1
|
Nghiem N, Wilson N, Krebs J, Tran T. Predicting the risk of diabetes complications using machine learning and social administrative data in a country with ethnic inequities in health: Aotearoa New Zealand. BMC Med Inform Decis Mak 2024; 24:274. [PMID: 39334279 PMCID: PMC11438423 DOI: 10.1186/s12911-024-02678-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: 08/31/2023] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND In the age of big data, linked social and administrative health data in combination with machine learning (ML) is being increasingly used to improve prediction in chronic disease, e.g., cardiovascular diseases (CVD). In this study we aimed to apply ML methods on extensive national-level health and social administrative datasets to assess the utility of these for predicting future diabetes complications, including by ethnicity. METHODS Five ML models were used to predict CVD events among all people with known diabetes in the population of New Zealand, utilizing nationwide individual-level administrative data. RESULTS The Xgboost ML model had the best predictive power for predicting CVD events three years into the future among the population with diabetes (N = 145,600). The optimization procedure also found limited improvement in prediction by ethnicity (using area under the receiver operating curve, [AUC]). The results indicated no trade-off between model predictive performance and equity gap of prediction by ethnicity (that is improving model prediction and reducing performance gaps by ethnicity can be achieved simultaneously). The list of variables of importance was different among different models/ethnic groups, for example: age, deprivation (neighborhood-level), having had a hospitalization event, and the number of years living with diabetes. DISCUSSION AND CONCLUSIONS We provide further evidence that ML with administrative health data can be used for meaningful future prediction of health outcomes. As such, it could be utilized to inform health planning and healthcare resource allocation for diabetes management and the prevention of CVD events. Our results may suggest limited scope for developing prediction models by ethnic group and that the major ways to reduce inequitable health outcomes is probably via improved delivery of prevention and management to those groups with diabetes at highest need.
Collapse
Affiliation(s)
- Nhung Nghiem
- Department of Public Health, University of Otago Wellington, Wellington City, Wellington, 6021, New Zealand.
| | - Nick Wilson
- John Curtin School of Medical Research, Australian National University, Canberra City, ACT, 2601, Australia
| | - Jeremy Krebs
- Department of Medicine, University of Otago Wellington, Wellington City, Wellington, 6021, New Zealand
| | - Truyen Tran
- Applied Artificial Intelligence Institute (A2I2), Deakin University, Geelong City, VIC, 3216, Australia
| |
Collapse
|
2
|
Pitti E, Vanni D, Viceconte N, Lembo A, Tanzilli G, Raparelli V, Petrella G, Cicero DO. Metabolic Crosstalk in Multimorbidity: Identifying Compensatory Effects Among Diabetes, Hypertension, and Dyslipidemia. J Endocr Soc 2024; 8:bvae152. [PMID: 39262573 PMCID: PMC11388003 DOI: 10.1210/jendso/bvae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Indexed: 09/13/2024] Open
Abstract
Context Metabolomics is becoming increasingly popular for detecting markers that indicate the presence of a specific disease. However, it is usually applied to studying individual ailments, yielding results that may not be directly relevant to people with multiple health conditions. Objective Our study proposes a different approach to explore metabolic crosstalk between various disease states. Design Setting and Patients We conducted a study on subjects at medium to high risk of developing coronary artery disease. We measured the plasma levels of 83 metabolites using nuclear magnetic resonance and analyzed the connections between these metabolites and various risk factors such as diabetes, hypertension, and dyslipidemia. Linear regression and multivariate analysis were combined for this purpose. Results Inspection of the metabolic maps created by our analysis helped us efficiently compare profiles. In this way, it was possible to discover opposing metabolic features among single conditions and their combination. Furthermore, we found compensating metabolic effects between diabetes, hypertension, and dyslipidemia involving mainly ketone body metabolism and fatty acid β-oxidation. Conclusion Our study introduces a novel approach to investigating how metabolism reacts to the simultaneous presence of multiple health conditions. This has allowed the detection of potential compensatory effects between diabetes, hypertension, and dyslipidemia, highlighting the complexity of metabolic crosstalk in patients with comorbidities. A better understanding of metabolic crosstalk like this could aid in developing focused treatments, resulting in improved therapeutic results.
Collapse
Affiliation(s)
- Erica Pitti
- Department of Chemical Science and Technology, University of Rome “Tor Vergata,” 00133 Rome, Italy
| | - Domitilla Vanni
- Department of Chemical Science and Technology, University of Rome “Tor Vergata,” 00133 Rome, Italy
| | - Nicola Viceconte
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University of Rome, Policlinic Umberto I, 00161 Rome, Italy
| | - Angelo Lembo
- Department of Chemical Science and Technology, University of Rome “Tor Vergata,” 00133 Rome, Italy
| | - Gaetano Tanzilli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University of Rome, Policlinic Umberto I, 00161 Rome, Italy
| | - Valeria Raparelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Greta Petrella
- Department of Chemical Science and Technology, University of Rome “Tor Vergata,” 00133 Rome, Italy
| | - Daniel O Cicero
- Department of Chemical Science and Technology, University of Rome “Tor Vergata,” 00133 Rome, Italy
| |
Collapse
|
3
|
Svahn S, Appelblad L, Lövheim H, Gustafson Y, Olofsson B, Gustafsson M. Prevalence of heart failure and trends in its pharmacological treatment between 2000 and 2017 among very old people. BMC Geriatr 2024; 24:701. [PMID: 39182036 PMCID: PMC11344298 DOI: 10.1186/s12877-024-05307-4] [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: 04/17/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024] Open
Abstract
PURPOSE The aim of this study was to describe a population of very old people with heart failure (HF), to analyse the use of cardiovascular drugs over time, and to explore factors influencing cardiovascular drug treatment for this group. METHODS All participants with information regarding HF diagnosis were selected from the Umeå 85+/Gerontological Regional Database (GERDA). The people in GERDA are all ≥85 years old. Trained investigators performed structured interviews and assessments. Information regarding medications and diagnoses was obtained from the participants and from medical records. Medical diagnoses were reviewed and confirmed by an experienced geriatrician. RESULTS In this very old population, the prevalence of HF was 29.6% among women and 30.7% among men. Between 2000 and 2017, there was an increase in the use of renin-angiotensin (RAS) inhibitors (odds ratio [OR] 1.107, 95% confidence interval [CI] 1.072-1.144) and beta-blockers (BBs) (OR 1.123, 95% CI 1.086-1.161) among persons with HF, whereas the prevalence of loop diuretics (OR 0.899, 95% CI 0.868-0.931) and digitalis (OR 0.864, 95% CI 0.828-0.901) decreased (p < 0.001 for all drug classes). Higher age was associated with lower use of RAS inhibitors and BBs. CONCLUSION In this HF population, the use of evidence-based medications for HF increased over time. This may be a sign of better awareness among prescribers regarding the under-prescribing of guidelines-recommended treatment to old people. Higher age associated with a lower prevalence of RAS inhibitors and BBs. This might indicate that further improvement is possible but could also represent a more cautious prescribing among frail very old individuals.
Collapse
Affiliation(s)
- Sofia Svahn
- Department of Medical and Translational Biology, Umeå University, Umeå, 901 87, Sweden.
| | - Leona Appelblad
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, 901 87, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, 901 87, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, 901 87, Sweden
| | - Birgitta Olofsson
- Department of Nursing, Umeå University, Umeå, 901 87, Sweden
- Department of Diagnostics and Intervention, Orthopedics, Umeå University, Umeå, 901 87, Sweden
| | - Maria Gustafsson
- Department of Medical and Translational Biology, Umeå University, Umeå, 901 87, Sweden
| |
Collapse
|
4
|
Berget AM, Moen VP, Hustoft M, Assmus J, Strand LI, Skouen JS, Hetlevik Ø. Use of primary healthcare services before and after specialized rehabilitation and its relation to changes in health and functioning: a longitudinal cohort study. J Rehabil Med 2024; 56:jrm39912. [PMID: 39161992 PMCID: PMC11348576 DOI: 10.2340/jrm.v56.39912] [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: 01/19/2024] [Accepted: 07/18/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVE To examine patients' use of primary healthcare (PHC) before and after specialized rehabilitation and its relation with self-reported health and functioning. DESIGN Longitudinal cohort study. PARTICIPANTS 451 rehabilitation patients. METHODS Register data were used to measure the frequency of visits to the general practitioner (GP) and physiotherapist (PT) in PHC 3 years before and after rehabilitation. Patients reported health (EQ-VAS) and functioning (SF-36) before rehabilitation and at 1 and 3 years after. Data are described for the total study cohort and subgroups with musculoskeletal disease (MSD) and cardiovascular disease (CVD). RESULTS There was an increase in GP and PT visits preceding rehabilitation and a gradual decrease thereafter. An exception was GP visits among patients with CVD, with few diagnosis-specific visits before but an increase after. Lower levels of health and functioning tended to be related to more frequent GP and PT visits. An indication of clinically important improvement was found among those with frequent GP visits in the MSD subgroup, and among those with 1-2 GP visits in the CVD subgroup. CONCLUSIONS The diverse relationship between health and functioning, and the use of PHC services at follow-up, may imply that additional factors besides healthcare use explain long-term improvement following rehabilitation.
Collapse
Affiliation(s)
- Anne Mette Berget
- Centre of Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Vegard Pihl Moen
- Centre of Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway; Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Merethe Hustoft
- Centre of Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway; Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
5
|
Stone CR, Harris DD, Broadwin M, Kanuparthy M, Nho JW, Yalamanchili K, Hamze J, Abid MR, Sellke FW. Semaglutide Improves Myocardial Perfusion and Performance in a Large Animal Model of Coronary Artery Disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.08.15.608191. [PMID: 39211263 PMCID: PMC11361037 DOI: 10.1101/2024.08.15.608191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Objective Coronary artery disease (CAD) is the leading cause of death worldwide. It imposes an enormous symptomatic burden on patients, leaving many with residual disease despite optimal procedural therapy, and up to 1/3 with debilitating angina amenable neither to procedures, nor to current pharmacologic options. Semaglutide, a glucagon-like peptide 1 agonist originally approved for management of diabetes, has garnered substantial attention for its capacity to attenuate cardiovascular risk. Although subgroup analyses in patients indicate promise, studies explicitly designed to isolate the impact of semaglutide on the sequelae of CAD, independently of comorbid diabetes or obesity, are lacking. Approach and Results Yorkshire swine (n=17) underwent placement of an ameroid constrictor around the left circumflex coronary artery to induce CAD. Oral semaglutide was initiated postoperatively at 1.5 mg and scaled up in 2 weeks to 3 mg in treatment animals (SEM, n=8) for a total of 5 weeks, while control animals (CON, n=9) received no drug. All then underwent myocardial harvest with acquisition of perfusion and functional data using microsphere injection and pressure-volume loop catheterization. Immunoblotting, immunohistochemistry, and immunofluorescence were performed on the most ischemic myocardial segments for mechanistic elucidation. SEM animals exhibited improved left ventricular ejection fraction, both at rest and during rapid myocardial pacing (both p<0.03), accompanied by increased perfusion to the most ischemic myocardial region at rest and during rapid pacing (both p<0.03); reduced perivascular and interstitial fibrosis (both p <0.03); and apoptosis (p=0.008). These changes were associated with increased activation of the endothelial-protective AMPK pathway (p=0.005), coupled with downstream increases in endothelial nitric oxide synthase (p=0.014). Conclusion This study is the first to reveal the capacity of oral semaglutide to augment cardiac function in the chronically ischemic heart in a highly translational large animal model, likely through AMPK-mediated improvement in endothelial function and perfusion to the ischemic myocardium.
Collapse
|
6
|
Meher T, Muhammad T, Ahmed W. Association Between Multimorbidity and Presence of Diagnosed Vision Problems Among the Middle-Aged and Older Population in India. Ophthalmic Epidemiol 2024:1-9. [PMID: 39116402 DOI: 10.1080/09286586.2024.2384061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/28/2023] [Accepted: 07/16/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE The aim of the study was to estimate the prevalence of diagnosed vision problems and to examine the association of single and multiple chronic conditions with vision problems among middle-aged and older adults in India. METHODS The study utilized data from the Longitudinal Ageing Study in India (LASI) Wave 1, (2017-18). Descriptive statistics along with bivariate and multivariable analyses were conducted to achieve the study objectives. RESULTS The prevalence of diagnosed vision problems in the sampled population was 48.2%. The older adults (60+ years) (55.3%) had shown a greater prevalence of vision problems than the middle-aged individuals (41%). Among chronic conditions, hypertension, diabetes, chronic lung diseases, chronic heart diseases, bone related diseases, psychiatric disorders, and high cholesterol were significantly associated with vision problems in the case of both middle-aged and older adults. Furthermore, odds of experiencing vision problems according to the presence of multimorbidity were higher in the middle-aged population [adjusted odds ratio (AOR) = 1.986; confidence interval (CI):1.855-2.126] than in the older population [AOR = 1.746; CI:1.644-1.854]. CONCLUSIONS Middle-aged and older adults with chronic illnesses and multimorbidity were at greater risk of vision problems. Due to the high prevalence of vision problem, interventions aimed at prevention or early detection are warranted.
Collapse
Affiliation(s)
- Trupti Meher
- Population Studies, International Institute for Population Sciences, Mumbai, India
| | - T Muhammad
- Population Studies, International Institute for Population Sciences, Mumbai, India
- Center for Healthy Aging, Pennsylvania State University, University Park, USA
| | - Waquar Ahmed
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| |
Collapse
|
7
|
Gong W, Sun P, Li X, Wang X, Zhang X, Cui H, Yang J. Investigating the Molecular Mechanisms of Resveratrol in Treating Cardiometabolic Multimorbidity: A Network Pharmacology and Bioinformatics Approach with Molecular Docking Validation. Nutrients 2024; 16:2488. [PMID: 39125368 PMCID: PMC11314475 DOI: 10.3390/nu16152488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/14/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Resveratrol is a potent phytochemical known for its potential in treating cardiometabolic multimorbidity. However, its underlying mechanisms remain unclear. Our study systematically investigates the effects of resveratrol on cardiometabolic multimorbidity and elucidates its mechanisms using network pharmacology and molecular docking techniques. METHODS We screened cardiometabolic multimorbidity-related targets using the OMIM, GeneCards, and DisGeNET databases, and utilized the DSigDB drug characterization database to predict resveratrol's effects on cardiometabolic multimorbidity. Target identification for resveratrol was conducted using the TCMSP, SymMap, DrugBank, Swiss Target Prediction, CTD, and UniProt databases. SwissADME and ADMETlab 2.0 simulations were used to predict drug similarity and toxicity profiles of resveratrol. Protein-protein interaction (PPI) networks were constructed using Cytoscape 3.9.1 software. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment analyses were performed via the DAVID online platform, and target-pathway networks were established. Molecular docking validated interactions between core targets and resveratrol, followed by molecular dynamics simulations on the optimal core proteins identified through docking. Differential analysis using the GEO dataset validated resveratrol as a core target in cardiometabolic multimorbidity. RESULTS A total of 585 cardiometabolic multimorbidity target genes were identified, and the predicted results indicated that the phytochemical resveratrol could be a major therapeutic agent for cardiometabolic multimorbidity. SwissADME simulations showed that resveratrol has potential drug-like activity with minimal toxicity. Additionally, 6703 targets of resveratrol were screened. GO and KEGG analyses revealed that the main biological processes involved included positive regulation of cell proliferation, positive regulation of gene expression, and response to estradiol. Significant pathways related to MAPK and PI3K-Akt signaling pathways were also identified. Molecular docking and molecular dynamics simulations demonstrated strong interactions between resveratrol and core targets such as MAPK and EGFR. CONCLUSIONS This study predicts potential targets and pathways of resveratrol in treating cardiometabolic multimorbidity, offering a new research direction for understanding its molecular mechanisms. Additionally, it establishes a theoretical foundation for the clinical application of resveratrol.
Collapse
Affiliation(s)
- Wei Gong
- Public Health School, Ningxia Medical University, Yinchuan 750004, China; (W.G.)
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
- School of Medical Information and Engineering, Ningxia Medical University, Yinchuan 750004, China
| | - Peng Sun
- Public Health School, Ningxia Medical University, Yinchuan 750004, China; (W.G.)
- Science and Technology Center, Ningxia Medical University, Yinchuan 750001, China
- Ningxia Hui Autonomous Region Institute of Medical Sciences, Ningxia Medical University, Yinchuan 750004, China
| | - Xiujing Li
- School of Pharmacy, Ningxia Medical University, Yinchuan 750004, China
| | - Xi Wang
- School of Pharmacy, Ningxia Medical University, Yinchuan 750004, China
| | - Xinyu Zhang
- School of Medical Information and Engineering, Ningxia Medical University, Yinchuan 750004, China
| | - Huimin Cui
- Public Health School, Ningxia Medical University, Yinchuan 750004, China; (W.G.)
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| | - Jianjun Yang
- Public Health School, Ningxia Medical University, Yinchuan 750004, China; (W.G.)
- Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan 750004, China
| |
Collapse
|
8
|
Baser O, Samayoa G, Rodchenko K, Isenman L, Baser E, Yapar N. The association between weight loss medications and cardiovascular complications. Obesity (Silver Spring) 2024; 32:1401-1409. [PMID: 38706431 DOI: 10.1002/oby.24037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Obesity and its cardiovascular complications are major causes of morbidity and mortality. Little is known in real-world settings about the effect of newly approved antiobesity medications (AOMs) on cardiovascular complications among patients with obesity. METHODS This retrospective cohort study examined the association between newly approved AOM use and cardiovascular events among Medicare patients with obesity using data from 2020 to 2022. Patient age, gender, comorbidity scores, socioeconomic status, and baseline cardiovascular comorbidities were compared descriptively. Subgroup analysis compared variables by medication type. Relative risk and absolute risk of cardiovascular disease (CVD) events were estimated using Cox and Aalen regression models. RESULTS The analysis included 5926 patients treated with semaglutide and tirzepatide, including Ozempic (5404 patients), Wegovy (375 patients), or Mounjaro (147 patients). Hypertension, type 2 diabetes, and hyperlipidemia were the most common comorbidities. For patients with AOMs, less incidence of heart failure (4.89% vs. 6.13%, p < 0.0001), atrial fibrillation (3.83% vs. 5.17%, p < 0.0001), arrhythmia (3.59% vs. 4.14%, p < 0.0153), and peripheral vascular disease (3.44% vs. 2.94%, p < 0.0395) was found versus patients without AOMs. Patients receiving AOMs showed an 8% risk reduction in any CVD. Protective effect on CVD was apparent over the first 375 days. CONCLUSIONS Results suggest that utilization of AOMs effectively alleviates the high prevalence of CVD.
Collapse
Affiliation(s)
- Onur Baser
- Department of Economics, Bogazici University, Istanbul, Turkey
- Graduate School of Public Health, City University of New York, New York, New York, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | | | | | - Erdem Baser
- Columbia Data Analytics, New York, New York, USA
| | - Nehir Yapar
- Columbia Data Analytics, New York, New York, USA
| |
Collapse
|
9
|
Rouhi AD, Roberson JL, Alberstadt AN, Shah SK, Maurer M, Bader E, Williams NN, Dumon KR. Enteral Access Outcomes in Patients Hospitalized With Cardiac Disease: A Retrospective Cohort Study. J Surg Res 2024; 299:43-50. [PMID: 38701703 DOI: 10.1016/j.jss.2024.04.005] [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: 11/09/2023] [Revised: 03/13/2024] [Accepted: 04/07/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Patients admitted with principal cardiac diagnosis (PCD) can encounter difficult inpatient stays that are often marked by malnutrition. In this setting, enteral feeding may improve nutritional status. This study examined the association of PCD with perioperative outcomes after elective enteral access procedures. METHODS Adult patients who underwent enteral access procedures between 2018 and 2020 at a tertiary care institution were reviewed retrospectively. Differences in baseline characteristics between patients with and without PCD were adjusted using entropy balancing. Multivariable logistic and linear regressions were subsequently developed to evaluate the association between PCD and nutritional outcomes, perioperative morbidity and mortality, length of stay, and nonelective readmission after enteral access. RESULTS 912 patients with enteral access met inclusion criteria, of whom 84 (9.2%) had a diagnosis code indicating PCD. Compared to non-PCD, patients with PCD more commonly received percutaneous endoscopic gastrostomy by general surgery and had a higher burden of comorbidities as measured by the Charlson comorbidity index. Multivariable risk adjustment generated a strongly balanced distribution of baseline covariates between patient groups (standardized differences ranged from -2.45 × 10-8 to 3.18 × 108). After adjustment, despite no significant association with in-hospital mortality, percentage change prealbumin, length of stay, or readmission, PCD was associated with an approximately 2.25-day reduction in time to meet goal feeds (95% CI -3.76 to -0.74, P = 0.004) as well as decreased odds of reoperation (adjusted odds ratio 0.28, 95% CI 0.09-0.86, P = 0.026) and acute kidney injury (adjusted odds ratio 0.24, 95% CI 0.06-0.91, P = 0.035). CONCLUSIONS Despite having more comorbidities than non-PCD, adult enteral access patients with PCD experienced favorable nutritional and perioperative outcomes.
Collapse
Affiliation(s)
- Armaun D Rouhi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey L Roberson
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angelika N Alberstadt
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Simrin Kesmia Shah
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madeline Maurer
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Bader
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noel N Williams
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
10
|
Kaushal A, Karimi DM, Nazari DR, Opare K, Museru M, Reza Nikoo DM. Environmental Exposure and Respiratory Health: Unraveling the Impact of Toxic Release Inventory Facilities on COPD Prevalence. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024:124286. [PMID: 38823548 DOI: 10.1016/j.envpol.2024.124286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024]
Abstract
This cross-sectional geospatial analysis explores the prevalence of Chronic Obstructive Pulmonary Disease (COPD) concerning the proximity to toxic release inventory (TRI) facilities in Jefferson County, Alabama. Employing the fuzzy analytical hierarchy process (FAHP), the study evaluates COPD prevalence, comorbidities, healthcare access, and individual health assessments. Given the mounting evidence linking environmental pollutants to COPD exacerbations, the research probes the influence of TRI sites on respiratory health, integrating Geographic Information Systems (GIS) to scrutinize the geospatial vulnerability of communities neighboring TRI sites. Socio-demographic disparities, economic conditions, and air pollution are emphasized in the analysis. The EPA's Toxic Release Inventory serves as the cornerstone for assessing the association between TRI proximity and COPD prevalence. The analysis uncovers a notable inverse correlation between distance from TRI sites and COPD prevalence, signaling potential health risks for populations residing closer to these facilities. Moreover, factors such as minority status, low income, and air pollution are associated with higher COPD prevalence, underscoring the imperative of comprehending the interplay between environmental exposure and respiratory health. This study bridges gaps in the literature by addressing the geographical nexus between COPD prevalence and pollution exposure. By leveraging FAHP, the research furnishes a holistic understanding of the multifaceted factors influencing vulnerability to COPD. The findings underscore the necessity for targeted public health interventions and policy measures to redress environmental disparities and alleviate the repercussions of TRI facilities on respiratory health.
Collapse
Affiliation(s)
- Aishwarya Kaushal
- Sustainable Smart Cities Research Center, University of Alabama-Birmingham, Birmingham, AL, USA; Department of Environmental Health Sciences, School of Public Health, the University of Alabama at Birmingham
| | - Dr Maryam Karimi
- Sustainable Smart Cities Research Center, University of Alabama-Birmingham, Birmingham, AL, USA; Department of Environmental Health Sciences, School of Public Health, the University of Alabama at Birmingham; Department of Civil, Construction, and Environmental Engineering, School of Engineering, the University of Alabama at Birmingham
| | - Dr Rouzbeh Nazari
- Sustainable Smart Cities Research Center, University of Alabama-Birmingham, Birmingham, AL, USA; Department of Environmental Health Sciences, School of Public Health, the University of Alabama at Birmingham; Department of Civil, Construction, and Environmental Engineering, School of Engineering, the University of Alabama at Birmingham.
| | - Kofi Opare
- Sustainable Smart Cities Research Center, University of Alabama-Birmingham, Birmingham, AL, USA; Department of Civil, Construction, and Environmental Engineering, School of Engineering, the University of Alabama at Birmingham
| | - Mujungu Museru
- Sustainable Smart Cities Research Center, University of Alabama-Birmingham, Birmingham, AL, USA; Department of Civil, Construction, and Environmental Engineering, School of Engineering, the University of Alabama at Birmingham
| | - Dr Mohammad Reza Nikoo
- Department of Civil and Architectural Engineering, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
11
|
Sehgal R, Markov Y, Qin C, Meer M, Hadley C, Shadyab AH, Casanova R, Manson JE, Bhatti P, Crimmins EM, Hägg S, Assimes TL, Whitsel EA, Higgins-Chen AT, Levine M. Systems Age: A single blood methylation test to quantify aging heterogeneity across 11 physiological systems. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.07.13.548904. [PMID: 37503069 PMCID: PMC10370047 DOI: 10.1101/2023.07.13.548904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Individuals, organs, tissues, and cells age in diverse ways throughout the lifespan. Epigenetic clocks attempt to quantify differential aging between individuals, but they typically summarize aging as a single measure, ignoring within-person heterogeneity. Our aim was to develop novel systems-based methylation clocks that, when assessed in blood, capture aging in distinct physiological systems. We combined supervised and unsupervised machine learning methods to link DNA methylation, system-specific clinical chemistry and functional measures, and mortality risk. This yielded a panel of 11 system-specific scores- Heart, Lung, Kidney, Liver, Brain, Immune, Inflammatory, Blood, Musculoskeletal, Hormone, and Metabolic. Each system score predicted a wide variety of outcomes, aging phenotypes, and conditions specific to the respective system. We also combined the system scores into a composite Systems Age clock that is predictive of aging across physiological systems in an unbiased manner. Finally, we showed that the system scores clustered individuals into unique aging subtypes that had different patterns of age-related disease and decline. Overall, our biological systems based epigenetic framework captures aging in multiple physiological systems using a single blood draw and assay and may inform the development of more personalized clinical approaches for improving age-related quality of life.
Collapse
|
12
|
Kurabayashi A, Iwashita W, Furihata K, Fukuhara H, Inoue K. Potential effect of the non-neuronal cardiac cholinergic system on hepatic glucose and energy metabolism. Front Cardiovasc Med 2024; 11:1381721. [PMID: 38818213 PMCID: PMC11137232 DOI: 10.3389/fcvm.2024.1381721] [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: 02/04/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024] Open
Abstract
The vagus nerve belongs to the parasympathetic nervous system, which is involved in the regulation of organs throughout the body. Since the discovery of the non-neuronal cardiac cholinergic system (NNCCS), several studies have provided evidence for the positive role of acetylcholine (ACh) released from cardiomyocytes against cardiovascular diseases, such as sympathetic hyperreactivity-induced cardiac remodeling and dysfunction as well as myocardial infarction. Non-neuronal ACh released from cardiomyocytes is believed to regulate key physiological functions of the heart, such as attenuating heart rate, offsetting hypertrophic signals, maintaining action potential propagation, and modulating cardiac energy metabolism through the muscarinic ACh receptor in an auto/paracrine manner. Moreover, the NNCCS may also affect peripheral remote organs (e.g., liver) through the vagus nerve. Remote ischemic preconditioning (RIPC) and NNCCS activate the central nervous system and afferent vagus nerve. RIPC affects hepatic glucose and energy metabolism through the central nervous system and vagus nerve. In this review, we discuss the mechanisms and potential factors responsible for NNCCS in glucose and energy metabolism in the liver.
Collapse
Affiliation(s)
| | - Waka Iwashita
- Department of Pathology, Kochi Medical School, Nankoku, Japan
| | - Kaoru Furihata
- Department of Pathology, Kochi Medical School, Nankoku, Japan
| | - Hideo Fukuhara
- Department of Urology, Kochi Medical School, Nankoku, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Nankoku, Japan
| |
Collapse
|
13
|
Münzel T, Molitor M, Kuntic M, Hahad O, Röösli M, Engelmann N, Basner M, Daiber A, Sørensen M. Transportation Noise Pollution and Cardiovascular Health. Circ Res 2024; 134:1113-1135. [PMID: 38662856 DOI: 10.1161/circresaha.123.323584] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Epidemiological studies have found that transportation noise increases the risk for cardiovascular morbidity and mortality, with solid evidence for ischemic heart disease, heart failure, and stroke. According to the World Health Organization, at least 1.6 million healthy life years are lost annually from traffic-related noise in Western Europe. Traffic noise at night causes fragmentation and shortening of sleep, elevation of stress hormone levels, and increased oxidative stress in the vasculature and the brain. These factors can promote vascular (endothelial) dysfunction, inflammation, and arterial hypertension, thus elevating cardiovascular risk. The present review focusses on the indirect, nonauditory cardiovascular health effects of noise. We provide an updated overview of epidemiological research on the effects of transportation noise on cardiovascular risk factors and disease, and mechanistic insights based on the latest clinical and experimental studies and propose new risk markers to address noise-induced cardiovascular effects in the general population. We will discuss the potential effects of noise on vascular dysfunction, oxidative stress, and inflammation in humans and animals. We will elaborately explain the underlying pathomechanisms by alterations of gene networks, epigenetic pathways, circadian rhythm, signal transduction along the neuronal-cardiovascular axis, and metabolism. We will describe current and future noise mitigation strategies. Finally, we will conduct an overall evaluation of the status of the current evidence of noise as a significant cardiovascular risk factor.
Collapse
Affiliation(s)
- Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Germany (T.M., M.M., M.K., O.H., A.D.)
- German Centre for Cardiovascular Research (DZHK), Rhine-Main, Germany (T.M., M.M., O.H., A.D.)
| | - Michael Molitor
- Department of Cardiology, University Medical Center Mainz, Germany (T.M., M.M., M.K., O.H., A.D.)
- German Centre for Cardiovascular Research (DZHK), Rhine-Main, Germany (T.M., M.M., O.H., A.D.)
| | - Marin Kuntic
- Department of Cardiology, University Medical Center Mainz, Germany (T.M., M.M., M.K., O.H., A.D.)
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz, Germany (T.M., M.M., M.K., O.H., A.D.)
- German Centre for Cardiovascular Research (DZHK), Rhine-Main, Germany (T.M., M.M., O.H., A.D.)
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Department Epidemiology and Public Health, University of Basel, Switzerland (M.R., N.E.)
| | - Nicole Engelmann
- Swiss Tropical and Public Health Institute, Department Epidemiology and Public Health, University of Basel, Switzerland (M.R., N.E.)
| | - Mathias Basner
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (M.B.)
| | - Andreas Daiber
- Department of Cardiology, University Medical Center Mainz, Germany (T.M., M.M., M.K., O.H., A.D.)
- German Centre for Cardiovascular Research (DZHK), Rhine-Main, Germany (T.M., M.M., O.H., A.D.)
| | - Mette Sørensen
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark (M.S.)
- Department of Natural Science and Environment, Roskilde University, Denmark (M.S.)
| |
Collapse
|
14
|
Hu B, He X, Sun H, Hu Y, Li F, Sun Y, Sun J, Feng L. Red and processed meat intake and risk of cardiovascular disease: A two-sample Mendelian randomization study. Clin Nutr ESPEN 2024; 60:289-297. [PMID: 38479924 DOI: 10.1016/j.clnesp.2024.02.014] [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: 07/23/2023] [Revised: 01/20/2024] [Accepted: 02/16/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Previous observational studies have yielded inconsistent findings regarding associations between red/processed meat intake and the risk of cardiovascular disease (CVD). Some studies have suggested positive relationships, while others have demonstrated no significant associations. However, causal effects remain uncertain. This 2023 Mendelianrandomization (MR) study investigated the causal relationship between red and processed meat (porkmeat, mutton meat, beef meat)intake and CVD risk by analyzing summary data from the UK Biobank (exposure), CARDIoGRAMplusC4D (coronary artery disease [CAD]), MEGASTROKE (stroke), Nielsen et al. (atrial fibrillation [AF]), HERMES (heart failure [HF]), and FinnGen (cardiovascular outcomes) public databases. METHODS Genome-wide association studies (GWAS) of red meat (pork, beef, and mutton) and processed meat were sourced from the United Kingdom (UK) Biobank. GWAS data on CVD for this study were obtained from the Gene and FinnGen consortia. The primary method employed for the two-sample MR analysis was inverse variance weighting (IVW). Sensitivity analysis was performed to assess the reliability and consistency of the results. RESULTS Genetically predicted red and processed meat consumption did not demonstrate a causal association with any CVD outcomes when employing the IVW method. For processed meat intake, the odds ratios (ORs) (95% confidence intervals CIs) in large consortia were as follows: 0.88 (0.56-1.39) for CAD, 0.91 (0.65-1.27) for AF, 0.84 (0.58-1.21) for HF, and 1.00 (0.75-1.05) for stroke. In FinnGen, the ORs were as follows: 1.15 (0.83-1.59) for CAD, 1.25 (0.75-2.07) for AF, 1.09 (0.73-1.64) for HF, and 1.27 (0.85-1.91) for stroke. For beef intake, the ORs (95% CIs) in large consortia were as follows: 0.70 (0.28-1.73) for CAD, 0.85 (0.49-1.49) for AF, 0.80 (0.35-1.83) for HF, and 1.29 (0.85-1.95) for stroke. In FinnGen, the ORs were as follows: 2.01 (0.75-5.39) for CAD, 1.83 (0.60-5.56) for AF, 0.80 (0.30-2.13) for HF, and 1.30 (0.62-2.73) for stroke. For pork intake, the ORs (95% CIs) in large consortia were as follows: 1.25 (0.37-4.22) for CAD, 1.26 (0.73-2.15) for AF, 1.71 (0.86-3.39) for HF, and 1.15 (0.63-2.11) for stroke. In FinnGen, the ORs were as follows: 1.12 (0.43-2.88) for CAD, 0.39 (0.08-1.83) for AF, 0.62 (0.20-1.88) for HF, and 0.60 (0.21-1.65) for stroke. For mutton intake, the ORs (95% CIs) in large consortia were as follows: 0.84 (0.48-1.44) for CAD, 0.84 (0.56-1.26) for AF, 1.04 (0.65-1.67) for HF, and 1.06 (0.77-1.45) for stroke. In FinnGen, the ORs were as follows: 1.20 (0.65-2.21) for CAD, 0.92 (0.44-1.92) for AF, 0.74 (0.34-1.58) for HF, and 0.75 (0.45-1.24) for stroke. The results remained robust and consistent in both the meta-analysis and supplementary MR analysis. CONCLUSIONS This MR study demonstrated no significant causal relationships between red/processed meat intake and the risk of the four CVD outcomes examined. Further investigation is warranted to confirm these findings.
Collapse
Affiliation(s)
- Bing Hu
- Department of Cardiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Xin He
- Department of Hematology, Zhongshan City People's Hospital, Zhongshan City, Guangdong, China
| | - Hao Sun
- Tumor Surgery Department, Zhongshan City People's Hospital, Zhongshan City, Guangdong, China
| | - Yongyi Hu
- Department of Cardiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China; Department of Chronic Disease Management, Zhongshan City People's Hospital, Zhongshan City, Guangdong, China
| | - Fei Li
- Department of Cardiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Yanxiang Sun
- Department of Cardiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Jie Sun
- Department of Cardiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Li Feng
- Department of Cardiology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China.
| |
Collapse
|
15
|
Elkattawy O, Phansalkar JV, Elkattawy S, Mohamed O, Javed J, Hossain A, Larry K, Patel S, Shah Y, Shamoon F. The Impact of Coronary Artery Disease on Outcomes in Patients With Peripartum Cardiomyopathy. Cureus 2024; 16:e59269. [PMID: 38813289 PMCID: PMC11135137 DOI: 10.7759/cureus.59269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction The purpose of this study was to determine the prevalence of coronary artery disease (CAD) among patients admitted with peripartum cardiomyopathy (PPCM) as well as to analyze the independent association of CAD with in-hospital outcomes among PPCM patients. Methods Data were obtained from the National Inpatient Sample from January 2016 to December 2019. We assessed the independent association of CAD with outcomes in patients admitted with PPCM. Predictors of mortality in patients admitted with PPCM were also analyzed. Results There was a total of 4,730 patients with PPCM, 146 of whom had CAD (3.1%). Multivariate analysis demonstrated that CAD in patients with PPCM was independently associated with several outcomes, and, among them, ST-segment elevation myocardial infarction (STEMI) (adjusted odds ratio (aOR): 58.457, 95% CI: 5.403-632.504, p= 0.001) was positively associated with CAD. CAD was found to be protective against preeclampsia (aOR: 0.351, 95% CI: 0.126-0.979, p = 0.045). Predictors of in-hospital mortality for patients with PPCM include cardiogenic shock (aOR: 12.818, 95% CI: 7.332-22.411, p = 0.001), non-ST elevation myocardial infarction (NSTEMI) (OR: 3.429, 95% CI: 1.43-8.22, p = 0.006), chronic kidney disease (OR: 2.851, 95% CI: 1.495-5.435, p = 0.001), and atrial fibrillation (OR: 2.326, 95% CI: 1.145-4.723, p = 0.020). Conclusion In a large cohort of patients admitted with PPCM, we found the prevalence of CAD to be 3.1%. CAD was associated with several adverse outcomes, including STEMI, but protective against preeclampsia.
Collapse
Affiliation(s)
- Omar Elkattawy
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Jay V Phansalkar
- Cardiothoracic Surgery, Rutgers University New Jersey Medical School, Newark, USA
| | - Sherif Elkattawy
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
| | - Omar Mohamed
- Medicine, Saint Barnabas Medical Center, Livingston, USA
| | - Jahanzeb Javed
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Afif Hossain
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Kulsum Larry
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Shriya Patel
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Yash Shah
- Radiology, Rutgers University New Jersey Medical School, Newark, USA
| | - Fayez Shamoon
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
| |
Collapse
|
16
|
Reitzinger S, Reiss M, Czypionka T. Costs attributable to hypercholesterolemia in a single period and over the life cycle. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01684-0. [PMID: 38517666 DOI: 10.1007/s10198-024-01684-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 02/05/2024] [Indexed: 03/24/2024]
Abstract
Hypercholesterolemia is a major risk factor for atherosclerotic cardiovascular disease leading to reduced (healthy) life years. The aim of this study is to quantify the societal costs associated with hypercholesterolemia. We use epidemiologic data on the distribution of cholesterol levels as well as data on relative risks regarding ischemic heart disease, stroke, and other cardiovascular diseases. The analytical approach is based on the use of population-attributable fractions applied to direct medical, direct non-medical and indirect costs using data of Austria. Within a life-cycle analysis we sum up the costs of hypercholesterolemia for the population of 2019 and, thus, consider future morbidity and mortality effects on this population. Epidemiologic data suggest that approximately half of Austria's population have low-density lipoprotein cholesterol (LDL-C) levels above the target levels (i.e., are exposed to increased risk). We estimate that 8.2% of deaths are attributable to hypercholesterolemia. Total costs amount to about 0.33% of GDP in the single-period view. In the life-cycle perspective, total costs amount to €806.06 million, €312.1 million of which are medical costs, and about €494 million arise due to production loss associated with hypercholesterolemia. The study points out that significant shares of deaths, entries into disability pension and care allowance, full-time equivalents lost to the labor market as well as monetary costs for the health system and the society could be avoided if LDL-C-levels of the population were reduced.
Collapse
Affiliation(s)
| | - Miriam Reiss
- Institute for Advanced Studies, Josefstädter Str. 39, 1080, Vienna, Austria
| | - Thomas Czypionka
- Institute for Advanced Studies, Josefstädter Str. 39, 1080, Vienna, Austria
- London School of Economics and Political Science, London, UK
| |
Collapse
|
17
|
Sansonetti M, Al Soodi B, Thum T, Jung M. Macrophage-based therapeutic approaches for cardiovascular diseases. Basic Res Cardiol 2024; 119:1-33. [PMID: 38170281 PMCID: PMC10837257 DOI: 10.1007/s00395-023-01027-9] [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: 05/03/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
Despite the advances in treatment options, cardiovascular disease (CVDs) remains the leading cause of death over the world. Chronic inflammatory response and irreversible fibrosis are the main underlying pathophysiological causes of progression of CVDs. In recent decades, cardiac macrophages have been recognized as main regulatory players in the development of these complex pathophysiological conditions. Numerous approaches aimed at macrophages have been devised, leading to novel prospects for therapeutic interventions. Our review covers the advancements in macrophage-centric treatment plans for various pathologic conditions and examines the potential consequences and obstacles of employing macrophage-targeted techniques in cardiac diseases.
Collapse
Affiliation(s)
- Marida Sansonetti
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, 30625, Hannover, Germany
| | - Bashar Al Soodi
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, 30625, Hannover, Germany
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, 30625, Hannover, Germany.
- REBIRTH-Center for Translational Regenerative Medicine, Hannover Medical School, 30625, Hannover, Germany.
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), 30625, Hannover, Germany.
| | - Mira Jung
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, 30625, Hannover, Germany.
| |
Collapse
|
18
|
Xu Y, Wang Q, Zou J, Chen Y, Zhou J, Dai W, Liu R, Liu M, Li X, Jiang S. CHD-related/specific mortality of 3.17 million people in a transitioning region: trends, risk factors, and prevention. Aging Clin Exp Res 2023; 35:3147-3156. [PMID: 37985650 DOI: 10.1007/s40520-023-02618-1] [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: 09/18/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Demographic shifts cause uncertain changes in the burden of coronary heart disease (CHD) in transitioning regions. We aimed to analyze the trends of CHD burden and its risk factors in Pudong, Shanghai, and explore prevention strategies for transitioning regions. METHODS We analyzed CHD-related and CHD-specific deaths in Pudong from 2005 to 2020, including the crude mortality rate (CMR), age-standardized mortality rate worldwide (ASMRW), years of life lost (YLL), and age-specific proportions. We also examined the impact of population aging on the burden of CHD. The Joinpoint Regression Program was used to analyze trends, and the decomposition method was used to evaluate the impact of demographics on the mortality rate. RESULTS Of the 86,171 CHD-related deaths, 52,152 (60.52%) were CHD-specific deaths. For both CHD-related and CHD-specific deaths, there was a significant increase in the CMR, ASMRW, and YLL rate, except in the 70-79-year age group, which exhibited a distinctive and statistically significant decline in these rates (all P < 0.05). There were steadily increasing trends in the rates caused by aging from 2005 to 2020, with average annual percent changes (AAPCs) of 42.59% and 41.43%, respectively (all P < 0.05). CONCLUSIONS Our results indicate that the CHD burden in Pudong has been persistently increasing, but in the age group of 70-79 years, substantial declines were observed. The quality of primary healthcare services may be a critical point in addressing the overwhelming CHD burden.
Collapse
Affiliation(s)
- Yaxin Xu
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
- Department of General Practice, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Qizhe Wang
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
- Department of General Practice, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Jian Zou
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Yichen Chen
- Office of Scientific Research and Information Management, Centres for Disease Control and Prevention, Pudong New Area, Shanghai, 200136, China
- Office of Scientific Research and Information Management, Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai, 200136, China
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Jing Zhou
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Wei Dai
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Ru Liu
- Department of General Practice, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China
| | - Ming Liu
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China.
- Shanghai Engineering Research Centre of AI Technology for Cardiopulmonary Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Xiaopan Li
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China.
- Office of Scientific Research and Information Management, Pudong Institute of Preventive Medicine, Pudong New Area, Shanghai, 200136, China.
| | - Sunfang Jiang
- Department of Health Management Centre, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China.
- Department of General Practice, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd., Xuhui, Shanghai, 200032, China.
| |
Collapse
|
19
|
Kim MJ, Tabtabai SR, Aseltine RH. Predictors of 30-Day Readmission in Patients Hospitalized With Heart Failure as a Primary Versus Secondary Diagnosis. Am J Cardiol 2023; 207:407-417. [PMID: 37782972 DOI: 10.1016/j.amjcard.2023.08.111] [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: 05/18/2023] [Revised: 08/11/2023] [Accepted: 08/20/2023] [Indexed: 10/04/2023]
Abstract
Short-term rehospitalizations are common, costly, and detrimental to patients with heart failure (HF). Current research and policy have focused primarily on 30-day readmissions for patients with HF as a primary diagnosis at index hospitalization, whereas a much larger population of patients are admitted with HF as a secondary diagnosis. This study aims to compare patients initially hospitalized for HF as either a primary or a secondary diagnosis, and to identify the most important factors in predicting 30-day readmission. Patients admitted with HF between 2014 and 2016 in the Nationwide Readmissions Database were included and divided into 2 cohorts: those admitted with a primary and secondary diagnosis of HF. Multivariable logistic regression was performed to predict 30-day readmission. Statistically significant predictors in multivariable logistic regression were used for dominance analysis to rank these factors by relative importance. Co-morbidities were the major driver of increased risk of 30-day readmission in both groups. Individual Elixhauser co-morbidities and the Elixhauser co-morbidity indexes were significantly associated with an increase in 30-day readmission. The 5 most important predictors of 30-day readmission according to dominance analysis were age, Elixhauser co-morbidity indexes of co-morbidity complications and readmission, number of diagnoses, and renal failure. These 5 factors accounted for 68% of the 30-day readmission risk. Measures of patient co-morbidities were among the strongest predictors of readmission risk. This study highlights the importance of expanding predictive models to include a broader set of clinical measures to create better-performing models of readmission risk for HF patients.
Collapse
Affiliation(s)
- Min-Jung Kim
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut; Center for Population Health, UConn Health, Farmington, Connecticut
| | - Sara R Tabtabai
- Heart Failure and Population Health, Trinity Health of New England, Hartford, Connecticut; Women's Heart Program, Saint Francis Hospital, Hartford, Connecticut
| | - Robert H Aseltine
- Division of Behavioral Sciences and Community Health; Center for Population Health, UConn Health, Farmington, Connecticut.
| |
Collapse
|
20
|
Birdal O. The Relationship Between C-reactive Protein Albumin Ratio and Long-Term Mortality in Patients With Acute Coronary Syndrome. Cureus 2023; 15:e47222. [PMID: 38022331 PMCID: PMC10653625 DOI: 10.7759/cureus.47222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Coronary artery disease (CAD) is one of the leading causes of death worldwide. CRP/albumin ratio is a sensitive indicator of inflammatory status. It has been shown that this parameter may be associated with poor short-term outcomes in CAD. In this study, we investigated the relationship between long-term mortality and the CRP/albumin ratio in patients with acute coronary syndromes (ACS). Material and methods This study was conducted on patients who applied to our hospital between January 2015 and December 2019 and were diagnosed with ACS. A total of 1689 patients were included in the study. Patients were divided into two groups according to mortality status, and long-term mortality predictors were investigated. Results The average follow-up period was 38.9±10.3 months. The mean age of the entire study group was 56.6±12.2 years, and 1440 (80.5%) of the patients were male. Comorbid diseases and blood parameters were significant between the two groups. In the regression analysis, creatine, hemoglobin, white blood cell count (WBC), neutrophil-lymphocyte ratio (NLR), and CRP albumin ratio (CAR) were found to be independent predictors. In the ROC analysis, it was observed that CAR had the best predictive value. Discussion An increased CAR level is an independent predictor of long-term mortality in ACS patients. It can be used in both short-term and long-term risk stratification for ACS patients.
Collapse
Affiliation(s)
- Oğuzhan Birdal
- Cardiology, Ataturk University Faculty of Medicine, Erzurum, TUR
| |
Collapse
|
21
|
Rogliani P, Radovanovic D, Ora J, Starc N, Verri S, Pistocchini E, Calzetta L. Assessing the relationship between cardiovascular and small airway disease and acute events in COPD: The ARCADIA study protocol. Pulm Pharmacol Ther 2023; 82:102231. [PMID: 37414133 DOI: 10.1016/j.pupt.2023.102231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
The initial alterations of chronic obstructive pulmonary disease (COPD) involve the small airways. Small airway disease (SAD) is related to lung hyperinflation and air trapping. Several lung function tests may detect the presence of SAD, namely forced mid-expiratory flows, residual volume (RV), RV/total lung capacity (TLC) ratio, functional residual capacity, airway resistances obtained with body-plethysmography and oscillometry, and the single-breath nitrogen washout test. Additionally, high-resolution computed tomography can detect SAD. In addition to SAD, COPD is related to cardiovascular disease (CVD) such as heart failure, peripheral vascular disease, and ischemic heart disease. No studies have assessed the relationship between CVD, COPD, and SAD. Therefore, the main objective of the Assessing the Relationship between Cardiovascular and small Airway Disease and Acute events in COPD (ARCADIA) study is to assess the risk of CVD in COPD patients according to SAD in a real-life setting. The correlation between CVD, mortality, and acute exacerbation of COPD (AECOPD) is also evaluated. ARCADIA is a 52-week prospective, multicentre, pilot, observational, cohort study conducted in ≥22 pulmonary centres in Italy and that enrols ≥500 COPD patients, regardless of disease severity (protocol registration: ISRCTN49392136). SAD is evaluated at baseline, after that CVD, mortality, and AECOPD are recorded at 6 and 12 months. Bayesian inference is used to quantify the risk and correlation of the investigated outcomes in COPD patients according to SAD. The ARCADIA study provides relevant findings in the daily clinical management of COPD patients.
Collapse
Affiliation(s)
- Paola Rogliani
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Josuel Ora
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nadia Starc
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Stefano Verri
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Elena Pistocchini
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
22
|
Robison RD, Singh M, Jiang L, Riester M, Duprey M, McGeary JE, Goyal P, Wu WC, Erqou S, Zullo A, Rudolph JL, Rogus-Pulia N. Acute Antipsychotic Use and Presence of Dysphagia Among Older Veterans with Heart Failure. J Am Med Dir Assoc 2023; 24:1303-1310. [PMID: 37478895 PMCID: PMC10527768 DOI: 10.1016/j.jamda.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Examine whether new antipsychotic (AP) exposure is associated with dysphagia in hospitalized patients with heart failure (HF). DESIGN Retrospective cohort. SETTINGS AND PARTICIPANTS AP-naïve Veterans hospitalized with HF and subsequently discharged to a skilled nursing facility (SNF) between October 1, 2010, and November 30, 2019. METHODS We linked Veterans Health Administration (VHA) electronic medical records with Centers for Medicare & Medicaid (CMS) Minimum Data Set (MDS) version 3.0 assessments and CMS claims. The exposure variable was administration of ≥1 dose of a typical or atypical AP during hospitalization. Our main outcome measure was dysphagia presence defined by (1) inpatient dysphagia diagnosis codes and (2) the SNF admission MDS 3.0 swallowing-related items to examine post-acute care dysphagia status. Inverse probability of treatment weighting was used for risk adjustment. RESULTS The analytic cohort consisted of 29,591 Veterans (mean age 78.5 ± 10.0 years; female 2.9%; n = 865). Acute APs were administered to 9.9% (n = 2941). Those receiving APs had differences in prior dementia [37.1%, n = 1091, vs 22.3%, n = 5942; standardized mean difference (SMD) = 0.33] and hospital delirium diagnoses (7.7%, n = 227 vs 2.8%, n = 754; SMD = 0.22). Acute AP exposure was associated with nearly double the risk for hospital dysphagia diagnosis codes [adjusted (adj.) relative risk (RR) 1.9, 95% CI 1.8, 2.1]. At the SNF admission MDS assessment, acute AP administration during hospitalization was associated with an increased dysphagia risk (adj. RR 1.2, 95% CI 1.0, 1.5) both in the oral (adj. RR 1.7, 95% CI 1.2, 2.0) and pharyngeal phases (adj. RR 1.3, 95% CI 1.0, 1.7). CONCLUSIONS AND IMPLICATIONS In this retrospective study, AP medication exposure was associated with increased dysphagia coding and MDS assessment. Considering other adverse effects, acute AP should be cautiously administered during hospitalization, particularly in those with dementia. Swallowing function is critical to hydration, nutrition, and medical management of HF; therefore, when acute APs are initiated, a swallow evaluation should be considered.
Collapse
Affiliation(s)
- Raele Donetha Robison
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, USA
| | - Mriganka Singh
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA
| | - Melissa Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Matthew Duprey
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Parag Goyal
- Division of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Wen-Chih Wu
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Sebhat Erqou
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Division of Cardiology, Providence VA Medical Center, Providence, RI, USA; Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Andrew Zullo
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health (SMPH), Madison, WI, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| |
Collapse
|
23
|
Khodneva Y, Levitan EB, Arora P, Presley CA, Oparil S, Cherrington AL. Disparities in Postdischarge Ambulatory Care Follow-Up Among Medicaid Beneficiaries With Diabetes, Hospitalized for Heart Failure. J Am Heart Assoc 2023; 12:e029094. [PMID: 37284763 PMCID: PMC10356027 DOI: 10.1161/jaha.122.029094] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/18/2023] [Indexed: 06/08/2023]
Abstract
Background Ambulatory follow-up for all patients with heart failure (HF) is recommended within 7 to 14 days after hospital discharge to improve HF outcomes. We examined postdischarge ambulatory follow-up of patients with comorbid diabetes and HF from a low-income population in primary and specialty care. Methods and Results Adults with diabetes and first hospitalizations for HF, covered by Alabama Medicaid in 2010 to 2019, were included and the claims analyzed for ambulatory care use (any, primary care, cardiology, or endocrinology) within 60 days after discharge using restricted mean survival time regression and negative binomial regression. Among 9859 Medicaid-covered adults with diabetes and first hospitalization for HF (mean age, 53.7 years; SD, 9.2 years; 47.3% Black; 41.8% non-Hispanic White; 10.9% Hispanic/Other [Other included non-White Hispanic, American Indian, Pacific Islander and Asian adults]; 65.4% women, 34.6% men), 26.7% had an ambulatory visit within 0 to 7 days, 15.2% within 8 to 14 days, 31.3% within 15 to 60 days, and 26.8% had no visit; 71% saw a primary care physician and 12% a cardiology physician. Black and Hispanic/Other adults were less likely to have any postdischarge ambulatory visit (P<0.0001) or the visit was delayed (by 1.8 days, P=0.0006 and by 2.8 days, P=0.0016, respectively) and were less likely to see a primary care physician than non-Hispanic White adults (adjusted incidence rate ratio, 0.96 [95% CI, 0.91-1.00] and 0.91 [95% CI, 0.89-0.98]; respectively). Conclusions More than half of Medicaid-covered adults with diabetes and HF in Alabama did not receive guideline-concordant postdischarge care. Black and Hispanic/Other adults were less likely to receive recommended postdischarge care for comorbid diabetes and HF.
Collapse
Affiliation(s)
- Yulia Khodneva
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Emily B. Levitan
- Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamALUSA
| | - Pankaj Arora
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Caroline A. Presley
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Suzanne Oparil
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Andrea L. Cherrington
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| |
Collapse
|
24
|
Srivastava S, Kumar M, Muhammad T, Debnath P. Prevalence and predictors of vision impairment among older adults in India: evidence from LASI, 2017-18. BMC Ophthalmol 2023; 23:251. [PMID: 37277715 DOI: 10.1186/s12886-023-03009-w] [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: 03/17/2022] [Accepted: 05/31/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Older adults experience a natural decline in health, physical and cognitive functionality, and vision impairment (VI) is one among them and has become an increasing health concern worldwide. The present study assessed the association of chronic morbidities such as diabetes, hypertension, stroke, heart diseases and various socioeconomic factors with VI among older Indian adults. METHODS Data for this study were derived from the nationally-representative Longitudinal Ageing Study in India (LASI), wave-1 (2017-18). VI was assessed using the cut-off of visual acuity worse than 20/80, and additional analysis was carried out using the definition of VI with a cut-off of visual acuity worse than 20/63. Descriptive statistics along with cross-tabulation were presented in the study. Proportion test was used to evaluate the significance level for sex differentials in VI among older adults. Additionally, multivariable logistic regression analysis was conducted to explore the factors associated with VI among older adults. RESULTS About 33.8% of males and 40% of females suffered from VI in India (visual acuity worse than 20/80). Meghalaya (59.5%) had the highest prevalence for VI among older males followed by Arunachal Pradesh (58.4%) and Tripura (45.2%). Additionally, Arunachal Pradesh (77.4%) had the highest prevalence for VI among females followed by Meghalaya (68.8%) and Delhi (56.1%). Among the health factors, stroke [AOR: 1.20; CI: 1.03-1.53] and hypertension [AOR: 1.12; CI: 1.01-1.22] were the significant risk factors for VI among older adults. Additionally, being oldest old [AOR: 1.58; CI: 1.32-1.89] and divorced/separated/deserted/others [AOR: 1.42; CI: 1.08-1.87] were significantly associated with VI. Moreover, older adults with higher educational status [AOR: 0.42; CI: 0.34, 0.52], currently working [AOR: 0.77; CI: 0.67, 0.88], from urban areas [AOR: 0.86; CI: 0.76-0.98] and from western region [AOR: 0.55; CI: 0.48-0.64] had lower odds of VI in this study. CONCLUSION This study identified higher rates of VI among those who are diagnosed with hypertension or stroke, currently unmarried, socioeconomically poorer, less educated and urban resident older people that can inform strategies to engage high risk groups. The findings also suggest that specific interventions that promote active aging are required for those who are socioeconomically disadvantaged as well as visually impaired.
Collapse
Affiliation(s)
- Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Manish Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
| | - Paramita Debnath
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| |
Collapse
|
25
|
Holm NN, Frølich A, Andersen O, Juul-Larsen HG, Stockmarr A. Longitudinal models for the progression of disease portfolios in a nationwide chronic heart disease population. PLoS One 2023; 18:e0284496. [PMID: 37079591 PMCID: PMC10118194 DOI: 10.1371/journal.pone.0284496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/30/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND AIM With multimorbidity becoming increasingly prevalent in the ageing population, addressing the epidemiology and development of multimorbidity at a population level is needed. Individuals subject to chronic heart disease are widely multimorbid, and population-wide longitudinal studies on their chronic disease trajectories are few. METHODS Disease trajectory networks of expected disease portfolio development and chronic condition prevalences were used to map sex and socioeconomic multimorbidity patterns among chronic heart disease patients. Our data source was all Danish individuals aged 18 years and older at some point in 1995-2015, consisting of 6,048,700 individuals. We used algorithmic diagnoses to obtain chronic disease diagnoses and included individuals who received a heart disease diagnosis. We utilized a general Markov framework considering combinations of chronic diagnoses as multimorbidity states. We analyzed the time until a possible new diagnosis, termed the diagnosis postponement time, in addition to transitions to new diagnoses. We modelled the postponement times by exponential models and transition probabilities by logistic regression models. FINDINGS Among the cohort of 766,596 chronic heart disease diagnosed individuals, the prevalence of multimorbidity was 84.36% and 88.47% for males and females, respectively. We found sex-related differences within the chronic heart disease trajectories. Female trajectories were dominated by osteoporosis and male trajectories by cancer. We found sex important in developing most conditions, especially osteoporosis, chronic obstructive pulmonary disease and diabetes. A socioeconomic gradient was observed where diagnosis postponement time increases with educational attainment. Contrasts in disease portfolio development based on educational attainment were found for both sexes, with chronic obstructive pulmonary disease and diabetes more prevalent at lower education levels, compared to higher. CONCLUSIONS Disease trajectories of chronic heart disease diagnosed individuals are heavily complicated by multimorbidity. Therefore, it is essential to consider and study chronic heart disease, taking into account the individuals' entire disease portfolio.
Collapse
Affiliation(s)
- Nikolaj Normann Holm
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| |
Collapse
|
26
|
Yacouba Moukeila MB, Thokerunga E, He F, Bongolo CC, Xia Y, Wang F, Gado AF, Mamoudou H, Khan S, Ousseina B, Ousmane HA, Diarra D, Ke J, Zhang Z, Wang Y. Adenosine 2 receptor regulates autophagy and apoptosis to alleviate ischemia reperfusion injury in type 2 diabetes via IRE-1 signaling. BMC Cardiovasc Disord 2023; 23:154. [PMID: 36964482 PMCID: PMC10039586 DOI: 10.1186/s12872-023-03116-y] [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: 10/05/2022] [Accepted: 02/08/2023] [Indexed: 03/26/2023] Open
Abstract
PURPOSE This study aimed to determine the effect and mechanism of action of adenosine 2 receptor (A2R) activation on myocardial ischemia reperfusion injury (MIRI) under diabetic conditions. METHODS MIRI type 2 diabetic rats and H9C2 cardiomyocytes were treated with A2R agonist and then subjected to hypoxia for 6 h and reoxygenation for 18 h. Myocardial damage, and infarct size were determined by cardiac ultrasound. Indicators of cardiomyocyte injury, creatine kinase-MB and cardiac troponin I were detected by Enzyme Linked Immunosorbent Assay. Endoplasmic reticulum stress (ERS) was determined through measuring the expression levels of ERS related genes GRP78, p-IRE1/IRE1, and p-JNKJNK. The mechanism of A2R cardio protection in MIRI through regulating ERS induced autophagy was determined by investigating the ER resident protein IRE-1. The ER-stress inducer Tunicamycin, and the IRE-1 inhibitor STF in combination with the A2R agonist NECA were used, and the cellular responses were assessed through autophagy proteins expression Beclin-1, p62, LC3 and apoptosis. RESULTS NECA improved left ventricular function post MIRI, limited myocardial infarct size, reduced myocardial damage, decreased cardiomyocytes apoptosis, and attenuated ERS induced autophagy through regulating the IRE-XBP1s-CHOP pathway. These actions resulted into overall protection of the myocardium against MIRI. CONCLUSION In summary, A2R activation by NECA prior to ischemia attenuates apoptosis, reduces ERS induced autophagy and restores left ventricular function. This protective effect occurs through regulating the IRE1-XBPs-CHOP related mechanisms. NECA is thus a potential target for the treatment of MIRI in patient with type 2 diabetes.
Collapse
Affiliation(s)
| | - Erick Thokerunga
- Program and Department of Clinical Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Feng He
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Christian Cedric Bongolo
- Program and Department of Clinical Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Yun Xia
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Fuyu Wang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Adamou Foumakoye Gado
- Department of Anesthesia and Intensive Care, Hôpital Général de Référence Niamey, Niamey, Niger
| | - Hama Mamoudou
- Department of Anesthesia and Intensive Care, National Hospital of Niamey, Niamey, Niger
| | - Shahzad Khan
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Bonkano Ousseina
- Department of Cardiovascular and Internal Medicine, Niamey Amirou Boubacar Diallo National Hospital, Abdou Moumouni University, Niamey, Niger
| | | | - Drissa Diarra
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jianjuan Ke
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
| | - Zongze Zhang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
| | - Yanlin Wang
- Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
| |
Collapse
|
27
|
Xiao B, Velez Edwards DR, Lucas A, Drivas T, Gray K, Keating B, Weng C, Jarvik GP, Hakonarson H, Kottyan L, Elhadad N, Wei W, Luo Y, Kim D, Ritchie M, Verma SS. Inference of Causal Relationships Between Genetic Risk Factors for Cardiometabolic Phenotypes and Female-Specific Health Conditions. J Am Heart Assoc 2023; 12:e026561. [PMID: 36846987 PMCID: PMC10111435 DOI: 10.1161/jaha.121.026561] [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: 05/17/2022] [Accepted: 11/11/2022] [Indexed: 03/01/2023]
Abstract
Background Cardiometabolic diseases are highly comorbid, but their relationship with female-specific or overwhelmingly female-predominant health conditions (breast cancer, endometriosis, pregnancy complications) is understudied. This study aimed to estimate the cross-trait genetic overlap and influence of genetic burden of cardiometabolic traits on health conditions unique to women. Methods and Results Using electronic health record data from 71 008 ancestrally diverse women, we examined relationships between 23 obstetrical/gynecological conditions and 4 cardiometabolic phenotypes (body mass index, coronary artery disease, type 2 diabetes, and hypertension) by performing 4 analyses: (1) cross-trait genetic correlation analyses to compare genetic architecture, (2) polygenic risk score-based association tests to characterize shared genetic effects on disease risk, (3) Mendelian randomization for significant associations to assess cross-trait causal relationships, and (4) chronology analyses to visualize the timeline of events unique to groups of women with high and low genetic burden for cardiometabolic traits and highlight the disease prevalence in risk groups by age. We observed 27 significant associations between cardiometabolic polygenic scores and obstetrical/gynecological conditions (body mass index and endometrial cancer, body mass index and polycystic ovarian syndrome, type 2 diabetes and gestational diabetes, type 2 diabetes and polycystic ovarian syndrome). Mendelian randomization analysis provided additional evidence of independent causal effects. We also identified an inverse association between coronary artery disease and breast cancer. High cardiometabolic polygenic scores were associated with early development of polycystic ovarian syndrome and gestational hypertension. Conclusions We conclude that polygenic susceptibility to cardiometabolic traits is associated with elevated risk of certain female-specific health conditions.
Collapse
Affiliation(s)
- Brenda Xiao
- Graduate Program in Genomics and Computational BiologyUniversity of PennsylvaniaPhiladelphiaPA
| | - Digna R. Velez Edwards
- Division of Quantitative Sciences, Department of Obstetrics and GynecologyVanderbilt University Medical CenterNashvilleTN
| | - Anastasia Lucas
- Department of GeneticsUniversity of PennsylvaniaPhiladelphiaPA
| | - Theodore Drivas
- Department of GeneticsUniversity of PennsylvaniaPhiladelphiaPA
| | - Kathryn Gray
- Department of Obstetrics and GynecologyBrigham and Women’s HospitalBostonMA
| | - Brendan Keating
- Department of SurgeryUniversity of PennsylvaniaPhiladelphiaPA
| | - Chunhua Weng
- Department of Biomedical InformaticsColumbia UniversityNew YorkNY
| | - Gail P. Jarvik
- Departments of Medicine (Medical Genetics) and Genome SciencesUniversity of Washington Medical CenterSeattleWA
| | - Hakon Hakonarson
- Center for Applied Genomics, Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Leah Kottyan
- Center for Autoimmune Genomics and Etiology and Division of Allergy & Immunology, Cincinnati Children’s Hospital Medical Center, Department of PediatricsUniversity of CincinnatiOH
| | - Noemie Elhadad
- Department of Biomedical InformaticsColumbia UniversityNew YorkNY
| | - Wei‐Qi Wei
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTN
| | - Yuan Luo
- Department of Preventive Medicine, Feinberg School of MedicineNorthwestern UniversityEvanstonIL
| | - Dokyoon Kim
- Department of Biostatistics and EpidemiologyUniversity of PennsylvaniaPhiladelphiaPA
| | - Marylyn Ritchie
- Department of GeneticsUniversity of PennsylvaniaPhiladelphiaPA
| | - Shefali Setia Verma
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPA
| |
Collapse
|
28
|
Nam Y, Jung SH, Yun JS, Sriram V, Singhal P, Byrska-Bishop M, Verma A, Shin H, Park WY, Won HH, Kim D. Discovering comorbid diseases using an inter-disease interactivity network based on biobank-scale PheWAS data. Bioinformatics 2023; 39:6960923. [PMID: 36571484 PMCID: PMC9825330 DOI: 10.1093/bioinformatics/btac822] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 12/03/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022] Open
Abstract
MOTIVATION Understanding comorbidity is essential for disease prevention, treatment and prognosis. In particular, insight into which pairs of diseases are likely or unlikely to co-occur may help elucidate the potential relationships between complex diseases. Here, we introduce the use of an inter-disease interactivity network to discover/prioritize comorbidities. Specifically, we determine disease associations by accounting for the direction of effects of genetic components shared between diseases, and categorize those associations as synergistic or antagonistic. We further develop a comorbidity scoring algorithm to predict whether diseases are more or less likely to co-occur in the presence of a given index disease. This algorithm can handle networks that incorporate relationships with opposite signs. RESULTS We finally investigate inter-disease associations among 427 phenotypes in UK Biobank PheWAS data and predict the priority of comorbid diseases. The predicted comorbidities were verified using the UK Biobank inpatient electronic health records. Our findings demonstrate that considering the interaction of phenotype associations might be helpful in better predicting comorbidity. AVAILABILITY AND IMPLEMENTATION The source code and data of this study are available at https://github.com/dokyoonkimlab/DiseaseInteractiveNetwork. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
Collapse
Affiliation(s)
| | | | - Jae-Seung Yun
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Vivek Sriram
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Pankhuri Singhal
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Anurag Verma
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hyunjung Shin
- Department of Artificial Intelligence, Ajou University, Suwon 16499, Republic of Korea
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | | | - Dokyoon Kim
- To whom correspondence should be addressed. or
| |
Collapse
|
29
|
Kopp W. Pathogenesis of (smoking-related) non-communicable diseases-Evidence for a common underlying pathophysiological pattern. Front Physiol 2022; 13:1037750. [PMID: 36589440 PMCID: PMC9798240 DOI: 10.3389/fphys.2022.1037750] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Non-communicable diseases, like diabetes, cardiovascular diseases, cancer, stroke, chronic obstructive pulmonary disease, osteoporosis, arthritis, Alzheimer's disease and other more are a leading cause of death in almost all countries. Lifestyle factors, especially poor diet and tobacco consumption, are considered to be the most important influencing factors in the development of these diseases. The Western diet has been shown to cause a significant distortion of normal physiology, characterized by dysregulation of the sympathetic nervous system, renin-angiotensin aldosterone system, and immune system, as well as disruption of physiological insulin and oxidant/antioxidant homeostasis, all of which play critical roles in the development of these diseases. This paper addresses the question of whether the development of smoking-related non-communicable diseases follows the same pathophysiological pattern. The evidence presented shows that exposure to cigarette smoke and/or nicotine causes the same complex dysregulation of physiology as described above, it further shows that the factors involved are strongly interrelated, and that all of these factors play a key role in the development of a broad spectrum of smoking-related diseases. Since not all smokers develop one or more of these diseases, it is proposed that this disruption of normal physiological balance represents a kind of pathogenetic "basic toolkit" for the potential development of a range of non-communicable diseases, and that the decision of whether and what disease will develop in an individual is determined by other, individual factors ("determinants"), such as the genome, epigenome, exposome, microbiome, and others. The common pathophysiological pattern underlying these diseases may provide an explanation for the often poorly understood links between non-communicable diseases and disease comorbidities. The proposed pathophysiological process offers new insights into the development of non-communicable diseases and may influence the direction of future research in both prevention and therapy.
Collapse
|
30
|
Arnold C, Hennrich P, Wensing M. Patient-reported continuity of care and the association with patient experience of cardiovascular prevention: an observational study in Germany. BMC PRIMARY CARE 2022; 23:176. [PMID: 35850657 PMCID: PMC9289649 DOI: 10.1186/s12875-022-01788-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
Background Cardiovascular diseases are often accompanied by comorbidities, which require good coordination of care. Especially in fragmented healthcare systems, it is important to apply strategies such as case management to achieve high continuity of care. The aim of this study was to document continuity of care from the patients’ perspective in ambulatory cardiovascular care in Germany and to explore the associations with patient-reported experience of cardiovascular prevention. Methods This cross-sectional observational study was performed in primary care practices in Germany. The study included patients with three recorded chronic diseases, including coronary heart disease. Continuity of care was measured with the Nijmegen Continuity Questionnaire, which addresses personal/relational and team/cross-boundary continuity. From aspects of medical care and health-related lifestyle counselling a patient-reported experience of cardiovascular prevention index was formed with a range of 0–7. The association between continuity of care within the family practice and patient-reported experience of cardiovascular prevention was examined, using a linear multilevel regression model that adjusted for sociodemographics, structured care programme and numbers of contacts with the family practice. Results Four hundred thirty-five patients from 26 family practices participated. In a comparison between general practitioners (GPs) and cardiologists, higher values for relational continuity of care were given for GPs. Team/cross-boundary continuity for ‘within the family practice’ had a mean of 4.0 (standard deviation 0.7) and continuity between GPs and cardiologists a mean of 3.8 (standard deviation 0.7). Higher personal continuity of care for GPs was positively associated with patient-reported experience (b = 0.75, 95% CI 0.45–1.05, P < 0.001). Conclusions Overall, there was high patient-reported continuity, which positively influenced the experience of cardiovascular prevention. Nevertheless, there is potential for improvement of personal continuity of the cardiologists and team/cross-boundary continuity between GPs and cardiologists. Structured care programs may be able to support this. Trial registration We registered the study prospectively on 7 November 2019 at the German Clinical Trials Register (DRKS) under ID no. DRKS00019219. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01788-7.
Collapse
|
31
|
Widen E, Lello L, Raben TG, Tellier LCAM, Hsu SDH. Polygenic Health Index, General Health, and Pleiotropy: Sibling Analysis and Disease Risk Reduction. Sci Rep 2022; 12:18173. [PMID: 36307513 PMCID: PMC9616929 DOI: 10.1038/s41598-022-22637-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/18/2022] [Indexed: 12/31/2022] Open
Abstract
We construct a polygenic health index as a weighted sum of polygenic risk scores for 20 major disease conditions, including, e.g., coronary artery disease, type 1 and 2 diabetes, schizophrenia, etc. Individual weights are determined by population-level estimates of impact on life expectancy. We validate this index in odds ratios and selection experiments using unrelated individuals and siblings (pairs and trios) from the UK Biobank. Individuals with higher index scores have decreased disease risk across almost all 20 diseases (no significant risk increases), and longer calculated life expectancy. When estimated Disability Adjusted Life Years (DALYs) are used as the performance metric, the gain from selection among ten individuals (highest index score vs average) is found to be roughly 4 DALYs. We find no statistical evidence for antagonistic trade-offs in risk reduction across these diseases. Correlations between genetic disease risks are found to be mostly positive and generally mild. These results have important implications for public health and also for fundamental issues such as pleiotropy and genetic architecture of human disease conditions.
Collapse
Affiliation(s)
- Erik Widen
- Department of Physics and Astronomy, Michigan State University, 567 Wilson Rd, East Lansing, MI, 48824, USA. .,Genomic Prediction, Inc., 671 US Highway One, North Brunswick, NJ, 08902, USA.
| | - Louis Lello
- Department of Physics and Astronomy, Michigan State University, 567 Wilson Rd, East Lansing, MI, 48824, USA. .,Genomic Prediction, Inc., 671 US Highway One, North Brunswick, NJ, 08902, USA.
| | - Timothy G Raben
- Department of Physics and Astronomy, Michigan State University, 567 Wilson Rd, East Lansing, MI, 48824, USA
| | - Laurent C A M Tellier
- Department of Physics and Astronomy, Michigan State University, 567 Wilson Rd, East Lansing, MI, 48824, USA.,Genomic Prediction, Inc., 671 US Highway One, North Brunswick, NJ, 08902, USA
| | - Stephen D H Hsu
- Department of Physics and Astronomy, Michigan State University, 567 Wilson Rd, East Lansing, MI, 48824, USA.,Genomic Prediction, Inc., 671 US Highway One, North Brunswick, NJ, 08902, USA
| |
Collapse
|
32
|
Paik H, Lee J, Jeong CS, Park JS, Lee JH, Rappoport N, Kim Y, Sohn HY, Jo C, Kim J, Cho SB. Identification of a pleiotropic effect of ADIPOQ on cardiac dysfunction and Alzheimer's disease based on genetic evidence and health care records. Transl Psychiatry 2022; 12:389. [PMID: 36114174 PMCID: PMC9481623 DOI: 10.1038/s41398-022-02144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 08/21/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Observations of comorbidity in heart diseases, including cardiac dysfunction (CD) are increasing, including and cognitive impairment, such as Alzheimer's disease and dementia (AD/D). This comorbidity might be due to a pleiotropic effect of genetic variants shared between CD and AD/D. Here, we validated comorbidity of CD and AD/D based on diagnostic records from millions of patients in Korea and the University of California, San Francisco Medical Center (odds ratio 11.5 [8.5-15.5, 95% Confidence Interval (CI)]). By integrating a comprehensive human disease-SNP association database (VARIMED, VARiants Informing MEDicine) and whole-exome sequencing of 50 brains from individuals with and without Alzheimer's disease (AD), we identified missense variants in coding regions including APOB, a known risk factor for CD and AD/D, which potentially have a pleiotropic role in both diseases. Of the identified variants, site-directed mutation of ADIPOQ (268 G > A; Gly90Ser) in neurons produced abnormal aggregation of tau proteins (p = 0.02), suggesting a functional impact for AD/D. The association of CD and ADIPOQ variants was confirmed based on domain deletion in cardiac cells. Using the UK Biobank including data from over 500000 individuals, we examined a pleiotropic effect of the ADIPOQ variant by comparing CD- and AD/D-associated phenotypic evidence, including cardiac hypertrophy and cognitive degeneration. These results indicate that convergence of health care records and genetic evidences may help to dissect the molecular underpinnings of heart disease and associated cognitive impairment, and could potentially serve a prognostic function. Validation of disease-disease associations through health care records and genomic evidence can determine whether health conditions share risk factors based on pleiotropy.
Collapse
Affiliation(s)
- Hyojung Paik
- Division of Supercomputing, Korea Institute of Science and Technology Information, Daejeon, 34141, Republic of Korea
- Bakar Computational Health Sciences Institute, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
- Department of Pediatrics, School of Medicine, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
- Department of Data and HPC Science, University of Science and Technology, Daejeon, 34113, Republic of Korea
| | - Junehawk Lee
- Division of Supercomputing, Korea Institute of Science and Technology Information, Daejeon, 34141, Republic of Korea
| | - Chan-Seok Jeong
- Division of Supercomputing, Korea Institute of Science and Technology Information, Daejeon, 34141, Republic of Korea
| | - Jun Sung Park
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Jeong Ho Lee
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Nadav Rappoport
- Bakar Computational Health Sciences Institute, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
- Departement of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beersheba, 8410501, Israel
| | - Younghoon Kim
- Division of Supercomputing, Korea Institute of Science and Technology Information, Daejeon, 34141, Republic of Korea
| | - Hee-Young Sohn
- Division of Brain Disease Research, Department for Chronic Disease Convergence Research, Korea National Institute of Health, Chungcheongbuk-do, 28159, Republic of Korea
| | - Chulman Jo
- Division of Brain Disease Research, Department for Chronic Disease Convergence Research, Korea National Institute of Health, Chungcheongbuk-do, 28159, Republic of Korea
| | - Jimin Kim
- Division of Supercomputing, Korea Institute of Science and Technology Information, Daejeon, 34141, Republic of Korea
| | - Seong Beom Cho
- Department of Bio-Medical Informatics, Gachon University, College of Medicine, Incheon, 21565, Republic of Korea.
| |
Collapse
|
33
|
Naisanga M, SekaggyaWiltshire C, Muhwezi WW, Musaazi J, Akena D. Prevalence and factors associated with psychological distress among patients on warfarin at the Uganda Heart Institute, Mulago Hospital. BMC Psychiatry 2022; 22:349. [PMID: 35596217 PMCID: PMC9123720 DOI: 10.1186/s12888-022-03998-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVD) are the leading cause of mortality worldwide and are significantly associated with multiple comorbid disorders including mental disorders such as psychological distress (PD). At increased risk of PD are CVD patient sub-categories that not only require chronic therapy but also need follow up with continuous blood tests and dose adjustments (like the patients on warfarin). However, not much has been done to ascertain the burden of PD among patients on warfarin in Uganda. OBJECTIVE To determine the prevalence and factors associated with PD among patients on anticoagulation with warfarin at the Uganda Heart Institute (UHI). METHODS In this analytical cross-sectional study, 197 participants were sampled from adults on warfarin attending the Uganda Heart Institute (UHI) out patient clinic. The Self Reporting Questionnaire (SRQ-20), a tool with a total maximum score of 20 and cutoff for PD at ≥6 was used to determine the presence of PD among participants, and a socio-demographic questionnaire to document the socio-demographic characteristics of the subjects. Additional questions including the underlying CVD diagnosis, medications used (besides warfarin) and presence of chronic illnesess were also assessed. Bi-variable and multi-variabe logistic regression analysis techniques were used to examine the associations between the dependent and independent variables. RESULTS The prevalence of PD was 32%. The unemployed participants were 4.5 times more likely to have PD (adjusted odds ratio [aOR]4.56, 95% confidence interval [CI]: 1.12-18.62, p = 0.04). Participants who had experienced social stressors were more likely to have PD (aOR: 11.38, CI: 3.60-36.04, p < 0.01). Other factors associated with a higher likelihood of having PD included: presence of other chronic comorbidities (aOR: 3.69, CI: 1.24-11.02, p = 0.02) and concomitant use of loop diuretics (aOR: 4.13, CI: 1.67-10.19,p < 0.01). A shorter length of time on warfarin (7-24 months) lowered the likelihood of PD (aOR: 0.23, CI: 0.07-0.74, p = 0.01). CONCLUSION The prevalence of PD was high among patients on warfarin in this low income setting and there is a need to characterize the specific psychiatric disorders in patients with CVD. Interventions that address the high burden of PD are urgently needed in this setting.
Collapse
Affiliation(s)
| | | | | | - Joseph Musaazi
- grid.11194.3c0000 0004 0620 0548Infectious Disease Institute, Kampala, Uganda
| | - Dickens Akena
- grid.11194.3c0000 0004 0620 0548Makerere University, Kampala, Uganda
| |
Collapse
|
34
|
Febrinasari RP, Stepvia S, Mashuri YA. Utilization of Standard Therapy and Adjunctive Isosorbide Dinitrate Pump with Clinical Outcomes in Acute Heart Failure Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Acute heart failure is a life-threatening medical condition. Thus, effective therapy is very important for this case. Utilization of standard therapy and adjunctive isosorbide dinitrate (ISDN) pump play an important role in reducing mortality, length of hospitalization, and national early warning score – NEWS 2. However, the research on the utilization of the ISDN pump as adjunctive therapy is still limited.
AIM: This study aimed to analyze the association between utilization of standard therapy and adjunctive ISDN pump with clinical outcomes (mortality, length of hospitalization, and NEWS 2) in patients with acute heart failure.
METHODS: This was a cohort retrospective observational study. The purposive sampling technique was utilized to select the acute heart failure patients in UNS Sukoharjo Hospital. All the data were obtained from medical records. Logistic regression was used to analyze the data.
RESULTS: A total of 94 patients were included as the samples. There was a significant association between the utilization of standard therapy (OR=7.9; CI 95%= 3.1–20.4; p < 0.001) or ISDN pump (OR=0.3; CI 95%= 0.1–0.7; p < 0.001) with the length of hospitalization. However, there was no significant association between the utilization of standard therapy (OR=1.1; CI 95%= 0.2–6.6; p = 0.9) and ISDN pump (OR=0.2; CI 95%= 0.02–1.6; p = 0.1) with NEWS 2 on patients with acute heart failure.
CONCLUSION: There was a significant association between the utilization of standard therapy and ISDN pump with the length of hospitalization.
Collapse
|
35
|
Valente HB, Silva VEDS, Barros TRM, Vanderlei FM, Laurino MJL, Botta AFB, Vanzella LM, Bongiovani AC, Vanderlei LCM. Relationship between the number of comorbidities, quality of life, and cardiac autonomic modulation in patients with coronary disease: a cross-sectional study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:450-455. [PMID: 35649066 DOI: 10.1590/1806-9282.20210919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/15/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate if there is a relationship between the number of comorbidities, autonomic modulation, and quality of life in patients diagnosed with coronary artery disease. METHODS A cross-sectional study was conducted at an outpatient rehabilitation center in Presidente Prudente-SP, Brazil. A total of 27 participants (65.33±9.23 years) diagnosed with coronary artery disease were assessed, from a cardiac rehabilitation program, independent of sex or age. The number of comorbidities was evaluated using the Self-Administered Comorbidity Questionnaire, and quality of life was evaluated using the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) (eight domains: functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health). To evaluate the cardiac autonomic modulation, the heart rate was registered beat to beat using an heart rate monitor in the supine position during rest for 30 min. A total of 1000 RR intervals were considered to calculate linear (time domain: RMSSD, SDNN; frequency domain: LF, HF, LF/HF) and nonlinear indices (SD1, SD2, SD1/SD2) of heart rate variability. RESULTS A negative correlation was observed between the aggregation of comorbidities and the pain domain of the SF-36 (r=-0.427; p=0.03). No significant correlations were observed between other variables (p>0.05). CONCLUSION The number of comorbidities is inversely related to the pain domain of the SF-36, suggesting that a higher pain level is related to a higher number of comorbidities in coronary artery disease patients.
Collapse
Affiliation(s)
- Heloisa Balotari Valente
- Universidade Estadual Paulista, School of Technology and Sciences - Presidente Prudente (SP), Brazil
| | | | | | | | - Maria Júlia Lopez Laurino
- Universidade Estadual Paulista, School of Technology and Sciences - Presidente Prudente (SP), Brazil
| | - Ana Flavia Balotari Botta
- Universidade Estadual Paulista, School of Technology and Sciences - Presidente Prudente (SP), Brazil
| | - Laís Manata Vanzella
- University Health Network, Toronto Rehabilitation Institute - East York (ON), Canada
| | | | | |
Collapse
|
36
|
Penna C, Comità S, Tullio F, Alloatti G, Pagliaro P. Challenges facing the clinical translation of cardioprotection: 35 years after the discovery of ischemic preconditioning. Vascul Pharmacol 2022; 144:106995. [DOI: 10.1016/j.vph.2022.106995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/17/2022] [Accepted: 04/16/2022] [Indexed: 12/19/2022]
|
37
|
Kirakalaprathapan A, Oremus M. Efficacy of telehealth in integrated chronic disease management for older, multimorbid adults with heart failure: A systematic review. Int J Med Inform 2022; 162:104756. [PMID: 35381436 DOI: 10.1016/j.ijmedinf.2022.104756] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND We conducted a systematic review to assess the comparative efficacy of integrated telehealth versus other strategies of chronic disease management in older, multimorbid adults with heart failure (HF) in primary care and community settings. Specific efficacy outcomes included CVD-related hospitalizations, rehospitalizations, and mortality. MATERIALS AND METHODS We searched for randomized controlled trials (RCTs) in MEDLINE, Scopus, EMBASE, CINAHL, and CENTRAL from the date of each database's inception to January 2020. The literature search retrieved 9,181 articles, which were screened by two independent raters. Twenty-two of these articles were included in the systematic review. Data extraction, risk of bias assessment, and narrative synthesis followed article screening. RESULTS This systematic review found that integrated telehealth is efficacious in reducing CVD-related hospitalizations, rehospitalizations, and mortality in older, multimorbid adults within primary care and community settings. However, numerous discrepancies existed between the studies, due largely to differences in telehealth modalities and risk of bias. Overall, the combinations of modalities were so diverse that the reviewed literature did not suggest an optimal integrated telehealth strategy. At most, no more than three studies featured the same combination of telehealth modalities and outcomes. Furthermore, only 3 of the 22 included RCTs scored low on the Cochrane risk of bias tool. CONCLUSIONS Researchers should focus on the quality of future RCTs to better assess the efficacy of different telehealth modalities in multimorbid older adults with HF. Also, since all the included RCTs focused on HF, a knowledge gap exists with regard to the efficacy of using integrated telehealth to manage other cardiovascular diseases (CVD).
Collapse
Affiliation(s)
| | - Mark Oremus
- School of Public Health Sciences, University of Waterloo, Canada.
| |
Collapse
|
38
|
Ravn MB, Uhd M, Svendsen ML, Ørtenblad L, Maribo T. How to Facilitate Adherence to Cardiac Rehabilitation in Primary Health Settings for Ischaemic Heart Disease Patients. The Perspectives of Health Professionals. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:837175. [PMID: 36188961 PMCID: PMC9397980 DOI: 10.3389/fresc.2022.837175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/25/2022] [Indexed: 12/21/2022]
Abstract
Background Cardiac rehabilitation (CR) is a class 1A recommendation and an integrated part of standard treatment for patients with cardiac disease. In Denmark, CR adheres to European guidelines, it is group-based and partly conducted in primary health settings. Despite high evidence for the benefits of CR, it remains underutilized. How to facilitate CR adherence in primary health settings is poorly understood. Aim This study explores health professional's perspectives on how to facilitate CR adherence for patients with ischaemic heart disease in primary health settings. Methods Data were collected through focus group discussions. Respondents were health professionals specialized in and working with CR in primary health settings. Data were analyzed using thematic analysis. Results Eleven health professionals participated in two focus group discussions. Five themes emerged as facilitators of CR; (1) placing the person at the center, (2) coherent programme, (3) flow of information, (4) contextual factors, and (5) feeling of belonging. Conclusion This study illuminates the complexity of facilitating adherence to CR in primary health settings and provides ways in which health professionals may facilitate adherence. Placing the person at the center is pivotal and may be done by adapting CR offers to patients' social context, culture and life circumstances and ensuring a feeling of belonging. The rhetoric related to CR should be positive and throughout the entire course of treatment health professionals should possess a generic and collective approach to and view of CR. Perceiving these elements as potential facilitators is of vital importance and addressing them may facilitate adherence.
Collapse
Affiliation(s)
- Maiken Bay Ravn
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- *Correspondence: Maiken Bay Ravn
| | - Maria Uhd
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | | | | | - Thomas Maribo
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| |
Collapse
|
39
|
Mehuys E, De Backer T, De Keyser F, Christiaens T, Van Hees T, Demarche S, Van Tongelen I, Boussery K. PREVALENCE AND MANAGEMENT OF DRUG INTERACTIONS BETWEEN NSAID AND ANTITHROMBOTICS IN AMBULATORY CARE. Br J Clin Pharmacol 2022; 88:3896-3902. [DOI: 10.1111/bcp.15288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences Ghent University Ghent Belgium
| | - Tine De Backer
- Department of Cardiology, Heart Centre Ghent University Hospital, Ghent, Belgium; and Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University Ghent Belgium
| | - Filip De Keyser
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Rheumatology Ghent University Hospital, Ghent, Belgium and praktijk10A Maldegem Belgium
| | | | | | | | - Inge Van Tongelen
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences Ghent University Ghent Belgium
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences Ghent University Ghent Belgium
| |
Collapse
|
40
|
Simou A, Xanthopoulos A, Giamouzis G, Papagiannis D, Dimos A, Economou D, Skoularigis J, Triposkiadis F. Coexisting morbidity burden in elderly hospitalized patients with and without heart failure. Hellenic J Cardiol 2022; 65:53-55. [DOI: 10.1016/j.hjc.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 02/08/2023] Open
|
41
|
Das DR, Nayak MR, Mohapatra D, Mahanta D. Association of Anxiety and Depression in Patients Undergoing Cardiac Catheterization With Number of Major Coronary Artery Stenosis: A Cross-Sectional Study. Cureus 2022; 14:e21630. [PMID: 35233310 PMCID: PMC8881283 DOI: 10.7759/cureus.21630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The relationship between the level of anxiety and depression among coronary artery disease (CAD) patients and coronary angiographic findings is ambiguously mentioned in studies. Past evidence shows that the relationship between anxiety and depression with coronary artery disease can be bidirectional. There is a paucity of literature on the association of levels of anxiety and depression with the number of coronary arteries involved in coronary artery disease. Methods This study was conducted in a tertiary care hospital to find the level of anxiety and depression in patients undergoing cardiac catheterization and their association with the numbers of the major coronary artery involved. Patients undergoing cardiac catheterization in the Department of Cardiovascular Science of a tertiary care hospital in India from May 2020 to December 2020 were considered for inclusion in the study. Coronary artery disease was diagnosed based on the combination of clinical, ECG, echocardiography, or biomarker parameters in various combinations. These patients were further subjected to coronary angiogram to know the extent of stenosis and the number of coronary vessels involved in the disease. The level of anxiety and depression was measured by using the Hospital Anxiety and Depression Scale (HADS) during the period of admission and at least 24 hours after diagnosis and at least 12 hours before cardiac catheterization. The data was entered into SPSS software version 22.0 (Armonk, NY: IBM Corp.) for statistical analysis. Chi-square test, Kolmogorov-Smirnov test, and Kruskal-Wallis test were used for the interpretation of data and find an association between severity of anxiety and depression with the number of major coronary vessels involved. Results Anxiety was seen in 83.3% of the patients with 31.5% having severe anxiety. Depression was found in 77.8% with 38.9% suffering from severe depression. The anxiety and depression scores of HADS were significantly higher in those with triple-vessel disease compared to the double-vessel or single-vessel disease. Conclusion Screening and management of anxiety and depression is an essential part of the care of patients with coronary artery disease. People with triple-vessel disease need the most attention and appropriate management of anxiety and depression.
Collapse
|
42
|
Herkert C, Graat-Verboom L, Gilsing-Fernhout J, Schols M, Kemps HMC. Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study. JMIR Form Res 2021; 5:e28634. [PMID: 34751655 PMCID: PMC8663616 DOI: 10.2196/28634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/01/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. OBJECTIVE The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. METHODS The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. RESULTS In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50% (5/10) were men. Of the 10 participants, 9 (90%) completed the 8-week program. Median adherence to the exercise prescription was 75% (IQR 37%-88%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86%, IQR 51%-100%, and final 2 weeks: 57%, IQR 8%-75%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. CONCLUSIONS Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. TRIAL REGISTRATION Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182.
Collapse
Affiliation(s)
- Cyrille Herkert
- Department of Cardiology, Máxima Medical Center, Eindhoven, Netherlands
| | | | | | - Manon Schols
- ParaMáx: Center for Paramedic Care, Máxima Medical Center, Eindhoven, Netherlands
| | - Hareld Marijn Clemens Kemps
- Department of Cardiology, Máxima Medical Center, Eindhoven, Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| |
Collapse
|
43
|
De Simone C, Fargnoli MC, Amerio P, Bianchi L, Esposito M, Pirro F, Potenza C, Ricceri F, Rongioletti F, Stingeni L, Prignano F. Risk of infections in psoriasis: assessment and challenges in daily management. Expert Rev Clin Immunol 2021; 17:1211-1220. [PMID: 34696673 DOI: 10.1080/1744666x.2021.1997592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In daily practice management of psoriasis, evaluation of risk factors for infections is having a growing influence. Indeed, in psoriatic patients, risk of infections may be due to psoriasis itself, immunomodulatory therapy, and comorbidities that may increase this risk and patient hospitalization. AREAS COVERED Given the greater understanding of psoriasis pathogenesis and the increasing number of treatment options, it is particularly important to customize therapy according to each, single patient; psoriasis features and comorbidities are also essential to tailor treatment goals. EXPERT OPINION In this perspective, the current knowledge on the infectious risk in psoriatic patient, related to comorbidities, such as diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary, to 'special populations,' to chronic infections, such as latent tuberculosis, chronic hepatitis B and C, and HIV, and to the most recent Covid-19 pandemic scenario, is reviewed and discussed in order to suggest the most appropriate approach and achieve the best available therapeutic option.
Collapse
Affiliation(s)
- Clara De Simone
- Institute of Dermatology, Catholic University, Rome, Italy.,Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paolo Amerio
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, Tor Vergata University of Rome, Italy
| | - Maria Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Pirro
- Institute of Dermatology, Catholic University, Rome, Italy.,Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Concetta Potenza
- Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Federica Ricceri
- Unit of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| | - Franco Rongioletti
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, via Università 40, 09124 Cagliari, Italy, IRCCS San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Francesca Prignano
- Unit of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| |
Collapse
|
44
|
Voglhuber J, Ljubojevic-Holzer S, Abdellatif M, Sedej S. Targeting Cardiovascular Risk Factors Through Dietary Adaptations and Caloric Restriction Mimetics. Front Nutr 2021; 8:758058. [PMID: 34660673 PMCID: PMC8514725 DOI: 10.3389/fnut.2021.758058] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022] Open
Abstract
The average human life expectancy continues to rise globally and so does the prevalence and absolute burden of cardiovascular disease. Dietary restriction promotes longevity and improves various cardiovascular risk factors, including hypertension, obesity, diabetes mellitus, and metabolic syndrome. However, low adherence to caloric restriction renders this stringent dietary intervention challenging to adopt as a standard practice for cardiovascular disease prevention. Hence, alternative eating patterns and strategies that recapitulate the salutary benefits of caloric restriction are under intense investigation. Here, we first provide an overview of alternative interventions, including intermittent fasting, alternate-day fasting and the Mediterranean diet, along with their cardiometabolic effects in animal models and humans. We then present emerging pharmacological alternatives, including spermidine, NAD+ precursors, resveratrol, and metformin, as promising caloric restriction mimetics, and briefly touch on the mechanisms underpinning their cardiometabolic and health-promoting effects. We conclude that implementation of feasible dietary approaches holds the promise to attenuate the burden of cardiovascular disease and facilitate healthy aging in humans.
Collapse
Affiliation(s)
- Julia Voglhuber
- Department of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | - Senka Ljubojevic-Holzer
- Department of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | - Mahmoud Abdellatif
- Department of Cardiology, Medical University of Graz, Graz, Austria
- Centre de Recherche des Cordeliers, Equipe labellisée par La Ligue Contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Institute Universitaire de France, Paris, France
| | - Simon Sedej
- Department of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
- Faculty of Medicine, Institute of Physiology, University of Maribor, Maribor, Slovenia
| |
Collapse
|
45
|
Influence of Hyperglycemia and Diabetes on Cardioprotection by Humoral Factors Released after Remote Ischemic Preconditioning (RIPC). Int J Mol Sci 2021; 22:ijms22168880. [PMID: 34445586 PMCID: PMC8396298 DOI: 10.3390/ijms22168880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023] Open
Abstract
Remote ischemic preconditioning (RIPC) protects hearts from ischemia-reperfusion (I/R) injury in experimental studies; however, clinical RIPC trials were unsatisfactory. This discrepancy could be caused by a loss of cardioprotection due to comorbidities in patients, including diabetes mellitus (DM) and hyperglycemia (HG). RIPC is discussed to confer protective properties by release of different humoral factors activating cardioprotective signaling cascades. Therefore, we investigated whether DM type 1 and/or HG (1) inhibit the release of humoral factors after RIPC and/or (2) block the cardioprotective effect directly at the myocardium. Experiments were performed on male Wistar rats. Animals in part 1 of the study were either healthy normoglycemic (NG), type 1 diabetic (DM1), or hyperglycemic (HG). RIPC was implemented by four cycles of 5 min bilateral hind-limb ischemia/reperfusion. Control (Con) animals were not treated. Blood plasma taken in vivo was further investigated in isolated rat hearts in vitro. Plasma from diseased animals (DM1 or HG) was administered onto healthy (NG) hearts for 10 min before 33 min of global ischemia and 60 min of reperfusion. Part 2 of the study was performed vice versa-plasma taken in vivo, with or without RIPC, from healthy rats was transferred to DM1 and HG hearts in vitro. Infarct size was determined by TTC staining. Part 1: RIPC plasma from NG (NG Con: 49 ± 8% vs. NG RIPC 29 ± 6%; p < 0.05) and DM1 animals (DM1 Con: 47 ± 7% vs. DM1 RIPC: 38 ± 7%; p < 0.05) reduced infarct size. Interestingly, transfer of HG plasma showed comparable infarct sizes independent of prior treatment (HG Con: 34 ± 9% vs. HG RIPC 35 ± 9%; ns). Part 2: No infarct size reduction was detectable when transferring RIPC plasma from healthy rats to DM1 (DM1 Con: 54 ± 13% vs. DM1 RIPC 53 ± 10%; ns) or HG hearts (HG Con: 60 ± 16% vs. HG RIPC 53 ± 14%; ns). These results suggest that: (1) RIPC under NG and DM1 induces the release of humoral factors with cardioprotective impact, (2) HG plasma might own cardioprotective properties, and (3) RIPC does not confer cardioprotection in DM1 and HG myocardium.
Collapse
|
46
|
Longitudinal family caregiving experiences in heart failure: Secondary qualitative analysis of interviews. Heart Lung 2021; 50:627-633. [PMID: 34091108 DOI: 10.1016/j.hrtlng.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Considering the potential impacts of family caregivers on heart failure management and the costs of healthcare, health professionals need to pay attention to the challenges faced by family caregivers. OBJECTIVE This study longitudinally explored the caregiving experiences of family caregivers of persons with heart failure. METHODS Serial interview scripts collected from 53 family caregivers were analyzed using a content analysis method. RESULTS The following themes emerged: (1) accumulating knowledge and skills for caregiving; (2) losing a sense of control; (3) balancing an unstable life; (4) constructing illness memory; (5) centering the patient in daily life; (6) accepting the loss of a family member; (7) coping with grief by drawing on social support; (8) facing financial responsibility; and (9) rethinking hospice care. CONCLUSION Family caregivers experience concern about unpredictable caregiving years, disease's fluctuating symptoms and poor prognosis. More educational opportunities, financial counseling programs, and palliative care consultations should be provided.
Collapse
|
47
|
Albert NM, Tyson RJ, Hill CL, DeVore AD, Spertus JA, Duffy C, Butler J, Patterson JH, Hernandez AF, Williams FB, Thomas L, Fonarow GC. Variation in use and dosing escalation of renin angiotensin system, mineralocorticoid receptor antagonist, angiotensin receptor neprilysin inhibitor and beta-blocker therapies in heart failure and reduced ejection fraction: Association of comorbidities. Am Heart J 2021; 235:82-96. [PMID: 33497697 DOI: 10.1016/j.ahj.2021.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND In patients with heart failure and reduced ejection fraction (HFrEF), angiotensin converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), or angiotensin receptor neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonists (MRA), and beta-blockers (βB) are underutilized. It is unknown if patients with and without comorbidities have similar ACEi/ARB/ARNI, MRA, and βB prescription patterns. METHODS Baseline data from the CHAMP-HF (Change the Management of Patients with Heart Failure) registry were categorized by history of atrial fibrillation, asthma/chronic lung disease, obstructive sleep apnea, and depression. Using multivariate hierarchical logistic models, associations of ACEi/ARB/ARNI, MRA and βB medication use and dose by comorbidities were assessed after adjusting for patient characteristics. RESULTS Of 4,815 HFrEF patients from 152 CHAMP-HF sites, ACEi/ARB/ARNI use was lower in patients with more comorbidities, and generally, MRA use was low and βB use was high. In adjusted analyses, patients with HFrEF and comorbid obstructive sleep apnea, vs. without, were more likely to be prescribed ARNI (OR [95% CI]: 1.25 [1.00, 1.55]); P = .047 and MRA (1.31 [1.11, 1.55]); P = .002 and less likely to be prescribed ACEi (0.74 [0.63, 0.88]); P < .001. Patients with atrial fibrillation, vs. without, were less likely to receive ACEi/ARB (0.82 [0.71, 0.95]); P = .006 and any study medication (0.81 [0.67, 0.97]); P = .020. Comorbid lung disease and history of depression were not associated with HFrEF prescriptions. CONCLUSIONS Renin-angiotensin-aldosterone blockade therapy prescription and dose varied by comorbidity status, but βB therapy did not. In quality efforts, leaders need to consider use and dosing of prescriptions in light of prevalent comorbidities.
Collapse
|
48
|
Application of quality by design approach for HPTLC simultaneous determination of amlodipine and celecoxib in presence of process-related impurity. Microchem J 2021. [DOI: 10.1016/j.microc.2020.105857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
49
|
Evans M, Morgan AR, Patel D, Dhatariya K, Greenwood S, Newland-Jones P, Hicks D, Yousef Z, Moore J, Kelly B, Davies S, Dashora U. Risk Prediction of the Diabetes Missing Million: Identifying Individuals at High Risk of Diabetes and Related Complications. Diabetes Ther 2021; 12:87-105. [PMID: 33190216 PMCID: PMC7843706 DOI: 10.1007/s13300-020-00963-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023] Open
Abstract
Early diagnosis and effective management of type 2 diabetes (T2D) are crucial in reducing the risk of developing life-changing complications such as heart failure, stroke, kidney disease, blindness and amputation, which are also associated with significant costs for healthcare providers. However, as T2D symptoms often develop slowly it is not uncommon for people to live with T2D for years without being aware of their condition-commonly known as the undiagnosed missing million. By the time a diagnosis is received, many individuals will have already developed serious complications. While the existence of undiagnosed diabetes has long been recognised, wide-reaching awareness among the general public, clinicians and policymakers is lacking, and there is uncertainty in how best to identify high-risk individuals. In this article we have used consensus expert opinion alongside the available evidence, to provide support for the diabetes healthcare community regarding risk prediction of the missing million. Its purpose is to provide awareness of the risk factors for identifying individuals at high, moderate and low risk of T2D and T2D-related complications. The awareness of risk predictors, particularly in primary care, is important, so that appropriate steps can be taken to reduce the clinical and economic burden of T2D and its complications.
Collapse
Affiliation(s)
- Marc Evans
- Diabetes Resource Centre, University Hospital Llandough, Cardiff, UK.
| | | | - Dipesh Patel
- Department of Diabetes, Division of Medicine, University College London, Royal Free NHS Trust, London, UK
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Sharlene Greenwood
- Renal Medicine, King's College Hospital, London, UK
- Renal Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Zaheer Yousef
- Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Jim Moore
- Stoke Road Surgery, Bishop's Cleeve, Cheltenham, UK
| | | | | | - Umesh Dashora
- East Sussex Healthcare NHS Trust, St Leonards-on-Sea, UK
| |
Collapse
|
50
|
Cheung JTK, Yu R, Woo J. Is polypharmacy beneficial or detrimental for older adults with cardiometabolic multimorbidity? Pooled analysis of studies from Hong Kong and Europe. Fam Pract 2020; 37:793-800. [PMID: 32596732 PMCID: PMC7699312 DOI: 10.1093/fampra/cmaa062] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Physicians often prescribe high numbers of medications for managing multiple cardiometabolic diseases. It is questionable whether polypharmacy (concurrent use of five or more medications) is beneficial or detrimental for older adults with cardiometabolic multimorbidity (co-occurrence of two or more diseases). OBJECTIVE To examine combined effects of multimorbidity and polypharmacy on hospitalization and frailty and to determine whether effect sizes of polypharmacy vary with numbers of cardiometabolic diseases. METHODS We pooled longitudinal data of community-dwelling older adults in Hong Kong, Israel, and 17 European countries. They completed questionnaires for baseline assessment from 2015 to 2018 and reassessment at 1-2-year follow-up. We performed regression analyses to address the objective. RESULTS Among 44 818 participants (mean age: 69.6 years), 28.3% had polypharmacy and 34.8% suffered from cardiometabolic multimorbidity. Increased risks of hospitalization and worsening frailty were found in participants with 'multimorbidity alone' [adjusted odds ratio (AOR) 1.10 and 1.26] and 'polypharmacy alone' (AOR 1.57 and 1.68). With 'multimorbidity and 'polypharmacy' combined, participants were not at additive risks (AOR 1.53 and 1.47). In stratified analysis, with increasing numbers of cardiometabolic diseases, associations of polypharmacy with hospitalization and frailty were attenuated but remained statistically significant. CONCLUSION Polypharmacy is less detrimental, yet still detrimental, for older adults living with cardiometabolic multimorbidity. Physicians should optimize prescription regardless of the number of diseases. Health policymakers and researchers need to consider their interrelationship in hospitalization risk predictions and in developing frailty scales.
Collapse
Affiliation(s)
- Johnny T K Cheung
- Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ruby Yu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jean Woo
- Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|