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Sabit H, Abdel-Ghany S, Abdallah MS, Abul-Maaty O, Khoder AI, Shoman NA, Farrag MS, Martasek P, Noreddin AM, Nazih M. Vitamin D: A key player in COVID-19 immunity and lessons from the pandemic to combat immune-evasive variants. Inflammopharmacology 2024; 32:3631-3652. [PMID: 39406981 DOI: 10.1007/s10787-024-01578-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 09/18/2024] [Indexed: 11/10/2024]
Abstract
As of the 7th of July 2024, 775,754,322 confirmed cases of COVID-19, including 7,053,902 deaths worldwide, had been reported to the WHO (World Health Organization). Nevertheless, untill the 15th of July 2024, a total of 13,578,710,228 vaccine doses had been administered, with almost no country spared from COVID-19 attacks. The pathophysiology of this virus is complicated, and several symptoms require a deep understanding of the actual mechanisms. It is unclear why some patients develop severe symptoms while others do not, although literature suggests a role for vitamin D. Vitamin D plays a crucial role in the infection or in ameliorating the severity of symptoms. The mechanism of action of vitamin D and vitamin D deficiency (VDD) is well understood. VDD is associated with increased hospitalization of severely ill patients and increased levels of COVID-19-caused mortality. Recent studies suggest that vitamin D levels and genetic variations in the vitamin D receptor (VDR) gene significantly impact the severity and outcomes of COVID-19, especially in the infections caused by Delta and Omicron variants. Furthermore, VDD causes immune system dysregulation upon infection with SARS-CoV-2, indicating that vitamin D sufficiency is crucial in fighting against COVID-19 infection. The therapeutic effect of vitamin D raises interest in its potential role as a prophylactic and treatment adjunct. We evaluate the immunomodulatory effects of vitamin D and its ability to enhance the efficacy of new antiviral drugs like molnupiravir and paxlovid against SARS-CoV-2. This review discusses the role of vitamin D sufficiency and VDD in COVID-19 initiation and progression, emphasizing the molecular mechanisms by which vitamin D exerts its actions as a proactive step for the next pandemic. However, there is still no clear evidence of vitamin D's impact on prevention and treatment, leading to contradictory findings. Therefore, large-scale randomized trials are required to reach a definitive conclusion. A bibliometric analysis of publications related to vitamin D, immunity, and COVID-19 revealed a significant increase in research activity in this area, particularly in 2020-2024, underscoring the growing recognition of vitamin D's potential role in the context of the pandemic.
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Affiliation(s)
- Hussein Sabit
- Department of Medical Biotechnology, College of Biotechnology, Misr University for Science and Technology, P. O. Box 77, Giza, Egypt.
| | - Shaimaa Abdel-Ghany
- Department of Environmental Biotechnology, College of Biotechnology, Misr University for Science and Technology, P. O. Box 77, Giza, Egypt
| | - Mahmoud S Abdallah
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Sadat City (USC), Sadat City, 32897, Egypt
- Department of PharmD, Faculty of Pharmacy, Jadara University, Irbid, 21110, Jordan
| | | | - Ahmed I Khoder
- Scientific Office, Egyptian Society of Pharmacogenomics and Personalized Medicine (ESPM), Cairo, Egypt
- Molecular Biology Department, Genetic Engineering and Biotechnology Research Institute, University of Sadat City, Sadat City, Egypt
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Menoufia University, Shebin El-Koum, Egypt
| | - Nabil A Shoman
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt
| | - Mohamed Sameh Farrag
- Scientific Office, Egyptian Society of Pharmacogenomics and Personalized Medicine (ESPM), Cairo, Egypt
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague Ke Karlovu 2, 128 08, Praha 2, Czech Republic
| | - Pavel Martasek
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague Ke Karlovu 2, 128 08, Praha 2, Czech Republic
| | - Ayman M Noreddin
- Scientific Office, Egyptian Society of Pharmacogenomics and Personalized Medicine (ESPM), Cairo, Egypt
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ahram Canadian University (ACU), 6th of October City, Giza, 12566, Egypt
- Department of Internal Medicine, School of Medicine, University of California-Irvine, Irvine, CA, USA
| | - Mahmoud Nazih
- Scientific Office, Egyptian Society of Pharmacogenomics and Personalized Medicine (ESPM), Cairo, Egypt.
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ahram Canadian University (ACU), 6th of October City, Giza, 12566, Egypt.
- Al Ryada University for Science and Technology (RST), ElMehwar ElMarkazy-2, Cairo - Alex desert RD K92, Sadat City, 16504, Egypt.
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Nagaoka R, Katano S, Yano T, Numazawa R, Yamano K, Fujisawa Y, Honma S, Kamoda T, Sato K, Kouzu H, Ohori K, Katayose M, Hashimoto A, Furuhashi M. Optimal serum 25-hydroxyvitamin D level to prevent sarcopenia in patients with heart failure: Insights from a dose-response relationship. Nutr Metab Cardiovasc Dis 2024; 34:606-617. [PMID: 38000999 DOI: 10.1016/j.numecd.2023.10.003] [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: 04/15/2023] [Revised: 08/09/2023] [Accepted: 10/04/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND AIMS Low serum 25-hydroxyvitamin D (25 [OH]D) levels have been associated with sarcopenia, frailty, and risk of cardiovascular disease, whereas high levels negatively impact clinical outcomes. We determined optimal serum 25(OH)D concentrations to minimise the probability of sarcopenia in patients with heart failure (HF) by examining the dose-dependent relationship between serum 25(OH)D levels and sarcopenia. METHODS AND RESULTS We enrolled 461 consecutive patients with HF (mean age, 72 ± 15 years; 39% female) who underwent dual-energy X-ray absorptiometry. Serum 25(OH)D levels were measured using a chemiluminescence immunoassay. Sarcopenia was diagnosed according to the 2019 Asian Working Group for Sarcopenia criteria. Overall, 49% of enrolled patients were diagnosed with sarcopenia. Adjusted logistic regression with restricted cubic spline function revealed that the odds ratio (OR) of sarcopenia increased in patients with HF presenting serum 25(OH)D levels <14.6 ng/ml or > 31.4 ng/ml, reaching the lowest OR at ∼20 ng/ml. Multivariate logistic regression revealed that a serum 25(OH)D level below 14.6 ng/mL was independently associated with the presence of sarcopenia (adjusted OR: 2.16, 95% confidence interval [CI]: 1.24-3.78). Incorporating serum 25(OH)D levels <14.6 ng/ml, but not <20.0 ng/ml, in the baseline model improved continuous net reclassification (0.334, 95% CI: 0.122-0.546) in patients with HF. CONCLUSION A U-shaped relationship exists between serum 25(OH)D levels and sarcopenia probability in patients with HF. Maintaining serum 25(OH)D levels between 14.6 and 31.4 ng/ml may help prevent sarcopenia in patients with HF.
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Affiliation(s)
- Ryohei Nagaoka
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan; Second Division of Physical Therapy, Sapporo Medical University School of Health Science, Sapporo, Japan.
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryo Numazawa
- Graduate School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kotaro Yamano
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Yusuke Fujisawa
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Suguru Honma
- Second Division of Physical Therapy, Sapporo Medical University School of Health Science, Sapporo, Japan; Department of Rehabilitation, Sapporo Cardiovascular Hospital, Sapporo, Japan
| | - Tatsuki Kamoda
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Kohei Sato
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Katsuhiko Ohori
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Masaki Katayose
- Second Division of Physical Therapy, Sapporo Medical University School of Health Science, Sapporo, Japan
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan; Division of Health Care Administration and Management, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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de Oliveira E Silva Ullmann T, Ramalho BJ, Laurindo LF, Tofano RJ, Rubira CJ, Guiguer EL, Barbalho SM, Flato UAP, Sloan KP, Araujo AC. Effects of Vitamin D Supplementation in Diabetic Kidney Disease: A Systematic Review. J Ren Nutr 2023; 33:618-628. [PMID: 37302723 DOI: 10.1053/j.jrn.2023.05.006] [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: 10/17/2022] [Revised: 05/05/2023] [Accepted: 05/27/2023] [Indexed: 06/13/2023] Open
Abstract
Diabetes Mellitus is a highly prevalent condition in which Diabetes Mellitus type 2 is the most common. Diabetic Kidney Disease is one of the most relevant complications and affects approximately one-third of patients with Diabetes Mellitus. It is characterized by increased urinary protein excretion and a decrease in glomerular filtration rate, assessed by serum creatinine levels. Recent studies have shown that vitamin D levels are low in these patients. This study aimed to conduct a systematic review of the effects of vitamin D supplementation on proteinuria and creatinine, which are important markers for assessing the severity of kidney disease in patients with Diabetic Kidney Disease. PUBMED, EMBASE, and COCHRANE databases were consulted, Preferred Reporting Items for a Systematic Review and Meta-Analysis guidelines were followed, and the COCHRANE toll for bias assessment was applied. Six papers were quantitative studies and fulfilled the inclusion criteria for this review. The results showed that vitamin D supplementation of 50,000 I.U./week for 8 weeks effectively reduced proteinuria and creatinine in patients with Diabetic Kidney Disease, particularly in patients with Diabetes Mellitus type 2. Vitamin D supplementation is beneficial for patients with Diabetic Kidney Disease by having essential effects on disease-related inflammatory markers, such as the reduction of proteinuria and creatinine. However, more clinical trials must be conducted to evaluate the intervention among more significant numbers of patients.
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Affiliation(s)
- Thais de Oliveira E Silva Ullmann
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil; Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Hospital Beneficente Unimar - University of Marília, São Paulo, Brazil
| | | | | | - Ricardo José Tofano
- Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Hospital Beneficente Unimar - University of Marília, São Paulo, Brazil
| | - Claudio José Rubira
- Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Hospital Beneficente Unimar - University of Marília, São Paulo, Brazil
| | - Elen Landgraf Guiguer
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil; Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Department of Biochemistry, School of Food and Technology of Marília, São Paulo, Brazil
| | - Sandra Maria Barbalho
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil; Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Department of Biochemistry, School of Food and Technology of Marília, São Paulo, Brazil.
| | - Uri Adrian Prync Flato
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil; Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil; Hospital Beneficente Unimar - University of Marília, São Paulo, Brazil
| | | | - Adriano Cressoni Araujo
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília, São Paulo, Brazil; Department of Biochemistry and Pharmacology, University of Marília, São Paulo, Brazil
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Wang X, Wang J, Gao T, Sun H, Yang B. Is vitamin D deficiency a risk factor for all-cause mortality and rehospitalization in heart failure patients?: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29507. [PMID: 35839043 PMCID: PMC11132358 DOI: 10.1097/md.0000000000029507] [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: 02/21/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The association of low 25-hydroxyvitamin D level with mortality and rehospitalization remains inconsistent in patients with heart failure. This systematic review and meta-analysis aimed to evaluate the value of blood 25-hydroxyvitamin D level in predicting all-cause mortality and hospitalization in heart failure patients. METHODS Two reviewers independently search the articles indexed in PubMed and Embase databases until November 30, 2021. Only the prospective or retrospective cohort studies evaluating the association of blood 25-hydroxyvitamin D level with all-cause mortality and rehospitalization in heart failure patients were selected. The predictive value of 25-hydroxyvitamin D level was summarized by pooling multivariable adjusted risk estimates for the bottom versus reference top 25-hydroxyvitamin D level. RESULTS Seven studies with a total of 5941 patients with heart failure were identified. The pooled adjusted risk ratio (RR) of all-cause mortality was 1.37 (95% confidence interval [CI] 1.13-1.66), with significant heterogeneity (I2 = 70.5%; P = 0.002). However, there was no clear association between low 25-hydroxyvitamin D level and all-cause rehospitalization risk (RR 1.38; 95% CI 0.87-2.19). CONCLUSIONS Low blood level of 25-hydroxyvitamin D may be an independent risk factor for all-cause mortality in patients with heart failure. Serum 25-hydroxyvitamin D level may provide prognostic information in heart failure patients. Additional randomized controlled trials are required to explore whether treatment of 25-hydroxyvitamin D deficiency by supplementation of vitamin D can improve survival in heart failure patients.
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Affiliation(s)
- Xiuming Wang
- Department of Air Force Service, Air Force Hospital from Northern Theater of Chinese People’s Liberation Army, Shenyang, China
| | - Jun Wang
- Department of pediatrics, Shenyang Fourth People’s Hospital, Shenyang, China
| | - Tingting Gao
- Department of Air Force Service, Air Force Hospital from Northern Theater of Chinese People’s Liberation Army, Shenyang, China
| | - Haitao Sun
- Department of Air Force Service, Air Force Hospital from Northern Theater of Chinese People’s Liberation Army, Shenyang, China
| | - Baisong Yang
- Department of Cardiovascular Medicine, Air Force Hospital from Northern Theater of Chinese People’s Liberation Army, Shenyang, China
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Wang J, Bieber BA, Hou FF, Port FK, Anand S. Mineral and bone disorder and management in the China Dialysis Outcomes and Practice Patterns Study. Chin Med J (Engl) 2019; 132:2775-2782. [PMID: 31856047 PMCID: PMC6940068 DOI: 10.1097/cm9.0000000000000533] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite a growing population of patients starting hemodialysis in China, little is known about markers of mineral bone disease (MBD) and their management. We present data on prevalence and correlates of hypocalcemia, hyperphosphatemia, and secondary hyperparathyroidism from the China Dialysis Outcomes and Practice Patterns Study (DOPPS), with evaluation of whether these laboratory markers triggered changes in management. METHODS We compared the frequency of measurement and prevalence of poor control of MBD markers in China DOPPS with other DOPPS regions. We also used generalized estimating equations to assess correlates of MBD markers, and separate models to assess predictors of vitamin D and phosphate binder prescriptions in the China DOPPS. RESULTS Severe hyperphosphatemia (>7 mg/dL) and secondary hyperparathyroidism (>600 pg/mL) were common (27% and 21% prevalence, respectively); both were measured infrequently (14.9% and 3.2% of patients received monthly measurements in China). Frequency of dialysis sessions was positively associated with hyperphosphatemia; presence of residual kidney function was negatively associated with both hyperphosphatemia and secondary hyperparathyroidism. Laboratory measures indicating poor control of MBD were not associated with subsequent prescription of active vitamin D or phosphate binder. CONCLUSIONS There are substantial opportunities for improvement and standardization of MBD management in China. Development of country-specific guidelines may yield realistic targets and standardization of medication use accounting for availability and cost.
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Affiliation(s)
- Jun Wang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | | | - Fan-Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | | | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
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Tarnoki AD, Szalontai L, Fagnani C, Tarnoki DL, Lucatelli P, Maurovich-Horvat P, Jermendy AL, Kovacs A, Molnar AA, Godor E, Fejer B, Hernyes A, Cirelli C, Fanelli F, Farina F, Baracchini C, Meneghetti G, Gyarmathy AV, Jermendy G, Merkely B, Pucci G, Schillaci G, Stazi MA, Medda E. Genetic and environmental factors on heart rate, mean arterial pressure and carotid intima-media thickness: A longitudinal twin study. Cardiol J 2019; 28:431-438. [PMID: 31489962 DOI: 10.5603/cj.a2019.0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/14/2019] [Accepted: 05/03/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Heart rate (HR), mean arterial pressure (MAP) and carotid intima-media thickness (cIMT) are moderately heritable cardiovascular traits, but the environmental effects on the longitudinal change of their heritability have never been investigated. METHODS 368 Italian and Hungarian twins (107 monozygotic, 77 dizygotic) underwent oscillometric measurement and B-mode sonography of bilateral carotid arteries in 2009/2010 and 2014. Within- -individual/cross-study wave, cross-twin/within-study wave and cross-twin/cross-study wave correlations were estimated, and bivariate Cholesky models were fitted to decompose the total variance at each wave and covariance between study waves into additive genetic, shared and unique environmental components. RESULTS For each trait, a moderate longitudinal stability was observed, with within-individual/crosswave correlations of 0.42 (95% CI: 0.33-0.51) for HR, 0.34 (95% CI: 0.24-0.43) for MAP, and 0.23 (95% CI: 0.12-0.33) for cIMT. Cross-twin/cross-wave correlations in monozygotic pairs were all significant and substantially higher than the corresponding dizygotic correlations. Genetic continuity was the main source of longitudinal stability, with across-time genetic correlations of 0.52 (95% CI: 0.29-0.71) for HR, 0.56 (95% CI: 0.31-0.81) for MAP, and 0.36 (95% CI: 0.07-0.64) for cIMT. Overlapping genetic factors explained respectively 57%, 77%, and 68% of the longitudinal covariance of the HR, MAP and cIMT traits. CONCLUSIONS Genetic factors have a substantial role in the longitudinal change of HR, MAP and cIMT; however, the influence of unique environmental factors remains relevant. Further studies should better elucidate whether epigenetic mechanisms have a role in influencing the stability of the investigated traits over time.
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Affiliation(s)
- Adam D Tarnoki
- Department of Radiology, Semmelweis University, 78/a Ulloi street, H-1082 Budapest, Hungary.,Hungarian Twin Registry, 29 Erdélyi street, 1212 Budapest, Hungary
| | - Laszlo Szalontai
- Department of Radiology, Semmelweis University, 78/a Ulloi street, H-1082 Budapest, Hungary.
| | - Corrado Fagnani
- Italian Twin Registry, Centre for Behavioural Sciences and Mental Health; Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - David L Tarnoki
- Department of Radiology, Semmelweis University, 78/a Ulloi street, H-1082 Budapest, Hungary.,Hungarian Twin Registry, 29 Erdélyi street, 1212 Budapest, Hungary
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 18 Hataror street, 1122 Budapest, Hungary
| | - Adam L Jermendy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 18 Hataror street, 1122 Budapest, Hungary
| | - Attila Kovacs
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 18 Hataror street, 1122 Budapest, Hungary
| | - Andrea Agnes Molnar
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 18 Hataror street, 1122 Budapest, Hungary
| | - Erika Godor
- Department of Radiology, Semmelweis University, 78/a Ulloi street, H-1082 Budapest, Hungary
| | - Bence Fejer
- Department of Radiology, Semmelweis University, 78/a Ulloi street, H-1082 Budapest, Hungary
| | - Anita Hernyes
- Department of Radiology, Semmelweis University, 78/a Ulloi street, H-1082 Budapest, Hungary
| | - Carlo Cirelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Fabrizio Fanelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Filippo Farina
- Department of Neurosciences, University of Padua School of Medicine, Via Giustiniani 5, 35128 Padova, Italy
| | - Claudio Baracchini
- Department of Neurosciences, University of Padua School of Medicine, Via Giustiniani 5, 35128 Padova, Italy
| | - Giorgio Meneghetti
- Department of Neurosciences, University of Padua School of Medicine, Via Giustiniani 5, 35128 Padova, Italy
| | - Anna V Gyarmathy
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, MD 21205 Baltimore, United States
| | - Gyorgy Jermendy
- 3rd Department of Internal Medicine, Bajcsy Zsilinszky Hospital, 89-91 Maglódi street, 1106 Budapest, Hungary
| | - Bela Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 18 Hataror street, 1122 Budapest, Hungary
| | - Giacomo Pucci
- Università di Perugia, Unità di Medicina Interna, Ospedale, Viale Tristano di Joannuccio 1, 05100 Terni, Italy.,Struttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Giuseppe Schillaci
- Università di Perugia, Unità di Medicina Interna, Ospedale, Viale Tristano di Joannuccio 1, 05100 Terni, Italy
| | - Maria A Stazi
- Italian Twin Registry, Centre for Behavioural Sciences and Mental Health; Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Emanuela Medda
- Italian Twin Registry, Centre for Behavioural Sciences and Mental Health; Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
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