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Kanu VR, Pulakuntla S, Kuruvalli G, Aramgam SL, Marthadu SB, Pannuru P, Hebbani AV, Desai PPD, Badri KR, Vaddi DR. Anti-atherogenic role of green tea (Camellia sinensis) in South Indian smokers. JOURNAL OF ETHNOPHARMACOLOGY 2024; 332:118298. [PMID: 38714238 DOI: 10.1016/j.jep.2024.118298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/22/2024] [Accepted: 05/04/2024] [Indexed: 05/09/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Green tea (Camellia sinensis) is a popular beverage consumed all over the world due to its health benefits. Many of these beneficial effects of green tea are attributed to polyphenols, particularly catechins. AIM OF THE STUDY The present study focuses on underlying anti-platelet aggregation, anti-thrombotic, and anti-lipidemic molecular mechanisms of green tea in South Indian smokers. MATERIALS AND METHODS We selected 120 South Indian male volunteers for this study to collect the blood and categorised them into four groups; control group individuals (Controls), smokers, healthy control individuals consuming green tea, and smokers consuming green tea. Smokers group subjects have been smoking an average 16-18 cigarettes per day for the last 7 years or more. The subjects (green tea consumed groups) consumed 100 mL of green tea each time, thrice a day for a one-year period. RESULTS LC-MS analysis revealed the presence of multiple phytocompounds along with catechins in green tea extract. Increased plasma lipid peroxidation (LPO), protein carbonyls, cholesterol, triglycerides, and LDL-cholesterol with decreased HDL-cholesterol levels were observed in smokers compared to the control group and the consumption of green tea showed beneficial effect. Furthermore, docking studies revealed that natural compounds of green tea had high binding capacity with 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMG-CoA) when compared to their positive controls, whereas (-) epigallocatechin-3-gallate (EGCG) and (-) epicatechin-gallate (ECG) had high binding capacity with sterol regulatory element-binding transcription factor 1 (SREBP1c). Further, our ex vivo studies showed that green tea extract (GTE) significantly inhibited platelet aggregation and increased thrombolytic activity in a dose dependent manner. CONCLUSION In conclusion, in smokers, catechins synergistically lowered oxidative stress, platelet aggregation and modified the aberrant lipid profile. Furthermore, molecular docking studies supported green tea catechins' antihyperlipidemic efficacy through strong inhibitory activity on HMG-CoA reductase and SREBP1c. The mitigating effects of green tea on cardiovascular disease risk factors in smokers that have been reported can be attributed majorly to catechins or to their synergistic effects.
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Affiliation(s)
| | - Swetha Pulakuntla
- School of Applied Sciences, REVA University, Bengaluru (Bangalore), 560064, KA, India
| | - Gouthami Kuruvalli
- School of Applied Sciences, REVA University, Bengaluru (Bangalore), 560064, KA, India
| | - Sree Latha Aramgam
- School of Applied Sciences, REVA University, Bengaluru (Bangalore), 560064, KA, India; Department of Neurobiology, Morehouse School of Medicine, GA, Atlanta, 30310, USA
| | | | - Padmavathi Pannuru
- School of Applied Sciences, REVA University, Bengaluru (Bangalore), 560064, KA, India
| | | | | | - Kameswara Rao Badri
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute, Morehouse School of Medicine, GA, Atlanta, 30310, USA; Clinical Analytical Chemistry Laboratory, Clinical Research Center, Morehouse School of Medicine, GA, Atlanta, 30310, USA.
| | - Damodara Reddy Vaddi
- School of Applied Sciences, REVA University, Bengaluru (Bangalore), 560064, KA, India; Department of Biochemistry, Sri Krishnadevaraya University, Anantapuramu, 515003, AP, India.
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McKnight M, Nnamani I, Volberding K, Cutshall BT, Wells DA. Non-ST elevation myocardial ischemia in a patient on modafinil. Nurse Pract 2024; 49:9-12. [PMID: 39049145 DOI: 10.1097/01.npr.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
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Chiou A, Hermel M, Chai Z, Eiseman A, Jeschke S, Mehta S, Khan U, Hoodbhoy Z, Safdar N, Khoja A, Junaid V, Vaughan E, Merchant AT, Iqbal J, Almas A, Virani SS, Sheikh S. Going from Primary to Primordial Prevention: Is the Juice Worth the Squeeze? Curr Cardiol Rep 2024:10.1007/s11886-024-02109-3. [PMID: 39073507 DOI: 10.1007/s11886-024-02109-3] [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] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE OF REVIEW While primary prevention strategies target individuals who are at high risk of cardiovascular disease, there is rising interest towards primordial prevention that focuses on preventing the development of risk factors upstream of disease detection. Therefore, we review the advantages of primordial prevention interventions on minimizing future cardiovascular events. RECENT FINDINGS Primordial prevention of atherosclerotic cardiovascular disease involves behavioral, genetic, and environmental strategies, starting from fetal/infant health and continuing throughout childhood and young adulthood. Early interventions focusing on modifiable risk factors such as physical inactivity, non-ideal body weight, smoking, and environmental pollutants are important towards preventing the initial occurrence of risk factors such as hypertension, dyslipidemia, and diabetes to ultimately reduce cardiovascular disease. Implementing primordial prevention strategies early on in life can minimize cardiovascular events and lead to healthy aging in the population. Future studies can further evaluate the effectiveness of various primordial prevention strategies.
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Affiliation(s)
- Andrew Chiou
- Department of Cardiology, Scripps Clinic, La Jolla, San Diego, CA, USA
| | - Melody Hermel
- Department of Cardiology, United Medical Doctors, La Jolla, San Diego, CA, USA
| | - Zohar Chai
- Department of Biological Sciences, University of California, San Diego, San Diego, CA, USA
| | - Ariana Eiseman
- Northeastern University Bouvé College of Health Science, Boston, MA, USA
| | - Sheila Jeschke
- Department of Cardiology, Scripps Clinic, La Jolla, San Diego, CA, USA
| | - Sandeep Mehta
- Department of Cardiology, Loyola University Medical Center, Chicago, IL, USA
| | - Unab Khan
- Department of Family Medicine, The Aga Khan University, Karachi, Pakistan
| | - Zahra Hoodbhoy
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Nilofer Safdar
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Adeel Khoja
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Medicine, The Aga Khan University, Stadium Road, Karachi, Pakistan
| | | | | | - Anwar T Merchant
- Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Junaid Iqbal
- Department of Medicine, The Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Aysha Almas
- Department of Medicine, The Aga Khan University, Stadium Road, Karachi, Pakistan
| | | | - Sana Sheikh
- Department of Medicine, The Aga Khan University, Stadium Road, Karachi, Pakistan.
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Odeny L, Gathecha G, Mwenda V, Kendagor A, Cheburet S, Mugi B, Mithi C, Jaguga F, Okinda K, Devotsu RK, Mohamed SF, Ong’ang’o JR. Tobacco smoking-attributable mortality in Kenya, 2012-2021. Tob Induc Dis 2024; 22:TID-22-134. [PMID: 39050115 PMCID: PMC11267916 DOI: 10.18332/tid/186170] [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: 11/19/2022] [Revised: 04/10/2023] [Accepted: 03/16/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Tobacco smoking poses a significant risk for various diseases, including cardiovascular diseases, chronic respiratory diseases, and cancers. In Kenya, tobacco-related deaths contribute substantially to non-communicable disease mortality. This study aims to quantify the mortality attributed to tobacco smoking in Kenya from 2012 to 2021. METHODS Employing a prevalence-based analysis model, the study utilized population attributable fraction (PAF) to estimate age-specific smoke attributable mortality (SAM) rates for individuals aged ≥35 years. Causes of death associated with tobacco use, including cancers, cardiovascular diseases, respiratory diseases, tuberculosis, and diabetes, were analyzed based on age, sex, and death records between 2012 and 2021. RESULTS Over the study period, 60228 deaths were attributed to tobacco-related diseases, with an annual increase observed until 2016 and subsequent fluctuations. Respiratory diseases, diabetes mellitus, malignant cancers, tuberculosis, and cardiovascular diseases collectively accounted for 16.5% of deaths among individuals aged ≥35 years. Notable contributors were pneumonia and influenza (respiratory diseases), esophageal cancer (cancers), and cerebrovascular diseases (cardiovascular diseases). Of the observed deaths, 16.5% were attributed to smoking, with respiratory diseases (40.5%), malignant cancers (31.4%), tuberculosis (13%), cardiovascular diseases (8.9%), and diabetes mellitus (6.1%) contributing. Pneumonia and influenza, esophageal cancer, chronic airway obstruction, and tuberculosis were primary causes, comprising 70% of all SAM. CONCLUSIONS Tobacco-related mortality is a significant public health concern in Kenya. Efforts should focus on preventing tobacco use and managing associated disease burdens. Smoking cessation initiatives and comprehensive tobacco control measures are imperative to mitigate the impact on population health.
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Affiliation(s)
- Lazarus Odeny
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Gladwell Gathecha
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Valerian Mwenda
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Anne Kendagor
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Samuel Cheburet
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Beatrice Mugi
- Radiology Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Caroline Mithi
- Internal Medicine Department, Kenyatta University Teaching, Referral and Research Hospital, Nairobi, Kenya
| | - Florence Jaguga
- Alcohol and Drug Abuse Rehabilitation Services Department, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Kennedy Okinda
- Research and Program Department, Kenyatta National Hospital, Othaya, Kenya
| | | | - Shukri F. Mohamed
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Rahedi Ong’ang’o
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Kisumu, Kenya
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Chen HC, Tai CJ, Huang JY, Kuo TA, Huang YD, Yen CH, Lee MC. Associations of fish oil with cardiovascular disease events: results from the Taiwan longitudinal study in aging. BMC Public Health 2024; 24:1979. [PMID: 39048951 PMCID: PMC11270879 DOI: 10.1186/s12889-024-19512-8] [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: 05/22/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The effectiveness of fish oil in preventing cardiovascular events is still debating. Some studies indicate a correlation between the use of fish oil supplements and reduced mortality or decreased incidence of stroke. However, other studies show no significant association between fish oil intake and stroke prevention, indicating an ongoing debate. This study aimed at exploring which subjects may benefit more from fish oil supplementation. METHODS This study utilized the data obtained through face-to-face interview from the Taiwan Longitudinal Study in Aging (TLSA). A total of 3,652 participants were included from the 2003 baseline data, after excluding patients with pre-existing ischemic heart disease or stroke. Participants were divided into two groups based on whether taking fish oil supplement or not. Participants were followed until 2015, estimating and comparing the all-cause mortality and cumulative incidence rate of stroke between both groups. RESULTS The results of the 12-year longitudinal study showed that the cumulative incidence rate of stroke in the fish oil supplementation group was 5.7%, compared to 7.7% in the non-supplemented group (P < 0.05). Additionally, the crude hazard ratio for stroke was significantly lower in the fish oil supplementation group (HR = 0.686;95% CI 0.476-0.987). However, after adjusting potential confounders, the adjusted risk of stroke was lower only for the diabetic patients supplemented with fish oil (aHR = 0.123; 95% CI 0.016-0.930) compared to non-diabetic patients (aHR = 0.917; 95% CI 0.616-1.364). CONCLUSION This study suggests that there is an association between fish oil supplementation and a lower cumulative incidence rate of subsequent stroke among diabetic patients.
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Affiliation(s)
- Hsiu-Chuan Chen
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chi-Jung Tai
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Gangshan Hospital, Kaohsiung, Taiwan
- Department of Family Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsu-Ann Kuo
- Department of Medical Sociology and Social Work, Chung Shan Medical University, Taichung, Taiwan
| | - Yuan-Der Huang
- Department of Obstetrics and Gynecology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Chi-Hua Yen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.
- College of Management, Chaoyang University of Technology, Taichung, Taiwan.
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
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Hosseininasab D, Shiraseb F, Ghaffarian-Ensaf R, Hosseini S, da Silva A, Hajinasab MM, Barry VW, de Courten B, Mirzaei K. Dairy intake and cardiovascular diseases risk factors: a cross-sectional study on Iranian obese and overweight women. BMC Public Health 2024; 24:1895. [PMID: 39010046 PMCID: PMC11251318 DOI: 10.1186/s12889-024-19232-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: 12/15/2023] [Accepted: 06/21/2024] [Indexed: 07/17/2024] Open
Abstract
OBJECTIVE Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide. Dietary interventions can directly affect several ASCVD risk factors. This study aimed to assess an association between dairy consumption and the odds of ASCVD and its risk factors in women with overweight and obesity. METHODS The present cross-sectional study was conducted on 390 Iranian women aged 18-48 years and body mass index (BMI) ≥ 25 kg/m². Dairy consumption was assessed using a 147-item food frequency questionnaire. Participants were divided into tertiles based on their dairy consumption with 130 (33.3%) women in each category. RESULTS The participants had an average age of 36.73 ± 9.18 years, and the mean BMI was 31.28 ± 4.30 kg/m2. In the unadjusted model, individuals in the third tertile of dairy consumption had 0.79 times lower odds of ASCVD compared to those in the first tertile (OR: 0.21; 95% Confidence Interval (CI): 0.11, 0.41; P-value = 0.001). Additionally, we observed a significant inverse relationship between higher dairy intake and adiposity markers, blood pressure, and Triglyceride glucose-body mass index (TyG-BMI). CONCLUSION The study revealed a negative association between dairy intake and the risk of ASCVD but this association diminished after adjusting for confounding factors. It also found a negative association between dairy consumption with BMI, fat mass index, body fat, blood pressure, and TyG-BMI.
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Affiliation(s)
- Dorsa Hosseininasab
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Farideh Shiraseb
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
| | | | - Shabnam Hosseini
- School of Human Nutrition, McGill University, Montreal, QC, Canada
| | | | - Mohammad Mahdi Hajinasab
- Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Vaughn W Barry
- Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, 3168, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, 3085, Australia
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran.
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Kumar KD, Choudhry HS, Shah VP, Desai AD, Sibala DR, Patel AM, Patel P, Eloy JA. Smoking impacts outcomes in transcervical Zenker's diverticulectomy. Am J Otolaryngol 2024; 45:104288. [PMID: 38640811 DOI: 10.1016/j.amjoto.2024.104288] [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: 01/09/2024] [Accepted: 04/07/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE There is sparse literature discussing the impact of smoking on postoperative outcomes following surgical treatment of Zenker's diverticulum. In this study, we seek to characterize differences in the management and outcomes of open Zenker's diverticulectomy based on patient smoking status. METHODS AND MATERIALS This paper is a retrospective cohort review. The 2005-2018 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for patients undergoing open Zenker's diverticulectomy. Chi-square and multivariable logistic regression were performed to determine statistical associations between postoperative outcomes and smoking status. RESULTS Of the 715 identified patients, 70 (9.8 %) were smokers and 645 (91.2 %) were non-smokers. Smokers were younger than non-smokers (mean 63.9 vs. 71.7 years, p < 0.001) and more likely to have a prolonged operative time (20.0 % vs. 11.6 %, p = 0.044). On multivariable regression analysis controlling for demographics and comorbidities, smokers had greater odds than non-smokers for developing overall postoperative complications (OR: 2.776, p = 0.013), surgical infections (OR: 3.194, p = 0.039), medical complications (OR: 3.563, p = 0.011), and medical infections (OR: 1.247, p = 0.016). Smokers also had greater odds for requiring ventilation/intubation (OR: 8.508, p = 0.025) and having a prolonged postoperative stay (OR: 2.425, p = 0.030). CONCLUSION In a cohort of patients undergoing transcervical Zenker's diverticulectomy, smokers are at increased risk for overall complications, medical complications, medical infections, surgical infections, prolonged postoperative stay, and ventilation/intubation.
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Affiliation(s)
- Keshav D Kumar
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Hannaan S Choudhry
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Vraj P Shah
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amar D Desai
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Dhiraj R Sibala
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aman M Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Prayag Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, NJ, USA.
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Kar N, Barreto S. Influence of Lifestyle Factors on Metabolic Syndrome in Psychiatric Patients Attending a Community Mental Health Setting: A Cross-sectional Study. Indian J Psychol Med 2024; 46:313-322. [PMID: 39056040 PMCID: PMC11268271 DOI: 10.1177/02537176231219770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Abstract
Background Metabolic syndrome (MetS) is a concern in psychiatric patients. We aimed to study the influence of the modifiable lifestyle factors on MetS in adult psychiatric patients along with associated clinical factors and quality of life. Methods Factors such as diet (Healthy Eating Index), exercise, substance use, cardiovascular risk (QRISK), illness severity (Clinical Global Impression), medications, adverse events (Systematic Monitoring of Adverse Events Related to Treatments), and quality of life (Recovering Quality of Life Scale) were assessed along with clinical components for MetS in 323 psychiatric patients receiving routine care and monitoring in a Community Mental Health Team. Results MetS was present in 50.5% (95% CI: 45.0-55.9). It was significantly associated with higher age, duration of mental illness, body mass index (BMI), QTc, QRISK, and antipsychotic drugs. In logistic regression, age, QTc, QRISK, and BMI remained significantly linked to MetS. Patients with or without MetS were comparable in their lifestyle factors such as diet, exercise, and substance use, along with the family history of metabolic disorders, age at onset of mental illness, duration of antipsychotic medication, side effects, psychiatric diagnoses, and quality of life. However, many patients with or without MetS had poorer diet and physical inactivity, indicating scope for interventions. Conclusions Around half of the psychiatric patients had MetS, and modifiable lifestyle factors did not differentiate individuals with or without MetS. The need for further research on the prevention and management of MetS in psychiatric patients is highlighted.
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Affiliation(s)
- Nilamadhab Kar
- University of Wolverhampton, United Kingdom
- Dept. of Psychiatry, Black Country Healthcare NHS Foundation Trust, Wolverhampton, United Kingdom
| | - Socorro Barreto
- Dept. of Psychiatry, Black Country Healthcare NHS Foundation Trust, Wolverhampton, United Kingdom
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Pierce SK, Reynolds KA, Sommer JL, El-Gabalawy R, Pietrzak RH, Sumner JA, Mota N. Maladaptive health factors as potential mediators for the association between posttraumatic stress disorder and cardiovascular disease: A sex-stratified analysis in the U.S. adult population. J Psychiatr Res 2024; 177:102-108. [PMID: 39002531 DOI: 10.1016/j.jpsychires.2024.06.028] [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: 02/07/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVES This study examined sex differences for health risk factors as potential mediators in the association between posttraumatic stress disorder (PTSD) and cardiovascular disease (CVD). METHODS Secondary data from the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions Wave 3 was used. This cross-sectional survey contains a nationally representative sample of 36,309 U.S. adults (nfemales = 20,447, Mage = 47.16, 95% CI = [46.74, 47,57]; nmales = 15,682, Mage = 45.88, 95% CI = [45.42, 46.34]). Natural effect models and logistic regression analyses were conducted to evaluate health risk factors (smoking, substance use, low physical activity, high body mass index [BMI], binge eating, and multiple health risk factors) as potential mediators for the PTSD-CVD relationship in females and males. RESULTS High BMI (indirect AOR = 1.05, 95% CI = [1.02, 1.07]) and substance use (indirect AOR = 0.93, 95% CI = [0.88, 0.98], p = 0.005) were potential mediators in females and males respectively. Binge eating, smoking, and low physical activity were not mediators in either sex. The number of health risk factors was also a potential mediator in females (indirect AOR = 1.12, 95% CI = [1.07, 1.19], p = <0.001) though not males (indirect AOR = 1.09, 95% CI = [1.00, 1.19], p = .059). CONCLUSIONS The results inform prevention strategies, such as screening for health risk factors to mitigate the adverse effect of PTSD on CVD risk. Findings also inform important directions for future longitudinal research to establish causal pathways.
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Affiliation(s)
- S K Pierce
- Department of Psychology, University of Manitoba, MB, Canada
| | - K A Reynolds
- Department of Psychology, University of Manitoba, MB, Canada; Department of Psychiatry, University of Manitoba, MB, Canada
| | - J L Sommer
- Department of Psychology, University of Manitoba, MB, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, MB, Canada
| | - R El-Gabalawy
- Department of Psychology, University of Manitoba, MB, Canada; Department of Psychiatry, University of Manitoba, MB, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, MB, Canada; Department of Clinical Health Psychology, University of Manitoba, MB, Canada
| | - R H Pietrzak
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - J A Sumner
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - N Mota
- Department of Psychiatry, University of Manitoba, MB, Canada; Department of Clinical Health Psychology, University of Manitoba, MB, Canada.
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Hott CDA, Santos BC, Hebert JR, Zhao L, Wirth MD, Vilela EG, Anastácio LR. Dietary inflammatory index after liver transplantation: Associated effects and long-term outcomes. Clin Nutr ESPEN 2024; 61:349-355. [PMID: 38777454 DOI: 10.1016/j.clnesp.2024.04.001] [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: 07/07/2023] [Revised: 02/06/2024] [Accepted: 04/03/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS We examined the dietary inflammatory potential in patients who underwent liver transplantation (LTx), associated factors and its relationship with clinical outcomes ten years after the initial evaluation. METHODS Dietary Inflammatory Index (DII®) scores were generated from data derived from the 24-h recall in 108 patients. RESULTS Patients with higher DII scores (highest tertile), indicating a pro-inflammatory diet, had significantly higher serum LDL cholesterol (108.0 vs 78.2 mg/dL, p = <0.01) at the initial evaluation. However, DII scores did not significantly predict the occurrence of clinical outcomes after ten years of follow-up. Patient age was predictive of neoplasia (OR:1.05 95% CI:1.00-1.11; p = 0.03). Higher BMI at the initial evaluation was associated with steatosis (OR:1.51; 95% CI:1.29-1.77; p < 0.01), and smoking history was associated with the occurrence of cardiovascular events (OR:7.71; 95% CI:1.53-38.79; p = 0.01). CONCLUSIONS A pro-inflammatory diet was associated with higher serum LDL cholesterol in the initial evaluation but may not be strongly related to clinical outcomes during long-term follow-up.
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Affiliation(s)
- Cristina de Almeida Hott
- Department of Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bárbara Chaves Santos
- Department of Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Longgang Zhao
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Michael D Wirth
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA; College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Eduardo Garcia Vilela
- Department of Medical Clinic, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lucilene Rezende Anastácio
- Department of Food Science, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Kairies-Schwarz N, Mussio I, Bulla-Holthaus N, Wankmüller E, Wolff G, Gontscharuk V, Heinen Y, Perings S, Brockmeyer M, Kelm M, Icks A. Risk and time preferences in individuals with lifestyle-related and non-lifestyle-related cardiovascular diseases: a pilot study. BMJ Open 2024; 14:e080867. [PMID: 38719330 PMCID: PMC11107805 DOI: 10.1136/bmjopen-2023-080867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/03/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES To (1) pilot a study of behavioural characterisation based on risk and time preferences in clinically well-characterised individuals, (2) assess the distribution of preferences in this population and (3) explore differences in preferences between individuals with 'lifestyle-related' (LS) and 'non-lifestyle-related' (NLS) cardiovascular diseases. DESIGN Cross-sectional study with an economic online experiment to collect risk and time preferences, a detailed clinical characterisation and a sociodemographic and lifestyle survey. A definition of LS and NLS groups was developed. SETTING Specialist outpatient clinics of the clinic for cardiology and pneumology of the University Hospital Düsseldorf and patients from a cardiology practice in Düsseldorf. PARTICIPANTS A total of 74 individuals with cardiovascular diseases. OUTCOMES Risk and time preferences. RESULTS The implementation of the study process, including participant recruitment and data collection, ran smoothly. The medical checklist, the survey and the time preference instrument were well received. However, the conceptual understanding of the risk preference instrument resulted in inconsistent choices for many participants (47%). The remaining individuals were more risk averse (27%) than risk seeking (16%) and risk neutral (10%). Individuals in our sample were also more impatient (49%) than patient (42%). The participant classification showed that 65% belonged to the LS group, 19% to the NLS group and 16% could not be assigned (unclear allocation to lifestyle (ULS) group). Excluding the ULS group, we show that individuals in the LS group were more risk seeking, and unexpectedly, more patient than those in the NLS group. CONCLUSIONS The process of the pilot study and its results can be used as a basis for the design of the main study. The differences in risk and time preferences between the LS and NLS groups provide us with a novel hypothesis for unhealthy behaviours: individuals never give up a bad habit, they simply postpone the latter, which can be tested alongside other additional research questions.
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Affiliation(s)
- Nadja Kairies-Schwarz
- Institute for Health Services Research and Health Economics & Centre for Health and Society, Heinrich-Heine-University, Düsseldorf, Germany
- German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Irene Mussio
- Department of Economics, University of Leeds, Leeds, UK
| | - Natalia Bulla-Holthaus
- Institute for Health Services Research and Health Economics & Centre for Health and Society, Heinrich-Heine-University, Düsseldorf, Germany
- Health Economics Research Center (CINCH), University of Duisburg-Essen, Essen, Germany
| | - Esther Wankmüller
- Clinic for Pediatrics 1, UK Essen, University Hospital Essen, Essen, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology, and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Klinik für Kardiologie, Klinikum Ibbenbüren, Stiftung Mathias Spital Rheine, Ibbenbüren, Germany
| | - Veronika Gontscharuk
- Institute for Health Services Research and Health Economics & Centre for Health and Society, Heinrich-Heine-University, Düsseldorf, Germany
| | - Yvonne Heinen
- Division of Cardiology, Pulmonology, and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stefan Perings
- Division of Cardiology, Pulmonology, and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Maximilian Brockmeyer
- Division of Cardiology, Pulmonology, and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Heinrich-Heine-University Düsseldorf, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics & Centre for Health and Society, Heinrich-Heine-University, Düsseldorf, Germany
- German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
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12
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Luo T, Tseng TS. Diet quality as assessed by the healthy eating index-2020 among different smoking status: an analysis of national health and nutrition examination survey (NHANES) data from 2005 to 2018. BMC Public Health 2024; 24:1212. [PMID: 38693488 PMCID: PMC11064397 DOI: 10.1186/s12889-024-18630-7] [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: 12/05/2023] [Accepted: 04/16/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Combining smoking with poor eating habits significantly elevates the risk of chronic illnesses and early death. Understanding of how dietary quality shifts post-smoking cessation remains limited. The objective of this study is to examine dietary quality - using Healthy Eating Index (HEI - 2020) and its 13 components, among current, former, and never smokers, and particularly the impact of quitting and the duration of cessation on dietary habits. METHODS A cross-sectional analysis of 31,569 adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 was conducted. Dietary quality was assessed using HEI-2020 scores, which were determined by NIH developed - simple HEI scoring algorithm per person. Smoking status was categorized into current, former, and never smokers, with further subdivisions for current (heavy/light smokers) and former smokers (duration post-cessation). Descriptive analysis and multiple regression models weighted to represent the US population were performed. RESULTS The current smoking rate was 19.4%, with a higher prevalence in males (22.5%) than females (17.5%). Current smokers reported statistically significantly lower HEI total score than both former and never smokers. Former smokers exhibited HEI scores similar to those of never smokers. The adjusted HEI total scores for current, former, and never smokers were 49.2, 54.0, and 53.3, respectively, with a statistically significant difference (p < 0.001). Moreover, light smokers had better total HEI score than heavy smokers (46.8 vs. 50.8, p < 0.001, respectively), but former and never smokers scored even higher. Quitting smoking immediately improved dietary quality, with former smokers reaching the dietary levels of never smokers within 5-10 years (53.8 vs. 53.3, p > 0.05, respectively). Compared to current smokers, former smokers tended to consume more beneficial foods (e.g., fruits, vegetables, greens and beans, whole grains, proteins, and fatty acids), while also consuming more sodium and less added sugar. CONCLUSIONS Current smokers, particularly heavy smokers, exhibit poorer dietary habits than former and never smokers. The dietary quality of former smokers aligns with never smokers over time, highlighting the positive impact of smoking cessation on diet. This has implications for reducing chronic disease risks associated with poor diet and smoking.
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Affiliation(s)
- Ting Luo
- Moores Cancer Center, School of Medicine, University of California San Diego, 9500 Gilman Dr, 92093-0905, La Jolla, CA, 92122, USA.
| | - Tung-Sung Tseng
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, 70122, USA
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13
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Bijla M, Saini SK, Pathak AK, Bharadwaj KP, Sukhavasi K, Patil A, Saini D, Yadav R, Singh S, Leeuwenburgh C, Kumar P. Microbiome interactions with different risk factors in development of myocardial infarction. Exp Gerontol 2024; 189:112409. [PMID: 38522483 DOI: 10.1016/j.exger.2024.112409] [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: 02/16/2024] [Revised: 03/10/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
Among all non-communicable diseases, Cardiovascular Diseases (CVDs) stand as the leading global cause of mortality. Within this spectrum, Myocardial Infarction (MI) strikingly accounts for over 15 % of all deaths. The intricate web of risk factors for MI, comprising family history, tobacco use, oral health, hypertension, nutritional pattern, and microbial infections, is firmly influenced by the human gut and oral microbiota, their diversity, richness, and dysbiosis, along with their respective metabolites. Host genetic factors, especially allelic variations in signaling and inflammatory markers, greatly affect the progression or severity of the disease. Despite the established significance of the human microbiome-nutrient-metabolite interplay in associations with CVDs, the unexplored terrain of the gut-heart-oral axis has risen as a critical knowledge gap. Moreover, the pivotal role of the microbiome and the complex interplay with host genetics, compounded by age-related changes, emerges as an area of vital importance in the development of MI. In addition, a distinctive disease susceptibility and severity influenced by gender-based or ancestral differences, adds a crucial insights to the association with increased mortality. Here, we aimed to provide an overview on interactions of microbiome (oral and gut) with major risk factors (tobacco use, alcohol consumption, diet, hypertension host genetics, gender, and aging) in the development of MI and therapeutic regulation.
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Affiliation(s)
- Manisha Bijla
- Department of Biotechnology, Guru Nanak Dev University, Amritsar, India
| | - Sunil Kumar Saini
- Department of Zoology, Swami Shraddhanand College, Delhi University, India
| | - Ajai Kumar Pathak
- Estonian Biocentre, Institute of Genomics, University of Tartu, Tartu, Estonia; Department of Human Genetics, KU Leuven, 3000 Leuven, Belgium
| | | | - Katyayani Sukhavasi
- Department of Cardiac Surgery and The Heart Clinic, Tartu University Hospital & Department of Cardiology, Institute of Clinical Medicine, Tartu University, Tartu, Estonia
| | - Ayurshi Patil
- ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Diksha Saini
- ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Rakesh Yadav
- Department of Cardiology, AIIMS, New Delhi, India
| | - Shalini Singh
- ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | | | - Pramod Kumar
- ICMR-National Institute of Cancer Prevention and Research, Noida, India.
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14
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Barkhurdar W, Hussain A, Saqlain M, Zahra R, Hussain I, Saqib M, Mumtaz H. Smoking behaviour in post-acute myocardial infarction patients: cross-sectional study. Ann Med Surg (Lond) 2024; 86:2531-2537. [PMID: 38694391 PMCID: PMC11060240 DOI: 10.1097/ms9.0000000000001333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/08/2023] [Indexed: 05/04/2024] Open
Abstract
Introduction Heart disease remains the leading cause of death in developed countries, and cigarette smoking contributes to a significant proportion of cardiovascular-related deaths. Abstaining from tobacco use is associated with a significant reduction in the risk of recurrent myocardial infarctions. Methodology In this cross-sectional study, 384 participants post-acute myocardial infarction (MI) were recruited through random sampling to explore the associations between smoking status and intention to quit smoking. Data collection took place over a 6-month period at a tertiary care hospital, Islamabad, Pakistan. Results The majority of participants were male (59.9%) and fell into the age category of 46-50 years (37.5%). Heavy daily smokers comprised the largest smoking group (41.6%), and non-ST-elevated MI was the most common subtype (40.1%). Intention to quit smoking varied among participants, with the pre-contemplation stage having the highest representation (19.3%), followed by contemplation (25.8%). Notably, a significant proportion of participants expressed no intention to quit smoking (35.4%). Conclusion Multinomial logistic regression analysis identified current smoking as a significant predictor of intention to quit in the preparation and contemplation stages. Overall, this study underscores the importance of considering smoking behaviour when evaluating the intention to quit smoking post-MI and highlights the need for tailored interventions and support strategies to address smoking cessation in this population. These findings offer valuable insights for the development of effective strategies aimed at reducing persistent smoking following MI and improving patient outcomes.
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Affiliation(s)
| | | | | | - Rida Zahra
- Holy Family Hospital Rawalpindi, Rawalpindi
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15
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Yuen VL, Zhang XJ, Ling X, Zhang Y, Kam KW, Chen LJ, Ip P, Tham CC, Cheung CY, Pang CP, Yam JC. Effects of firsthand tobacco smoking on retinal vessel caliber: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2024; 262:1397-1407. [PMID: 37682335 DOI: 10.1007/s00417-023-06223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE To review the effects of firsthand tobacco smoking on central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) of firsthand tobacco smokers. METHODS We performed a search on EMBASE and PubMed for studies up to 15th July 2022. Two independent reviewers selected studies with baseline data of CRAE and CRVE of current smokers, nonsmokers, and former smokers. Initial search identified 893 studies, of which 10 were included in the meta-analysis. Two independent reviewers extracted data from the included studies. The quality of studies was assessed by the Newcastle-Ottawa Scale. RESULTS In this meta-analysis, 7431 nonsmokers, 2448 current smokers and 5786 former smokers, as well as 7404 nonsmokers, 2430 current smokers and 5763 former smokers were included in CRAE and CRVE analysis respectively. Nonsmokers had narrower CRVE (Weighted mean difference [WMD], -12.15; 95% CI, -17.33 - -6.96) and CRAE (WMD, -4.77; 95% CI, -7.96 - -1.57) than current smokers, and narrower CRVE (WMD, -3.08; 95% CI, -6.06 - -0.11) than former smokers. Current smokers had wider CRVE (WMD, 10.42; 95% CI, 7.80 - 13.04) and CRAE (WMD, 7.05; 95% CI, 6.65 - 7.46) than former smokers. Subgroup analysis and sensitivity analysis were performed. CONCLUSION Firsthand tobacco smoking resulted in wider CRAE and CRVE in current and former smokers, particularly in CRVE, and such changes may not be reversible after smoking cessation. Therefore, retinal vessel caliber may reflect the effects of firsthand tobacco smoking and be used to estimate the risk of cardiovascular diseases.
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Affiliation(s)
- Vincent L Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiangtian Ling
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China.
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Hong Kong Eye Hospital, Hong Kong SAR, China.
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China.
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16
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Xu Y, Pouncey AL, Zhou Z, Woodward M, Harris K. Smoking as a risk factor for lower extremity peripheral artery disease in women compared to men: A systematic review and meta-analysis. PLoS One 2024; 19:e0300963. [PMID: 38656947 PMCID: PMC11042699 DOI: 10.1371/journal.pone.0300963] [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: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND To investigate whether the relationship between smoking and peripheral artery disease (PAD) differs by sex (PROSPERO CRD42022352318). METHODS PubMed, EMBASE, and CINAHL were searched (3 March 2024) for studies reporting associations between smoking and PAD in both sexes, at least adjusted for age. Data were pooled using random effects. Between-study heterogeneity was examined using I2 statistic and Cochran's Q test. Newcastle-Ottowa Scale was adopted for quality assessment. RESULTS Four cohort studies (n = 2,117,860, 54.4% women) and thirteen cross-sectional studies (n = 230,436, 59.9% women) were included. In cohort studies, former and current smokers had higher risk of PAD than never smokers. Compared to those who never or previously smoked, women current smokers (relative risk (RR) 5.30 (95% confidence interval 3.17, 8.87)) had higher excess risk of PAD than men (RR 3.30 (2.46, 4.42)), women-to-men ratio of RR 1.45 (1.30, 1.62)(I2 = 0%, p = 0.328). In cross-sectional studies, risk of PAD was higher among former and current compared to never smokers, more so in men, women-to-men ratios of odds ratio: 0.64 (0.46, 0.90)(I2 = 30%, p = 0.192), 0.63 (0.50, 0.79)(I2 = 0%, p = 0.594), respectively. For both sexes, risk of PAD was higher among current smokers compared to those who were not currently smoking. Cohort studies and five cross-sectional studies were of good quality, scoring 6 to 8 of a possible maximum 9 points. Eight cross-sectional studies scored 2 to 5. DISCUSSIONS Further research is required to elucidate sex differences in the relationships between smoking and PAD, as the current evidence is limited and mixed. Tobacco-control programs should consider both sexes.
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Affiliation(s)
- Ying Xu
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Australian Institute of Health Innovation, Centre for Health Systems and Safety Research, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Anna Louise Pouncey
- Faculty of Medicine, Department of Vascular Surgery, Division of Surgery and Cancer, Imperial College London, QEQM, St Mary’s Hospital, London, United Kingdom
| | - Zien Zhou
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Katie Harris
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Wilcox NS, Amit U, Reibel JB, Berlin E, Howell K, Ky B. Cardiovascular disease and cancer: shared risk factors and mechanisms. Nat Rev Cardiol 2024:10.1038/s41569-024-01017-x. [PMID: 38600368 DOI: 10.1038/s41569-024-01017-x] [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] [Accepted: 03/20/2024] [Indexed: 04/12/2024]
Abstract
Cardiovascular disease (CVD) and cancer are among the leading causes of morbidity and mortality globally, and these conditions are increasingly recognized to be fundamentally interconnected. In this Review, we present the current epidemiological data for each of the modifiable risk factors shared by the two diseases, including hypertension, hyperlipidaemia, diabetes mellitus, obesity, smoking, diet, physical activity and the social determinants of health. We then review the epidemiological data demonstrating the increased risk of CVD in patients with cancer, as well as the increased risk of cancer in patients with CVD. We also discuss the shared mechanisms implicated in the development of these conditions, highlighting their inherent bidirectional relationship. We conclude with a perspective on future research directions for the field of cardio-oncology to advance the care of patients with CVD and cancer.
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Affiliation(s)
- Nicholas S Wilcox
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Uri Amit
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob B Reibel
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eva Berlin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kendyl Howell
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Mambo A, Yang Y, Mahulu E, Zihua Z. Investigating the interplay of smoking, cardiovascular risk factors, and overall cardiovascular disease risk: NHANES analysis 2011-2018. BMC Cardiovasc Disord 2024; 24:193. [PMID: 38575889 PMCID: PMC10993506 DOI: 10.1186/s12872-024-03838-7] [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: 12/15/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND This study explores the intricate relationship between smoking, cardiovascular disease (CVD) risk factors and their combined impact on overall CVD risk, utilizing data from NHANES 2011-2018. METHODS Participants were categorized based on the presence of CVD, and we compared their demographic, social, and clinical characteristics. We utilized logistic regression models, receiver operating characteristics (ROC) analysis, and the chi-squared test to examine the associations between variables and CVD risk. RESULTS Significant differences in characteristics were observed between those with and without CVD. Serum cotinine levels exhibited a dose-dependent association with CVD risk. The highest quartile of cotinine levels corresponded to a 2.33-fold increase in risk. Smoking, especially in conjunction with lower HDL-c, significantly increases CVD risk. Combinations of smoking with hypertension, central obesity, diabetes, and elevated triglycerides also contributed to increased CVD risk. Waist-to-Height Ratio, Visceral Adiposity Index, A Body Shape Index, Conicity Index, Triglyceride-Glucose Index, Neutrophil, Mean platelet volume and Neutrophil to Lymphocyte ratio demonstrated significant associations with CVD risk, with varying levels of significance post-adjustment. When assessing the combined effect of smoking with multiple risk factors, a combination of smoking, central obesity, higher triglycerides, lower HDL-c, and hypertension presented the highest CVD risk, with an adjusted odds ratio of 14.18. CONCLUSION Smoking, when combined with central obesity, higher triglycerides, lower HDL-c, and hypertension, presented the highest CVD risk, with an adjusted odds ratio of 14.18.
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Affiliation(s)
- Athumani Mambo
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Cardiology, Benjamin Mkapa Hospital, P.O.Box 11088, Dodoma, Tanzania
| | - Yulu Yang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Emmerenceana Mahulu
- Department of Otorhinolaryngology, Benjamin Mkapa Hospital, P.O.Box 11088, Dodoma, Tanzania
| | - Zhou Zihua
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Lai H, Liu Q, Ye Q, Liang Z, Long Z, Hu Y, Wu Q, Jiang M. Impact of smoking cessation duration on lung cancer mortality: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2024; 196:104323. [PMID: 38462148 DOI: 10.1016/j.critrevonc.2024.104323] [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: 12/09/2023] [Revised: 02/11/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Smoking history is a heterogeneous situation for different populations, and numerous studies suggest that smoking cessation is conducive to reduce the mortality of lung cancer. However, no quantitative meta-analysis regarding smoking cessation duration based on different populations has demonstrated it clearly. METHODS We systematically searched four electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Scoups) till February 2023. Eligible studies reported the association between lung cancer survival and duration of smoking cessation. Additionally, we stratified the study population according to whether they had lung cancer at the time they quit smoking. Studies were pooled with the random-effects model. RESULTS Out of the 11,361 potential studies initially identified, we included 24 studies involving 969,560 individuals in our analysis. Lung cancer mortality varied across two groups: general quitters and peri-diagnosis quitters. For general quitters, those who had quit smoking for less than 10 years exhibited an RR of 0.64 (95% CI [0.55-0.76]), while those who quit for 10-20 years had an RR of 0.33 (0.25-0.43), over 20 years had an RR of 0.16 (0.11-0.24), and never-smokers had an RR at 0.11 (0.07-0.15). Among peri-diagnosis quitters, the 1-year Overall Survival (OS) showed an RR of 0.80 (0.67-0.96), the 2-year OS had an RR of 0.89 (0.80-0.98), the 3-year OS had an RR of 0.93 (0.84-1.03), and the 5-year OS had an RR of 0.85 (0.76-0.96). CONCLUSIONS Earlier and longer smoking cessation is associated with reduced lung cancer mortality, no matter in which cessation stage for two different populations.
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Affiliation(s)
- Hongkun Lai
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Quanzhen Liu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Nanshan College, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - Qianxian Ye
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Ziyang Liang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Zhiwei Long
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Yinghong Hu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Qianlong Wu
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China; Guangzhou Medical University, Guangzhou 510180, China
| | - Mei Jiang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China.
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20
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Wolters I, Kastaun S, Kotz D. Associations between body mass index and smoking behaviour: A cross-sectional study of the German adult population. Physiol Behav 2024; 275:114436. [PMID: 38103627 DOI: 10.1016/j.physbeh.2023.114436] [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: 07/24/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Both smoking and high body weight are risk factors for disease, hence, the association between smoking and body weight is an important health issue. Furthermore, concern about weight gain after quitting smoking is for many smokers a barrier to smoking cessation. The present study aims to explore the association between body mass index (BMI) and current tobacco smoking status in the population of Germany, and smoking and quitting behaviour amongst smokers (and recent ex-smokers =<12 months since quitting). METHODS Cross-sectional analysis of two waves of data collected from March through June 2021 through a representative face-to-face household survey in Germany (N = 3 997 respondents aged ≥18). The associations between smoking and quitting behaviours and BMI were analysed through four regression models adjusted for socio-demographic, socio-economic, and smoking characteristics of respondents. RESULTS Long-term ex-smokers (>= 12 months since quitting smoking) were more likely to have a higher BMI compared to never smokers (β = 0.64, 95% confidence interval (CI) = 0.10-1.19). There was no statistically significant association between current smoking status or recent ex-smoking status and BMI (β = -0.29,95 %CI = -0.75-0.17 and β = -0.53, 95 %CI = -2.45-1.40). Among current smokers, no statistically significant association was found between BMI and the motivation to stop smoking (OR = 1.01, 95 %CI = 0.99-1.03). Neither number of cigarettes smoked a day nor outcome of most recent quit attempt were related to BMI (β = 0.01, 95 %CI = -0.04-0.05 and OR = 0.41, 95 %CI = 0.05-3.05). CONCLUSION In the German population long-term ex-smoking but not current and recent ex-smoking was associated with increased BMI. Future research should further explore the association between smoking behaviour and abdominal obesity, preferably using a more accurate measure for abdominal obesity than BMI.
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Affiliation(s)
- Isabel Wolters
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Sabrina Kastaun
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany; Institute of General Practice (ifam), Centre for Health and Society (chs), Patient-Physician Communication Research Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany; Department of Behavioural Science and Health, University College London, London, United Kingdom.
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21
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Chaturvedi A, Zhu A, Gadela NV, Prabhakaran D, Jafar TH. Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases. Hypertension 2024; 81:387-399. [PMID: 38152897 PMCID: PMC10863660 DOI: 10.1161/hypertensionaha.123.21354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
High blood pressure causes over 10 million preventable deaths annually globally. Populations in low- and middle-income countries suffer the most, experiencing increased uncontrolled blood pressure and cardiovascular disease (CVD) deaths. Despite improvements in high-income countries, disparities persist, notably in the United States, where Black individuals face up to 4× higher CVD mortality than White individuals. Social determinants of health encompass complex, multidimensional factors linked to an individual's birthplace, upbringing, activities, residence, workplaces, socioeconomic and environmental structures, and significantly affect health outcomes, including hypertension and CVD. This review explored how social determinants of health drive disparities in hypertension and related CVD morbidity from a socioecological and life course perspective. We present evidence-based strategies, emphasizing interventions tailored to specific community needs and cross-sector collaboration to address health inequalities rooted in social factors, which are key elements toward achieving the United Nations' Sustainable Development Goal 3.4 for reducing premature CVD mortality by 30% by 2030.
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Affiliation(s)
- Abhishek Chaturvedi
- Georgetown University, MedStar Washington Hospital Center, Washington, DC (A.C.)
| | - Anqi Zhu
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (A.Z., T.H.J.)
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India (D.P.)
- Public Health Foundation of India, Gurugram, India (D.P.)
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore (A.Z., T.H.J.)
- Aga Khan University, Karachi, Pakistan (T.H.J.)
- Duke Global Health Institute, Durham, NC (T.H.J.)
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22
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Chopra A, Franco-Duarte R, Rajagopal A, Choowong P, Soares P, Rito T, Eberhard J, Jayasinghe TN. Exploring the presence of oral bacteria in non-oral sites of patients with cardiovascular diseases using whole metagenomic data. Sci Rep 2024; 14:1476. [PMID: 38233502 PMCID: PMC10794416 DOI: 10.1038/s41598-023-50891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024] Open
Abstract
Cardiovascular diseases (CVDs) encompass various conditions affecting the heart and its blood vessels and are often linked with oral microbes. Our data analysis aimed to identify oral bacteria from other non-oral sites (i.e., gut, arterial plaque and cultured blood) that could be linked with CVDs. Taxonomic profiling identified bacteria to the species level and compared with the Human Oral Microbiome Database (HOMD). The oral bacteria in the gut, cultured blood and arterial plaque samples were catalogued, with their average frequency calculated for each sample. Additionally, data were filtered by comparison with the Human Microbiome Project (HMP) database. We identified 17,243 microbial species, of which 410 were present in the HOMD database and further denominated as "oral", and were found in at least one gut sample, but only 221 and 169 species were identified in the cultured blood and plaque samples, respectively. Of the 410 species, 153 were present solely in oral-associated environments after comparison with the HMP database, irrespective of their presence in other body sites. Our results suggest a potential connection between the presence of specific species of oral bacterial and occurrence of CVDs. Detecting these oral bacterial species in non-oral sites of patients with CVDs could help uncover the link between oral health and general health, including cardiovascular conditions via bacterial translocation.
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Affiliation(s)
- Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ricardo Franco-Duarte
- Department of Biology, CBMA (Center of Molecular and Environmental Biology), University of Minho, Braga, Portugal
- Institute of Science and Innovation for Biosustainability (IB-S), University of Minho, Braga, Portugal
| | - Anjale Rajagopal
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Phannaphat Choowong
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, University of Sydney, Sydney, Australia
| | - Pedro Soares
- Department of Biology, CBMA (Center of Molecular and Environmental Biology), University of Minho, Braga, Portugal
- Institute of Science and Innovation for Biosustainability (IB-S), University of Minho, Braga, Portugal
| | - Teresa Rito
- Department of Biology, CBMA (Center of Molecular and Environmental Biology), University of Minho, Braga, Portugal
- Institute of Science and Innovation for Biosustainability (IB-S), University of Minho, Braga, Portugal
| | - Joerg Eberhard
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, University of Sydney, Sydney, Australia
| | - Thilini N Jayasinghe
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, University of Sydney, Sydney, Australia.
- The Charles Perkins Centre, The University of Sydney, University of Sydney, Sydney, Australia.
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23
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Yoo JE, Jeong SM, Lee KN, Lee H, Yoon JW, Han K, Shin DW. Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Study. JMIR Public Health Surveill 2024; 10:e46450. [PMID: 38198206 PMCID: PMC10809165 DOI: 10.2196/46450] [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: 02/12/2023] [Revised: 09/18/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Heart failure (HF) is one of the most common initial manifestations of cardiovascular disease in patients with type 2 diabetes. Although smoking is an independent risk factor for HF, there is a lack of data for the incidence of HF according to changes in smoking behaviors in patients with type 2 diabetes. OBJECTIVE We aimed to examine the association between interval changes in smoking behavior and the risk of HF among patients with type 2 diabetes. METHODS We conducted a retrospective cohort study using the National Health Insurance Service database. We identified 365,352 current smokers with type 2 diabetes who had 2 consecutive health screenings (2009-2012) and followed them until December 31, 2018, for the incident HF. Based on smoking behavior changes between 2 consecutive health screenings, participants were categorized into quitter, reducer I (≥50% reduction) and II (<50% reduction), sustainer (reference group), and increaser groups. RESULTS During a median follow-up of 5.1 (IQR 4.0-6.1) years, there were 13,879 HF cases (7.8 per 1000 person-years). Compared to sustainers, smoking cessation was associated with lower risks of HF (adjusted hazard ratio [aHR] 0.90, 95% CI0.86-0.95), whereas increasers showed higher risks of HF than sustainers; heavy smokers who increased their level of smoking had a higher risk of HF (aHR 1.13, 95% CI 1.04-1.24). In the case of reducers, the risk of HF was not reduced but rather increased slightly (reducer I: aHR 1.14, 95% CI 1.08-1.21; reducer II: aHR 1.03, 95% CI 0.98-1.09). Consistent results were noted for subgroup analyses including type 2 diabetes severity, age, and sex. CONCLUSIONS Smoking cessation was associated with a lower risk of HF among patients with type 2 diabetes, while increasing smoking amount was associated with a higher risk for HF than in those sustaining their smoking amount. There was no benefit from reduction in smoking amount.
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Affiliation(s)
- Jung Eun Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su-Min Jeong
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu Na Lee
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Won Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
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24
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Baker A, Kartsonaki C. Aspirin Use and Survival Among Patients With Breast Cancer: A Systematic Review and Meta-Analysis. Oncologist 2024; 29:e1-e14. [PMID: 37358878 PMCID: PMC10769789 DOI: 10.1093/oncolo/oyad186] [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: 04/05/2023] [Accepted: 05/25/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Previous meta-analyses have indicated that aspirin could affect breast cancer outcomes, particularly when taken post-diagnostically. However, several recent studies appear to show little to no association between aspirin use and breast cancer mortality, all-cause mortality, or recurrence. AIMS This study aims to conduct an updated systematic review and meta-analysis on the associations of pre-diagnostic and post-diagnostic aspirin use with the aforementioned breast cancer outcomes. It also looks, through subgroup analyses and meta-regressions, at a range of variables that could explain the associations between aspirin use and breast cancer outcomes. RESULTS In total, 24 papers and 149 860 patients with breast cancer were included. Pre-diagnostic aspirin use was not associated with breast-cancer-specific mortality (HR 0.98, 95% CI, 0.80-1.20, P = .84) or recurrence (HR 0.94, 95% CI, 0.88-1.02, P = .13). Pre-diagnostic aspirin was associated with non-significantly higher all-cause mortality (HR 1.27, 95% CI, 0.95-1.72, P = .11). Post-diagnostic aspirin was not significantly associated with all-cause mortality (HR 0.87, 95% CI, 0.71-1.07, P = .18) or recurrence (HR 0.89, 95% CI, 0.67-1.16, P = .38). Post-diagnostic aspirin use was significantly associated with lower breast-cancer-specific mortality (HR 0.79, 95% CI, 0.64-0.98, P = .032). CONCLUSIONS The only significant association of aspirin with breast cancer outcomes is lower breast-cancer-specific mortality in patients who used aspirin post-diagnostically. However, factors such as selection bias and high inter-study heterogeneity mean that this result should not be treated as conclusive, and more substantial evidence such as that provided by RCTs is needed before any decisions on new clinical uses for aspirin should be made.
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Affiliation(s)
- Adam Baker
- Department of Medical Sciences, Worcester College, University of Oxford, Oxford, UK
| | - Christiana Kartsonaki
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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25
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Patel R, Peesay T, Krishnan V, Wilcox J, Wilsbacher L, Khan SS. Prioritizing the primary prevention of heart failure: Measuring, modifying and monitoring risk. Prog Cardiovasc Dis 2024; 82:2-14. [PMID: 38272339 PMCID: PMC10947831 DOI: 10.1016/j.pcad.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/27/2024]
Abstract
With the rising incidence of heart failure (HF) and increasing burden of morbidity, mortality, and healthcare expenditures, primary prevention of HF targeting individuals in at-risk HF (Stage A) and pre-HF (Stage B) Stages has become increasingly important with the goal to decrease progression to symptomatic (Stage C) HF. Identification of risk based on traditional risk factors (e.g., cardiovascular health which can be assessed with the American Heart Association's Life's Essential 8 framework), adverse social determinants of health, inherited risk of cardiomyopathies, and identification of risk-enhancing factors, such as patients with viral disease, exposure to cardiotoxic chemotherapy, and history of adverse pregnancy outcomes should be the first step in evaluation for HF risk. Next, use of guideline-endorsed risk prediction tools such as Pooled Cohort Equations to Prevent Heart Failure provide quantification of absolute risk of HF based in traditional risk factors. Risk reduction through counseling on traditional risk factors is a core focus of implementation of prevention and may include the use of novel therapeutics that target specific pathways to reduce risk of HF, such as mineralocorticoid receptor agonists (e.g., fineronone), angiotensin-receptor/neprolysin inhibitors, and sodium glucose co-transporter-2 inhibitors. These interventions may be limited in at-risk populations who experience adverse social determinants and/or individuals who reside in rural areas. Thus, strategies like telemedicine may improve access to preventive care. Gaps in the current knowledge base for risk-based prevention of HF are highlighted to outline future research that may target approaches for risk assessment and risk-based prevention with the use of artificial intelligence, genomics-enhanced strategies, and pragmatic trials to develop a guideline-directed medical therapy approach to reduce risk among individuals with Stage A and Stage B HF.
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Affiliation(s)
- Ruchi Patel
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tejasvi Peesay
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vaishnavi Krishnan
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane Wilcox
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lisa Wilsbacher
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sadiya S Khan
- Department of Medicine, Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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26
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Mallah MA, Soomro T, Ali M, Noreen S, Khatoon N, Kafle A, Feng F, Wang W, Naveed M, Zhang Q. Cigarette smoking and air pollution exposure and their effects on cardiovascular diseases. Front Public Health 2023; 11:967047. [PMID: 38045957 PMCID: PMC10691265 DOI: 10.3389/fpubh.2023.967047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/26/2023] [Indexed: 12/05/2023] Open
Abstract
Cardiovascular disease (CVD) has no socioeconomic, topographical, or sex limitations as reported by the World Health Organization (WHO). The significant drivers of CVD are cardio-metabolic, behavioral, environmental, and social risk factors. However, some significant risk factors for CVD (e.g., a pitiable diet, tobacco smoking, and a lack of physical activities), have also been linked to an elevated risk of cardiovascular disease. Lifestyles and environmental factors are known key variables in cardiovascular disease. The familiarity with smoke goes along with the contact with the environment: air pollution is considered a source of toxins that contribute to the CVD burden. The incidence of myocardial infarction increases in males and females and may lead to fatal coronary artery disease, as confirmed by epidemiological studies. Lipid modification, inflammation, and vasomotor dysfunction are integral components of atherosclerosis development and advancement. These aspects are essential for the identification of atherosclerosis in clinical investigations. This article aims to show the findings on the influence of CVD on the health of individuals and human populations, as well as possible pathology and their involvement in smoking-related cardiovascular diseases. This review also explains lifestyle and environmental factors that are known to contribute to CVD, with indications suggesting an affiliation between cigarette smoking, air pollution, and CVD.
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Affiliation(s)
| | - Tahmina Soomro
- Department of Sociology, Shah Abdul Latif University, Khairpur, Pakistan
| | - Mukhtiar Ali
- Department of Chemical Engineering, Quaid-e-Awam University of Engineering, Science and Technology, Nawabshah, Sindh, Pakistan
| | - Sobia Noreen
- Department of Pharmaceutics Technology, Institute of Pharmacy, University of Innsbruck, Insbruck, Austria
| | - Nafeesa Khatoon
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Akriti Kafle
- School of Nursing, Zhengzhou University, Zhengzhou, China
| | - Feifei Feng
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wei Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Muhammad Naveed
- Department of Physiology and Pharmacology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
| | - Qiao Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China
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27
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Elfu Feleke B, Morton J, Magliano D, Shaw JE. Trends of hospitalisation for cardiovascular diseases among people with diabetes in Australia. Diabetes Res Clin Pract 2023; 205:110973. [PMID: 37884064 DOI: 10.1016/j.diabres.2023.110973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/06/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE To describe trends in hospitalisation for subtypes of cardiovascular diseases among people with diabetes. METHODS The data sources included the Australian diabetes registry, admitted hospitalisation datasets, and death registry from 2011 to 2019. The outcomes comprised hospital admissions for: all CVD; all cerebrovascular diseases, ischaemic and haemorrhagic stroke; angina and ischaemic heart disease (AIHD); non-ST elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI); atrial fibrillation and flutter (AFF). Data were analysed using Stata and Joinpoint regression software.Rates were standardised for age and sex. Annual percentage change (APC) was reported. RESULTS In type 1 diabetes, there were increases in hospitalisation for all cerebrovascular diseases (APC 4.5, 95 % CI: 1.2, 7.9) and ischaemic stroke (2.3, 95 % CI: 1.6, 3.0). There were declines in STEMI (-2.6, 95 % CI: -5.0, -0.1) and AIHD (-3.1, 95 % CI: -5.5, -0.7). In type 2 diabetes, hospitalisation for all CVD declined (-0.9, 95 % CI: -1.4, -0.3). Hospitalisation rates for ischaemic stroke increased (4.1, 95 % CI: 3.1, 5.1). There were declines in NSTEMI (-2.5, 95 % CI: -3.2, -1.8) and AIHD (-4.2, 95 % CI: -4.8, -3.5). CONCLUSION In type 1 and 2 diabetes, hospitalisation for ischaemic stroke increased while coronary diagnoses declined.
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Affiliation(s)
- Berhanu Elfu Feleke
- Monash University, School of Public Health and Preventive Medicine, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Jedidiah Morton
- Monash University, School of Public Health and Preventive Medicine, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Dianna Magliano
- Monash University, School of Public Health and Preventive Medicine, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Monash University, School of Public Health and Preventive Medicine, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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28
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Wéber A, Laversanne M, Nagy P, Kenessey I, Soerjomataram I, Bray F. Gains in life expectancy from decreasing cardiovascular disease and cancer mortality - an analysis of 28 European countries 1995-2019. Eur J Epidemiol 2023; 38:1141-1152. [PMID: 37676425 PMCID: PMC10663201 DOI: 10.1007/s10654-023-01039-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Life expectancy (LE) is an indicator of societal progress among rapidly aging populations. In recent decades, the displacement of deaths from cardiovascular disease (CVD) and cancer have been key drivers in further extending LE on the continent, though improvements vary markedly by country, sex, and over time. This study provides a comparative overview of the age-specific contributions of CVD and cancer to increasing LE in the 27 European Union member states, plus the U.K. METHODS Cause-by-age decompositions of national changes in LE were conducted for the years 1995-1999 and 2015-2019 based on the standard approach of multiple decrement life tables to quantify the relative impact over time. The contributions of CVD and cancer mortality changes to differences in LE were computed by sex and age for each of the 28 countries. We examine the difference between the member states before 2004 ("founding countries") and those which accessed the EU after 2004 ("A10 countries"). RESULTS Among men, declines in CVD mortality in the founding countries of the EU were larger contributors to increasing LE over the last decades than malignant neoplasms: 2.26 years were gained by CVD declines versus 1.07 years for cancer, with 2.23 and 0.84 years gained in A10 countries, respectively. Among women in founding countries, 1.81 and 0.54 additional life years were attributable to CVD and cancer mortality declines, respectively, while in A10 countries, the corresponding values were 2.33 and 0.37 years. Lung and stomach cancer in men, and breast cancer in women were key drivers of gains in LE due to cancer overall, though rising mortality rates from lung cancer diminished the potential impact of increasing female LE in both EU founding (e.g., France, Spain, and Sweden) and A10 countries (e.g., Croatia, Hungary, and Slovenia), notably among cohorts aged 55-70 years. Over the 25 years, the LE gap between the two sets of countries narrowed from 6.22 to 5.59 years in men, and from 4.03 to 3.12 years for women, with diminishing female mortality from CVD as a determinative contributor. CONCLUSION This study underscores the continued existence of an East-West divide in life expectancy across the EU27 + 1, evident on benchmarking the founding vs. A10 countries. In EU founding countries, continuous economic growth alongside improved health care, health promotion and protection policies have contributed to steady declines in mortality from chronic diseases, leading to increases in life expectancy. In contrast, less favourable mortality trends in the EU A10 countries indicate greater economic and health care challenges, and a failure to implement effective health policies.
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Affiliation(s)
- András Wéber
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
- Hungarian National Cancer Registry and National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary.
| | - Mathieu Laversanne
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Péter Nagy
- Department of Molecular Immunology and Toxicology and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
- Department of Anatomy and Histology, Laboratory of Redox Biology, University of Veterinary Medicine, Budapest, Hungary
- Chemistry Institute, University of Debrecen, Debrecen, Hungary
| | - István Kenessey
- Hungarian National Cancer Registry and National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | | | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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29
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Merzah M, Póliska S, Balogh L, Sándor J, Szász I, Natae S, Fiatal S. A Transcriptomic Analysis of Smoking-Induced Gene Expression Alterations in Coronary Artery Disease Patients. Int J Mol Sci 2023; 24:13920. [PMID: 37762221 PMCID: PMC10530857 DOI: 10.3390/ijms241813920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Smoking is a well established risk factor for coronary artery disease (CAD). Despite this, there have been no previous studies investigating the effects of smoking on blood gene expression in CAD patients. This single-centre cross-sectional study was designed with clearly defined inclusion criteria to address this gap. We conducted a high-throughput approach using next generation sequencing analysis with a single-end sequencing protocol and a read length of 75-cycles. Sixty-one patients with a median age of 67 years (range: 28-88 years) were recruited, and only 44 subjects were included for further analyses. Our investigation revealed 120 differentially expressed genes (DEGs) between smokers and nonsmokers, with a fold change (FC) of ≥1.5 and a p-value < 0.05. Among these DEGs, 15 were upregulated and 105 were downregulated. Notably, when applying a more stringent adjusted FC ≥ 2.0, 31 DEGs (5 upregulated, annotated to immune response pathways, and 26 downregulated, involving oxygen and haem binding or activity, with FDR ≤ 0.03) remained statistically significant at an alpha level of <0.05. Our results illuminate the molecular mechanisms underlying CAD, fortifying existing epidemiological evidence. Of particular interest is the unexplored overexpression of RCAN3, TRAV4, and JCHAIN genes, which may hold promising implications for the involvement of these genes in CAD among smokers.
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Affiliation(s)
- Mohammed Merzah
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (M.M.); (J.S.); (S.N.)
| | - Szilárd Póliska
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - László Balogh
- Cardiology and Cardiac Surgery Clinic, University of Debrecen, H-4032 Debrecen, Hungary
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (M.M.); (J.S.); (S.N.)
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - István Szász
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (M.M.); (J.S.); (S.N.)
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Shewaye Natae
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (M.M.); (J.S.); (S.N.)
| | - Szilvia Fiatal
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (M.M.); (J.S.); (S.N.)
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Atkinson J, Simpson G, Walker SP, Tong S, Hastie R, Lindquist A. The long-term risk of cardiovascular disease among women with a history of hypertensive disorders of pregnancy: a systematic review of clinical practice guidelines. BMC Cardiovasc Disord 2023; 23:443. [PMID: 37689661 PMCID: PMC10492379 DOI: 10.1186/s12872-023-03446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/12/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND The lifelong risks of cardiovascular disease following preeclampsia and gestational hypertension are well-established. However, it is unclear whether this evidence has been translated into clinical practice guidelines. Thus, this review aimed to assess the quality and content of Australian clinical practice guidelines regarding the risk of cardiovascular disease following gestational hypertension and preeclampsia. METHODS We conducted a systematic search of MEDLINE (Ovid), EMBASE (Ovid), and CINAHL databases, as well as hospital, obstetric society, and medical college websites. Publications were included if: they were a clinical practice guideline; were published in the previous ten years; and included recommendations for the management of future cardiovascular disease risk following hypertensive disorders of pregnancy. Quality assessment was performed using Appraisal of Guidelines for Research and Evaluation Instrument Version Two (AGREE-II) and AGREE Recommendations Excellence Instrument (AGREE-REX). RESULTS Eighteen guidelines were identified, and of these, less than half (n = 8) included recommendations for managing future cardiovascular risk following hypertensive disorders of pregnancy. Across these eight, four main counselling recommendations were found regarding (1) risk of future cardiovascular disease; (2) risk factor screening; (3) lifestyle interventions; and (4) prenatal counselling for future pregnancies. The quality and content of these recommendations varied significantly, and the majority of guidelines (87.5%) were assessed as low to moderate quality. CONCLUSIONS There are limited Australian clinical practice guidelines providing appropriate advice regarding future risk of cardiovascular disease following hypertensive disorders of pregnancy. The quality and content of these guidelines varied significantly. These findings highlight the need for improved translation from evidence-based research to enhance clinical care and guidance.
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Affiliation(s)
- Jessica Atkinson
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal. Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Grace Simpson
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal. Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal. Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
- Mercy Perinatal. Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia
| | - Anthea Lindquist
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia.
- Mercy Perinatal. Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia.
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Liu S, Jiang Z, Zhang Y, Pang S, Hou Y, Liu Y, huang Y, Peng N, Tang Y. A nomogramic model for predicting the left ventricular ejection fraction of STEMI patients after thrombolysis-transfer PCI. Front Cardiovasc Med 2023; 10:1178417. [PMID: 37745105 PMCID: PMC10517723 DOI: 10.3389/fcvm.2023.1178417] [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: 03/21/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Background The prognosis of ST-segment elevation myocardial infarction (STEMI) is closely linked to left ventricular ejection fraction (LVEF). In contrast to primary percutaneous coronary intervention (PPCI), thrombolysis-transfer PCI (TTPCI) is influenced by multiple factors that lead to heterogeneity in cardiac function and prognosis. The aim of this study is to develop a nomogram model for predicting early LVEF in STEMI patients with TTPCI, based on routine indicators at admission. Method We retrospectively reviewed data from patients diagnosed with STEMI at five network hospitals of our PCI center who performed TTPCI as door-to-balloon time (the interval between arrival at the hospital and intracoronary balloon inflation) over 120 min, from February 2018 to April 2022. Categorical variables were analyzed using Pearson χ2 tests or Fisher exact tests, while Student's t-test or Mann-Whitney U-test was used to compare continuous variables. Subsequently, independent risk factors associated with reduced LVEF one week after TTPCI were identified through comprehensive analysis by combining All-Subsets Regression with Logistic Regression. Based on these indicators, a nomogram model was developed, and validated using the area under the receiver operating characteristic (ROC) curve and the Bootstrap method. Results A total of 288 patients were analyzed, including 60 with LVEF < 50% and 228 with LVEF ≥ 50%. The nomogram model based on six independent risk factors including age, heart rate (HR), hypertension, smoking history, Alanine aminotransferase (ALT), and Killip class, demonstrated excellent discrimination with an AUC of 0.84 (95% CI: 0.78-0.89), predicted C-index of 0.84 and curve fit of 0.713. Conclusions The nomogram model incorporating age, HR, hypertension, smoking history, ALT and Killip class could accurately predict the early LVEF ≥ 50% probability of STEMI patients undergoing TTPCI, and enable clinicians' early evaluation of cardiac function in STEMI patients with TTPCI and early optimization of treatment.
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Affiliation(s)
- Shuai Liu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- Department of Emergency Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zhihui Jiang
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Yuanyuan Zhang
- Department of Geriatrics, General Hospital of Southern Theater Command, Guangzhou, China
| | - Shuwen Pang
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Emergency Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yan Hou
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yipei Liu
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University Guangzhou, Guangzhou, China
| | - Yuekang huang
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University Guangzhou, Guangzhou, China
| | - Na Peng
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University Guangzhou, Guangzhou, China
| | - Youqing Tang
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- Department of Emergency Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
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Frederiksen TC, Dahm CC, Preis SR, Lin H, Trinquart L, Benjamin EJ, Kornej J. The bidirectional association between atrial fibrillation and myocardial infarction. Nat Rev Cardiol 2023; 20:631-644. [PMID: 37069297 DOI: 10.1038/s41569-023-00857-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 04/19/2023]
Abstract
Atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI) and vice versa. This bidirectional association relies on shared risk factors as well as on several direct and indirect mechanisms, including inflammation, atrial ischaemia, left ventricular remodelling, myocardial oxygen supply-demand mismatch and coronary artery embolism, through which one condition can predispose to the other. Patients with both AF and MI are at greater risk of stroke, heart failure and death than patients with only one of the conditions. In this Review, we describe the bidirectional association between AF and MI. We discuss the pathogenic basis of this bidirectional relationship, describe the risk of adverse outcomes when the two conditions coexist, and review current data and guidelines on the prevention and management of both conditions. We also identify important gaps in the literature and propose directions for future research on the bidirectional association between AF and MI. The Review also features a summary of methodological approaches for the study of bidirectional associations in population-based studies.
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Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Sarah R Preis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ludovic Trinquart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Emelia J Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
| | - Jelena Kornej
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
- Framingham Heart Study, Framingham, MA, USA.
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Kim KY, Lim JU, Kang HS, Kim JS, Kim SK, Kim SJ, Lee SH, Yeo CD. Smoking Status at Time of Diagnosis Affects the Efficacy of Anti-PD-1/L1 Therapy in Patients With Advanced NSCLC. In Vivo 2023; 37:2357-2364. [PMID: 37652510 PMCID: PMC10500490 DOI: 10.21873/invivo.13340] [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: 05/13/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM Programmed death ligand-1 (PD-L1) expression is known to be a predictive biomarker for response to immunotherapy in non-small cell lung cancer (NSCLC). However, PD-L1 is not always a reliable predictive biomarker. In the present study, we aimed to compare responses to immunotherapy according to smoking status in NSCLC patients receiving immunotherapy in second line or further line treatment. PATIENTS AND METHODS The lung cancer registry database of the Catholic Medical Center, Seoul, Republic of Korea was used. Patients were eligible for this study if they were diagnosed with histologically confirmed NSCLC and received immune checkpoint inhibitors (ICIs) as second-line or further line therapy from January 2017 to December 2021. RESULTS Overall, 220 patients with NSCLC treated with ICIs were enrolled. There were 40 never smokers, 73 former smokers, and 107 current smokers. In multivariate analysis, smoking status, pathologic type, and PD-L1 expression were significant factors affecting PFS. Sex, ECOG performance status, pathologic type, and PD-L1 expression were significant factors affecting OS. CONCLUSION Smoking status at diagnosis of lung cancer could be a predictive biomarker for response to ICIs in patients with advanced NSCLC.
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Affiliation(s)
- Kyu Yean Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Uk Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Seon Kang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Kyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Joon Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Dong Yeo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Fragkou PC, Ikonomidis I, Benas D, Kavatha D, Moschopoulos CD, Protopapas K, Kostelli G, Thymis J, Mpirmpa D, Galani I, Tsakona M, Oikonomopoulou C, Theocharous G, Gorgoulis VG, Gallos P, Tsiodras S, Antoniadou A, Papadopoulos A, Triantafyllidi H. Endothelial Glycocalyx Integrity in Treatment-Naïve People Living with HIV before and One Year after Antiretroviral Treatment Initiation. Viruses 2023; 15:1505. [PMID: 37515191 PMCID: PMC10383742 DOI: 10.3390/v15071505] [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: 05/06/2023] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Endothelial glycocalyx (EG) derangement has been associated with cardiovascular disease (CVD). Studies on EG integrity among people living with HIV (PLWH), are lacking. We conducted a prospective cohort study among treatment-naïve PLWH who received emtricitabine/tenofovir alafenamide, combined with either an integrase strand transfer inhibitor (INSTI, dolutegravir, raltegravir or elvitegravir/cobicistat), or a protease inhibitor (PI, darunavir/cobicistat). We assessed EG at baseline, 24 (±4) and 48 (±4) weeks, by measuring the perfused boundary region (PBR, inversely proportional to EG thickness), in sublingual microvessels. In total, 66 consecutive PLWH (60 (90.9%) males) with a median age (interquartile range, IQR) of 37 (12) years, were enrolled. In total, 40(60.6%) received INSTI-based regimens. The mean (standard deviation) PBR decreased significantly from 2.17 (0.29) μm at baseline to 2.04 (0.26) μm (p = 0.019), and then to 1.93 (0.3) μm (p < 0.0001) at 24 (±4) and 48 (±4) weeks, respectively. PBR did not differ among treatment groups. PLWH on INSTIs had a significant PBR reduction at 48 (±4) weeks. Smokers and PLWH with low levels of viremia experienced the greatest PBR reduction. This study is the first to report the benefit of antiretroviral treatment on EG improvement in treatment-naïve PLWH and depicts a potential bedside biomarker and therapeutic target for CVD in PLWH.
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Affiliation(s)
- Paraskevi C Fragkou
- First Department of Critical Care and Pulmonary Services, Evangelismos Hospital, Athens Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Ignatios Ikonomidis
- Second Department of Cardiology, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dimitrios Benas
- Second Department of Cardiology, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dimitra Kavatha
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Charalampos D Moschopoulos
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Protopapas
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Gavriella Kostelli
- Second Department of Cardiology, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - John Thymis
- Second Department of Cardiology, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dionysia Mpirmpa
- Second Department of Cardiology, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Irene Galani
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Maria Tsakona
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Chrysanthi Oikonomopoulou
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - George Theocharous
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vassilis G Gorgoulis
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Parisis Gallos
- Computational Biomedicine Laboratory, Department of Digital Systems, University of Piraeus, 18536 Piraeus, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Antonios Papadopoulos
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Helen Triantafyllidi
- Second Department of Cardiology, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Bermúdez-López M, Martí-Antonio M, Castro-Boqué E, Bretones MDM, Farràs C, Gonzalez J, Pamplona R, Lecube A, Mauricio D, Cambray S, Valdivielso JM, Fernández E. Cumulative tobacco consumption has a dose-dependent effect on atheromatosis burden and improves severe atheromatosis prediction in asymptomatic middle-aged individuals: The ILERVAS study. Atherosclerosis 2023; 375:75-83. [PMID: 37276714 DOI: 10.1016/j.atherosclerosis.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND AIMS Sex-specific impact of cumulative tobacco consumption (CTC) on atheromatosis extension and total plaque area remains unknown. We aimed to determine the impact of CTC in atheromatosis localization and burden. METHODS We performed a cross-sectional analysis in 8330 asymptomatic middle-aged individuals. 12-territory vascular ultrasounds in carotid and femoral arteries were performed to detect atheromatous plaque presence and to measure total plaque area. Adjusted regressions and conditional predictions by smoking habit or CTC (stratified in terciles as low (≤13.53), medium (13.54-29.3), and high (>29.3 packs-year)) were calculated. Severe atheromatosis (SA, ≥3 territories with atheroma plaque) was predicted with the Systematic COronary Risk Evaluation 2 (SCORE2) model. The improvement of SA prediction after adding CTC was evaluated. RESULTS CTC was associated with an increased risk of atheromatosis, stronger in femoral than in carotid artery, but similar in both sexes. A dose-dependent effect of CTC on the number of territories with atheroma plaque and total plaque area was observed. Addition of CTC to the SCORE2 showed a higher sensitivity, accuracy, and negative predictive value in males, and a higher specificity and positive predictive value in females. In both sexes, the new SCORE2-CTC model showed a significant increase in AUC (males: 0.033, females: 0.038), and in the integrated discrimination index (males: 0.072; females: 0.058, p < 0.001). Age and CTC were the most important clinical predictors of SA in both sexes. CONCLUSIONS CTC shows a dose-dependent association with atheromatosis burden, impacts more strongly in femoral arteries, and improves SA prediction.
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Affiliation(s)
- Marcelino Bermúdez-López
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain.
| | - Manuel Martí-Antonio
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - Eva Castro-Boqué
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - María Del Mar Bretones
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - Cristina Farràs
- Centre d'Atenció Primària Cappont. Gerència Territorial de Lleida, Institut Català de la Salut, Barcelona, Spain; Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGol), Barcelona, Spain
| | - Jessica Gonzalez
- Departament de Medicina Respiratòria, Hospital Universitari Arnau de Vilanova, Grup Recerca Translational Medicina Respiratòria, IRBLleida, Universitat de Lleida, Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Reinald Pamplona
- Departament de Medicina Experimental, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Albert Lecube
- Departament d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Grup de Recerca Obesitat i Metabolisme (ODIM), IRBLleida, Universitat de Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Dídac Mauricio
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departament d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; Faculty of Medicine, University of Vic & Central University of Vic, Vic, Spain
| | - Serafi Cambray
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - José Manuel Valdivielso
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain.
| | - Elvira Fernández
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
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Drumright LN, Nance RM, Ruderman SA, Ma J, Whitney BM, Hahn A, Fredericksen RJ, Luu B, Lober WB, Moore RD, Budoff MJ, Keruly JC, Christopoulos K, Puryear S, Willig A, Cropsey K, Mathews WC, Cachay E, Bamford L, Eron JJ, Napravnik S, Mayer KH, O'Cleirigh C, Mccaul ME, Chander G, Feinstein MJ, Saag MS, Kitahata MM, Heckbert SR, Crane HM, Delaney JAC. Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV. HIV Med 2023; 24:703-715. [PMID: 36855253 PMCID: PMC10330202 DOI: 10.1111/hiv.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/19/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES People with HIV have a higher risk of myocardial infarction (MI) than the general population, with a greater proportion of type 2 MI (T2MI) due to oxygen demand-supply mismatch compared with type 1 (T1MI) resulting from atherothrombotic plaque disruption. People living with HIV report a greater prevalence of cigarette and alcohol use than do the general population. Alcohol use and smoking as risk factors for MI by type are not well studied among people living with HIV. We examined longitudinal associations between smoking and alcohol use patterns and MI by type among people living with HIV. DESIGN AND METHODS Using longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort, we conducted time-updated Cox proportional hazards models to determine the impact of smoking and alcohol consumption on adjudicated T1MI and T2MI. RESULTS Among 13 506 people living with HIV, with a median 4 years of follow-up, we observed 177 T1MI and 141 T2MI. Current smoking was associated with a 60% increase in risk of both T1MI and T2MI. In addition, every cigarette smoked per day was associated with a 4% increase in risk of T1MI, with a suggestive, but not significant, 2% increase for T2MI. Cigarette use had a greater impact on T1MI for men than for women and on T2MI for women than for men. Increasing alcohol use was associated with a lower risk of T1MI but not T2MI. Frequency of heavy episodic alcohol use was not associated with MI. CONCLUSIONS Our findings reinforce the prioritization of smoking reduction, even without cessation, and cessation among people living with HIV for MI prevention and highlight the different impacts on MI type by gender.
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Affiliation(s)
- Lydia N Drumright
- University of Washington, Seattle, Washington, USA
- University of Cambridge, Cambridge, UK
| | | | | | - Jimmy Ma
- University of Washington, Seattle, Washington, USA
| | | | - Andrew Hahn
- University of Washington, Seattle, Washington, USA
| | | | - Brandon Luu
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | | | | | | | | | | | - Sarah Puryear
- University of California, San Francisco, California, USA
| | | | | | | | - Edward Cachay
- University of California, San Diego, California, USA
| | - Laura Bamford
- University of California, San Diego, California, USA
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sonia Napravnik
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | | | - Geetanjali Chander
- University of Washington, Seattle, Washington, USA
- Johns Hopkins University, Baltimore, Maryland, USA
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Banks E, Yazidjoglou A, Joshy G. Electronic cigarettes and health outcomes: epidemiological and public health challenges. Int J Epidemiol 2023:7165279. [PMID: 37192053 PMCID: PMC10396413 DOI: 10.1093/ije/dyad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/28/2023] [Indexed: 05/18/2023] Open
Affiliation(s)
- Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Amelia Yazidjoglou
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
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Chen JL, Hsiao CH, Yen CC. Prognostic value of cardiac troponin in elderly patients with paroxysmal supraventricular tachycardia: A multicenter study. Am J Emerg Med 2023; 69:167-172. [PMID: 37149956 DOI: 10.1016/j.ajem.2023.04.041] [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: 02/10/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND An elevated level of cardiac troponin I (cTnI) frequently accompanies an episode of supraventricular tachycardia (SVT). However, the predictive value of cTnI in elderly SVT patients has not been examined. METHODS We collected the electronic medical records of elderly SVT patients (over 65 years old) who visited four Taiwanese emergency departments over a 2-year period. The patients who underwent cTnI testing were included in the cohort and further categorized based on their cTnI results (positive or negative). The study's primary outcomes were the 5-year risks of major adverse cardiovascular events (MACE) and SVT recurrence. RESULTS One hundred and twenty-four patients met the inclusion criteria. Of these patients, 39 (31.5%) had a positive cTnI result, and 85 (68.5%) had a negative cTnI result. Patients with a positive cTnI result were older (p = 0.029) and had a longer hospital stay (p = 0.023) than those with a negative cTnI result. Multivariate analysis showed that age > 75 years (OR = 2.41; 95% CI 1.07-5.45; p = 0.034) was an independent predictor for cTnI elevation. In the survival analysis, no difference in the incidence of five-year MACE (p = 0.656) was observed between the cTnI-positive and cTnI-negative groups. Multivariate analysis revealed that a history of coronary artery disease was the only significant independent risk factor for MACE (HR = 4.30; 95% 95% CI 1.41-13.05; p = 0.010). For SVT recurrence, the multivariate analysis revealed that previous SVT (HR = 3.37; 95% CI 1.53-7.39; p = 0.002), smoking history (HR = 2.32; 95% CI 1.03-5.24; p = 0.043), and RFA treatment (HR = 0.20; 95% CI 0.06-0.65; p = 0.008) were significant independent predictors. CONCLUSIONS An increased cardiac troponin level may not effectively indicate the risk of MACE in elderly SVT patients. Physicians might want to be cautious when interpreting troponin test results for this specific patient group.
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Affiliation(s)
- Jyun-Long Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chien-Han Hsiao
- Department of Linguistics, Indiana University, Bloomington, IN, USA
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; Department of Emergency Medicine, Jen-Ai Hospital, Dali Branch, Taichung, Taiwan.
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Pan C, Sun X, Song J, Yu C, Guo Y, Wang S, Gao R, Ning F, Pang Z, Chen Z, Li L. The Prospective Associations of Egg Consumption with the Risk of Total Cerebrovascular Disease Morbidity among Chinese Adults. Nutrients 2023; 15:nu15081808. [PMID: 37111029 PMCID: PMC10142563 DOI: 10.3390/nu15081808] [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: 03/16/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Studies investigating the relationship between egg consumption and the risk of cerebrovascular disease (CED) have yielded inconsistent results. This study evaluated the association between egg consumption and the risk of CED among Chinese adults. METHODS Data were obtained from China Kadoorie Biobank, Qingdao. A computerised questionnaire was used to collect information regarding egg consumption frequency. CED events were tracked through linkage with the Disease Surveillance Point System and the new national health insurance databases. Cox proportional hazards regression analyses were used to evaluate associations between egg consumption and CED risk controlling for potential confounders. RESULTS After a median follow-up of 9.2 years, 865 and 1083 CED events among men and women, respectively, were documented. More than 50% of participants consumed eggs daily with an average age of 52.0 (10.4) years at baseline. No association between egg consumption and CED were identified in the whole cohort and women. However, a 28% lower risk of CED was observed in those who consumed eggs at a higher frequency (HR = 0.72, 95% CI: 0.55-0.95) and a significant trend for the association (p for trend = 0.012) in a multivariable model in men. CONCLUSION Higher frequency of egg consumption was associated with a lower risk of total CED events among men but not women in Chinese adults. The beneficial effect on women warrants further investigations.
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Affiliation(s)
- Chi Pan
- School of Public Health, Qingdao University, Qingdao 266071, China
| | - Xiaohui Sun
- Qingdao Municipality Center for Disease Control and Prevention, Qingdao 266033, China
- Qingdao Institute of Preventive Medicine, Qingdao 266033, China
| | - Jiahui Song
- School of Public Health, Qingdao University, Qingdao 266071, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Shaojie Wang
- Qingdao Municipality Center for Disease Control and Prevention, Qingdao 266033, China
- Qingdao Institute of Preventive Medicine, Qingdao 266033, China
| | - Ruqin Gao
- School of Public Health, Qingdao University, Qingdao 266071, China
| | - Feng Ning
- Qingdao Municipality Center for Disease Control and Prevention, Qingdao 266033, China
- Qingdao Institute of Preventive Medicine, Qingdao 266033, China
| | - Zengchang Pang
- Qingdao Municipality Center for Disease Control and Prevention, Qingdao 266033, China
- Qingdao Institute of Preventive Medicine, Qingdao 266033, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
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Fu X, Wang J, Jiang S, Wu J, Mu Z, Tang Y, Wang S, Fu H, Ma H, Zhao Y. Mortality trend analysis of ischemic heart disease in China between 2010 and 2019: a joinpoint analysis. BMC Public Health 2023; 23:644. [PMID: 37016366 PMCID: PMC10071740 DOI: 10.1186/s12889-023-15549-3] [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: 08/17/2022] [Accepted: 03/28/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND This study presented the mortality trend of ischemic heart disease (IHD) in Chinese residents from 2010 to 2019 and provided a basis for further establishment of relevant interventions. METHODS Data, such as sex, age, urban and rural areas, and death status, were extracted from the China Death Surveillance Dataset from 2010 to 2019, with mortality and age-adjusted death rates (AADRs) as the main indicators. The joinpoint regression model was used to analyze mortality and AADRs trends in IHD. A semi-structured expert interview was conducted to propose targeted intervention measures and countermeasures. RESULTS We observed an overall upward trend in IHD mortality rates and AADRs in China from 2010 to 2019 (average annual percentage change [AAPC] = 5.14%, AAPCAADRs = 1.60%, P < 0.001). Mortality rates and AADRs increased for both males (AAPC = 4.91%, AAPCAADRs = 1.09%, P < 0.05) and females (AAPC = 5.57%, AAPCAADRs = 1.84%, P < 0.001), with higher mortality rate for males than females but higher variation for females than males. Urban (AAPC = 4.80%, AAPCAADRs = 1.76%, P < 0.05) and rural (AAPC = 5.31%, P < 0.001; AAPCAADRs = 0.99%, P > 0.05) mortality rates increased, with the mortality rate higher in rural areas than in urban areas. In the age analysis, mortality rate was higher in middle-aged and older adults than in other age groups. The age-sex cross-analysis found the highest trend in mortality rates among females aged ≥ 75 years (annual percentage change [APC] = 2.43%, P < 0.05). CONCLUSIONS The upward trend in IHD mortality in China from 2010 to 2019, especially among female residents aged ≥ 75 years, poses continuing challenges to public health policies and actions.
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Affiliation(s)
- Xiaoli Fu
- Department of Health Management of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Jing Wang
- Department of Health Management of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Shuai Jiang
- The First Affiliated Hospital of Zhengzhou University, Henan, People's Republic of China
- Institute for Hospital Management of Henan Province, Henan, People's Republic of China
| | - Jian Wu
- Department of Health Management of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Zihan Mu
- Department of Health Management of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Yanyu Tang
- Department of Health Management of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Suxian Wang
- Department of Health Management of Public Health, Zhengzhou University, Henan, People's Republic of China
| | - Hang Fu
- The First Affiliated Hospital of Zhengzhou University, Henan, People's Republic of China
- Institute for Hospital Management of Henan Province, Henan, People's Republic of China
| | - He Ma
- Health Service and Management, Shangzhen College, Henan University of Traditional Chinese Medicine, Henan, People's Republic of China
| | - Yaojun Zhao
- Operation Management Department, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan, People's Republic of China.
- Institute for Hospital Management of Henan Province, Henan, People's Republic of China.
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Watanabe D, Gando Y, Murakami H, Kawano H, Yamamoto K, Morishita A, Miyatake N, Miyachi M. Longitudinal trajectory of vascular age indices and cardiovascular risk factors: a repeated-measures analysis. Sci Rep 2023; 13:5401. [PMID: 37012303 PMCID: PMC10070355 DOI: 10.1038/s41598-023-32443-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
This study aimed to identify the modifiable cardiovascular risk factors associated with longitudinal changes, which are nine functional and structural biological vascular aging indicators (BVAIs), to propose an effective method to prevent biological vascular aging. We conducted a longitudinal study of 697 adults (a maximum of 3636 BVAI measurements) who were, at baseline, aged between 26 and 85 years and whose BVAIs were measured at least twice between 2007 and 2018. The nine BVAIs were measured using vascular testing and an ultrasound device. Covariates were assessed using validated questionnaires and devices. During the mean follow-up period of 6.7 years, the average number of BVAI measurements ranged from 4.3 to 5.3. The longitudinal analysis showed a moderate positive correlation between the common carotid intima-media thickness (IMT) and chronological age in both men (r = 0.53) and women (r = 0.54). In the multivariate analysis, BVAIs were associated with factors such as age, sex, residential area, smoking status, blood clinical chemistry test levels, number of comorbidities, physical fitness, body mass, physical activity, and dietary intake. The IMT is the most useful BVAI. Our findings suggest that modifiable cardiovascular risk factors are associated with longitudinal changes in BVAI as represented by IMT.
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Affiliation(s)
- Daiki Watanabe
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-City, Saitama, 359-1192, Japan
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-Ku, Tokyo, 162-8636, Japan
| | - Yuko Gando
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-Ku, Tokyo, 162-8636, Japan
- Faculty of Sport Science, Surugadai University, 698 Azu, Hanno-City, Saitama, 357-8555, Japan
| | - Haruka Murakami
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-Ku, Tokyo, 162-8636, Japan
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Noji-Higashi, Kusatsu-City, Shiga, 525-8577, Japan
| | - Hiroshi Kawano
- Faculty of Letters, Kokushikan University, 4-28-1 Setagaya, Setagaya-Ku, Tokyo, 154-8515, Japan
| | - Kenta Yamamoto
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano, Nakano-Ku, Tokyo, 164-8530, Japan
| | - Akie Morishita
- Okayama Southern Institute of Health, Okayama Health Foundation, 408-1 Hirata, Okayama-City, Okayama, 700-0952, Japan
| | - Nobuyuki Miyatake
- Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-Cho, Kita-Gun, Kagawa, 761-0793, Japan
| | - Motohiko Miyachi
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-City, Saitama, 359-1192, Japan.
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-Ku, Tokyo, 162-8636, Japan.
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Çakir M. Evaluation of Smoking and Associated Factors in Turkey. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:766-772. [PMID: 37551186 PMCID: PMC10404323 DOI: 10.18502/ijph.v52i4.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/21/2022] [Indexed: 08/09/2023]
Abstract
Background The aim of the present study was to evaluate the use of tobacco products and associated factors in Turkey based on the Turkey Health Survey 2019 data conducted by the Turkish Statistical Institute (TUIK). Method The study was designed as a cross-sectional research. It was conducted by utilizing the "Turkey Health Survey 2019" microdata set from the Turkish Statistical Institute. The data of 17,084 people aged 15 years and over were evaluated. Results The study examined the data of 17,084 individuals aged ≥15 years surveyed by the TUIK. 27.2% of the participants used tobacco products every day, 3.4% used occasionally, and 54.2% never used them. Furthermore, 15.8% of the participants were exposed to secondhand smoking for ≥1 hour every day, while 7% were exposed to secondhand smoking for <1 hour every day in a closed environment. The reasons for starting to use tobacco products were friend influence for 33.4% of the participants, wannabe for 25.2%, and curiosity for 18.6%. Conclusion More than a quarter of people aged ≥15 years in Turkey smoke every day. The frequency of using tobacco products every day, the daily number of cigarettes smoked, and the frequency of exposure to tobacco products in closed areas were higher among men.
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Affiliation(s)
- Mustafa Çakir
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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43
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du Toit WL, Kruger R, Gafane-Matemane LF, Schutte AE, Louw R, Mels CMC. Markers of arterial stiffness and urinary metabolomics in young adults with early cardiovascular risk: the African-PREDICT study. Metabolomics 2023; 19:28. [PMID: 36988718 PMCID: PMC10060307 DOI: 10.1007/s11306-023-01987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/04/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Increased exposure to risk factors in the young and healthy contributes to arterial changes, which may be accompanied by an altered metabolism. OBJECTIVES To increase our understanding of early metabolic alterations and how they associate with markers of arterial stiffness, we profiled urinary metabolites in young adults with cardiovascular disease (CVD) risk factor(s) and in a control group without CVD risk factors. METHODS We included healthy black and white women and men (N = 1202), aged 20-30 years with a detailed CVD risk factor profile, reflecting obesity, physical inactivity, smoking, excessive alcohol intake, masked hypertension, hyperglycemia, dyslipidemia and low socio-economic status, forming the CVD risk group (N = 1036) and the control group (N = 166). Markers of arterial stiffness, central systolic blood pressure (BP) and pulse wave velocity were measured. A targeted metabolomics approach was followed by measuring amino acids and acylcarnitines using a liquid chromatography-tandem mass spectrometry method. RESULTS In the CVD risk group, central systolic BP (adjusted for age, sex, ethnicity) was negatively associated with histidine, arginine, asparagine, serine, glutamine, dimethylglycine, threonine, GABA, proline, methionine, pyroglutamic acid, aspartic acid, glutamic acid, branched chain amino acids (BCAAs) and butyrylcarnitine (all P ≤ 0.048). In the same group, pulse wave velocity (adjusted for age, sex, ethnicity, mean arterial pressure) was negatively associated with histidine, lysine, threonine, 2-aminoadipic acid, BCAAs and aromatic amino acids (AAAs) (all P ≤ 0.044). In the control group, central systolic BP was negatively associated with pyroglutamic acid, glutamic acid and dodecanoylcarnitine (all P ≤ 0.033). CONCLUSION In a group with increased CVD risk, markers of arterial stiffness were negatively associated with metabolites related to AAA and BCAA as well as energy metabolism and oxidative stress. Our findings may suggest that metabolic adaptations may be at play in response to increased CVD risk to maintain cardiovascular integrity.
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Affiliation(s)
- Wessel L du Toit
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Lebo F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
- School of Population Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Roan Louw
- Human Metabolomics, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Catharina M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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Chhor M, Tulpar E, Nguyen T, Cranfield CG, Gorrie CA, Chan YL, Chen H, Oliver BG, McClements L, McGrath KC. E-Cigarette Aerosol Condensate Leads to Impaired Coronary Endothelial Cell Health and Restricted Angiogenesis. Int J Mol Sci 2023; 24:ijms24076378. [PMID: 37047355 PMCID: PMC10094580 DOI: 10.3390/ijms24076378] [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: 12/22/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of mortality worldwide, with cigarette smoking being a major preventable risk factor. Smoking cessation can be difficult due to the addictive nature of nicotine and the withdrawal symptoms following cessation. Electronic cigarettes (e-Cigs) have emerged as an alternative smoking cessation device, which has been increasingly used by non-smokers; however, the cardiovascular effects surrounding the use of e-Cigs remains unclear. This study aimed to investigate the effects of e-Cig aerosol condensate (EAC) (0 mg and 18 mg nicotine) in vitro on human coronary artery endothelial cells (HCAEC) and in vivo on the cardiovascular system using a mouse model of ‘e-vaping’. In vitro results show a decrease in cell viability of HCAEC when exposed to EAC either directly or after exposure to conditioned lung cell media (p < 0.05 vs. control). Reactive oxygen species were increased in HCAEC when exposed to EAC directly or after exposure to conditioned lung cell media (p < 0.0001 vs. control). ICAM-1 protein expression levels were increased after exposure to conditioned lung cell media (18 mg vs. control, p < 0.01). Ex vivo results show an increase in the mRNA levels of anti-angiogenic marker, FKBPL (p < 0.05 vs. sham), and endothelial cell adhesion molecule involved in barrier function, ICAM-1 (p < 0.05 vs. sham) in murine hearts following exposure to electronic cigarette aerosol treatment containing a higher amount of nicotine. Immunohistochemistry also revealed an upregulation of FKBPL and ICAM-1 protein expression levels. This study showed that despite e-Cigs being widely used for tobacco smoking cessation, these can negatively impact endothelial cell health with a potential to lead to the development of cardiovascular disease.
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Affiliation(s)
- Michael Chhor
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.C.); (E.T.); (T.N.); (C.G.C.); (C.A.G.); (Y.L.C.); (H.C.); (B.G.O.)
| | - Esra Tulpar
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.C.); (E.T.); (T.N.); (C.G.C.); (C.A.G.); (Y.L.C.); (H.C.); (B.G.O.)
| | - Tara Nguyen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.C.); (E.T.); (T.N.); (C.G.C.); (C.A.G.); (Y.L.C.); (H.C.); (B.G.O.)
| | - Charles G. Cranfield
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.C.); (E.T.); (T.N.); (C.G.C.); (C.A.G.); (Y.L.C.); (H.C.); (B.G.O.)
| | - Catherine A. Gorrie
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.C.); (E.T.); (T.N.); (C.G.C.); (C.A.G.); (Y.L.C.); (H.C.); (B.G.O.)
| | - Yik Lung Chan
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.C.); (E.T.); (T.N.); (C.G.C.); (C.A.G.); (Y.L.C.); (H.C.); (B.G.O.)
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.C.); (E.T.); (T.N.); (C.G.C.); (C.A.G.); (Y.L.C.); (H.C.); (B.G.O.)
| | - Brian G. Oliver
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.C.); (E.T.); (T.N.); (C.G.C.); (C.A.G.); (Y.L.C.); (H.C.); (B.G.O.)
| | - Lana McClements
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.C.); (E.T.); (T.N.); (C.G.C.); (C.A.G.); (Y.L.C.); (H.C.); (B.G.O.)
- Institute for Biomedical Materials and Devices, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia
- Correspondence: (L.M.); (K.C.M.)
| | - Kristine C. McGrath
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.C.); (E.T.); (T.N.); (C.G.C.); (C.A.G.); (Y.L.C.); (H.C.); (B.G.O.)
- Correspondence: (L.M.); (K.C.M.)
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Mezhal F, Oulhaj A, Abdulle A, AlJunaibi A, Alnaeemi A, Ahmad A, Leinberger-Jabari A, Al Dhaheri AS, AlZaabi E, Al-Maskari F, Alanouti F, Alameri F, Alsafar H, Alblooshi H, Alkaabi J, Wareth LA, Aljaber M, Kazim M, Weitzman M, Al-Houqani M, Ali MH, Tuzcu EM, Oumeziane N, El-Shahawy O, Al-Rifai RH, Sherman S, Shah SM, Alzaabi T, Loney T, Almahmeed W, Idaghdour Y, Ahmed LA, Ali R. High prevalence of cardiometabolic risk factors amongst young adults in the United Arab Emirates: the UAE Healthy Future Study. BMC Cardiovasc Disord 2023; 23:137. [PMID: 36922773 PMCID: PMC10015775 DOI: 10.1186/s12872-023-03165-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in the world. In the United Arab Emirates (UAE), it accounts for 40% of mortality. CVD is caused by multiple cardiometabolic risk factors (CRFs) including obesity, dysglycemia, dyslipidemia, hypertension and central obesity. However, there are limited studies focusing on the CVD risk burden among young Emirati adults. This study investigates the burden of CRFs in a sample of young Emiratis, and estimates the distribution in relation to sociodemographic and behavioral determinants. METHODS Data was used from the baseline data of the UAE Healthy Future Study volunteers. The study participants were aged 18 to 40 years. The study analysis was based on self-reported questionnaires, anthropometric and blood pressure measurements, as well as blood analysis. RESULTS A total of 5167 participants were included in the analysis; 62% were males and the mean age of the sample was 25.7 years. The age-adjusted prevalence was 26.5% for obesity, 11.7% for dysglycemia, 62.7% for dyslipidemia, 22.4% for hypertension and 22.5% for central obesity. The CRFs were distributed differently when compared within social and behavioral groups. For example, obesity, dyslipidemia and central obesity in men were found higher among smokers than non-smokers (p < 0.05). And among women with lower education, all CRFs were reported significantly higher than those with higher education, except for hypertension. Most CRFs were significantly higher among men and women with positive family history of common non-communicable diseases. CONCLUSIONS CRFs are highly prevalent in the young Emirati adults of the UAE Healthy Future Study. The difference in CRF distribution among social and behavioral groups can be taken into account to target group-specific prevention measures.
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Affiliation(s)
- Fatima Mezhal
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, UAE.
| | - Abderrahim Oulhaj
- Department of Epidemiology and Public Health, College of Medicine and Health Sciences, Khalifa University of Sciences and Technology, Abu Dhabi, UAE
| | - Abdishakur Abdulle
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, UAE
| | | | - Abdulla Alnaeemi
- Department of Cardiology, Zayed Military Hospital, Abu Dhabi, UAE
| | - Amar Ahmad
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, UAE
| | | | - Ayesha S Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Eiman AlZaabi
- Department of Pathology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Fatma Al-Maskari
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
- Zayed Center for Health Sciences, UAE University, Al-Ain, UAE
| | - Fatme Alanouti
- College of Natural and Health Sciences, Zayed University, Abu Dhabi, UAE
| | | | - Habiba Alsafar
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, UAE
- Department of Genetics and Molecular Biology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Hamad Alblooshi
- Abu Dhabi Blood Bank Services, SEHA, Abu Dhabi & Al-Ain,, UAE
| | - Juma Alkaabi
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Laila Abdel Wareth
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | - Marina Kazim
- Abu Dhabi Blood Bank Services, SEHA, Abu Dhabi & Al-Ain,, UAE
| | - Michael Weitzman
- Department of Environmental Medicine, New York University of Medicine, New York, USA
| | - Mohammad Al-Houqani
- Department of Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Mohammad Hag Ali
- Department of Health Science, Higher Colleges of Technology, Abu Dhabi, UAE
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Naima Oumeziane
- Abu Dhabi Blood Bank Services, SEHA, Abu Dhabi & Al-Ain,, UAE
| | - Omar El-Shahawy
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Rami H Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Scott Sherman
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Syed M Shah
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Thekra Alzaabi
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, UAE
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Youssef Idaghdour
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, UAE
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
- Zayed Center for Health Sciences, UAE University, Al-Ain, UAE
| | - Raghib Ali
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, UAE
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Heris CL, Cutmore M, Chamberlain C, Smith N, Simpson V, Sherriff S, Wright D, Slater K, Eades S. Don't Follow the Smoke-Listening to the Tobacco Experiences and Attitudes of Urban Aboriginal Adolescents in the Study of Environment on Aboriginal Resilience and Child Health (SEARCH). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4587. [PMID: 36901596 PMCID: PMC10002023 DOI: 10.3390/ijerph20054587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Preventing smoking among young Aboriginal people is important for reducing health inequities. Multiple factors were associated with adolescent smoking in the SEARCH baseline survey (2009-12) and discussed in a follow-up qualitative study that aimed to inform prevention programs. Twelve yarning circles were facilitated by Aboriginal research staff at two NSW sites in 2019 with 32 existing SEARCH participants aged 12-28 (17 female, 15 male). Open discussion around tobacco was followed by a card sorting activity, prioritising risk and protective factors and program ideas. The age of initiation varied by generation. Older participants had established smoking in their early adolescence, whereas the current younger teens had little exposure. Some smoking commenced around high school (from Year 7), and social smoking increased at age 18. Mental and physical health, smoke-free spaces and strong connections to family, community and culture promoted non-smoking. The key themes were (1) drawing strength from culture and community; (2) how the smoking environment shapes attitudes and intentions; (3) non-smoking as a sign of good physical, social and emotional wellbeing; and (4) the importance of individual empowerment and engagement for being smoke-free. Programs promoting good mental health and strengthening cultural and community connections were identified as a priority for prevention.
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Affiliation(s)
- Christina L. Heris
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Acton, Canberra, ACT 2601, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Melbourne, VIC 3000, Australia
| | | | - Catherine Chamberlain
- Indigenous Health Equity Unit, University of Melbourne, Parkville, Melbourne, VIC 3000, Australia
| | - Natalie Smith
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, NSW 2650, Australia
| | - Victor Simpson
- Riverina Medical and Dental Aboriginal Corporation, Wagga Wagga, NSW 2650, Australia
| | | | - Darryl Wright
- Tharawal Aboriginal Corporation, Airds, Sydney, NSW 2560, Australia
| | - Kym Slater
- Tharawal Aboriginal Corporation, Airds, Sydney, NSW 2560, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Melbourne, VIC 3000, Australia
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Atkinson J, Wei W, Potenza S, Simpson G, Middleton A, Walker S, Tong S, Hastie R, Lindquist A. Patients' understanding of long-term cardiovascular risks and associated health-seeking behaviours after pre-eclampsia. Open Heart 2023; 10:openhrt-2022-002230. [PMID: 36914205 PMCID: PMC10016282 DOI: 10.1136/openhrt-2022-002230] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE The lifelong risks of cardiovascular disease following hypertensive disorders of pregnancy are well described. Awareness of these risks and associated health-seeking behaviours among affected individuals remains unclear. We aimed to assess participants' knowledge of their cardiovascular disease risk and relevant health-seeking behaviours following a pregnancy affected by preeclampsia or gestational hypertension. METHODS We undertook a single-site, cross-sectional cohort study. The target population included individuals who birthed at a large tertiary referral centre in Melbourne, Australia, between 2016 and 2020, and were diagnosed with gestational hypertension or pre-eclampsia. Participants completed a survey assessing pregnancy details, medical comorbidities, knowledge of future risks and health-seeking behaviours post-pregnancy. RESULTS 1526 individuals met inclusion criteria and 438 (28.6%) completed the survey. Of these, 62.6% (n=237) were unaware of their increased risk of cardiovascular disease following a hypertensive disorder of pregnancy. Participants who reported awareness of their increased risk were more likely to have annual blood pressure monitoring (54.6% vs 38.1%, p<0.01), and at least one assessment of blood cholesterol (p<0.01), blood glucose (p=0.03) and renal function (p=0.01). Participants who were aware were more likely to be taking antihypertensive medication (24.5% vs 6.6%, p<0.01) since pregnancy, compared with those who were unaware. There were no differences between groups in diet, exercise or smoking habits. CONCLUSION Among our study cohort, risk awareness was associated with increased health-seeking behaviours. Participants who were aware of their increased risk of cardiovascular disease were more likely to have regular cardiovascular risk factor assessments. They were also more likely to be taking antihypertensive medication.
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Affiliation(s)
- Jessica Atkinson
- Department of Obstetrics & Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - William Wei
- School of Medicine, Deakin University, Burwood, Victoria, Australia
| | - Stephanie Potenza
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Grace Simpson
- Department of Obstetrics & Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Anna Middleton
- Department of Obstetrics & Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan Walker
- Department of Obstetrics & Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Department of Obstetrics & Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Department of Obstetrics & Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anthea Lindquist
- Department of Obstetrics & Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia .,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Yoo JE, Jeong SM, Yeo Y, Jung W, Yoo J, Han K, Lee CM, Park JH, Park KW, Shin DW. Smoking Cessation Reduces the Risk of Heart Failure: A Nationwide Cohort Study. JACC. HEART FAILURE 2023; 11:277-287. [PMID: 36647926 DOI: 10.1016/j.jchf.2022.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is a lack of data for the incidence of heart failure (HF) according to changes in smoking behaviors. OBJECTIVES The authors aimed to investigate the effects of smoking behavior change on development of HF. METHODS In this population-based, retrospective cohort study using the Korean National Health Insurance System database, the authors identified 778,608 current smokers who participated in a health screening program in 2009 and in a follow-up screening in 2011. Participants were categorized into quitters, reducers I (≥50% reduction) and II (<50% reduction), sustainers, and increasers. RESULTS During a median follow-up of 6.3 years, there were 23,329 HF events (4.8 per 1,000 person-years). Compared with sustainers, the risk of HF was increased among increasers (adjusted hazard ratio [aHR]: 1.06 [95% CI: 1.02-1.10]). By contrast, quitters had a reduced risk for HF (aHR: 0.86 [95% CI: 0.83-0.90]). Even heavy smokers who quit smoking had a lower risk for HF than those who sustained heavy smoking (aHR: 0.90 [95% CI: 0.85-0.95]). In reducers, the risk of HF was not reduced but rather increased slightly (≥50% reduction, aHR: 1.06 [95% CI: 1.01-1.11]; <50% reduction, aHR: 1.04 [95% CI: 1.00-1.08]). CONCLUSIONS Current smokers who increased their smoking amount were associated with a higher risk for HF development compared to sustainers, whereas self-reported smoking cessation was associated with a lower risk of HF. There was no benefit from reduction in smoking amount. Self-reported smoking cessation should be reinforced whenever possible to prevent HF.
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Affiliation(s)
- Jung Eun Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su-Min Jeong
- Department of Family Medicine, Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yohwan Yeo
- Department of Family Medicine, Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Wonyoung Jung
- Department of Family Medicine, Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juhwan Yoo
- Department of Biomedicine and Health Science, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Cheol Min Lee
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Woo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine, Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
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49
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Association of glaucoma and lifestyle with incident cardiovascular disease: a longitudinal prospective study from UK Biobank. Sci Rep 2023; 13:2712. [PMID: 36792671 PMCID: PMC9931750 DOI: 10.1038/s41598-023-29613-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
The shared pathophysiological features of the cerebrovascular disease (CVD) and glaucoma suggest an association between the two diseases. Using the prospective UK Biobank cohort, we examined the associations between glaucoma and incident CVD and assessed the extent to which a healthy lifestyle reduced the CVD risk in subjects with glaucoma, using a scoring system consisting of four factors: current smoking, obesity, regular physical activity, and a healthy diet. During a mean follow-up time of 8.9 years, 22,649 (4.9%) incident CVD cases were documented. Multivariable Cox regression analyses revealed that subjects with glaucoma were significantly more likely to exhibit incident CVD (hazard ratio [HR]:1.19, 95% confidence interval [CI] 1.03-1.37; p = 0.016) than controls. In the further subgroup analyses, glaucoma increased incident CVD risk both in the young (40-55 years) and the old (56-70 years) and in both sexes, with higher risk in the young (HR: 1.33, CI 1.02-1.74) and female subjects (HR: 1.32, CI 1.14-1.52). When we analyze the associations between glaucoma and incident CVD by lifestyle factors, the highest absolute risks were observed in individuals with both glaucoma and an unhealthy lifestyle (HR: 2.66, CI 2.22-3.19). In conclusion, glaucoma was an independent risk factor for incident CVD. A healthy lifestyle was associated with a substantially lower risk for CVD incidence among adults with glaucoma.
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50
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Modifiable Risk Factors for Cardiovascular Disease among Women with and without a History of Hypertensive Disorders of Pregnancy. Nutrients 2023; 15:nu15020410. [PMID: 36678281 PMCID: PMC9867024 DOI: 10.3390/nu15020410] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women. Hypertensive disorders of pregnancy (HDP) affect 5−10% of pregnancies worldwide, and are an independent risk factor for CVD. A greater understanding of the rates of modifiable CVD risk factors in women with a history of HDP can inform CVD prevention priorities in this group. The aim of this study was to understand the rates of individual and multiple modifiable risk factors for CVD (body mass index, fruit and vegetable intake, physical activity, sitting time, smoking, alcohol consumption and depressive symptoms) among women with a history of HDP, and assess whether they differ to women without a history of HDP. This study is a cross-sectional analysis of self-reported data collected for the Australian Longitudinal Study of Women’s Health (ALSWH). The sample included 5820 women aged 32−37 years old, who completed survey 7 of the ALSWH in 2015. Women with a history of HDP had a higher multiple CVD modifiable risk factor score compared to those without HDP (mean (SD): 2.3 (1.4) vs. 2.0 (1.3); p < 0.01). HDP history was significantly associated with a higher body mass index (p < 0.01), high-risk alcohol consumption (p = 0.04) and more depressive symptoms (p < 0.01). Understanding that women with a history of HDP have higher CVD risk factors, specifically body mass index, alcohol consumption and depressive symptoms, allows clinicians to provide appropriate and tailored CVD interventions for this group of women.
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