the relationship between frailty and health-related quality of life among community-dwelling adults with CVD. METHODS AND RESULTS This cross-sectional study included 489 Korean patients aged >20 years diagnosed with CVD. Data were collected through an online survey conducted in June, 2021. The mediation hypothesis was tested using a serial multiple mediation model and the bootstrapping method. Approximately 39.5% of patients in this study were in a frail state. Our main finding revealed that frailty had an indirect effect on health-related quality of life through all three different pathways: each single mediation of exercise self-efficacy and physical activity, and the serial multiple mediation of exercise self-efficacy and physical activity as the first and second mediators, respectively. The direct effect of frailty on the health-related quality of life was also significant. CONCLUSION Frail adults with CVD tended to have lower levels of self-efficacy, physical activity, and poor health-related quality of life. Thus, early identification of frailty and interventions targeting the promotion of self-efficacy and physical activity may improve health-related quality of life in adults with CVD. Longitudinal studies are necessary to further refine our findings across other samples and to address the limitations of the current study.
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Affiliation(s)
- Mi Hwa Won
- Associate Professor, Department of Nursing, Wonkwang University, Iksan, South Korea. E-mail address:
| | - JiYeon Choi
- Associate Professor, Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea E-mail:
| | - Youn Jung Son
- Professor, Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
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Sagris M, Antonopoulos AS, Theofilis P, Oikonomou E, Siasos G, Tsalamandris S, Antoniades C, Brilakis ES, Kaski JC, Tousoulis D. Risk factors profile of young and older patients with myocardial infarction. Cardiovasc Res 2022; 118:2281-2292. [PMID: 34358302 DOI: 10.1093/cvr/cvab264] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/03/2021] [Indexed: 12/18/2022] Open
Abstract
Myocardial infarction (MI) among young adults (<45 years) represents a considerable proportion of the total heart attack incidents. The underlying pathophysiologic characteristics, atherosclerotic plaque features, and risk factors profile differ between young and older patients with MI. This review article discusses the main differences between the younger and elderly MI patients as well as the different pathogenic mechanisms underlying the development of MI in the younger. Young patients with MI often have eccentric atherosclerotic plaques with inflammatory features but fewer lesions, and are more likely to be smokers, obese, and have poor lifestyle, such as inactivity and alcohol intake. Compared to older MI patients, younger are more likely to be men, have familial-combined hyperlipidaemia and increased levels of lipoprotein-a. In addition, MI in younger patients may be related to use of cannabis, cocaine use, and androgenic anabolic steroids. Genomic differences especially in the pathways of coagulation and lipid metabolism have also been identified between young and older patients with MI. Better understanding of the risk factors and the anatomic and pathophysiologic processes in young adults can improve MI prevention and treatment strategies in this patient group. Awareness could help identify young subjects at increased risk and guide primary prevention strategies. Additional studies focusing on gene pathways related to lipid metabolism, inflammation, and coagulation are needed.
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Affiliation(s)
- Marios Sagris
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Panagiotis Theofilis
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Evangelos Oikonomou
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Gerasimos Siasos
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sotirios Tsalamandris
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
- Division of Cardiovascular Medicine, Oxford Centre of Research Excellence, British Heart Foundation, Oxford, OX3 9DU, UK
- Division of Cardiovascular Medicine, Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, OX3 9DU, UK
| | - Emmanouil S Brilakis
- Division of Cardiovascular Medicine, Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA
| | - Juan C Kaski
- Division of Cardiovascular Medicine, Molecular and Clinical Sciences Research Institute, St George's University of London, London SW17 0RE, UK
| | - Dimitris Tousoulis
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
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Cho EB, Yeo Y, Jung JH, Jeong SM, Han K, Yang JH, Shin DW, Min JH. Acute myocardial infarction risk in multiple sclerosis and neuromyelitis optica spectrum disorder: A nationwide cohort study in South Korea. Mult Scler 2022; 28:1849-1858. [PMID: 35695204 DOI: 10.1177/13524585221096964] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The link between neuromyelitis optica spectrum disorder (NMOSD) and cardiovascular disease is currently unclear. OBJECTIVE To determine the acute myocardial infarction (MI) risk in patients with MS and NMOSD. METHODS This study analyzed the Korean National Health Insurance Service database between January 2010 and December 2017. The included patients comprised 1503/1675 adults with MS/NMOSD who had not experienced ischemic heart disease or ischemic stroke at the index date. Matched controls were selected based on age, sex, and the presence of hypertension, diabetes mellitus (DM), and dyslipidemia. RESULTS The risks of developing MI were 2.61 (hazard ratio (HR), 95% confidence interval (CI) 1.73-3.95) and 1.95 (95% CI = 1.18-3.22) times higher in MS and NMOSD compared with the control populations. Patients with NMOSD had a similar MI risk compared with patients with MS, after adjusting for age, sex, income, hypertension, DM, and dyslipidemia (HR = 0.59, 95% CI = 0.34-1.02, p = 0.059). Among each patient group, the MI risk did not differ significantly with age (20-39, 40-64 or ⩾65 years), sex, or the presence of hypertension, DM, or dyslipidemia. CONCLUSION The MI risk increased in MS and NMOSD and seemed to be comparable between NMOSD and MS.
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Affiliation(s)
- Eun Bin Cho
- Department of Neurology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, South Korea/Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Yohwan Yeo
- Department of Family Medicine, College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea/Department of Clinical Research Design & Evaluation and Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea/Center for Wireless and Population Health Systems, University of California San Diego, San Diego, CA, USA
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea/Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea/Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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Schriefl C, Schoergenhofer C, Buchtele N, Mueller M, Poppe M, Clodi C, Ettl F, Merrelaar A, Boegl MS, Steininger P, Holzer M, Herkner H, Schwameis M. Out-of-Sample Validity of the PROLOGUE Score to Predict Neurologic Function after Cardiac Arrest. J Pers Med 2022; 12:jpm12060876. [PMID: 35743661 PMCID: PMC9225634 DOI: 10.3390/jpm12060876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The clinical value of a prognostic score depends on its out-of-sample validity because inaccurate outcome prediction can be not only useless but potentially fatal. We aimed to evaluate the out-of-sample validity of a recently developed and highly accurate Korean prognostic score for predicting neurologic outcome after cardiac arrest in an independent, plausibly related sample of European cardiac arrest survivors. Methods: Analysis of data from a European cardiac arrest center, certified in compliance with the specifications of the German Council for Resuscitation. The study sample included adults with nontraumatic out-of-hospital cardiac arrest admitted between 2013 and 2018. Exposure was the PROgnostication using LOGistic regression model for Unselected adult cardiac arrest patients in the Early stages (PROLOGUE) score, including 12 clinical variables readily available at hospital admission. The outcome was poor 30-day neurologic function, as assessed using the cerebral performance category scale. The risk of a poor outcome was calculated using the PROLOGUE score regression equation. Predicted risk deciles were compared to observed outcome estimates in a complete-case analysis, a best-case analysis, and a multiple-data-imputation analysis using the Markov chain Monte Carlo method. Results: A total of 1051 patients (median 61 years, IQR 50–71; 29% female) were analyzed. A total of 808 patients (77%) were included in the complete-case analysis. The PROLOGUE score overestimated the risk of poor neurologic outcomes in the range of 40% to 100% predicted risk, involving 63% of patients. The model fit did not improve after missing data imputation. Conclusions: In a plausibly related sample of European cardiac arrest survivors, risk prediction by the PROLOGUE score was largely too pessimistic and failed to replicate the high accuracy found in the original study. Using the PROLOGUE score as an example, this study highlights the compelling need for independent validation of a proposed prognostic score to prevent potentially fatal mispredictions.
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Affiliation(s)
- Christoph Schriefl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | | | - Nina Buchtele
- Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Matthias Mueller
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Michael Poppe
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Anne Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Magdalena Sophie Boegl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Philipp Steininger
- Emergency Department, Clinic Hietzing, Vienna Healthcare Group, 1130 Vienna, Austria;
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
- Correspondence:
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (C.S.); (M.M.); (M.P.); (C.C.); (F.E.); (A.M.); (M.S.B.); (M.H.); (M.S.)
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An S, Ahn C, Jang J, Lee J, Kang D, Lee JK, Park SK. Comparison of the Prevalence of Cardiometabolic Disorders and Comorbidities in Korea and the United States: Analysis of the National Health and Nutrition Examination Survey. J Korean Med Sci 2022; 37:e149. [PMID: 35535376 PMCID: PMC9091432 DOI: 10.3346/jkms.2022.37.e149] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Comparison of the prevalence of cardiometabolic disorders (CMDs) and comorbidities in Korea and the United States (US) can be an important indicator for forecasting future risk of cardiovascular events in Korea. This study aimed to estimate and compare the prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, obesity, and metabolic syndrome (MetS) in Korea and the US. METHODS A total of 15,872 individuals from the US National Health and Nutrition Examination Survey (NHANES) 2003-2014 and 26,492 from the Korea NHANES (KNHANES) 2007-2014 were included. Additionally, 164,339 (139,345 from the Health Examinees-Gem Study and 24,994 from the Cardiovascular Disease Association Study) participants enrolled in the Korea Genome and Epidemiology Study were included to investigate the differences of CMDs between urban and rural regions. To estimate the age-standardized prevalence of CMDs in individuals aged 40-69 years, direct standardization using the World Health Organization standard population was performed. RESULTS The prevalence of CMDs was lower in Korea than the US (hypertension 49.9% vs. 56.8%; DM 13.4% vs. 14.3%; hypercholesterolemia 16.8% vs. 17.8%; obesity 36.2% vs. 38.6%; and MetS 29.4% vs. 36.5%). According to the median survey years, dyslipidemia has become more prevalent in Korea than in the US since 2010. The prevalence of CMDs was greater in rural than that in urban areas in Korea. CONCLUSION The prevalence of dyslipidemia in Korea exceeded that of the US after 2010, which was associated with increasing burden of cardiovascular events. The present study suggests that further preventive strategies are needed to mitigate the prevalence of CMDs in Korea.
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Affiliation(s)
- Seokyung An
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Choonghyun Ahn
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Jieun Jang
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Juyeon Lee
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Daehee Kang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Koo Lee
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea.
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Heo J, Yoo J, Lee H, Lee IH, Kim JS, Park E, Kim YD, Nam HS. Prediction of Hidden Coronary Artery Disease Using Machine Learning in Patients With Acute Ischemic Stroke. Neurology 2022; 99:e55-e65. [PMID: 35470135 DOI: 10.1212/wnl.0000000000200576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A machine learning technique for identifying hidden coronary artery disease (CAD) might be useful. We developed and validated machine learning models to predict patients with hidden CAD and assess long-term outcomes in patients with acute ischemic stroke. METHODS Multidetector coronary computed tomography was performed for patients without known history of CAD. Primary outcomes were defined as having any degree of CAD and having obstructive CAD (≥50% stenosis). Demographic variables, risk factors, laboratory results, Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, NIH Stroke Scale score, blood pressure, and carotid artery stenosis were used to develop and validate machine learning models to predict CAD. Area under the receiver operating characteristic curves (AUC) was calculated for performance analysis, and Kaplan-Meier and Cox survival analyses of long-term outcomes were performed. Major adverse cardiovascular events (MACE) were defined as ischemic stroke, myocardial infarction, unstable angina, urgent coronary revascularization, and cardiovascular mortality. RESULTS Overall, 1,710 patients were included for the training dataset and 348 patients for the validation dataset. An Extreme Gradient Boosting model was developed to predict any degree of CAD, which showed an AUC of 0.763 (95% CI 0.711-0.814) on validation. A logistic regression model was used to predict obstructive CAD and had an AUC of 0.714 (95% CI 0.692-0.799). During the first 5 years of follow-up, MACE occurred more frequently when predicted of any CAD (P = 0.022) or obstructive CAD (P < 0.001). Cox proportional analysis showed that the hazard ratio of MACE was 1.5 (95% CI 1.1-2.2; P = 0.016) when predicted of any CAD, whereas it was 1.9 (95% CI 1.3-2.6; P < 0.001) for obstructive CAD. DISCUSSION We demonstrated that machine learning may help identify hidden CAD in patients with acute ischemic stroke. Long-term outcomes were also associated with prediction results. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with acute ischemic stroke with CAD risk factors but no known history of CAD, a machine learning model predicts CAD on multidetector coronary computed tomography with an AUC of 0.763 (95% CI 0.711-0.814).
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Affiliation(s)
- JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Hyungwoo Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Il Hyung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eunjeong Park
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Mucalo I, Brajković A, Strgačić M, Ramalho-de-Oliveira D, Ribarić E, Bobinac A. Budget Impact Analysis of Pharmacist-Led Medication Management in Cardiovascular and Type 2 Diabetic Patients. Healthcare (Basel) 2022; 10:healthcare10040722. [PMID: 35455900 PMCID: PMC9027851 DOI: 10.3390/healthcare10040722] [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: 02/18/2022] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022] Open
Abstract
The paper aims to identify and measure the costs and savings associated with the delivery of Comprehensive Medication Management (CMM) services in Croatia in patients diagnosed with hypertension accompanied by at least one additional established cardiovascular disease (CVD) and/or type 2 diabetes mellitus (DMT2) who use five or more medicines daily. The budget impact analysis (BIA) employed in this study compares the total costs of CMM to the cost reductions expected from CMM. The cost reductions (or savings) are based on the reduced incidence of unwanted clinical events and healthcare service utilisation rates due to CMM. The BIA model is populated by data on medication therapy costs, labour, and training from the pilot CMM intervention introduced in Zagreb’s main Health Centre, while relevant international published sources were used to estimate the utilisation, incidence, and unwanted clinical events rates. Total direct costs, including pharmacists’ labour and training (EUR 2,667,098) and the increase in the cost of prescribed medication (EUR 5,182,864) amounted to EUR 7,849,962 for 3 years, rendering the cost per treated patient per year EUR 57. CMM is expected to reduce the utilisation rates of healthcare services and the incidence of unwanted clinical events, leading to a total 3-year reduction in healthcare costs of EUR 7,787,765. Given the total CMM costs of EUR 7,849,962, CMM’s 3-year budget impact equals EUR 92,869, rendering per treated patient an incremental cost of CMM EUR 0.67. Hence, CMM appears to be an affordable intervention for addressing medication mismanagement and irrational drug use.
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Affiliation(s)
- Iva Mucalo
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia;
- Correspondence: ; Tel.: +38-51-6394-802
| | - Andrea Brajković
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia;
| | - Marija Strgačić
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia;
| | - Djenane Ramalho-de-Oliveira
- College of Pharmacy, Centre for Pharmaceutical Care Studies, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil;
| | - Elizabeta Ribarić
- Center for Health Economics and Pharmacoeconomics (CHEP), Faculty of Economics and Business, University of Rijeka, 51 000 Rijeka, Croatia; (E.R.); (A.B.)
| | - Ana Bobinac
- Center for Health Economics and Pharmacoeconomics (CHEP), Faculty of Economics and Business, University of Rijeka, 51 000 Rijeka, Croatia; (E.R.); (A.B.)
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Adverse Pregnancy Outcomes and Maternal Chronic Diseases in the Future: A Cross-Sectional Study Using KoGES-HEXA Data. J Clin Med 2022; 11:jcm11051457. [PMID: 35268548 PMCID: PMC8911450 DOI: 10.3390/jcm11051457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 01/27/2023] Open
Abstract
Adverse pregnancy outcomes (APOs) are associated with an increased risk of chronic diseases, including cardiovascular disease (CVD) and metabolic syndrome (MS), in the future. We designed a large-scale cohort study to evaluate the influence of APOs (preeclampsia, gestational diabetes mellitus (GDM), stillbirth, macrosomia, and low birth weight) on the incidence of chronic diseases, body measurements, and serum biochemistry in the future and investigate whether combinations of APOs had additive effects on chronic diseases. We used health examinee data from the Korean Genome and Epidemiology Study (KoGES-HEXA) and extracted data of parous women (n = 30,174; mean age, 53.02 years) for the analysis. Women with APOs were more frequently diagnosed with chronic diseases and had a family history of chronic diseases compared with women without APOs. Composite APOs were associated with an increased risk of hypertension, diabetes mellitus, hyperlipidemia, angina pectoris, stroke, and MS (adjusted odds ratio: 1.093, 1.379, 1.269, 1.351, 1.414, and 1.104, respectively) after adjustment for family history and social behaviors. Preeclampsia and GDM were associated with an increased risk of some chronic diseases; however, the combination of preeclampsia and GDM did not have an additive effect on the risk. APOs moderately influenced the future development of maternal CVD and metabolic derangements, independent of family history and social behaviors.
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Lee YJ, Lee YP, Seo CS, Choi ES, Han BH, Yoon JJ, Jang SH, Jeong CG, Mun YJ, Kang DG, Lee HS. The Modulation of Nrf-2/HO-1 Signaling Axis by Carthamus tinctorius L. Alleviates Vascular Inflammation in Human Umbilical Vein Endothelial Cells. PLANTS 2021; 10:plants10122795. [PMID: 34961267 PMCID: PMC8704092 DOI: 10.3390/plants10122795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/18/2022]
Abstract
Carthamus tinctorius L., known as safflower, has been used in traditional treatment for cardiovascular, cerebrovascular, and diabetic vascular complications. We proposed to investigate how the ethanol extract of Carthamus tinctorius L. (ECT) can be used ethnopharmacologically and alleviate vascular inflammatory processes under cytokine stimulation in human vascular endothelial cells. Using the optimized HPLC method, six markers were simultaneously analyzed for quality control of ECT. Pretreatment with ECT (10–100 μg/mL) significantly reduced the increase of leukocyte adhesion to HUVEC by TNF-α in a dose-dependent manner. Cell adhesion molecules (CAMs) such as intracellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and endothelial cell selectin (E-selectin) are decreased by ECT. In addition, ECT significantly suppressed TNF-α-induced oxidative stress referring to reactive oxygen species (ROS) production. p65 NF-κB nuclear translocation and its activation were inhibited by ECT. Furthermore, pretreatment of ECT increased the HO-1 expression, and nuclear translocation of Nrf-2. These data suggest the potential role of ECT as a beneficial therapeutic herb in vascular inflammation via ROS/NF-kB pathway and the regulation of Nrf-2/HO-1 signaling axis is involved in its vascular protection. Thus, further study will be needed to clarify which compound is dominant for protection of vascular diseases.
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Affiliation(s)
- Yun Jung Lee
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (Y.J.L.); (B.H.H.); (J.J.Y.); (S.H.J.)
- Professional Graduate School of Korean Medicine, College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.S.C.); (Y.J.M.)
| | - Yong Pyo Lee
- Division of Infectious Disease Diagnosis Control, Honam Regional Center for Disease Control and Prevention, 103 Sangmusimin-ro, Seo-gu, Gwangju 62298, Korea;
| | - Chang Seob Seo
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon 34054, Korea;
| | - Eun Sik Choi
- Professional Graduate School of Korean Medicine, College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.S.C.); (Y.J.M.)
| | - Byung Hyuk Han
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (Y.J.L.); (B.H.H.); (J.J.Y.); (S.H.J.)
- Professional Graduate School of Korean Medicine, College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.S.C.); (Y.J.M.)
| | - Jung Joo Yoon
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (Y.J.L.); (B.H.H.); (J.J.Y.); (S.H.J.)
- Professional Graduate School of Korean Medicine, College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.S.C.); (Y.J.M.)
| | - Se Hoon Jang
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (Y.J.L.); (B.H.H.); (J.J.Y.); (S.H.J.)
- Professional Graduate School of Korean Medicine, College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.S.C.); (Y.J.M.)
| | - Chae Ghang Jeong
- North London Collegiate School Jeju, 33 Global Edu-ro, Seogwipo, Jeju 63644, Korea;
| | - Yeun Ja Mun
- Professional Graduate School of Korean Medicine, College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.S.C.); (Y.J.M.)
| | - Dae Gill Kang
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (Y.J.L.); (B.H.H.); (J.J.Y.); (S.H.J.)
- Professional Graduate School of Korean Medicine, College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.S.C.); (Y.J.M.)
- Correspondence: (D.G.K.); (H.S.L.)
| | - Ho Sub Lee
- Hanbang Cardio-Renal Syndrome Research Center, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (Y.J.L.); (B.H.H.); (J.J.Y.); (S.H.J.)
- Professional Graduate School of Korean Medicine, College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.S.C.); (Y.J.M.)
- Correspondence: (D.G.K.); (H.S.L.)
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Park MS, Lee S, Ahn T, Kim D, Jung MH, Choi JH, Han S, Ryu KH, Kim EJ. Current status of cardiac rehabilitation among representative hospitals treating acute myocardial infarction in South Korea. PLoS One 2021; 16:e0261072. [PMID: 34879117 PMCID: PMC8654170 DOI: 10.1371/journal.pone.0261072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/23/2021] [Indexed: 12/26/2022] Open
Abstract
Cardiac rehabilitation services are mostly underutilized despite the documentation of substantial morbidity and mortality benefits of cardiac rehabilitation post-acute myocardial infarction. To assess the implementation rate and barriers to cardiac rehabilitation in hospitals dealing with acute myocardial infarction in South Korea, between May and July 2016, questionnaires were emailed to cardiology directors of 93 hospitals in South Korea; all hospitals were certified institutes for coronary interventions. The questionnaires included 16 questions on the hospital type, cardiology practice, and implementation of cardiac rehabilitation. The obtained data were categorized into two groups based on the type of the hospital (secondary or tertiary) and statistically analysed. Of the 72 hospitals that responded (response rate of 77%), 39 (54%) were tertiary medical centers and 33 (46%) were secondary medical centers. All hospitals treated acute myocardial infarction patients and performed emergency percutaneous coronary intervention; 79% (57/72) of the hospitals performed coronary artery bypass grafting. However, the rate of implementation of cardiac rehabilitation was low overall (28%, 20/72 hospitals) and even lower in secondary medical centers (12%, 4/33 hospitals) than in tertiary centers (41%, 16/39 hospitals, p = 0.002). The major barriers to cardiac rehabilitation included the lack of staff (59%) and lack of space (33%). In contrast to the wide availability of acute-phase invasive treatment for AMI, the overall implementation of cardiac rehabilitation is extremely poor in South Korea. Considering the established benefits of cardiac rehabilitation in patients with acute myocardial infarction, more administrative support, such as increasing the fee for cardiac rehabilitation services by an appropriate level of health insurance coverage should be warranted.
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Affiliation(s)
- Myung Soo Park
- Department of Cardiology, Hallym University Dongtan Sacred Hospital, Hwaseong, South Korea
| | - Sunki Lee
- Department of Cardiology, Hallym University Dongtan Sacred Hospital, Hwaseong, South Korea
| | - Taehoon Ahn
- Department of Cardiology, Korea University Anam Hospital, Seoul, South Korea
| | - Doyoung Kim
- Department of Cardiology, Hallym University Dongtan Sacred Hospital, Hwaseong, South Korea
| | - Mi-Hyang Jung
- Department of Cardiology, Hallym University Dongtan Sacred Hospital, Hwaseong, South Korea
| | - Jae Hyuk Choi
- Department of Cardiology, Hallym University Dongtan Sacred Hospital, Hwaseong, South Korea
| | - Seongwoo Han
- Department of Cardiology, Hallym University Dongtan Sacred Hospital, Hwaseong, South Korea
| | - Kyu Hyung Ryu
- Department of Cardiology, Hallym University Dongtan Sacred Hospital, Hwaseong, South Korea
| | - Eung Ju Kim
- Department of Cardiology, Korea University Guro Hospital, Seoul, South Korea
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Zhang Y, Jiao Y, Wang C, Zhang C, Wang H, Feng Z, Gu Y, Wang Z. Design and characterization of small-diameter tissue-engineered blood vessels constructed by electrospun polyurethane-core and gelatin-shell coaxial fiber. Bioengineered 2021; 12:5769-5788. [PMID: 34519254 PMCID: PMC8806492 DOI: 10.1080/21655979.2021.1969177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 01/12/2023] Open
Abstract
Substitution or bypass is the most effective treatment for vascular occlusive diseases.The demand for artificial blood vessels has seen an unprecedented rise due to the limited supply of autologous blood vessels. Tissue engineering is the best approach to provide artificial blood vessels. In this study, a new type of small-diameter artificial blood vessel with good mechanical and biological properties was designed by using electrospinning coaxial fibers. Four groups of coaxial fibers vascular membranes having polyurethane/gelatin core-shell structure were cross-linked by the EDC-NHS system and characterized. The core-shell structure of the coaxial vascular fibers was observed by transmission electron microscope. After the crosslinking, the stress and elastic modulus increased and the elongation decreased, burst pressure of 0.11 group reached the maximum (2844.55 ± 272.65 mmHg) after cross-linking, which acted as the experimental group. Masson staining identified blue-stained ring or elliptical gelatin ingredients in the vascular wall. The cell number in the vascular wall of the coaxial group was found in muscle embedding experiment significantly higher than that of the non-coaxial group at all time points(p < 0.001). Our results showed that the coaxial vascular graft with the ratio of 0.2:0.11 had better mechanical properties (burst pressure reached 2844.55 ± 272.65 mmHg); Meanwhile its biological properties were also outstanding, which was beneficial to cell entry and offered good vascular remodeling performance.Polyurethane (PU); Gelatin (Gel); Polycaprolactone (PCL); polylactic acid (PLA);1-(3-Dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride (EDC); N-Hydroxy succinimide (NHS); 4-Morpholine-ethane-sulfonic (MES); phosphate buffered saline (PBS); fetal calf serum (FCS); Minimum Essential Medium (MEM); Dimethyl sulfoxide (DMSO); hematoxylin-eosin (HE).
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Affiliation(s)
- Yuanguo Zhang
- Department of Vascular Surgery, Xuan Wu Hospital of Capital Medical University, Beijing, China
| | - Yuhao Jiao
- Department of Vascular Surgery, Xuan Wu Hospital of Capital Medical University, Beijing, China
| | - Cong Wang
- Department of Vascular Surgery, Xuan Wu Hospital of Capital Medical University, Beijing, China
| | - Chengchao Zhang
- Department of Vascular Surgery, Xuan Wu Hospital of Capital Medical University, Beijing, China
| | - Han Wang
- Division of Biomaterials, National Institiutes for Food and Drug Control, Beijing, China
| | - Zengguo Feng
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuan Wu Hospital of Capital Medical University, Beijing, China
| | - Zhonggao Wang
- Department of Vascular Surgery, Xuan Wu Hospital of Capital Medical University, Beijing, China
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Current Status of Cardiac Rehabilitation in the Regional Cardiocerebrovascular Centers in Korea. J Clin Med 2021; 10:jcm10215079. [PMID: 34768598 PMCID: PMC8585050 DOI: 10.3390/jcm10215079] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Regional Cardiocerebrovascular Centers (RCCs)—a Korean government initiative—seek to reduce medical gaps across regions, and their cardiac rehabilitation (CR) programs are expected to model post-acute care for the Korean CR program. Accordingly, this study aimed to evaluate the current status of CR programs in the RCCs. We distributed surveys on the CR condition, activity, and barriers to 12 RCCs in different provinces. The results revealed significant gaps in the annual number of acute myocardial infarction admissions, and CR candidates, capacity, and density across the 12 RCCs. The CR capacity (50–500) and density (0.42–7.36) indicated particularly large gaps. Twelve RCCs had the necessary facilities, equipment and personnel for CR assessments and management, with high CR referral (97%) and patient education (78%) rates. However, the inpatient CR exercise training (56%) participation rate was inadequate, with much lower enrollment (47%) and adherence (17%) rates to the outpatient CR program and large differences across centers. Therefore, this study’s results will provide the evidence required to establish special national health strategies to overcome the CR barriers of patient, doctor/hospital, and policy factors for activating Korean CR programs.
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Kabłak-Ziembicka A, Przewłocki T. Clinical Significance of Carotid Intima-Media Complex and Carotid Plaque Assessment by Ultrasound for the Prediction of Adverse Cardiovascular Events in Primary and Secondary Care Patients. J Clin Med 2021; 10:4628. [PMID: 34682751 PMCID: PMC8538659 DOI: 10.3390/jcm10204628] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022] Open
Abstract
Recently published recommendations from the American Society of Echocardiography on 'Carotid Arterial Plaque Assessment by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk' provoked discussion once more on the potential clinical applications of carotid intima-media complex thickness (CIMT) and carotid plaque assessment in the context of cardiovascular risk in both primary and secondary care patients. This review paper addresses key issues and milestones regarding indications, assessment, technical aspects, recommendations, and interpretations of CIMT and carotid plaque findings. We discuss lacks of evidence, limitations, and possible future directions.
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Affiliation(s)
- Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Krakow, Poland
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland;
- Department of Interventional Cardiology, John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland
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Choi D, Choi S, Choi S, Park SM, Yoon HS. Association of Rosacea With Cardiovascular Disease: A Retrospective Cohort Study. J Am Heart Assoc 2021; 10:e020671. [PMID: 34558290 PMCID: PMC8649155 DOI: 10.1161/jaha.120.020671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is emerging evidence that rosacea, a chronic cutaneous inflammatory disease, is associated with various systemic diseases. However, its association with cardiovascular disease (CVD) remains controversial. We aimed to investigate whether patients with rosacea are at increased risk of developing CVD. Methods and Results This retrospective cohort study from the Korean National Health Insurance Service-Health Screening Cohort included patients with newly diagnosed rosacea (n=2681) and age-, sex-, and index year-matched reference populations without rosacea (n=26 810) between 2003 and 2014. The primary outcome was subsequent CVD including coronary heart disease and stroke. Multivariable Cox regression analyses were used to evaluate adjusted hazard ratios for subsequent CVD adjusted for major risk factors of CVD. Compared with the reference population (13 410 women; mean [SD] age, 57.7 [9.2] years), patients with rosacea (1341 women; mean [SD] age, 57.7 [9.2] years) displayed an increased risk for CVD (adjusted hazard ratios, 1.20; 95% CI, 1.03-1.40) and coronary heart disease (adjusted hazard ratios, 1.29; 95% CI, 1.05-1.60). The risk for stroke was not significantly elevated (adjusted hazard ratios, 1.12; 95% CI, 0.91-1.37). Conclusions This study suggests that patients with rosacea are more likely to develop subsequent CVD. Proper education for patients with rosacea to manage other modifiable risk factors of CVD along with rosacea is needed.
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Affiliation(s)
- Daein Choi
- Department of Biomedical Sciences Seoul National University Graduate School Seoul South Korea.,Department of Medicine Mount Sinai Beth IsraelIcahn School of Medicine at Mount Sinai New York NY
| | - Sungjun Choi
- Department of Dermatology Seoul National University Hospital Seoul South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences Seoul National University Graduate School Seoul South Korea
| | - Sang Min Park
- Department of Biomedical Sciences Seoul National University Graduate School Seoul South Korea.,Department of Family Medicine Seoul National University Hospital Seoul South Korea
| | - Hyun-Sun Yoon
- Department of Dermatology SMG-SNU Boramae Medical Center Seoul South Korea
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49
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Tan T, Zhou Y, Wan Y, Fan Z, Xu R, Gao X. Transition from metabolically healthy to unhealth status associated with risk of carotid artery plaque in Chinese adults. BMC Cardiovasc Disord 2021; 21:469. [PMID: 34583633 PMCID: PMC8477551 DOI: 10.1186/s12872-021-02279-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/20/2021] [Indexed: 01/27/2023] Open
Abstract
Objective We aimed to evaluate the association between the shift of metabolic status and future risk of carotid artery plaque (CAP) in community-based Chinese adults. Methods The current study included 9836 Chinese adults (4085 males and 5751 females, mean age 35.8 years) with metabolically healthy status at baseline (2013). Metabolically healthy status was defined as no self-reported history of metabolic diseases and cancer, and normal blood pressure, fasting blood glucose, glycated hemoglobin A1c level, and lipid profiles. Metabolically unhealthy status was defined if any of the following metabolic abnormalities were confirmed twice during follow up: high blood pressure, impaired glucose regulation, high triglycerides, high total cholesterol, high low-density lipoprotein cholesterols, or low high-density lipoprotein cholesterols. The transition was confirmed if participants’ metabolic status shifted from baseline healthy to unhealthy status during follow up (2014–2018). Results We have identified 133 incident cases of CAP during follow up. Compared to those who remained metabolically healthy, the transition to high blood pressure, high total cholesterol, and high low-density lipoprotein cholesterols, were associated with high risk of developing carotid artery plaque (Hazards ratios (HRs) ranged from 1.69 to 2.34; p < 0.05 for all). The transition to impaired glucose regulation, high total triglycerides, and low high-density lipoprotein cholesterols, were associated with high risk of carotid artery plaque only in participants with metabolically healthy overweight at baseline (HR ranged from 1.95 to 4.62; p < 0.05 for all). Conclusion The transition from baseline metabolically healthy status to unhealth status was associated with high risk of incident CAP. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02279-w.
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Affiliation(s)
- Tao Tan
- Department of Clinical Nutrition, Ren Ji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yiquan Zhou
- Department of Clinical Nutrition, Ren Ji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yanping Wan
- Department of Clinical Nutrition, Ren Ji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.,Shanghai Key Laboratory of Pediatrics Gastroenterology and Nutrition, Shanghai, China
| | - Zhuping Fan
- Department of Digestion, Ren Ji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Renying Xu
- Department of Clinical Nutrition, Ren Ji Hospital South Campus, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China. .,Shanghai Key Laboratory of Pediatrics Gastroenterology and Nutrition, Shanghai, China.
| | - Xiang Gao
- Department of Nutrition Science, The Pennsylvania State University, State College, PA, USA
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50
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Kang KW, Song JE, Lee BH, Jeon MJ, Yu ES, Kim DS, Lee SR, Sung HJ, Choi CW, Park Y, Kim BS. A nationwide study of patients with monoclonal gammopathy of undetermined significance with a 10-year follow-up in South Korea. Sci Rep 2021; 11:18449. [PMID: 34531426 PMCID: PMC8445957 DOI: 10.1038/s41598-021-97664-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/27/2021] [Indexed: 11/08/2022] Open
Abstract
In clinical practice, most patients with monoclonal gammopathy of undetermined significance (MGUS) undergo long-term follow-up without disease progression. There is insufficient real-world data about how closely and whether anything other than disease progression should be monitored. Herein, we performed a nationwide study of 470 patients with MGUS with a 10-year follow-up to determine the patterns of disease progression and other comorbidities. During the follow-up period, 158 of 470 patients with MGUS (33.62%) progressed to symptomatic monoclonal gammopathies. Most of these were multiple myeloma (134/470 patients, 28.51%), and those diagnosed within 2 years after diagnosis of MGUS was high. Approximately 30-50% of patients with MGUS had hypertension, diabetes, hyperlipidemia, and osteoarthritis at the time of diagnosis, and these comorbidities were newly developed during the follow-up period in approximately 50% of the remaining patients with MGUS. Approximately 20-40% of patients with MGUS have acute or chronic kidney failure, thyroid disorders, disc disorders, peripheral neuropathy, myocardial infarction, stroke, and heart failure during the follow-up period. Altogether, when MGUS is diagnosed, close follow-up of the possibility of progression to multiple myeloma is required, especially within 2 years after diagnosis; simultaneously, various comorbidities should be considered and monitored during the follow-up of patients with MGUS. Continuous research is needed to establish appropriate follow-up guidelines.
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Affiliation(s)
- Ka-Won Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Ji Eun Song
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Byung-Hyun Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Min Ji Jeon
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Eun Sang Yu
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Dae Sik Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Se Ryeon Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Hwa Jung Sung
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Chul Won Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Yong Park
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Byung Soo Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
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