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Ali MR, Nacer H, Lawson CA, Khunti K. Racial and Ethnic Disparities in Primary Prevention of Cardiovascular Disease. Can J Cardiol 2024; 40:1016-1030. [PMID: 38309463 DOI: 10.1016/j.cjca.2024.01.028] [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: 10/29/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024] Open
Abstract
Cardiovascular disease (CVD) disproportionately affects ethnic-minority groups globally. Ethnic-minority groups face particularly high CVD burden and mortality, exacerbated by disparities across modifiable risk factors, wider determinants of health, and limited access to preventative interventions. This narrative review summarizes evidence on modifiable risk factors, such as physical activity, hypertension, diet, smoking, alcohol consumption, diabetes, and the polypill for the primary prevention of CVD in ethnic minorities. Across these factors, we find inequities in risk factor prevalence. The evidence underscores that inequalities in accessibility to interventions and treatments impede progress in reducing CVD risk using primary prevention interventions for ethnic-minority people. Although culturally tailored interventions show promise, further research is required across the different risk factors. Social determinants of health and structural inequities also exacerbate CVD risk for ethnic-minority people and warrant greater attention. Additionally, we find that only limited ethnicity-specific data and guidelines are available on CVD primary prevention interventions for most risk factors. To address these gaps in research, we provide recommendations that include the following: investigating the sustainability and real-world effectiveness of culturally sensitive interventions; ensuring that ethnic-minority peoples' perspectives are considered in research; longitudinal tracking of risk factors; interventions and outcomes in ethnic-minority people; and ensuring that data collection and reporting of ethnicity data are standardized.
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Affiliation(s)
- Mohammad R Ali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom; Diabetes Research Centre, University of Leicester, Leicester, United Kingdom.
| | | | - Claire A Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands, University of Leicester, Leicester, United Kingdom
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Mohamed MO, Ghosh AK, Banerjee A, Mamas M. Socioeconomic and Ethnic Disparities in the Process of Care and Outcomes Among Cancer Patients With Acute Coronary Syndrome. Can J Cardiol 2024; 40:1146-1153. [PMID: 38537671 DOI: 10.1016/j.cjca.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/26/2024] [Accepted: 03/14/2024] [Indexed: 05/01/2024] Open
Abstract
Cancer and acute coronary syndrome (ACS) are the leading causes of morbidity and mortality globally, with many shared risk factors. There are several challenges to the management of patients with cancer presenting with ACS, owing to their higher baseline risk profile, the complexities of their cancer-related therapies and prognosis, and their higher risk of adverse outcomes after ACS. Although previous studies have demonstrated disparities in the care of both cancer and ACS among patients from ethnic minorities and socioeconomic deprivation, there is limited evidence around the magnitude of such disparities specifically in cancer patients presenting with ACS. This review summarises the current literature on differences in prevalence and management of ACS among patients with cancer from ethnic minorities and socioeconomically deprived backgrounds, as well as the gaps in evidence around the care of this high-risk population and potential solutions.
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Affiliation(s)
- Mohamed O Mohamed
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Arjun K Ghosh
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Cardio-Oncology Service, Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom.
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3
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Townsend R, Fairley A, Gregory S, Ritchie C, Stevenson E, Shannon OM. Nutrition for dementia prevention: a state of the art update for clinicians. Age Ageing 2024; 53:ii30-ii38. [PMID: 38745491 DOI: 10.1093/ageing/afae030] [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: 11/27/2023] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Dementia prevalence continues to rise. It is therefore essential to provide feasible and effective recommendations to encourage healthy brain ageing and reduce dementia risk across the population. Appropriate nutrition represents a potential strategy to mitigate dementia risk and could be recommended by clinicians as part of mid-life health checks and other health initiatives to reduce dementia prevalence. The purpose of this review is to provide a clinician-focused update on the current state of the knowledge on nutrition and dementia prevention. METHODS Narrative review. RESULTS Strong evidence exists to support the consumption of healthy, plant-based dietary patterns (e.g. Mediterranean, MIND or Nordic diet) for maintaining cognitive function and reducing dementia risk in later life and is supported by dementia prevention guideline from leading public health bodies (e.g. World Health Organization). Emerging evidence suggests potential cognitive benefits of consuming specific nutrients/foods (e.g. n-3 fatty acids or fish, flavonols and B-vitamins) and multi-nutrient compounds (e.g. Fortasyn Connect). Challenges and opportunities for integrating nutritional/dietary interventions for dementia prevention into clinical practice are explored in this review. CONCLUSIONS Appropriate nutrition represents an important factor to help facilitate healthy cognitive ageing and allay dementia risk. The information provided in this article can help clinicians provide informed opinions on appropriate nutritional strategies as part of mid-life Health Checks and other risk reduction initiatives.
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Affiliation(s)
- Rebecca Townsend
- School of Biomedical, Nutritional and Sport Sciences, Human Nutrition & Exercise Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Andrea Fairley
- School of Biomedical, Nutritional and Sport Sciences, Human Nutrition & Exercise Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Scottish Brain Sciences, Edinburgh, UK
| | - Craig Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Scottish Brain Sciences, Edinburgh, UK
- Brain Health and Neurodegenerative Medicine, Mackenzie Institute, University of St Andrews, St Andrews, UK
| | - Emma Stevenson
- School of Biomedical, Nutritional and Sport Sciences, Human Nutrition & Exercise Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Oliver M Shannon
- Human Nutrition & Exercise Research Centre, Population Health Sciences Institute, Centre for Healthier Lives, Newcastle University, Newcastle upon Tyne, UK
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Ojeda-Granados C, Campisi E, Barchitta M, Agodi A. Genetic, lifestyle and metabolic factors contributing to cardiovascular disease in the Italian population: a literature review. Front Nutr 2024; 11:1379785. [PMID: 38638292 PMCID: PMC11024791 DOI: 10.3389/fnut.2024.1379785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Cardiovascular diseases (CVD) represent a major health problem worldwide. In Italy, despite the decline in CVD mortality and disability-adjusted life years recently observed, CVD remains the leading cause of death. The development of CVD has a complex and multifactorial etiology that involves environmental, lifestyle/behavioral (e.g., unhealthy diet, physical inactivity, smoking, and alcohol abuse), metabolic, and genetic factors. Although a large number of CVD susceptibility genetic variants have been identified, some seem to confer risk according to the genetic background or ethnicity of the population. Some CVD-associated polymorphisms with appreciable frequency in the Italian population may be important contributors to the development and progression of the most prevalent CVD in the population. This literature review aims to provide an overview of the epidemiology of CVD in Italy, as well as to highlight the main genetic, lifestyle/behavioral, and metabolic factors contributing to CVD risk in this population.
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Affiliation(s)
- Claudia Ojeda-Granados
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
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Beydoun MA, Beydoun HA, Hu YH, El-Hajj ZW, Georgescu MF, Noren Hooten N, Li Z, Weiss J, Lyall DM, Waldstein SR, Hedges DW, Gale SD, Launer LJ, Evans MK, Zonderman AB. Helicobacter pylori, persistent infection burden and structural brain imaging markers. Brain Commun 2024; 6:fcae088. [PMID: 38529358 PMCID: PMC10961948 DOI: 10.1093/braincomms/fcae088] [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: 03/28/2023] [Revised: 01/11/2024] [Accepted: 03/11/2024] [Indexed: 03/27/2024] Open
Abstract
Persistent infections, whether viral, bacterial or parasitic, including Helicobacter pylori infection, have been implicated in non-communicable diseases, including dementia and other neurodegenerative diseases. In this cross-sectional study, data on 635 cognitively normal participants from the UK Biobank study (2006-21, age range: 40-70 years) were used to examine whether H. pylori seropositivity (e.g. presence of antibodies), serointensities of five H. pylori antigens and a measure of total persistent infection burden were associated with selected brain volumetric structural MRI (total, white, grey matter, frontal grey matter (left/right), white matter hyperintensity as percent intracranial volume and bi-lateral sub-cortical volumes) and diffusion-weighted MRI measures (global and tract-specific bi-lateral fractional anisotropy and mean diffusivity), after an average 9-10 years of lag time. Persistent infection burden was calculated as a cumulative score of seropositivity for over 20 different pathogens. Multivariable-adjusted linear regression analyses were conducted, whereby selected potential confounders (all measures) and intracranial volume (sub-cortical volumes) were adjusted, with stratification by Alzheimer's disease polygenic risk score tertile when exposures were H. pylori antigen serointensities. Type I error was adjusted to 0.007. We report little evidence of an association between H. pylori seropositivity and persistent infection burden with various volumetric outcomes (P > 0.007, from multivariable regression models), unlike previously reported in past research. However, H. pylori antigen serointensities, particularly immunoglobulin G against the vacuolating cytotoxin A, GroEL and outer membrane protein antigens, were associated with poorer tract-specific white matter integrity (P < 0.007), with outer membrane protein serointensity linked to worse outcomes in cognition-related tracts such as the external capsule, the anterior limb of the internal capsule and the cingulum, specifically at low Alzheimer's disease polygenic risk. Vacuolating cytotoxin A serointensity was associated with greater white matter hyperintensity volume among individuals with mid-level Alzheimer's disease polygenic risk, while among individuals with the highest Alzheimer's disease polygenic risk, the urease serointensity was consistently associated with reduced bi-lateral caudate volumes and the vacuolating cytotoxin A serointensity was linked to reduced right putamen volume (P < 0.007). Outer membrane protein and urease were associated with larger sub-cortical volumes (e.g. left putamen and right nucleus accumbens) at middle Alzheimer's disease polygenic risk levels (P < 0.007). Our results shed light on the relationship between H. pylori seropositivity, H. pylori antigen levels and persistent infection burden with brain volumetric structural measures. These data are important given the links between infectious agents and neurodegenerative diseases, including Alzheimer's disease, and can be used for the development of drugs and preventive interventions that would reduce the burden of those diseases.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Yi-Han Hu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Ziad W El-Hajj
- Department of Biology, McGill University, Montreal, QC H3A 1B1, Canada
| | - Michael F Georgescu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Zhiguang Li
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA 94305, USA
| | - Donald M Lyall
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, Scotland, UK
| | - Shari R Waldstein
- Department of Psychology, University of Maryland, Catonsville, MD 21250, USA
- Division of Gerontology, Geriatrics, and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Dawson W Hedges
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA
| | - Shawn D Gale
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224, USA
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Shannon OM, Townsend R, Malcomson FC, Matu J, Griffiths A, Jennings A, Ward N, Papier K, Best N, French C, Scheelbeek P, Kim C, Ochieng B, Jay F, Shepherd K, Corfe B, Fairley A, McEvoy CT, Minihane AM, Sim YJ, Stevenson E, Gregory S. Adherence to the Eatwell Guide and population and planetary health: A Rank Prize Forum report. NUTR BULL 2024; 49:108-119. [PMID: 38294140 DOI: 10.1111/nbu.12661] [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: 10/13/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
This report summarises a Forum conducted in June 2023 to explore the current state of the knowledge around the Eatwell Guide, which is the UK government's healthy eating tool, in relation to population and planetary health. The 1.5-day Forum highlighted the limited, albeit promising evidence linking higher adherence to the Eatwell Guide with favourable health outcomes, including reduced overall mortality risk, lower abdominal obesity in post-menopausal women and improved cardiometabolic health markers. Similarly, evidence was presented to suggest that higher adherence to the Eatwell Guide is associated with reduced greenhouse gas emissions. Presentations were given around cultural adaptations of the Eatwell Guide, including African Heritage and South Asian versions, which are designed to increase the acceptability and uptake of the Eatwell Guide in these communities in the United Kingdom. Presentations highlighted ongoing work relevant to the applications of the Eatwell Guide in randomised controlled trials and public health settings, including the development of a screening tool to quantify Eatwell Guide adherence. The Forum ended with a World Café-style event, in which the strengths and limitations of the Eatwell Guide were discussed, and directions for future research were identified. This Forum report serves as a primer on the current state of the knowledge on the Eatwell Guide and population and planetary health and will be of interest to researchers, healthcare professionals and public health officials.
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Affiliation(s)
- Oliver M Shannon
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Rebecca Townsend
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Dame Margaret Barbour Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Fiona C Malcomson
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Jamie Matu
- School of Health, Leeds Beckett University, Leeds, UK
| | | | - Amy Jennings
- School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nicola Ward
- School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nicola Best
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Chloe French
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Pauline Scheelbeek
- Centre on Climate Change & Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Curie Kim
- Basic and Clinical Neuroscience, School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bertha Ochieng
- Centre for Primary Care Research, De Montfort University, Leicester, UK
| | | | | | - Bernard Corfe
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Andrea Fairley
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Dame Margaret Barbour Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Claire T McEvoy
- School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Anne-Marie Minihane
- Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Yi Jia Sim
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Dame Margaret Barbour Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Emma Stevenson
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Dame Margaret Barbour Building, Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Chen-Xu J, Varga O, Mahrouseh N, Eikemo TA, Grad DA, Wyper GMA, Badache A, Balaj M, Charalampous P, Economou M, Haagsma JA, Haneef R, Mechili EA, Unim B, von der Lippe E, Baravelli CM. Subnational inequalities in years of life lost and associations with socioeconomic factors in pre-pandemic Europe, 2009-19: an ecological study. Lancet Public Health 2024; 9:e166-e177. [PMID: 38429016 DOI: 10.1016/s2468-2667(24)00004-5] [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: 07/13/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Health inequalities have been associated with shorter lifespans. We aimed to investigate subnational geographical inequalities in all-cause years of life lost (YLLs) and the association between YLLs and socioeconomic factors, such as household income, risk of poverty, and educational attainment, in countries within the European Economic Area (EEA) before the COVID-19 pandemic. METHODS In this ecological study, we extracted demographic and socioeconomic data from Eurostat for 1390 small regions and 285 basic regions for 32 countries in the EEA, which was complemented by a time-trend analysis of subnational regions within the EEA. Age-standardised YLL rates per 100 000 population were estimated from 2009 to 2019 based on methods from the Global Burden of Disease study. Geographical inequalities were assessed using the Gini coefficient and slope index of inequality. Socioeconomic inequalities were assessed by investigating the association between socioeconomic factors (educational attainment, household income, and risk of poverty) and YLLs in 2019 using negative binomial mixed models. FINDINGS Between Jan 1, 2009, and Dec 31, 2019, YLLs lowered in almost all subnational regions. The Gini coefficient of YLLs across all EEA regions was 14·2% (95% CI 13·6-14·8) for females and 17·0% (16·3 to 17·7) for males. Relative geographical inequalities in YLLs among women were highest in the UK (Gini coefficient 11·2% [95% CI 10·1-12·3]) and among men were highest in Belgium (10·8% [9·3-12·2]). The highest YLLs were observed in subnational regions with the lowest levels of educational attainment (incident rate ratio [IRR] 1·19 [1·13-1·26] for females; 1·22 [1·16-1·28] for males), household income (1·35 [95% CI 1·19-1·53]), and the highest poverty risk (1·25 [1·18-1·34]). INTERPRETATION Differences in YLLs remain within, and between, EEA countries and are associated with socioeconomic factors. This evidence can assist stakeholders in addressing health inequities to improve overall disease burden within the EEA. FUNDING Research Council of Norway; Development, and Innovation Fund of Hungary; Norwegian Institute of Public Medicine; and COST Action 18218 European Burden of Disease Network.
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Affiliation(s)
- José Chen-Xu
- Comprehensive Health Research Centre, Public Health Research Centre, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal; Public Health Unit, Local Health Unit Baixo Mondego, Figueira da Foz, Portugal
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Syreon Research Institute, Budapest, Hungary
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Terje Andreas Eikemo
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Diana A Grad
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Grant M A Wyper
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Population Health and Wellbeing, Public Health Scotland, Glasgow, Scotland
| | - Andreea Badache
- Swedish Institute of Disability Research, School of Health Sciences, Örebro University, Örebro, Sweden; School of Health Sciences, Örebro University, Örebro, Sweden
| | - Mirza Balaj
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Periklis Charalampous
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Mary Economou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - Enkeleint A Mechili
- Department of Healthcare, Faculty of Health, University of Vlora, Vlora, Albania; School of Medicine, University of Crete, Crete, Greece
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy
| | - Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Platts K, Scott E, Griffiths K, Carter A. Attitudes to and perceptions of workplace health promotion amongst employees from ethnic minorities in the UK: A scoping review. Work 2024:WOR230576. [PMID: 38393877 DOI: 10.3233/wor-230576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Ethnic minorities make up approximately 14% of the UK workforce. Despite the disproportionate burden of ill-health amongst ethnic minorities, and the increased interest in Diversity, Equity & Inclusion (DE&I) in the workplace, workplace health and wellbeing interventions are still most often designed for the ethnic majority. OBJECTIVE The purpose of this scoping review was to explore the depth and breadth of evidence on the attitudes to and perceptions of health and wellbeing interventions in the workplace within ethnic minority groups in the UK, and to identify gaps in evidence that would provide direction for future research needs. METHODS A scoping review with quality appraisal was undertaken, supplemented by a review of grey literature and a narrative review exploring related evidence from the knowledge bases related to community and cultural adaptation. RESULTS Only three peer-reviewed studies met inclusion criteria, preventing broad conclusions. 14 papers from the community and cultural adaptation literature provided additional information about how health promotion may be approached effectively in the workplace, including the importance of culturally sensitive, people-centred design, and the use of established adaptation frameworks. CONCLUSION The literature suggests a need for improvements in four key areas: (1) reporting of ethnic minorities in data relating to workplace health and wellbeing research, (2) more thorough review of perceptions and attitudes of ethnic minority workers in the UK, (3) design of culturally appropriate interventions that are tested for impact, and (4) testing of the effectiveness of culturally adapted interventions.
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Rokkedrejer SI, Schlünssen V, Kinnerup MB, Vestergaard JM, Kolstad HA, Cramer C. Risk of myocardial infarction among pigeon breeders: A follow-up study. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2024; 78:507-511. [PMID: 38240700 DOI: 10.1080/19338244.2024.2302113] [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: 06/08/2023] [Accepted: 01/01/2024] [Indexed: 02/08/2024]
Abstract
Pigeon breeders are exposed to high levels of fine particulate organic matter in the pigeon lofts. A total of 6,704 pigeon breeders and their 1:30 sex and age-matched referents from the general Danish population were followed from 1980 or first year of membership in the Danish Racing Pigeon Association, until first event of myocardial infarction, emigration, death, or end of study, on December 31, 2013. Information on outcomes and covariates was obtained by record linkage with national registers. Stratified Cox regression models estimated the hazard ratio of myocardial infarction, adjusted for occupation and residence at the start of follow-up. Compared with referents, pigeon breeders had an adjusted hazard ratio of 1.14 (95% CI: 1.05-1.22) for myocardial infarction. Exposure to pigeon-derived organic dust may increase the risk of myocardial infarction, but this finding needs to be corroborated.
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Affiliation(s)
- Sandra Ileby Rokkedrejer
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Unit for Work, Environment and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Martin Byskov Kinnerup
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Christine Cramer
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Unit for Work, Environment and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
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10
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Abukari MH, Appiah CA, Kwarteng A, Iddrisu S. Cardiovascular risk assessment of people living in prison in the Northern region of Ghana. INTERNATIONAL JOURNAL OF PRISON HEALTH 2024; 20:102-115. [PMID: 38984556 DOI: 10.1108/ijoph-09-2022-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
PURPOSE The health of people living in prisons (PLP) frequently remains marginalised in national development discourse, particularly in resource-constrained settings like Ghana. This study aims to determine the prevalence of cardiovascular disease (CVD) risk factors among PLP at a prison facility in the Northern Region of Ghana. DESIGN/METHODOLOGY/APPROACH A cross-sectional study involving 134 male persons in prison, aged 18-79 years, was conducted to assess their dietary habits, tobacco use, alcohol consumption, sleep behaviour and physical activity practices. Serum lipid profile, fasting blood glucose (FBG), blood pressure (BP) and body mass indices of participants were also measured. FINDINGS Almost half (48.1%) of the participants had abnormal lipid levels. Those with FBG in the diabetes range (= 7.0 mmol/l) constituted 3.9%, while 16.7% were in the impaired FBG range (6.1-6.9 mmol/l). Participants with BP within the pre-hypertension range were 54.5%. The majority of participants (92%) had a low daily intake of fruits and vegetables. Few participants were active smokers (5%) and alcohol users (2%). The average sleep duration at night among the participants was 5.54 ± 2.07 h. The majority (74%) of the participants were sedentary. About a quarter of the participants (24.6%) had overweight/obesity. ORIGINALITY/VALUE This study highlights the CVD risks among PLP. Findings suggest the need for targeted interventions, such as dietary and lifestyle modification strategies, regular physical activity and routine screening for diabetes, dyslipidaemia and hypertension. These interventions within the prison space could significantly improve the cardiovascular health of PLP in resource-limited settings.
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Affiliation(s)
| | - Collins Afriyie Appiah
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alexander Kwarteng
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sherifa Iddrisu
- Department of Nutrition and Dietetics, Tamale Technical University, Tamale, Ghana
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11
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Ho AFW, Yau CE, Ho JSY, Lim SH, Ibrahim I, Kuan WS, Ooi SBS, Chan MY, Sia CH, Mosterd A, Gijsberts CM, de Hoog VC, Bank IEM, Doevendans PA, de Kleijn DPV. Predictors of major adverse cardiac events among patients with chest pain and low HEART score in the emergency department. Int J Cardiol 2024; 395:131573. [PMID: 37931658 DOI: 10.1016/j.ijcard.2023.131573] [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: 08/11/2023] [Revised: 10/08/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
AIM For patients who present to the emergency departments (ED) with undifferentiated chest pain, the risk of major adverse cardiac events (MACE) may be underestimated in low-HEART score patients. We aimed to identify characteristics of patients who were classified as low risk by HEART score but subsequently developed MACE at 6 weeks. METHODS We studied a multiethnic cohort of patients who presented with chest pain arousing suspicion of acute coronary syndrome to EDs in the Netherlands and Singapore. Patients were risk-stratified using HEART score and followed up for MACE at 6 weeks. Risk factors of developing MACE despite low HEART scores (scores 0-3) were identified using logistic and Cox regression models. RESULTS Among 1376 (39.8%) patients with low HEART scores, 63 (4.6%) developed MACE at 6 weeks. More males (53/806, 6.6%) than females (10/570, 2.8%) with low HEART score developed MACE. There was no difference in outcomes between ethnic groups. Among low-HEART score patients with 2 points for history, 21% developed MACE. Among low-HEART score patients with 1 point for troponin, 50% developed MACE, while 100% of those with 2 points for troponin developed MACE. After adjusting for HEART score and potential confounders, male sex was independently associated with increased odds (OR 4.12, 95%CI 2.14-8.78) and hazards (HR 3.93, 95%CI 1.98-7.79) of developing MACE despite low HEART score. CONCLUSION Male sex, highly suspicious history and elevated troponin were disproportionately associated with MACE. These characteristics should prompt clinicians to consider further investigation before discharge.
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Affiliation(s)
- Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Pre-hospital & Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore.
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jamie Sin-Ying Ho
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Irwani Ibrahim
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | - Win Sen Kuan
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | | | - Mark Y Chan
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Centre, Amersfoort, the Netherlands
| | - Crystel M Gijsberts
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Vince C de Hoog
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ingrid E M Bank
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pieter A Doevendans
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Dominique P V de Kleijn
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
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12
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Ranasinghe SU, Ekanayake EMDS, Ranasinghe LI, Tennakoon SUB. Recalibration of Framingham risk for a local population of Sri Lanka. BMC Public Health 2024; 24:165. [PMID: 38216900 PMCID: PMC10785388 DOI: 10.1186/s12889-023-17601-8] [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: 03/02/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Cardiovascular Diseases (CVD) account for the highest number of deaths and disability globally and within Sri Lanka. A CVD risk prediction tool is a simple means of early identification of high-risk groups which is a cost-effective preventive strategy, especially for resource-poor countries. Distribution of risk factor levels varies in different regions even within the same country, thus a common risk estimation tool for the country may give false local predictions. Since there are few published data related to Sri Lanka the aim of this study was to recalibrate the Framingham equation according to the local risk factor profile of a population in the Kurunegala region in Sri Lanka. METHOD A cross-sectional study was conducted with the participation of 1 102 persons from the Kurunegala Regional Director of Health Services area and the data was collected using an interviewer-administered questionnaire, anthropometric, blood pressure, and biochemical measurements. CVD risk was estimated using Framingham original and recalibrated CVD risk assessment methods. Current CVD mortality and morbidity data and the recalibration method conducted by the method described by Wilson and colleagues were used for calculations. RESULTS Original and recalibrated Framingham CVD risk scores predicted 55.5% (N = 612) and 62.3% (N = 687) to be having less than 10% CVD risk respectively. Further, the original and recalibrated CVD Risk Scores predicted 2.2% (N = 24) and 1.8% (N = 20) to be having CVD risk more than 40% respectively. CONCLUSION These findings show an over prediction of the CVD risk with the original Framingham risk calculations which signifies the importance of development of a region-specific risk prediction tool using local risk factor data in Sri Lanka which will prevent unnecessary expenditure to manage people without risk of CVD.
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Affiliation(s)
| | - E M D S Ekanayake
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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13
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Beydoun MA, Beydoun HA, Hu YH, Li Z, Wolf C, Meirelles O, Noren Hooten N, Launer LJ, Evans MK, Zonderman AB. Infection burden and its association with neurite orientation dispersion and density imaging markers in the UK Biobank. Brain Behav Immun 2024; 115:394-405. [PMID: 37858740 PMCID: PMC10873031 DOI: 10.1016/j.bbi.2023.10.009] [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: 06/05/2023] [Revised: 09/15/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Infection burden (IB), although linked to neurodegeneration, including Alzheimer's Disease (AD), has not been examined against neurite orientation, dispersion, and density imaging (NODDI) measures. METHODS Among 38,803 UK Biobank adults (Age:40-70 years), we tested associations of total IB (IBtotal, 47.5 %) and hospital-treated IB (IBhosp, 9.7 %) with NODDI measures (5-15 years later), including volume fraction of Gaussian isotropic diffusion (ISOVF), intra-cellular volume fraction (ICVF) and orientation dispersion (OD) indices, using multiple linear regression models. RESULTS Total and hospital-treated infection burdens (IBtotal and IBhosp) were associated with increased ISOVF, indicating increased free-water component. IBtotal was positively associated with OD, indicating that at higher IBtotal there was greater fanning of neurites. This was more evident in the lower cardiovascular health group. IBhosp was associated with higher OD, and lower ICVF at higher AD polygenic risk. Together, these findings indicate that both total and hospital-treated infections have effects on NODDI outcomes in the direction of poor brain health. These effects were largely homogeneous across cardiovascular health and AD polygenic risk groups, with some effects shown to be stronger at poor cardiovascular health and/or higher AD risk. CONCLUSIONS Total and hospital-treated infections were associated with poorer white matter microstructure (higher ISOVF or OD or lower ICVF), with some heterogeneity across cardiovascular health and AD risk. Longitudinal studies with multiple repeats on neuroimaging markers in comparable samples are needed.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA.
| | - Hind A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA; Alexander T. Augusta Military Medical Center, Fort Belvoir, VA, USA
| | - Yi-Han Hu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Zhiguang Li
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Claudia Wolf
- Department of Education and Psychology, Freie Universitat, Berlin, Germany; Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Osorio Meirelles
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
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14
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Beydoun MA, Beydoun HA, Noren Hooten N, Meirelles O, Li Z, El-Hajj ZW, Weiss J, Maino Vieytes CA, Launer LJ, Evans MK, Zonderman AB. Hospital-treated prevalent infections, the plasma proteome and incident dementia among UK older adults. iScience 2023; 26:108526. [PMID: 38162022 PMCID: PMC10755048 DOI: 10.1016/j.isci.2023.108526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/18/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
The plasma proteome can mediate the association of hospital-treated infections with dementia incidence. We screened up to 37,269 UK Biobank participants aged 50-74 years for the presence of a prevalent hospital-treated infection, subsequently tested as a predictor for ≤1,463 plasma proteins and dementia incidence. Four-way decomposition models decomposed infection-dementia total effect into pure mediation, pure interaction, neither or both through the plasma proteome. Hospital-treated infections increased dementia two-fold. The strongest mediation effect was through the growth differentiation factor 15 (GDF15) protein. Top 17 proteomic mediators explained collectively 5% of the total effect, while pathway analysis of all mediators (k = 221 plasma proteins) revealed top pathways including the immune system, signal transduction, metabolism, disease and metabolism of proteins, with the GDF15 cluster reflecting most strongly the "transmembrane receptor protein tyrosine kinase signaling pathway". The association of hospital-treated infections with dementia was partially mediated through GDF15 and other plasma proteomic markers.
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Affiliation(s)
- May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Hind A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA
- AT Augusta Military Medical Center, Fort Belvoir, VA 22060, USA
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Osorio Meirelles
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Zhiguang Li
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Ziad W. El-Hajj
- Department of Biology, McGill University, Montreal, QC, Canada
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Palo Alto, CA 94305, USA
| | - Christian A. Maino Vieytes
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD 21224, USA
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Ab Rahman N, Lim MT, Lee FY, Wo WK, Yeoh HS, Peariasamy KM, Sivasampu S. Thrombocytopenia and venous thromboembolic events after BNT162b2, CoronaVac, ChAdOx1 vaccines and SARS-CoV-2 infection: a self-controlled case series study. Sci Rep 2023; 13:20471. [PMID: 37993548 PMCID: PMC10665324 DOI: 10.1038/s41598-023-47486-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: 10/18/2022] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
This study assessed the association between COVID-19 vaccines, SARS-CoV-2 infection and the risk of thrombocytopenia and venous thromboembolism (VTE). This self-controlled case series study used hospital records between 1st February 2021 and 28th February 2022 linked to the national immunisation registry and COVID-19 surveillance data in Malaysia. Conditional Poisson regression was used to estimate incidence rate ratios (IRR) of events in the risk period (day 1-21 post-exposure) relative to control period with the corresponding 95% confidence interval (CI) adjusted for calendar period. We found no significant increased risk of thrombocytopenia in 1-21 days following BNT162b2, CoronaVac and ChAdOx1 vaccines while the risk was increased following SARS-CoV-2 infection (IRR 15.52, 95% CI 13.38-18.00). Similarly, vaccination with BNT162b2, CoronaVac, or ChAdOx1 was not associated with an increased risk of VTE during the 1-21 days risk period. SARS-CoV-2 infection was associated with increased risk of VTE (IRR 39.84, 95% CI 27.45-32.44). Our findings showed low event rates of thrombocytopenia and VTE following booster vaccination with comparable safety profiles between those who received homologous and heterologous booster combinations. Our findings showed the risk of thrombocytopenia and VTE was not increased after COVID-19 vaccination while the risks were substantially higher after SARS-CoV-2 infection.
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Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia.
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Fei Yee Lee
- Clinical Research Centre, Selayang Hospital, Ministry of Health, Kepong, Selangor, Malaysia
| | - Wee Kee Wo
- National Pharmaceutical Regulatory Agency, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Hee Sheong Yeoh
- National Pharmaceutical Regulatory Agency, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
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16
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Beydoun MA, Beydoun HA, Gale SD, Hedges D, Weiss J, Li Z, Erickson LD, Noren Hooten N, Launer LJ, Evans MK, Zonderman AB. Cardiovascular health, infection burden and their interactive association with brain volumetric and white matter integrity outcomes in the UK Biobank. Brain Behav Immun 2023; 113:91-103. [PMID: 37393057 PMCID: PMC11040741 DOI: 10.1016/j.bbi.2023.06.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Cardiovascular health is associated with brain magnetic resonance imaging (MRI) markers of pathology and infections may modulate this association. METHODS Using data from 38,803 adults (aged 40-70 years) and followed-up for 5-15 years, we tested associations of prevalent total (47.5%) and hospital-treated infection burden (9.7%) with brain structural and diffusion-weighted MRI (i.e., sMRI and dMRI, respectively) common in dementia phenome. Poor white matter tissue integrity was operationalized with lower global and tract-specific fractional anisotropy (FA) and higher mean diffusivity (MD). Volumetric sMRI outcomes included total, gray matter (GM), white matter (WM), frontal bilateral GM, white matter hyperintensity (WMH), and selected based on previous associations with dementia. Cardiovascular health was measured with Life's Essential 8 score (LE8) converted to tertiles. Multiple linear regression models were used, adjusting for intracranial volumes (ICV) for subcortical structures, and for demographic, socio-economic, and the Alzheimer's Disease polygenic risk score for all outcomes, among potential confounders. RESULTS In fully adjusted models, hospital-treated infections were inversely related to GM (β ± SE: -1042 ± 379, p = 0.006) and directly related to WMH as percent of ICV (Loge transformed) (β ± SE:+0.026 ± 0.007, p < 0.001). Both total and hospital-treated infections were associated with poor WMI, while the latter was inversely related to FA within the lowest LE8 tertile (β ± SE:-0.0011 ± 0.0003, p < 0.001, PLE8×IB < 0.05), a pattern detected for GM, Right Frontal GM, left accumbens and left hippocampus volumes. Within the uppermost LE8 tertile, total infection burden was linked to smaller right amygdala while being associated with larger left frontal GM and right putamen volumes, in the overall sample. Within that uppermost tertile of LE8, caudate volumes were also positively associated with hospital-treated infections. CONCLUSIONS Hospital-treated infections had more consistent deleterious effects on volumetric and white matter integrity brain neuroimaging outcomes compared with total infectious burden, particularly in poorer cardiovascular health groups. Further studies are needed in comparable populations, including longitudinal studies with multiple repeats on neuroimaging markers.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States.
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States
| | - Shawn D Gale
- Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Dawson Hedges
- Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, United States
| | - Zhiguang Li
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States
| | - Lance D Erickson
- Department of Sociology, Brigham Young University, Provo, UT, United States
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, United States
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17
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Weiss J, Beydoun MA, Beydoun HA, Fanelli-Kuczmarski MT, Banerjee S, Hamrah A, Evans MK, Zonderman AB. Pathways explaining racial/ethnic disparities in incident all-cause dementia among middle-aged US adults. Alzheimers Dement 2023; 19:4299-4310. [PMID: 36868873 PMCID: PMC10475144 DOI: 10.1002/alz.12976] [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: 09/27/2022] [Revised: 12/16/2022] [Accepted: 01/13/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Racial disparities in dementia incidence exist, but less is known about their presence and drivers among middle-aged adults. METHODS We used time-to-event analysis among a sample of 4378 respondents (age 40-59 years at baseline) drawn from the third National Health and Nutrition Examination Surveys (NHANES III) with administrative linkage-spanning the years 1988-2014-to evaluate potential mediating pathways through socioeconomic status (SES), lifestyle, and health-related characteristics. RESULTS Compared with Non-Hispanic White (NHW) adults, Non-White adults had a higher incidence of AD-specific (hazard ratio [HR] = 2.05, 95% confidence interval [CI]: 1.21, 3.49) and all-cause dementia (HR = 2.01, 95% CI: 1.36, 2.98). Diet, smoking, and physical activity were among characteristics on the pathway between race/ethnicity, SES, and dementia, with health-mediating effects of smoking and physical activity on dementia risk. DISCUSSION We identified several pathways that may generate racial disparities in incident all-cause dementia among middle-aged adults. No direct effect of race was observed. More studies are needed to corroborate our findings in comparable populations.
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Affiliation(s)
- Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, USA
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Hind A. Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Marie T. Fanelli-Kuczmarski
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Sri Banerjee
- Public Health Doctoral Programs, Walden University, Minneapolis, MN, USA
| | | | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
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18
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Beydoun HA, Beydoun MA, Meirelles O, Erickson LD, Gamaldo AA, Weiss J, Launer LJ, Evans MK, Zonderman AB. Cardiovascular health, infection burden, and incident dementia in the UK Biobank. Alzheimers Dement 2023; 19:4475-4487. [PMID: 37547953 PMCID: PMC10592296 DOI: 10.1002/alz.13405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/25/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Among older adults, total and hospitalized infection may be associated with incidence of all-cause and Alzheimer's disease (AD) dementias, with variation by cardiovascular health (CVH). METHODS We used Cox proportional hazards (PH) models to examine the relationships between International Classification of Diseases-10th revision (ICD-10)-specific viral and bacterial infectious agents and incident all-cause and AD dementia among 355,046 UK Biobank participants ≥50 years at baseline. Life's Essential 8 (LE8) index reflected CVH. RESULTS In both sexes, total infection burden (yes vs. no) was associated with all-cause dementia, with significant interactions by LE8 tertiles, whereby this relationship was significant only in the lowest LE8 tertile. Hospital-treated infection burden (yes vs no) was significantly related to all-cause and AD dementia, with no significant interaction with LE8 tertile. Age group patterns were detected. DISCUSSION AD and all-cause dementia were related to hospital-treated infections, while CVH modified the relationship of total infection burden with all-cause dementia. Highlights Secondary analysis on >355,000 UK Biobank participants ≥50 years at baseline. Alzheimer's disease and all-cause dementia are both related to hospital-treated infection. Cardiovascular health modifies association of infection burden with all-cause dementia.
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Affiliation(s)
- Hind A. Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224
| | - Osorio Meirelles
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224
| | | | - Alyssa A. Gamaldo
- Human Development and Family Studies, Penn State University, State College, PA 16802
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Palo Alto, CA 94305
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD 21224
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Jordan KP, Rathod-Mistry T, van der Windt DA, Bailey J, Chen Y, Clarson L, Denaxas S, Hayward RA, Hemingway H, Kyriacou T, Mamas MA. Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study. Eur J Prev Cardiol 2023; 30:1151-1161. [PMID: 36895179 PMCID: PMC10442054 DOI: 10.1093/eurjpc/zwad055] [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: 09/01/2022] [Revised: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
AIMS Most adults presenting in primary care with chest pain symptoms will not receive a diagnosis ('unattributed' chest pain) but are at increased risk of cardiovascular events. To assess within patients with unattributed chest pain, risk factors for cardiovascular events and whether those at greatest risk of cardiovascular disease can be ascertained by an existing general population risk prediction model or by development of a new model. METHODS AND RESULTS The study used UK primary care electronic health records from the Clinical Practice Research Datalink linked to admitted hospitalizations. Study population was patients aged 18 plus with recorded unattributed chest pain 2002-2018. Cardiovascular risk prediction models were developed with external validation and comparison of performance to QRISK3, a general population risk prediction model. There were 374 917 patients with unattributed chest pain in the development data set. The strongest risk factors for cardiovascular disease included diabetes, atrial fibrillation, and hypertension. Risk was increased in males, patients of Asian ethnicity, those in more deprived areas, obese patients, and smokers. The final developed model had good predictive performance (external validation c-statistic 0.81, calibration slope 1.02). A model using a subset of key risk factors for cardiovascular disease gave nearly identical performance. QRISK3 underestimated cardiovascular risk. CONCLUSION Patients presenting with unattributed chest pain are at increased risk of cardiovascular events. It is feasible to accurately estimate individual risk using routinely recorded information in the primary care record, focusing on a small number of risk factors. Patients at highest risk could be targeted for preventative measures.
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Affiliation(s)
- Kelvin P Jordan
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - Trishna Rathod-Mistry
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Danielle A van der Windt
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - James Bailey
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - Ying Chen
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
- Wisdom Lake Academy of Pharmacy, Xi'an Jiaotong-Liverpool University, Suzhou 215123, Jiangsu, China
| | - Lorna Clarson
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK
- Health Data Research UK, University College London, 222 Euston Road, London NW1 2DA, UK
| | - Richard A Hayward
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, Maple House 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Theocharis Kyriacou
- School of Computing and Mathematics, Keele University, Staffordshire ST5 5AA, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire ST5 5BG, UK
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20
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Petermann-Rocha F, Deo S, Celis-Morales C, Ho FK, Bahuguna P, McAllister D, Sattar N, Pell JP. An Opportunity for Prevention: Associations Between the Life's Essential 8 Score and Cardiovascular Incidence Using Prospective Data from UK Biobank. Curr Probl Cardiol 2023; 48:101540. [PMID: 36528209 DOI: 10.1016/j.cpcardiol.2022.101540] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
To investigate the association between the Life's Essential 8 (LE8) score and the incidence of four cardiovascular outcomes (ischemic heart disease, myocardial infarction, stroke, and heart failure [HF]) - separately and as a composite outcome of major adverse cardiovascular events (MACE) - in UK Biobank. 250,825 participants were included in this prospective study. Smoking, non-HDL cholesterol, blood pressure, body mass index, HbA1c, physical activity, diet, and sleep were used to create a modified version of the LE8 score. Associations between the score (both as a continuous score and as quartiles) and outcomes were investigated using adjusted Cox proportional hazard models. The potential impact fractions of two scenarios were also calculated. Over a median follow-up of 10.4 years, there were 25,068 MACE. Compared to individuals in the highest quartile of the score (healthiest), those in the lowest quartile (least healthy) had 2.07 (95% CI: 1.99; 2.16) higher risk for MACE. The highest relative risk gradient of the individual outcomes was observed for HF (HRlowest quartile: 2.67 [95% CI: 2.42; 2.94]). The magnitude of association was stronger in participants below 50 years, women, and ethnic minorities. A targeted intervention that increased, by 10-points, the score among individuals in the lowest quartile could have prevented 9.2% of MACE. Individuals with a lower LE8 score experienced more MACE, driven especially by incident HF. Our scenarios suggested that relevant interventions targeted towards those in the lowest quartile may have a greater impact than interventions producing small equal changes across all quartiles.
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Affiliation(s)
- Fanny Petermann-Rocha
- BHF Cardiovascular Research Centre. School of Cardiovascular and Metabolic Health, University of Glasgow. Glasgow, UK; Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Salil Deo
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK; Louis Stokes Cleveland VA Medical Center, Cleveland USA; Department of Surgery, Case School of Medicine, Case Western Reserve University, Cleveland USA
| | - Carlos Celis-Morales
- BHF Cardiovascular Research Centre. School of Cardiovascular and Metabolic Health, University of Glasgow. Glasgow, UK; Human Performance Laboratory, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, Chile
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK
| | - Pankaj Bahuguna
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow Glasgow, UK
| | - David McAllister
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK
| | - Naveed Sattar
- BHF Cardiovascular Research Centre. School of Cardiovascular and Metabolic Health, University of Glasgow. Glasgow, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow. Glasgow, UK.
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21
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Panahian M, Yavari T, Tafti F, Faridi M. Cardiovascular risk in adults with different levels of physical activity. J Natl Med Assoc 2023; 115:119-126. [PMID: 36717352 DOI: 10.1016/j.jnma.2023.01.006] [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: 10/23/2022] [Revised: 11/01/2022] [Accepted: 01/09/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Physical inactivity is a behavioral and modifiable risk factor for cardiovascular disease. We aimed to assess the association of walking or moderate to vigorous physical activity of various durations with cardiovascular risk in age and sex groups of the adult general population. METHODS This research was a secondary analysis of cross-sectional data from a Brazilian cohort study (2009 to 2014) on the general population in an urban area. Overall, 1208 patients (48.2% males) aged 20-59 years [mean (SD) age = 38.8 (12.0) years] were included. RESULTS We developed two well-fitted logistic models for investigating the main and interaction effects of physical activity; C-statistic = 74.1 and 80.4, respectively. Older age groups showed a higher association with the risk of cardiovascular disease, adjusted odds ratio OR (95%CI) = 5.28 (2.69, 10.76) for age ≥ 50 years. Walking < 150 min/w was not significant for all age groups (all P ≥ 0.139) compared with the base category (20-29 years). Also, moderate to vigorous physical activity < 150 min/w was not associated with lower cardiovascular risk. However, for moderate to vigorous physical activity ≥ 150 min/w, our results were indicative of a significant protective role for people in 30-39 and ≥ 50 age ranges; OR = 0.20 (0.09, 0.46) and 0.22 (0.10, 0.48), respectively (both P < 0.001). CONCLUSION Our study did not suggest a protective role for walking. However, moderate to vigorous physical activity ≥ 150 min/w was associated with a lower risk of cardiovascular disease in older patients.
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Affiliation(s)
- Mohammadreza Panahian
- Independent Researcher, Valiasr st., Fereshteh st., Agha Bozorgi alley, Tehran, Iran.
| | - Tahereh Yavari
- Faculty of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Tafti
- School of Medicine, Imam Reza Hoapital, Aja University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Faridi
- Department of Health Psychology, Faculty of Psychology and Educational Sciences, Roudehen Islamic Azad University, Tehran, Iran
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22
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Razieh C, Zaccardi F, Miksza J, Davies MJ, Hansell AL, Khunti K, Yates T. Differences in the risk of cardiovascular disease across ethnic groups: UK Biobank observational study. Nutr Metab Cardiovasc Dis 2022; 32:2594-2602. [PMID: 36064688 DOI: 10.1016/j.numecd.2022.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS To describe sociodemographic, lifestyle, environmental and traditional clinical risk factor differences between ethnic groups and to investigate the extent to which such differences confound the association between ethnic groups and the risk of cardiovascular disease (CVD) METHODS AND RESULTS: A total of 440,693 white European (55.9% women), 7305 South Asian (48.6%) and 7628 black African or Caribbean (57.7%) people were included from UK Biobank. Associations between ethnicity and cardiovascular outcomes (composite of non-fatal stroke, non-fatal myocardial infarction and CVD death) were explored using Cox-proportional hazard models. Models were adjusted for sociodemographic, lifestyle, environmental and clinical risk factors. Over a median (IQR) of 12.6 (11.8, 13.3) follow-up years, there were 22,711 (5.15%) cardiovascular events in white European, 463 (6.34%) in South Asian and 302 (3.96%) in black African or Caribbean individuals. For South Asian people, the cardiovascular hazard ratio (HR) compared to white European people was 1.28 (99% CI [1.16, 1.43]). For black African or Caribbean people, the HR was 0.80 (0.66, 0.97). The elevated risk of CVD in South Asians remained after adjusting for differences in sociodemographic, lifestyle, environmental and clinical factors, whereas the lower risk in black African or Caribbean was largely attenuated. CONCLUSIONS South Asian, but not black African or Caribbean individuals, have a higher risk of CVD compared to white European individuals. This higher risk in South Asians was independent of sociodemographic, lifestyle, environmental and clinical factors.
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Affiliation(s)
- Cameron Razieh
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK; Office for National Statistics, Newport, NP10 8XG, UK.
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Joanne Miksza
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Anna L Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, LE1 7RH, UK; NIHR Health Protection Research Unit (HPRU) in Environmental Exposures and Health at the University of Leicester, Leicester, LE1 7RH, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK
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23
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Buawangpong N, Pinyopornpanish K, Phrommintikul A, Chindapan N, Devahastin S, Chattipakorn N, Chattipakorn SC. Increased plasma trimethylamine- N-oxide levels are associated with mild cognitive impairment in high cardiovascular risk elderly population. Food Funct 2022; 13:10013-10022. [PMID: 36069253 DOI: 10.1039/d2fo02021a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Trimethylamine-N-oxide (TMAO) has been shown to be associated with cardiovascular (CV) disease and cognitive impairment. The association between early stages of cognitive impairment and TMAO in a high CV risk population has not been previously investigated. This study aimed to investigate the association between the plasma TMAO level and cognitive function in a population with a high risk of CV disease. Participants at a high risk of CV were included. The cognition was evaluated using the Montreal Cognitive Assessment. A score lower than 25 out of 30 was used to indicate mild cognitive impairment (MCI). Blood samples of all participants (n = 233) were collected to measure the plasma levels of TMAO and other metabolic parameters, including fasting blood sugar and lipid profiles. Logistic regression was used to evaluate the association between MCI and high plasma TMAO levels, adjusted for confounding factors. Of 233 patients, the mean age of patients in this study was 64 years old (SD 8.4). The median TMAO level was 4.31 μM (IQR 3.95). The high TMAO level was an independent risk factor of MCI (aOR 2.36, 95% CI 1.02 to 5.47; p 0.046), when adjusted for age, gender, health care service scheme, smoking history, metabolic syndrome, and history of established CV events. The high TMAO level was associated with MCI, after adjustment for potential confounding factors. These findings demonstrate that plasma TMAO levels can serve for target prediction as an independent risk factor for MCI in this population.
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Affiliation(s)
- Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200
| | - Nathamol Chindapan
- Department of Food Technology, Faculty of Science, Siam University, Bangkok, Thailand 10160
| | - Sakamon Devahastin
- Advanced Food Processsing Rsesearch Laboratory, Department of Food Engineering, Faculty of Engineering, King Mongkut's University of Technology Thonburi, Bangkok, Thailand 10140.,The Academy of Science, The Royal Society of Thailand, Dusit, Bangkok, Thailand 10300
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200. .,Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200.,Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand 50200
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 50200. .,Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand 50200.,Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand 50200
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