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Zhang X, Wan Y, Karunathilaka N, Chan W, Kostner K, Hartel G, Coats AJS, Atherton JJ, Punyadeera C. Prognostic utility of serum NT-proBNP (fragments 1-76aa and 13-71aa) and galectin-3 in predicting death and re-hospitalisation due to cardiovascular events in patients with heart failure. Heart Vessels 2024; 39:86-94. [PMID: 37537380 PMCID: PMC10764512 DOI: 10.1007/s00380-023-02296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
Patients with heart failure (HF) are at a higher risk of rehospitalisation. In this study, we investigated the prognostic utility of galectin-3 (Gal-3) and NT-proBNP fragments (1-76aa and 13-71aa) as biomarkers to predict outcomes for patients with HF. We collected blood samples from patients with HF (n = 101). Gal-3 and NT-proBNP fragments (1-76aa and 13-71aa) concentrations were measured by immunoassay. Survival analysis and Cox proportional regression models were used to determine the prognostic utility of Gal-3 and NT-proBNP fragments. In patients with increased baseline levels of NT-proBNP1-76 the time to primary endpoint (cardiovascular death or re-hospitalisation) was significantly shorter (p = 0.0058), but not in patient with increased baseline levels of Gal-3 or NTproBNP13-71. Patients with increased levels of NT-proBNP13-71aa at 1 month showed reduced time to the primary endpoint (p = 0.0123). Our findings demonstrated that Gal-3 and NT-proBNP can be used as prognostic biomarkers to stratify patients with HF.
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Affiliation(s)
- Xi Zhang
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia
| | - Yunxia Wan
- Saliva and Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nuwan Karunathilaka
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia
| | - Wandy Chan
- The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Adult Hospital, Brisbane, QLD, Australia
| | - Gunter Hartel
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Andrew J S Coats
- Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- University of Warwick, Coventry, UK
- Monash University, Clayton, Australia
| | - John J Atherton
- Cardiology Department, Faculty of Medicine, Royal Brisbane and Women's Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia.
- Saliva and Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
- Translational Research Institute, Woolloongabba, Australia.
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia.
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2
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Hamilton-Craig C, Kostner K, Colquhoun D, Nicholls SJ. Omega-3 fatty acids and cardiovascular prevention: is the jury still out? Intern Med J 2023; 53:2330-2335. [PMID: 38105550 DOI: 10.1111/imj.16283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/01/2023] [Indexed: 12/19/2023]
Abstract
The cardiovascular benefits of omega-3 polyunsaturated fatty acids (O3FA) remain a point of confusion in clinical medicine. Recently two large, randomised trials were published with discordant findings regarding the overall benefits of omega-3 supplementation, resulting in unnecessary confusion and therapeutic nihilism. Epidemiological studies clearly show high intake of fish and measured O3FA (mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) in tissues are inversely associated with cardiovascular events and total mortality. These fatty acids are 'essential' and depend almost entirely on intake with very little production from within the body. The efficacy of supplementation depends on background tissue levels, in contradistinction to drug therapy. Insufficient dosing of omega-3 supplementation using less than 1 g/day and lack of titration to target by failing to measure O3FA levels in the blood may explain these conflicting trial outcomes. We review the current evidence regarding O3FA supplementation and cardiovascular outcomes, describe possible reasons for the discrepant results in the literature including recent controversial data around the mineral oil comparator used in REDUCE-IT and discuss the potential use of the omega-3 index to guide management and optimise supplementation in those at greatest risk.
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Affiliation(s)
- Christian Hamilton-Craig
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine, Griffith University, Sunshine Coast, Queensland, Australia
| | - Karam Kostner
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Director of Cardiology, Mater Hospital, Brisbane, Queensland, Australia
| | - David Colquhoun
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Clinical and Preventive Cardiology, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Stephen J Nicholls
- Victoria Heart Institute, Melbourne, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
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3
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Sarkies MN, Testa L, Best S, Moullin JC, Sullivan D, Bishop W, Kostner K, Clifton P, Hare D, Brett T, Hutchinson K, Black A, Braithwaite J, Nicholls SJ, Kangaharan N, Pang J, Abhayaratna W, Horton A, Watts GF. Barriers to and Facilitators of Implementing Guidelines for Detecting Familial Hypercholesterolaemia in Australia. Heart Lung Circ 2023; 32:1347-1353. [PMID: 37865587 DOI: 10.1016/j.hlc.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 07/27/2023] [Accepted: 09/06/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Familial hypercholesterolaemia (FH) is a genetic condition that is a preventable cause of premature cardiovascular morbidity and mortality. High-level evidence and clinical practice guidelines support preventative care for people with FH. However, it is estimated that less than 10% of people at risk of FH have been detected using any approach across Australian health settings. The aim of this study was to identify the implementation barriers to and facilitators of the detection of FH in Australia. METHODS Four, 2-hour virtual focus groups were facilitated by implementation scientists and a clinicians as part of the 2021 Australasian FH Summit. Template analysis was used to identify themes. RESULTS There were 28 workshop attendees across four groups (n=6-8 each), yielding 13 barriers and 10 facilitators across three themes: (1) patient related, (2) provider related, and (3) system related. A "lack of care pathways" and "upskilling clinicians in identifying and diagnosing FH" were the most interconnected barriers and facilitators for the detection of FH. CONCLUSIONS The relationships between barriers and facilitators across the patient, provider, and system themes indicates that a comprehensive implementation strategy is needed to address these different levels. Future research is underway to develop a model for implementing the Australian FH guidelines into practice.
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Affiliation(s)
- Mitchell N Sarkies
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
| | - Luke Testa
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Stephanie Best
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Vic, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic, Australia
| | - Joanna C Moullin
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - David Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Warrick Bishop
- Department of Cardiology, Calvary Cardiac Centre, Calvary Health Care, Hobart, Tas, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Peter Clifton
- Department of Endocrinology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - David Hare
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
| | - Tom Brett
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Karen Hutchinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Andrew Black
- Department of Cardiology, Royal Hobart Hospital, Hobart, Tas, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | | | - Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Walter Abhayaratna
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Ari Horton
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Vic, Australia; Monash Heart and Monash Children's Hospital, Monash Health, Melbourne, Vic, Australia; Monash Genetics, Monash Health, Melbourne, Vic, Australia; Department of Genomic Medicine, The Royal Melbourne Hospital, Parkville, Vic, Australia; Department of Paediatrics, Monash University Clayton, Vic, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
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Rizzo M, Colletti A, Penson PE, Katsiki N, Mikhailidis DP, Toth PP, Gouni-Berthold I, Mancini J, Marais D, Moriarty P, Ruscica M, Sahebkar A, Vinereanu D, Cicero AFG, Banach M, Al-Khnifsawi M, Alnouri F, Amar F, Atanasov AG, Bajraktari G, Banach M, Gouni-Berthold I, Bhaskar S, Bielecka-Dąbrowa A, Bjelakovic B, Bruckert E, Bytyçi I, Cafferata A, Ceska R, Cicero AF, Chlebus K, Collet X, Daccord M, Descamps O, Djuric D, Durst R, Ezhov MV, Fras Z, Gaita D, Gouni-Berthold I, Hernandez AV, Jones SR, Jozwiak J, Kakauridze N, Kallel A, Katsiki N, Khera A, Kostner K, Kubilius R, Latkovskis G, John Mancini G, David Marais A, Martin SS, Martinez JA, Mazidi M, Mikhailidis DP, Mirrakhimov E, Miserez AR, Mitchenko O, Mitkovskaya NP, Moriarty PM, Mohammad Nabavi S, Nair D, Panagiotakos DB, Paragh G, Pella D, Penson PE, Petrulioniene Z, Pirro M, Postadzhiyan A, Puri R, Reda A, Reiner Ž, Radenkovic D, Rakowski M, Riadh J, Richter D, Rizzo M, Ruscica M, Sahebkar A, Serban MC, Shehab AM, Shek AB, Sirtori CR, Stefanutti C, Tomasik T, Toth PP, Viigimaa M, Valdivielso P, Vinereanu D, Vohnout B, von Haehling S, Vrablik M, Wong ND, Yeh HI, Zhisheng J, Zirlik A. Nutraceutical approaches to non-alcoholic fatty liver disease (NAFLD): A position paper from the International Lipid Expert Panel (ILEP). Pharmacol Res 2023; 189:106679. [PMID: 36764041 DOI: 10.1016/j.phrs.2023.106679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
Non-Alcoholic Fatty Liver Disease (NAFLD) is a common condition affecting around 10-25% of the general adult population, 15% of children, and even > 50% of individuals who have type 2 diabetes mellitus. It is a major cause of liver-related morbidity, and cardiovascular (CV) mortality is a common cause of death. In addition to being the initial step of irreversible alterations of the liver parenchyma causing cirrhosis, about 1/6 of those who develop NASH are at risk also developing CV disease (CVD). More recently the acronym MAFLD (Metabolic Associated Fatty Liver Disease) has been preferred by many European and US specialists, providing a clearer message on the metabolic etiology of the disease. The suggestions for the management of NAFLD are like those recommended by guidelines for CVD prevention. In this context, the general approach is to prescribe physical activity and dietary changes the effect weight loss. Lifestyle change in the NAFLD patient has been supplemented in some by the use of nutraceuticals, but the evidence based for these remains uncertain. The aim of this Position Paper was to summarize the clinical evidence relating to the effect of nutraceuticals on NAFLD-related parameters. Our reading of the data is that whilst many nutraceuticals have been studied in relation to NAFLD, none have sufficient evidence to recommend their routine use; robust trials are required to appropriately address efficacy and safety.
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Affiliation(s)
- Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, Via del Vespro 141, 90127 Palermo, Italy.
| | - Alessandro Colletti
- Department of Science and Drug Technology, University of Turin, Turin, Italy
| | - Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, Medical School, University College London (UCL), London, UK
| | - Peter P Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
| | - Ioanna Gouni-Berthold
- Department of Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Germany
| | - John Mancini
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Patrick Moriarty
- Division of Clinical Pharmacology, Division of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Dragos Vinereanu
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular disease risk research center, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy; IRCCS Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.
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5
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Penson PE, Bruckert E, Marais D, Reiner Ž, Pirro M, Sahebkar A, Bajraktari G, Mirrakhimov E, Rizzo M, Mikhailidis DP, Sachinidis A, Gaita D, Latkovskis G, Mazidi M, Toth PP, Pella D, Alnouri F, Postadzhiyan A, Yeh HI, Mancini GBJ, von Haehling S, Banach M, Al‐Khnifsawi M, Alnouri F, Amar F, Atanasov AG, Bajraktari G, Banach M, Bhaskar S, Bytyçi I, Bjelakovic B, Bruckert E, Cafferata A, Ceska R, Cicero AF, Collet X, Daccord M, Descamps O, Djuric D, Durst R, Ezhov MV, Fras Z, Gaita D, Hernandez AV, Jones SR, Jozwiak J, Kakauridze N, Kallel A, Katsiki N, Khera A, Kostner K, Kubilius R, Latkovskis G, Mancini GJ, Marais AD, Martin SS, Martinez JA, Mazidi M, Mikhailidis DP, Mirrakhimov E, Miserez AR, Mitchenko O, Mitkovskaya NP, Moriarty PM, Nabavi SM, Nair D, Panagiotakos DB, Paragh G, Pella D, Penson PE, Petrulioniene Z, Pirro M, Postadzhiyan A, Puri R, Reda A, Reiner Ž, Radenkovic D, Rakowski M, Riadh J, Richter D, Rizzo M, Ruscica M, Sahebkar A, Sattar N, Serban M, Shehab AM, Shek AB, Sirtori CR, Stefanutti C, Tomasik T, Toth PP, Viigimaa M, Valdivielso P, Vinereanu D, Vohnout B, von Haehling S, Vrablik M, Wong ND, Yeh H, Zhisheng J, Zirlik A. Step-by-step diagnosis and management of the nocebo/drucebo effect in statin-associated muscle symptoms patients: a position paper from the International Lipid Expert Panel (ILEP). J Cachexia Sarcopenia Muscle 2022; 13:1596-1622. [PMID: 35969116 PMCID: PMC9178378 DOI: 10.1002/jcsm.12960] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
Statin intolerance is a clinical syndrome whereby adverse effects (AEs) associated with statin therapy [most commonly statin-associated muscle symptoms (SAMS)] result in the discontinuation of therapy and consequently increase the risk of adverse cardiovascular outcomes. However, complete statin intolerance occurs in only a small minority of treated patients (estimated prevalence of only 3-5%). Many perceived AEs are misattributed (e.g. physical musculoskeletal injury and inflammatory myopathies), and subjective symptoms occur as a result of the fact that patients expect them to do so when taking medicines (the nocebo/drucebo effect)-what might be truth even for over 50% of all patients with muscle weakness/pain. Clear guidance is necessary to enable the optimal management of plasma in real-world clinical practice in patients who experience subjective AEs. In this Position Paper of the International Lipid Expert Panel (ILEP), we present a step-by-step patient-centred approach to the identification and management of SAMS with a particular focus on strategies to prevent and manage the nocebo/drucebo effect and to improve long-term compliance with lipid-lowering therapy.
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Affiliation(s)
- Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Eric Bruckert
- Pitié-Salpetrière Hospital and Sorbonne University, Cardio metabolic Institute, Paris, France
| | - David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Matteo Pirro
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Clinic of Cardiology, University Clinical Centre of Kosova, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Internal Disease, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Erkin Mirrakhimov
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Diseases, Bishkek, Kyrgyzstan
| | - Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,Division of Endocrinology, Diabetes and Metabolism, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, University College London Medical School, University College London (UCL), London, UK
| | - Alexandros Sachinidis
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Timisoara, Romania.,Clinica de Cardiologie, Institutul de Boli Cardiovasculare Timisoara, Timisoara, Romania
| | - Gustavs Latkovskis
- Pauls Stradins Clinical University Hospital, Riga, Latvia.,University of Latvia, Riga, Latvia
| | - Mohsen Mazidi
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK.,Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter P Toth
- CGH Medical Center, Sterling, IL, USA.,Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Pella
- 2nd Department of Cardiology of the East Slovak Institute of Cardiovascular Disease and Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic
| | - Fahad Alnouri
- Cardiovascular Prevention Unit, Adult Cardiology Department, Prince Sultan Cardiac Centre Riyadh, Riyadh, Saudi Arabia
| | - Arman Postadzhiyan
- Department of General Medicine, Emergency University Hospital 'St. Anna', Medical University of Sofia, Sofia, Bulgaria
| | - Hung-I Yeh
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - G B John Mancini
- Department of General Medicine, Emergency University Hospital 'St. Anna', Medical University of Sofia, Sofia, Bulgaria
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Maciej Banach
- Polish Moother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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6
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Koh N, Ference BA, Nicholls SJ, Navar AM, Chew DP, Kostner K, He B, Tse HF, Dalal J, Santoso A, Ako J, Tada H, Park JJ, Ong ML, Lim E, Subramaniam T, Li YH, Phrommintikul A, Iyengar SS, Ray S, Park KW, Tan HC, Chunhamaneewat N, Yeo KK, Tan JWC. Asian Pacific Society of Cardiology Consensus Recommendations on Dyslipidaemia. Eur Cardiol 2022; 16:e54. [PMID: 35024056 PMCID: PMC8728885 DOI: 10.15420/ecr.2021.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022] Open
Abstract
The prevalence of dyslipidaemia has been increasing in the Asia-Pacific region and this is attributed to dietary changes and decreasing physical activity. While there has been substantial progress in dyslipidaemia therapy, its management in the region is hindered by limitations in awareness, adherence and healthcare costs. The Asian Pacific Society of Cardiology (APSC) developed these consensus recommendations to address the need for a unified approach to managing dyslipidaemia. These recommendations are intended to guide general cardiologists and internists in the assessment and treatment of dyslipidaemia and are hoped to pave the way for improving screening, early diagnosis and treatment. The APSC expert panel reviewed and appraised the evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed, which were then put to an online vote. The resulting consensus recommendations tackle contemporary issues in the management of dyslipidaemia, familial hypercholesterolaemia and lipoprotein(a) in the Asia-Pacific region.
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Affiliation(s)
| | | | | | | | - Derek P Chew
- Flinders University of South Australia Australia
| | - Karam Kostner
- Mater Hospital and University of Queensland Australia
| | - Ben He
- Shanghai Chest Hospital China
| | | | - Jamshed Dalal
- Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital Mumbai, India
| | - Anwar Santoso
- National Cardiovascular Centre, Harapan Kita Hospital, Department of Cardiology-Vascular Medicine, Universitas Indonesia Indonesia
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara, Kanagawa, Japan
| | | | - Jin Joo Park
- Seoul National University Bundang Hospital South Korea
| | | | - Eric Lim
- National Heart Centre Singapore Singapore
| | | | - Yi-Heng Li
- National Cheng Kung University Hospital Taiwan
| | | | | | - Saumitra Ray
- Vivekananda Institute of Medical Sciences Kolkata, India
| | | | | | | | | | - Jack Wei Chieh Tan
- National Heart Centre Singapore Singapore.,University of Cambridge UK.,Victorian Heart Institute Melbourne, Australia
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7
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Broom E, Thomas JT, Petersen S, Gooi A, Ward C, Gardener G, Kostner K, Lee-Tannock A, Kumar S. Management of Fetal Supraventricular Tachycardia: Case Series from a Tertiary Perinatal Cardiac Center. Fetal Diagn Ther 2021; 48:794-800. [PMID: 34753148 DOI: 10.1159/000519911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fetal supraventricular tachycardia is a relatively uncommon cardiac rhythm abnormality which is often associated with adverse perinatal outcomes if untreated. Although there are several treatment modalities and protocols in use globally, there is no consensus as to the most effective antiarrhythmic to manage this condition. AIM This study aimed to evaluate perinatal outcomes following prenatal maternal therapy for fetal supraventricular tachycardia. MATERIALS AND METHODS This was a 20-year retrospective cohort study. Institutional records were reviewed for antenatal therapy choice and maternal and fetal outcomes. RESULTS Sixty-nine cases met diagnostic criteria for fetal SVT, of which 56 (81%) received maternal antiarrhythmic therapy. Digoxin was the most common, but least effective, first-line therapy in 28 patients, achieving successful rate reversion in 35.7%. Thirty-one patients (55%) required second-line therapy, and this was most successful with digoxin and flecainide polytherapy achieving rate reversion in 17 of 18 cases (94.5%) at a median of 3 days (1.5-7). Hydrops was present in 23 (33%) cases at initial presentation, 16 of which achieved rate reversion. There was minimal difference in treatment efficacy comparing single- or multiple-agent treatment in the setting of hydrops (50% vs. 42.8%). Side effects occurred in 14/56 treated patients (25%) but were severe in only 8 (14.3%) women, most commonly with digoxin and flecainide polytherapy (6 of 8 cases). There were 3 (4%) fetal deaths amongst the study cohort. CONCLUSIONS Digoxin and flecainide polytherapy were well tolerated and successfully achieved rhythm and rate control in fetuses with prenatally diagnosed supraventricular tachycardia. The presence of hydrops was a poor prognostic feature.
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Affiliation(s)
- Elisha Broom
- Mater Centre for Maternal Fetal Medicine, Mater Mother's Hospital, South Brisbane, Queensland, Australia
| | - Joseph T Thomas
- Mater Centre for Maternal Fetal Medicine, Mater Mother's Hospital, South Brisbane, Queensland, Australia.,Mater Research Institute-University of Queensland, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Scott Petersen
- Mater Centre for Maternal Fetal Medicine, Mater Mother's Hospital, South Brisbane, Queensland, Australia.,Mater Research Institute-University of Queensland, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Alex Gooi
- Qld Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Cameron Ward
- Qld Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Glenn Gardener
- Mater Centre for Maternal Fetal Medicine, Mater Mother's Hospital, South Brisbane, Queensland, Australia.,Mater Research Institute-University of Queensland, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Karam Kostner
- Department of Adult Cardiology, Mater Health Services, South Brisbane, Queensland, Australia
| | - Alison Lee-Tannock
- Mater Centre for Maternal Fetal Medicine, Mater Mother's Hospital, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Centre for Maternal Fetal Medicine, Mater Mother's Hospital, South Brisbane, Queensland, Australia.,Mater Research Institute-University of Queensland, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, Australia.,Department of Obstetrics and Gynaecology, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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8
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Zhang X, Karunathilaka N, Senanayake S, Subramaniam VN, Chan W, Kostner K, Fraser J, Atherton JJ, Punyadeera C. The potential prognostic utility of salivary galectin-3 concentrations in heart failure. Clin Res Cardiol 2019; 109:685-692. [PMID: 31598750 DOI: 10.1007/s00392-019-01557-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/24/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients with HF are at a higher risk of rehospitalisation and, as such, significant costs to our healthcare system. A non-invasive method to collect body fluids and measure Gal-3 could improve the current management of HF. In this study, we investigated the potential prognostic utility of salivary Galectin-3 (Gal-3) in patients with heart failure (HF). METHODS We collected saliva samples from patients with HF (n = 105) either at hospital discharge or during routine clinical visits. Gal-3 concentrations in saliva samples were measured by ELISA. The Kaplan-Meier survival curve analysis and Cox proportional regression model were used to determine the potential prognostic utility of salivary Gal-3 concentrations. RESULTS The primary end point was either cardiovascular death or hospitalisation. Salivary Gal-3 concentrations were significantly higher (p < 0.05) in patients with HF who subsequently experienced the primary endpoint compared to those who did not. HF patients with salivary Gal-3 concentrations > 172.58 ng/mL had a significantly (p < 0.05) higher cumulative risk of the primary endpoint compared to those with lower salivary Gal-3 concentrations. In patients with HF, salivary Gal-3 concentration was a predictor of the primary endpoint even after adjusting for other covariates. CONCLUSIONS In our pilot study, HF patients with salivary Gal-3 concentrations of > 172.58 ng/mL demonstrated a higher cumulative risk of the primary outcome compared to those with lower Gal-3 levels, even after adjusting for other variables. Confirming our findings in a larger multi-centre clinical trial in the future would enable salivary Gal-3 measurements to form part of routine management for patients with HF.
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Affiliation(s)
- Xi Zhang
- Saliva and Liquid Biopsy Translational Research Team, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Nuwan Karunathilaka
- Saliva and Liquid Biopsy Translational Research Team, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Sameera Senanayake
- Australian Centre For Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - V Nathan Subramaniam
- School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Wandy Chan
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Adult Hospital, Brisbane, QLD, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - John J Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital and University of Queensland School of Medicine, Brisbane, QLD, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Research Team, School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, GPO Box 2434, Brisbane, QLD, 4001, Australia.
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9
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Frampton A, Wahi S, Dooris M, Kostner K, Cramp P, Davies K, Chong A. P4359Re-characterising the left ventricular outflow tract and annulus in bi- and tricuspid aortic valves by 3D echocardiography - Comparative insights and implications for aortic valve area calculations. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stenosis severity is defined by the calculated aortic valve area (AVA) using the Doppler-derived continuity equation (CE; AVACE = 0.785 x (LVOTd)2 x LVOT VTI/AV VTI (LVOTd = left ventricular outflow tract diameter; AV = aortic valve; VTI = velocity-time integral)). The LVOTd is the “Achilles heel” due to limitations of conventional 2D imaging and unstandardized measurement sites (0.5–1cm “apical” in the LVOT (LVOTdApi) vs “annulus” level (LVOTdAnn)) with no consensus even in recent guidelines. Geometrical differences in the LVOT and annulus of bicuspid (BAV) and tricuspid (TAV) aortic valves are further confounders. There remains a paucity of evidence to guide best practice. Erroneous LVOTd values will result in inaccurate AVACE estimations, triggering inappropriate intervention, or inaction.
Purpose
To define the optimal LVOTd by transthoracic echocardiography (TTE; LVOTdApi vs LVOTdAnn by 2D vs 3D) for AVACE calculation, and to identify factors accounting for any observed differences between BAVs and TAVs. AVA measured by 3D TTE planimetry (AVA3D) was the reference standard.
Methods
TTEs with 3D datasets of the AV complex in patients with BAVs and TAVs were included. 2D-LVOTdApi and 2D-LVOTdAnn were measured from 2D parasternal long-axis images. 3D-LVOTd values were calculated from the measured circumference, area, and average of minor/major dimensions at the “apical” (3D-LVOTdApi-Circ; 3D-LVOTdApi-Area; 3D-LVOTdApi-Ave) and “annulus” (3D-LVOTdAnn-Circ; 3D-LVOTdAnn-Area; 3D-LVOTdAnn-Ave) levels using multiplanar reconstruction. LVOTVTI and AVVTI were traced from standard spectral Doppler waveforms. The ratio of minor:major dimensions was used as an eccentricity index (EI) of the “apical” (EIApi) and “annulus” (EIAnn) sites.
Results
53 BAVs and 52 TAVs were included. Mean BAV-AVA3D and TAV-AVA3D were 3.48±0.93cm2 and 3.41±0.69cm2 respectively. In BAVs, estimated AVACE using 3D-LVOTdApi-Circ (3.43±1.05cm2; Intraclass correlation (ICC) 0.971) and 3D-LVOTdAnn-Circ (3.40±1.01cm2; ICC 0.968) correlated best with AVA3D. Conversely in TAVs, 3D-LVOTdApi-Area (3.29±0.69cm2; ICC 0.983) and 3D-LVOTdAnn-Area (3.24±0.70cm2; ICC 0.975) performed optimally. 3D-LVOTdApi-Circ and 3D-LVOTdAnn-Circ overestimated TAV-AVA3D due to the greater ellipticity of the “apical” and “annulus” sites in TAVs (TAV vs BAV: EIApi 0.78 vs 0.83, P=0.04; EIAnn 0.84 vs 0.90, P<0.005). 2D-LVOTd-derived AVACE were predictable underestimations of the AVA3D but the “annulus” level outperformed “apical” in both BAVs and TAVs (BAV-ICC 0.857 vs 0.771; TAV-ICC 0.917 vs 0.889).
Conclusions
The “apical” LVOT and “annulus” are more circular in BAVs where 3D circumference (3D-LVOTdApi-Circ or 3D-LVOTdAnn-Circ) yielded the best AVACE. The more elliptical geometry in TAVs resulted in 3D area (3D-LVOTdApi-Area or 3D-LVOTdAnn-Area) the preferred technique. Resolving the quandary of measurement site, 2D-LVOTdAnn is favored over 2D-LVOTdApi for both BAVs and TAVs.
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Affiliation(s)
- A Frampton
- Mater Adult Hospital, Department of Cardiology, Brisbane, Australia
| | - S Wahi
- University of Queensland, Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
| | - M Dooris
- Mater Adult Hospital, Department of Cardiology, Brisbane, Australia
| | - K Kostner
- Mater Adult Hospital, Department of Cardiology, Brisbane, Australia
| | - P Cramp
- Mater Adult Hospital, Department of Cardiology, Brisbane, Australia
| | - K Davies
- Mater Adult Hospital, Department of Cardiology, Brisbane, Australia
| | - A Chong
- University of Queensland, Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
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10
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Liu X, Williams G, Kostner K, Brown WJ. The Effect of Tai Chi on Quality of Life in Centrally Obese Adults with Depression. J Altern Complement Med 2019; 25:1005-1008. [PMID: 31448950 DOI: 10.1089/acm.2019.0050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this pilot study was to assess the effects of a t'ai chi program on health-related quality of life (HR-QOL) in centrally obese adults with depression. Methods: Two hundred thirteen participants were randomly allocated to either a t'ai chi intervention group (n = 106) or a usual medical care control group (n = 107). The t'ai chi group involved 3 × 1.5 h supervised and group-based training sessions per week for 24 weeks. Indicators of HR-QOL were assessed by questionnaire at baseline, 12 weeks, and 24 weeks. Results: There were significant improvements in favor of the t'ai chi group for the SF-36 subscales of physical functioning (p < 0.01), role physical (p < 0.01), and role emotional (p < 0.01) at 12 and 24 weeks. Scores for bodily pain were improved in the control group at 12 weeks (p < 0.01) and 24 weeks (p < 0.05), but not in the t'ai chi group. There was also a significant improvement in favor of the control group in general health (p < 0.05) at 12 weeks, but not at 24 weeks. A further analysis showed clinically significant changes in favor of the t'ai chi group in physical functioning (p < 0.05 or p = 0.05), role physical (p < 0.05), and role emotional (p < 0.05), and in favor of the control group in bodily pain (p < 0.05) at 12 and 24 weeks. Conclusions: The findings show that t'ai chi exercise improved indicators of HR-QOL including physical functioning, role physical, and role emotional in centrally obese adults with depression.
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Affiliation(s)
- Xin Liu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.,School of Wushu, Wuhan Sport University, Wuhan, China.,The University of Queensland School of Medicine, Brisbane, Australia
| | - Gail Williams
- The University of Queensland School of Public Health, Brisbane, Australia
| | - Karam Kostner
- The University of Queensland School of Medicine, Brisbane, Australia.,Department of Cardiology, Mater Health Services, Brisbane, Australia
| | - Wendy J Brown
- The University of Queensland School of Human Movement and Nutrition Sciences, Brisbane, Australia
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11
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Zhang Y, Zhou Y, van der Mei IAF, Simpson S, Ponsonby AL, Lucas RM, Tettey P, Charlesworth J, Kostner K, Taylor BV. Lipid-related genetic polymorphisms significantly modulate the association between lipids and disability progression in multiple sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:636-641. [PMID: 30782980 DOI: 10.1136/jnnp-2018-319870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/14/2018] [Accepted: 12/24/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate whether lipid-related or body mass index (BMI)-related common genetic polymorphisms modulate the associations between serum lipid levels, BMI and disability progression in multiple sclerosis (MS). METHODS The association between disability progression (annualised Expanded Disability Status Scale (EDSS) change over 5 years, ΔEDSS) and lipid-related or BMI-related genetic polymorphisms was evaluated in a longitudinal cohort (n=184), diagnosed with MS. We constructed a cumulative genetic risk score (CGRS) of associated polymorphisms (p<0.05) and examined the interactions between the CGRS and lipid levels (measured at baseline) in predicting ΔEDSS. All analyses were conducted using linear regression. RESULTS Five lipid polymorphisms (rs2013208, rs9488822, rs17173637, rs10401969 and rs2277862) and one BMI polymorphism (rs2033529) were nominally associated with ΔEDSS. The constructed lipid CGRS showed a significant, dose-dependent association with ΔEDSS (ptrend=1.4×10-6), such that participants having ≥6 risk alleles progressed 0.38 EDSS points per year faster compared with those having ≤3. This CGRS model explained 16% of the variance in ΔEDSS. We also found significant interactions between the CGRS and lipid levels in modulating ΔEDSS, including high-density lipoprotein (HDL; pinteraction=0.005) and total cholesterol:high-density lipoprotein ratio (TC:HDL; pinteraction=0.030). The combined model (combination of CGRS and the lipid parameter) explained 26% of the disability variance for HDL and 27% for TC:HDL. INTERPRETATION In this prospective cohort study, both lipid levels and lipid-related polymorphisms individually and jointly were associated with significantly increased disability progression in MS. These results indicate that these polymorphisms and tagged genes might be potential points of intervention to moderate disability progression.
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Affiliation(s)
- Yan Zhang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ingrid A F van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Prudence Tettey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,School of Public Health, University of Ghana, Accra, Ghana
| | - Jac Charlesworth
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Karam Kostner
- Mater Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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12
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Kostner K. High intensity lipid‐lowering therapy after acute coronary syndromes: room for improvement. Med J Aust 2019; 210:73-74. [DOI: 10.5694/mja2.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Frampton A, Wahi S, Dooris M, Kostner K, Cramp P, Davies K, Chong A. Phenotyping the Left Ventricular Outflow Tract (LVOT) and Aortic Annulus of Bi- (BAV) and Trileaflet (TAV) Aortic Valves with 3D Transthoracic Echocardiography (TTE) – Geometrical Insights to Guide Optimal Aortic Valve Area (AVA) Calculations and Minimize Errors. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Ross DM, Arthur C, Burbury K, Ko BS, Mills AK, Shortt J, Kostner K. Chronic myeloid leukaemia and tyrosine kinase inhibitor therapy: assessment and management of cardiovascular risk factors. Intern Med J 2018; 48 Suppl 2:5-13. [PMID: 29388307 DOI: 10.1111/imj.13716] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Several BCR-ABL1 tyrosine kinase inhibitors (TKIs) are approved for the first-line treatment of chronic phase chronic myeloid leukaemia (CML). Disease control is achieved in the vast majority of patients and disease-specific survival is excellent. Consequently, there is now emphasis on managing comorbidities and minimising treatment-related toxicity. Second-generation TKIs have cardiovascular risks that are greater than with imatinib treatment, but these risks must be balanced against the superior CML responses encountered with more potent TKIs. Cardiovascular risk should be assessed at baseline using a locally validated model based on the Framingham risk equation. Clinicians involved in the care of CML patients should be aware of the vascular complications of TKIs and manage cardiovascular risk factors early to mitigate treatment-related risks. Reversible risk factors, such as dyslipidaemia, smoking, diabetes and hypertension, should be addressed. We summarise the available data on cardiovascular complications in CML patients treated with TKIs. Using the latest evidence and collective expert opinion, we provide practical advice for clinicians to assess, stratify and manage cardiovascular risk in people with CML receiving TKI therapy.
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Affiliation(s)
- David M Ross
- Department of Haematology, Royal Adelaide Hospital and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Chris Arthur
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kate Burbury
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Brian S Ko
- MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Anthony K Mills
- Division of Cancer Services, Princess Alexandra Hospital, Melbourne, Victoria, Australia
| | - Jake Shortt
- Monash Haematology, Department of Haematology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Hospital and University of Queensland, Brisbane, Queensland, Australia
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15
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Liu X, Hollingworth S, Williams G, Martin J, Kostner K, Crompton D, Xue C, Vitetta L. Use of complementary and alternative medicines in people with depression and central obesity: Findings from a Tai Chi and Qigong study. Journal of Traditional Chinese Medical Sciences 2018. [DOI: 10.1016/j.jtcms.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Boyle S, Nicolae M, Kostner K, Davies K, Cukovski I, Cunliffe A, Morton A. Dilated Cardiomyopathy in Pregnancy: Outcomes From an Australian Tertiary Centre for Maternal Medicine and Review of the Current Literature. Heart Lung Circ 2018; 28:591-597. [PMID: 29685714 DOI: 10.1016/j.hlc.2018.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/29/2017] [Accepted: 02/20/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripartum cardiomyopathy is associated with significant risks of decline in left ventricular function and adverse maternal and fetal outcome in subsequent pregnancy. The risks of pregnancy in women with dilated cardiomyopathy are unclear. We aimed to assess the outcome of pregnancy in women with dilated cardiomyopathy seen at our institution and to review the literature on this subject. METHODS A retrospective audit of the outcomes of 14 pregnancies to 12 women with dilated cardiomyopathy. RESULTS There were no cardiac events and no woman had a decline in left ventricular function during pregnancy. There was a high rate of prematurity and adverse fetal outcome related to this, including four neonatal deaths. CONCLUSION Maternal outcomes in this small series were satisfactory though only three women had moderate-severe left ventricular dysfunction at baseline. There was a high rate of premature delivery and adverse neonatal outcome.
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Affiliation(s)
- Siobhan Boyle
- Princess Alexandra Hospital, Brisbane, Qld, Australia
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17
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Frampton A, Wahi S, Cramp P, Davies K, Kostner K, Chong A. Can Three-Dimensional Echocardiography Shed Light on the Optimal Left Ventricular Outflow Tract Diameter Measurement for Assessment of Aortic Valve Area in Bicuspid Aortic Valves: The Where, How, and Why? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Ignatescu M, Zorn G, Kneussl M, Maurer G, Lang IM, Huber K, Kostner K. Plasma Lp(a) Levels Are Increased in Patients with Chronic Thromboembolic Pulmonary Hypertension. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryChronic thromboembolic pulmonary hypertension (CTEPH) is a disease resulting from the thromboembolic obstruction of the segmental and/or large size pulmonary arteries, subsequently leading to pulmonary arterial hypertension. Incomplete resolution of acute pulmonary emboli and thrombus organization are believed to be important for the development of the disease. Primary pulmonary hypertension (PPH) is a further disease that at present is poorly understood but shows a clinical picture similar to CTEPH. Since lipoprotein(a) [Lp(a)], a genetically determined risk factor for atherosclerosis and thrombosis, has been found increased in plasma of patients with deep vein thrombosis and pulmonary embolism, we measured plasma Lp(a) levels in 40 patients with CTEPH and 50 patients with PPH and compared them to 50 matched controls. The median for Lp(a) plasma levels was significantly higher in CTEPH patients (26.6 mg/dl) than in PPH patients (9.6 mg/dl) and controls (7.2 mg/dl). Increased plasma Lp(a) could, therefore, play a significant role in the mechanisms of ongoing thrombosis and thrombus organization in CTEPH, while its possible role in PPH can be limited to a small number of patients.
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19
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Go G, Davies KT, O'Callaghan C, Senior W, Kostner K, Fagermo N, Prasad SB. Negative predictive value of dobutamine stress echocardiography for perioperative risk stratification in patients with cardiac risk factors and reduced exercise capacity undergoing non-cardiac surgery. Intern Med J 2017; 47:1376-1384. [PMID: 28967164 DOI: 10.1111/imj.13629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/06/2017] [Accepted: 09/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guidelines recommend functional testing for myocardial ischaemia in the perioperative setting in patients with greater than one recognised cardiac risk factor and self-reported reduced exercise capacity. AIM To determine the clinical utility of dobutamine stress echocardiography (DSE) for perioperative risk stratification in patients undergoing major non-cardiac surgery. METHODS Data on 79 consecutive patients undergoing DSE for perioperative risk stratification at a single centre were retrospectively reviewed to determine rates of major adverse cardiac events (MACE) during the index hospitalisation and 30 days post-discharge. Echocardiography and outcome data were obtained through a folder audit and echolab database. RESULTS Out of the 79 DSE performed for perioperative risk stratification, 11 (14%) were positive (DSE +ve) and 68 (86%) were negative (DSE -ve). Management in the DSE +ve group included medical optimisation without invasive intervention (n = 7(64%)), diagnostic coronary angiography (n = 3(27%)) and coronary artery bypass graft (n = 1(9%)). None of the patients underwent percutaneous coronary intervention preoperatively. Perioperative MACE in the DSE +ve group was 36% compared to 4% in the DSE-ve group (P = 0.006). DSE +ve was a powerful predictor of perioperative inpatient MACE (OR 12.4, 95% CI 2.3-67, P = 0.003). The positive predictive value of DSE +ve status was 36%, whereas the negative predictive value of DSE-ve status for perioperative MACE was 96%. CONCLUSION DSE for perioperative risk stratification had a high clinical utility in patients undergoing major non-cardiac surgery. In particular, a normal DSE had a high negative predictive value for perioperative MACE.
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Affiliation(s)
- Gus Go
- Department of Internal Medicine, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Kathy T Davies
- Department of Cardiology, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Cara O'Callaghan
- Department of Internal Medicine, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Wendy Senior
- Department of Cardiology, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Narelle Fagermo
- Department of Internal Medicine, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Sandhir B Prasad
- Department of Cardiology, Mater Hospital Brisbane, Brisbane, Queensland, Australia.,Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Zhang X, Walsh T, Atherton JJ, Kostner K, Schulz B, Punyadeera C. Identification and Validation of a Salivary Protein Panel to Detect Heart Failure Early. Am J Cancer Res 2017; 7:4350-4358. [PMID: 29158831 PMCID: PMC5695135 DOI: 10.7150/thno.21727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/24/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Over 26 million people suffer from heart failure (HF) globally. Current diagnosis of HF relies on clinical evaluation, blood assays and imaging techniques. Our aim is to develop a diagnostic assay to detect HF in at risk individuals within the community using human saliva as a medium, potentially leading to a simple, safe early warning system. METHODS Saliva samples were collected from healthy controls (n=36) and HF patients (n=75). Salivary proteome profiles were analysed by Sequential Window Acquisition of All Theoretical fragment ion spectra - Mass Spectrometry (SWATH-MS). A total of 738 proteins were quantified and 177 proteins demonstrated significant differences between HF patients and healthy controls. Candidate biomarkers were chosen based on their abundance and difference between the two cohorts. A multi-protein panel was developed using logistic regression analysis. The diagnostic performance of the multi-protein panel was assessed using receiver operative characteristic curves. The candidate proteins were further confirmed, using western blot analysis, and validated technically, using an independent biological cohort. RESULTS A group of six proteins were chosen in the discovery phase as potential candidates based on their differences in the abundance between the two cohorts. During the validation phase, two of the proteins were not detected with western blotting and as such were removed. The final panel consists of four proteins with sensitivity of 83.3%, specificity of 62.5% with an area under ROC curve of 0.78 in discriminating healthy controls from NYHA class I/II HF patients, and was validated in a second independent cohort study. CONCLUSION Analysis of salivary proteome using SWATH-MS revealed novel HF-specific protein candidates yielding high diagnostic performance. A multi-centre longitudinal clinical trial will be the next step before clinical implementation of this panel.
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Wu CJJ, Sung HC, Chang AM, Atherton J, Kostner K, McPhail SM. Cardiac-diabetes self-management program for Australians and Taiwanese: A randomized blocked design study. Nurs Health Sci 2017; 19:307-315. [PMID: 28544230 DOI: 10.1111/nhs.12346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/06/2017] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
Abstract
Cardiac disease and type 2 diabetes are prevalent diseases globally. Cardiac rehabilitation and diabetes self-management programs empower patients' self-management to improve their health outcomes. However, inappropriate delivery modes and continuing low participation rates indicate some programs are less than optimal. A previous study demonstrated the feasibility of incorporating telephone and text messages into a cardiac-diabetes self-management program in Australia; however, the program did not specifically address patients' cultural backgrounds. This current study used a randomized blocked design to evaluate short-term efficacy of the cardiac-diabetes self-management program incorporating telephone and text-messaging across different cultural contexts in Australia and Taiwan in comparison to usual care. No significant differences between groups were observed for outcomes of self-care behavior, self efficacy, knowledge and health-related quality of life, with patients in both groups demonstrating improvements. Patient-reported outcomes indicated some evidence of an interaction effect between country of origin and group allocation. Findings indicated an improved tendency of outcome measures between the baseline and follow-up assessments within usual care and intervention groups. Further research is required to clarify components of the program work for each cultural group.
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Affiliation(s)
- Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Queensland, Australia
| | - Huei-Chuan Sung
- Graduate Institute of Long-term Care and Taiwanese Center of Evidence-based Health Care, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Anne M Chang
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - John Atherton
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Karam Kostner
- Mater Adult Hospital, Mater Health Services, South Brisbane, Queensland, Australia
| | - Steven M McPhail
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
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Tettey P, Simpson S, Taylor B, Ponsonby AL, Lucas RM, Dwyer T, Kostner K, van der Mei IA. An adverse lipid profile and increased levels of adiposity significantly predict clinical course after a first demyelinating event. J Neurol Neurosurg Psychiatry 2017; 88:395-401. [PMID: 28320766 DOI: 10.1136/jnnp-2016-315037] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/23/2017] [Accepted: 02/21/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the prospective associations between adiposity and lipid-related variables and conversion to multiple sclerosis (MS), time to subsequent relapse and progression in disability. METHODS A cohort of 279 participants with a first clinical diagnosis of central nervous system demyelination was prospectively followed to 5-year review. Height, weight, waist and hip circumference were measured, and serum samples taken for measurement of lipids and apolipoproteins. Survival analysis was used for conversion to MS and time to relapse, and linear regression for annualised change in disability (Expanded Disability Status Scale). RESULTS Higher body mass index (BMI; adjusted HR (aHR): 1.22 (1.04 to 1.44) per 5 kg/m2 increase), hip circumference (aHR: 1.32 (1.12 to 1.56) per 10 cm increase) and triglyceride levels (aHR: 1.20 (1.03 to 1.40) per unit increase) were associated with increased risk of subsequent relapse, while adiposity and lipid-related measures were not associated with conversion to MS. In addition, higher BMI (β: 0.04 (0.01 to 0.07) per 5 kg/m2 increase), hip circumference (β: 0.04 (0.02 to 0.08) per 10 cm increase), waist circumference (β: 0.04 (0.02 to 0.07) per 10 cm increase), total cholesterol to high-density lipoprotein ratio (TC/HDL ratio; β: 0.05 (0.001 to 0.10) and non-HDL; β: 0.04 (0.001 to 0.08) at study entry) were associated with a higher subsequent annual change in disability. CONCLUSIONS Higher levels of adiposity, non-HDL and TC/HDL ratio were prospectively associated with a higher rate of disability progression, and higher adiposity and triglycerides were associated with relapse but not with conversion to MS. Improving the lipid profile and losing weight into the healthy range could reduce the accumulation of disability.
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Affiliation(s)
- Prudence Tettey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Turning Point, Monash University, Fitzroy, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Terence Dwyer
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Karam Kostner
- Mater Hospital, University of Queensland, Queensland, Australia
| | | | - Ingrid Af van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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23
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Bellgard MI, Walker CE, Napier KR, Lamont L, Hunter AA, Render L, Radochonski M, Pang J, Pedrotti A, Sullivan DR, Kostner K, Bishop W, George PM, O'Brien RC, Clifton PM, Bockxmeer FMV, Nicholls SJ, Hamilton-Craig I, Dawkins HJ, Watts GF. Design of the Familial Hypercholesterolaemia Australasia Network Registry: Creating Opportunities for Greater International Collaboration. J Atheroscler Thromb 2017; 24:1075-1084. [PMID: 28344196 PMCID: PMC5656770 DOI: 10.5551/jat.37507] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Familial Hypercholesterolemia (FH) is the most common and serious monogenic disorder of lipoprotein metabolism that leads to premature coronary heart disease. There are over 65,000 people estimated to have FH in Australia, but many remain undiagnosed. Patients with FH are often undertreated, but with early detection, cascade family testing and adequate treatment, patient outcomes can improve. Patient registries are key tools for providing new information on FH and enhancing care worldwide. The development and design of the FH Australasia Network Registry is a crucial component in the comprehensive model of care for FH, which aims to provide a standardized, high-quality and cost-effective system of care that is likely to have the highest impact on patient outcomes. Informed by stakeholder engagement, the FH Australasia Network Registry was collaboratively developed by government, patient and clinical networks and research groups. The open-source, webbased Rare Disease Registry Framework was the architecture chosen for this registry owing to its open-source standards, modular design, interoperability, scalability and security features; all these are key components required to meet the ever changing clinical demands across regions. This paper provides a high level blueprint for other countries and jurisdictions to help inform and map out the critical features of an FH registry to meet their particular health system needs.
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Affiliation(s)
| | - Caroline E Walker
- Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia
| | | | - Leanne Lamont
- Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia
| | - Adam A Hunter
- Centre for Comparative Genomics, Murdoch University, Murdoch
| | - Lee Render
- Centre for Comparative Genomics, Murdoch University, Murdoch
| | | | - Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia
| | - Annette Pedrotti
- Familial Hypercholesterolaemia Family Support Group of Western Australia
| | | | | | - Warrick Bishop
- Menzies Institute for Medical Research, University of Tasmania
| | | | | | - Peter M Clifton
- School of Pharmacy and Medical Sciences, University of South Australia
| | - Frank M Van Bockxmeer
- Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital.,School of Surgery, University of Western Australia
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide
| | | | - Hugh Js Dawkins
- Centre for Comparative Genomics, Murdoch University, Murdoch.,Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia.,Centre for Population Health Research, Curtin University of Technology.,School of Pathology and Laboratory Medicine, University of Western Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia.,Lipid Disorders Clinic, Cardiometabolic Service, Royal Perth Hospital
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Doucet B, Kostner K, Kaiser O, Hawley C, Isbel N. Live donor study - implications of kidney donation on cardiovascular risk with a focus on lipid parameters including lipoprotein a. Nephrology (Carlton) 2017; 21:901-4. [PMID: 27062186 DOI: 10.1111/nep.12792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/14/2016] [Accepted: 04/01/2016] [Indexed: 12/29/2022]
Abstract
In this prospective observational cohort study, we evaluate the change in cardiovascular risk parameters, with a focus on lipids, in live kidney donors 1 year post donation. Body mass index, systolic/diastolic blood pressure, kidney function (chromium-51 ethylenediaminetetraacetic acid estimated glomerular filtration) and lipid parameters were measured at baseline and 1 year. Data on 87 live kidney donors were collected. Body mass index increased from 26.5 ± 2.7 pre to 27.4 ± 3.0 kg/m(2) post donation (p < 0.0001). Chromium-51 ethylenediaminetetraacetic acid estimated glomerular filtration decreased from 111.8 ± 20.0 pre to 72.1 ± 13.1 mL/min/1.73 m(2) post donation (p < 0.0001). Serum triglyceride levels increased from 0.8 (interquartile range 0.6-1.3) pre to 1.0 mmol/L (interquartile range 0.7-1.6) post donation (p = 0.0004). Statin use increased from 11.5% pre to 21% post donation (p < 0.005). Low-density lipoprotein remained stable, and other lipids (high-density lipoprotein, apolipoprotein B and lipoprotein a) did not change post donation.
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Affiliation(s)
- Brian Doucet
- Department of Cardiology, Mater Misericordiae Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Misericordiae Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Omar Kaiser
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Carmel Hawley
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Nicole Isbel
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia. .,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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25
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Wu CJJ, Atherton JJ, MacIsaac RJ, Courtney M, Chang AM, Thompson DR, Kostner K, MacIsaac AI, d'Emden M, Graves N, McPhail SM. Effectiveness of the cardiac-diabetes transcare program: protocol for a randomised controlled trial. BMC Health Serv Res 2017; 17:109. [PMID: 28153000 PMCID: PMC5290652 DOI: 10.1186/s12913-017-2043-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/20/2017] [Indexed: 12/03/2022] Open
Abstract
Background This paper presents a protocol for a randomised controlled trial of the Cardiac-Diabetes Transcare program which is a transitional care, multi-modal self-management program for patients with acute coronary syndrome comorbid with type 2 diabetes. Prior research has indicated people hospitalised with dual cardiac and diabetes diagnoses are at an elevated risk of hospital readmissions, morbidity and mortality. The primary aim of this study is to evaluate the effectiveness (and cost-effectiveness) of a Cardiac-Diabetes Transcare intervention program on 6-month readmission rate in comparison to usual care. Methods/Design A two-armed, randomised controlled trial with blinded outcome assessment will be conducted to evaluate the comparative effectiveness of two modes of care, including a Usual Care Group and a Cardiac-Diabetes Transcare Intervention (in addition to usual care) Group. The primary outcome is 6-month readmission rate, although a range of secondary outcomes will be collected (including self-efficacy) at baseline, 1, 3 and 6 month reassessments. The intervention group will receive in-hospital education tailored for people recovering from an acute coronary syndrome-related hospital admission who have comorbid diabetes, and they will also receive home visits and telephone follow-up by a trained Research Nurse to reinforce and facilitate disease-management-related behaviour change. Both groups will receive usual care interventions offered or referred from participating hospital facilities. A sample size of 432 participants from participating hospitals in the Australian states of Queensland and Victoria will be recruited for 90% power based on the most conservative scenarios modelled for sample size estimates. Discussion The study outlined in this protocol will provide valuable insight into the effectiveness of a transitional care intervention targeted for people admitted to hospital with cardiac-related presentations commencing in the inpatient hospital setting and transition to the home environment. The purpose of theory-based intervention comprising face-to-face sessions and telephone follow up for patients with acute coronary syndrome and type 2 diabetes is to increase self-efficacy to enhance self-management behaviours and thus improve health outcomes and reduce hospital readmissions. Trial registration This study has been registered with the Australian New Zealand Clinical Trials Registry dated 16/12/2014: ACTRN12614001317684.
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Affiliation(s)
- Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Rd, Banyo, Qld, 4014, Australia. .,School of Nursing, Queensland University of Technology, Brisbane, Australia. .,Royal Brisbane and Women's Hospital, (RBWH), Brisbane, Australia. .,Mater Medical Research Institute-University of Queensland (MRI-UQ), Brisbane, Australia.
| | - John J Atherton
- Royal Brisbane and Women's Hospital, (RBWH), Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia
| | - Richard J MacIsaac
- Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,St Vincent's Institute of Medical Research, Melbourne, Australia
| | - Mary Courtney
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Rd, Banyo, Qld, 4014, Australia
| | - Anne M Chang
- School of Nursing, Director of Centre for Evidence Based Healthy Ageing, Queensland University of Technology, Brisbane, Australia
| | - David R Thompson
- Director of Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karam Kostner
- Mater Medical Research Institute-University of Queensland (MRI-UQ), Brisbane, Australia.,Department of Cardiology, Mater Health Services, University of Queensland, Brisbane, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Michael d'Emden
- Royal Brisbane and Women's Hospital, (RBWH), Brisbane, Australia
| | - Nick Graves
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia.,Australian Centre for Health Services Innovation, Brisbane, Australia
| | - Steven M McPhail
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
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26
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Mirzaee S, Kostner K. A Review of the Evidence in Recommended Dietary Fat Intake and Further Cardiovascular Events. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Liu X, Furuya-Kanamori L, Siskind D, Crompton D, Williams GM, Kostner K, Vitetta L, Doi SA. An evidence-based scale for the antecedents of depressive symptoms in Australian adults. Australas Psychiatry 2016; 24:466-9. [PMID: 26858242 DOI: 10.1177/1039856216629842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop and test a self-reported scale designed to measure the antecedents of depression. METHODS Participants of the Sustainable Mastery of Innovative Lifelong Exercise (SMILE) Tai Chi program were invited to complete the scale for antecedents of depressive symptoms. The scale included questions regarding events/factors the participants have experienced over the past three months and preceded their depressive symptoms. The reliability of the questions was assessed using the Cronbach's alpha. Principal components analysis was used to examine if there were domains of interest across the scale questions. RESULTS A total of 126 participants completed the scale. The scale had a good internal consistency (Cronbach's α = 0.82). Principal components analysis identified three components (life events, psychosocial problems, and physical/health problems) in the scale and the components detected the root categories of depression in more than 56% of the cases. CONCLUSIONS This simple self-administered scale has proven to provide a reliable measure for the antecedent factors of depression in the SMILE Tai Chi cohort; further validation of the scale in different settings is encouraged.
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Affiliation(s)
- Xin Liu
- Research Fellow, School of Health Sciences, Wuhan Sport University, China; School of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Luis Furuya-Kanamori
- PhD Candidate, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Dan Siskind
- Associate Professor, Queensland Center for Mental Health Research, Brisbane, QLD, and; Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - David Crompton
- Professor, School of Medicine, The University of Queensland, Australia; Metro South Addiction and Mental Health Services, Brisbane, QLD, and; Centre for Neuroscience, Recovery and Mental Health, Brisbane, QLD, Australia
| | - Gail M Williams
- Professor, School of Public Health, The University of Queensland, Woolloongabba, QLD, Australia
| | - Karam Kostner
- Associate Professor, School of Medicine, The University of Queensland, Woolloongabba, QLD, and; Mater Health Services, Brisbane, QLD, Australia
| | - Luis Vitetta
- Professor, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Suhail A Doi
- Associate Professor, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
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29
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Kotani K, Sahebkar A, Serban MC, Ursoniu S, Mikhailidis DP, Mariscalco G, Jones SR, Martin S, Blaha MJ, Toth PP, Rizzo M, Kostner K, Rysz J, Banach M. Lipoprotein(a) Levels in Patients With Abdominal Aortic Aneurysm. Angiology 2016; 68:99-108. [PMID: 26980774 DOI: 10.1177/0003319716637792] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Circulating markers relevant to the development of abdominal aortic aneurysm (AAA) are currently required. Lipoprotein(a), Lp(a), is considered a candidate marker associated with the presence of AAA. The present meta-analysis aimed to evaluate the association between circulating Lp(a) levels and the presence of AAA. The PubMed-based search was conducted up to April 30, 2015, to identify the studies focusing on Lp(a) levels in patients with AAA and controls. Quantitative data synthesis was performed using a random effects model, with standardized mean difference (SMD) and 95% confidence interval (CI) as summary statistics. Overall, 9 studies were identified. After a combined analysis, patients with AAA were found to have a significantly higher level of Lp(a) compared to the controls (SMD: 0.87, 95% CI: 0.41-1.33, P < .001). This result remained robust in the sensitivity analysis, and its significance was not influenced after omitting each of the included studies from the meta-analysis. The present meta-analysis confirmed a higher level of circulating Lp(a) in patients with AAA compared to controls. High Lp(a) levels can be associated with the presence of AAA, and Lp(a) may be a marker in screening for AAA. Further studies are needed to establish the clinical utility of measuring Lp(a) in the prevention and management of AAA.
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Affiliation(s)
- Kazuhiko Kotani
- 1 Division of Community and Family Medicine, Jichi Medical University, Shimotsuke-City, Japan
| | - Amirhossein Sahebkar
- 2 Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,3 Metabolic Research Centre, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Maria-Corina Serban
- 4 Discipline of Pathophysiology, Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Sorin Ursoniu
- 5 Discipline of Public Health, Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Dimitri P Mikhailidis
- 6 Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London, London, United Kingdom
| | - Giovanni Mariscalco
- 7 Department of Cardiovascular Sciences, University of Leicester Glenfield Hospital, Leicester, United Kingdom
| | - Steven R Jones
- 8 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Seth Martin
- 8 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Michael J Blaha
- 8 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Peter P Toth
- 8 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.,9 Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
| | - Manfredi Rizzo
- 10 Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Karam Kostner
- 11 Mater Hospital, University of Queensland, St Lucia, Australia
| | - Jacek Rysz
- 12 Department of Hypertension, Nephrology and Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Poland
| | - Maciej Banach
- 12 Department of Hypertension, Nephrology and Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Poland
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Zhang X, Wan Y, Chata R, Brazzale A, Atherton JJ, Kostner K, Dimeski G, Punyadeera C. A pilot study to demonstrate diagnostic potential of galectin-3 levels in saliva. J Clin Pathol 2016; 69:1100-1104. [DOI: 10.1136/jclinpath-2016-203631] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/17/2016] [Accepted: 04/21/2016] [Indexed: 12/19/2022]
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31
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Rowe M, Rutherford M, Kostner K. An unusual cause of ST elevation: Coronary vasospasm complicating acute myocarditis - A case report and review of the literature. J Clin Prev Cardiol 2016. [DOI: 10.4103/2250-3528.192699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kotani K, Sahebkar A, Serban C, Andrica F, Toth PP, Jones SR, Kostner K, Blaha MJ, Martin S, Rysz J, Glasser S, Ray KK, Watts GF, Mikhailidis DP, Banach M. Tibolone decreases Lipoprotein(a) levels in postmenopausal women: A systematic review and meta-analysis of 12 studies with 1009 patients. Atherosclerosis 2015; 242:87-96. [DOI: 10.1016/j.atherosclerosis.2015.06.056] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
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Abstract
Cardiovascular disease (CVD) mortality and morbidity increases with increasing age, largely as a result of increased lifetime exposure as well as increased prevalence of CVD risk factors. Hospitalization for CVD increases by a factor of over 18× for those aged 85+ years versus those aged <30 years. In spite of this, life expectancy continues to increase, and in Australia for people reaching the age of 65 years, it is now 84 years in men and 87 years in women. The number of people for whom lipid management is potentially indicated therefore increases with aging. This is especially the case for secondary prevention and for people aged 65-75 years for whom there is also evidence of benefit from primary prevention. Many people in this age group are not treated with lipid-lowering drugs, however. Even those with CVD may be suboptimally treated, with one study showing treatment rates to fall from ~60% in those aged <50 years to <15% for those aged 85+ years. Treatment of the most elderly patient groups remains controversial partly from the lack of randomized trial intervention data and partly from the potential for adverse effects of lipid therapy. There are many complex issues involved in the decision to introduce effective lipid-lowering therapy and, unfortunately, in many instances there is not adequate data to make evidence-based decisions regarding management. This review summarizes the current state of knowledge of the management of lipid disorders in the elderly and proposes guidelines for management.
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Affiliation(s)
- Ian Hamilton-Craig
- Griffith University School of Medicine, Griffith Health Institute, Gold Coast, QLD, Australia
- Flinders University School of Medicine, Adelaide, SA, Australia
| | - David Colquhoun
- Wesley Medical Centre, Auchenflower, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Karam Kostner
- University of Queensland, Brisbane, QLD, Australia
- Department of Cardiology, Mater Hospital, Woolloongabba, QLD, Australia
| | - Stan Woodhouse
- University of Queensland, Brisbane, QLD, Australia
- Taylor Medical Centre, Woolloongabba, QLD, Australia
| | - Michael d’Emden
- University of Queensland, Brisbane, QLD, Australia
- Department of Endocrinology, Royal Brisbane Hospital, Herston, QLD, Australia
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Banach M, Rizzo M, Toth PP, Farnier M, Davidson MH, Al-Rasadi K, Aronow WS, Athyros V, Djuric DM, Ezhov MV, Greenfield RS, Hovingh GK, Kostner K, Serban C, Lighezan D, Fras Z, Moriarty PM, Muntner P, Goudev A, Ceska R, Nicholls SJ, Broncel M, Nikolic D, Pella D, Puri R, Rysz J, Wong ND, Bajnok L, Jones SR, Ray KK, Mikhailidis DP. Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel. Expert Opin Drug Saf 2015; 14:935-55. [PMID: 25907232 DOI: 10.1517/14740338.2015.1039980] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Banach M, Rizzo M, Toth PP, Farnier M, Davidson MH, Al-Rasadi K, Aronow WS, Athyros V, Djuric DM, Ezhov MV, Greenfield RS, Hovingh GK, Kostner K, Serban C, Lighezan D, Fras Z, Moriarty PM, Muntner P, Goudev A, Ceska R, Nicholls SJ, Broncel M, Nikolic D, Pella D, Puri R, Rysz J, Wong ND, Bajnok L, Jones SR, Ray KK, Mikhailidis DP. Statin intolerance - an attempt at a unified definition. Position paper from an International Lipid Expert Panel. Arch Med Sci 2015; 11:1-23. [PMID: 25861286 PMCID: PMC4379380 DOI: 10.5114/aoms.2015.49807] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/08/2015] [Accepted: 03/10/2015] [Indexed: 02/07/2023] Open
Abstract
Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin associated muscle symptoms (SAMS), and avoided the use of the term 'statin intolerance'. Although muscle syndromes are the most common adverse effects observed after statin therapy, excluding other side effects might underestimate the number of patients with statin intolerance, which might be observed in 10-15% of patients. In clinical practice, statin intolerance limits effective treatment of patients at risk of, or with, cardiovascular disease. Knowledge of the most common adverse effects of statin therapy that might cause statin intolerance and the clear definition of this phenomenon is crucial to effectively treat patients with lipid disorders. Therefore, the aim of this position paper was to suggest a unified definition of statin intolerance, and to complement the recent EAS statement on SAMS, where the pathophysiology, diagnosis and the management were comprehensively presented.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Peter P. Toth
- University of Illinois College of Medicine, Peoria, IL, USA
| | | | | | | | - Wilbert S. Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
| | - Vasilis Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dragan M. Djuric
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marat V. Ezhov
- Department of Atherosclerosis, Cardiology Research Center, Moscow, Russia
| | | | - G. Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karam Kostner
- Mater Hospital, University of Queensland, St Lucia, QLD, Australia
| | - Corina Serban
- University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
| | - Daniel Lighezan
- University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
| | - Zlatko Fras
- Department of Vascular Medicine, Preventive Cardiology Unit, University Medical Centre Ljubljana, Slovenia Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Patrick M. Moriarty
- Department of Medicine, Schools of Pharmacy and Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Assen Goudev
- Department of Cardiology, Queen Giovanna University Hospital, Sofia, Bulgaria
| | - Richard Ceska
- 3 Department of Internal Medicine, Charles University, Praha, Czech Republic
| | - Stephen J. Nicholls
- South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, Australia
| | - Marlena Broncel
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Lodz, Poland
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Daniel Pella
- First Department Of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Košice, Slovakia
| | | | - Jacek Rysz
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, USA
| | - Laszlo Bajnok
- First Department of Medicine, University of Pecs, Pecs, Hungary
| | - Steven R. Jones
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Kausik K. Ray
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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Colquhoun D, Hamilton-Craig I, Kostner K, Woodhouse S, d’Emden M. High prevalence of suboptimal lipid management in the elderly: A call for new treatment guidelines. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wan Y, Xhang X, Atherton JJ, Kostner K, Dimeski G, Punyadeera C. A multimarker approach to diagnose and stratify heart failure. Int J Cardiol 2014; 181:369-75. [PMID: 25555282 DOI: 10.1016/j.ijcard.2014.12.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/21/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND We have previously demonstrated that circulating NT-proBNP is truncated at the N and C termini. Aims of this study are three-fold: firstly to determine whether the NT-proBNP levels correlate with NYHA functional classes when measuring with different antibody pairs; secondly to evaluate the diagnostic potential of ProBNP and; thirdly to investigate whether combining NT-proBNP assays with or without ProBNP would lead to better diagnostic accuracies. METHODS Plasma samples were collected from healthy controls (n=52) and HF patients (n=46). Customized AlphaLISA® immunoassays were developed and validated to measure the concentrations of proBNP and NT-proBNP (with antibodies targeting 13-45, 13-76, 28-76). The diagnostic performance and predictive value of proBNP and NT-proBNP assays and their combinations were evaluated. RESULTS Plasma proBNP assay showed acceptable diagnostic performance. NT-proBNP13-76 assay is useful in diagnosing and stratifying HF patients. The diagnostic performance of NT-proBNP13-76 demonstrated improvement over commercial NT-proBNP tests. The combination of NT-proBNP13-76 with NT-proBNP28-76 assays gave the best diagnostic assay performance. CONCLUSION Our results demonstrate that while there is major heterogeneity in circulating NT-proBNP, specific epitopes of the peptides are extraordinarily stable, providing ideal targets for clinically useful diagnostic assays. Future new clinical diagnostic clinical trials should include a multimarker approach rather than using a single marker to diagnose HF.
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Affiliation(s)
- Yunxia Wan
- The University of Queensland Diamantina Institute, The University of Queensland, The Translational Research Institute, Woolloongabba, Australia
| | - Xi Xhang
- The University of Queensland Diamantina Institute, The University of Queensland, The Translational Research Institute, Woolloongabba, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Australia; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Adult Hospital, Brisbane, Queensland, Australia
| | - Goce Dimeski
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Chemical Pathology Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Chamindie Punyadeera
- The University of Queensland Diamantina Institute, The University of Queensland, The Translational Research Institute, Woolloongabba, Australia.
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Tettey P, Simpson S, Taylor B, Blizzard L, Ponsonby AL, Dwyer T, Kostner K, van der Mei I. An adverse lipid profile is associated with disability and progression in disability, in people with MS. Mult Scler 2014; 20:1737-44. [DOI: 10.1177/1352458514533162] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: There is accumulating data suggesting an association between serum lipids, apolipoproteins and disability in multiple sclerosis (MS). Objectives: To investigate the associations between serum lipids, apolipoproteins and disability in MS. Methods: A cohort of 178 participants with clinically-definite MS in southern Tasmania, Australia were prospectively followed from 2002 – 2005, and serum samples were obtained at study entry and at each biannual review, to measure lipid profile and apolipoprotein levels. Associations with disability and annual change in disability were evaluated using linear regression and multilevel mixed-effects linear regression. Results: In the unadjusted analyses, nearly all lipid-related variables were positively associated with Expanded Disability Status Scale (EDSS). After adjustment for confounders, total cholesterol (TC) ( p = 0.037), apolipoprotein B (ApoB) ( p = 0.003), and the apolipoprotein B to apolipoprotein A-I ratio (ApoB/ApoA-I ratio) ( p = 0.018) were independently associated with a higher EDSS. Higher body mass index (BMI) was also independently associated with higher EDSS ( p = 0.013). With the progression analysis, the total cholesterol to high density lipoprotein (HDL) ratio (TC/HDL ratio) ( p = 0.029) was prospectively associated with subsequent change in EDSS. Conclusion: In this prospective population-based cohort study, an adverse lipid profile was associated with high levels of MS disability and disease progression. Improving serum lipids may be beneficial for MS patients, to potentially improve clinical outcomes and vascular comorbidities.
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Affiliation(s)
- Prudence Tettey
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Steve Simpson
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Bruce Taylor
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Leigh Blizzard
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | | | - Terence Dwyer
- Murdoch Children’s Research Institute, University of Melbourne, Australia
| | | | - Ingrid van der Mei
- Menzies Research Institute Tasmania, University of Tasmania, 17 Liverpool Street, Hobart TAS 7000, Australia
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Tettey P, Simpson S, Taylor B, Blizzard L, Ponsonby AL, Dwyer T, Kostner K, van der Mei I. Adverse lipid profile is not associated with relapse risk in MS: Results from an observational cohort study. J Neurol Sci 2014; 340:230-2. [DOI: 10.1016/j.jns.2014.02.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 02/19/2014] [Accepted: 02/27/2014] [Indexed: 12/11/2022]
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Wu CJJ, Sung HC, Chang AM, Atherton J, Kostner K, Courtney M, McPhail SM. Protocol for a randomised blocked design study using telephone and text-messaging to support cardiac patients with diabetes: a cross cultural international collaborative project. BMC Health Serv Res 2013; 13:402. [PMID: 24106997 PMCID: PMC3852414 DOI: 10.1186/1472-6963-13-402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes is rising internationally. Patients with diabetes have a higher risk of cardiovascular events accounting for substantial premature morbidity and mortality, and health care expenditure. Given healthcare workforce limitations, there is a need to improve interventions that promote positive self-management behaviours that enable patients to manage their chronic conditions effectively, across different cultural contexts. Previous studies have evaluated the feasibility of including telephone and Short Message Service (SMS) follow up in chronic disease self-management programs, but only for single diseases or in one specific population. Therefore, the aim of this study is to evaluate the feasibility and short-term efficacy of incorporating telephone and text messaging to support the care of patients with diabetes and cardiac disease, in Australia and in Taiwan. METHODS/DESIGN A randomised controlled trial design will be used to evaluate a self-management program for people with diabetes and cardiac disease that incorporates the use of simple remote-access communication technologies. A sample size of 180 participants from Australia and Taiwan will be recruited and randomised in a one-to-one ratio to receive either the intervention in addition to usual care (intervention) or usual care alone (control). The intervention will consist of in-hospital education as well as follow up utilising personal telephone calls and SMS reminders. Primary short term outcomes of interest include self-care behaviours and self-efficacy assessed at baseline and four weeks. DISCUSSION If the results of this investigation substantiate the feasibility and efficacy of the telephone and SMS intervention for promoting self management among patients with diabetes and cardiac disease in Australia and Taiwan, it will support the external validity of the intervention. It is anticipated that empirical data from this investigation will provide valuable information to inform future international collaborations, while providing a platform for further enhancements of the program, which has potential to benefit patients internationally. TRIAL REGISTRATION ACTRN 12611001196932.
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Affiliation(s)
- Chiung-Jung Jo Wu
- School of Nursing, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4059, Australia.
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Foo JYY, Wan Y, Schulz BL, Kostner K, Atherton J, Cooper-White J, Dimeski G, Punyadeera C. Circulating Fragments of N-Terminal Pro–B-Type Natriuretic Peptides in Plasma of Heart Failure Patients. Clin Chem 2013; 59:1523-31. [DOI: 10.1373/clinchem.2012.200204] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND
The use of nonstandardized N-terminal pro–B-type natriuretic peptide (NT-proBNP) assays can contribute to the misdiagnosis of heart failure (HF). Moreover, there is yet to be established a common consensus regarding the circulating forms of NT-proBNP being used in current assays. We aimed to characterize and quantify the various forms of NT-proBNP in the circulation of HF patients.
METHODS
Plasma samples were collected from HF patients (n = 20) at rest and stored at −80 °C. NT-proBNP was enriched from HF patient plasma by use of immunoprecipitation followed by mass spectrometric analysis. Customized homogeneous sandwich AlphaLISA® immunoassays were developed and validated to quantify 6 fragments of NT-proBNP.
RESULTS
Mass spectrometry identified the presence of several N- and C-terminally processed forms of circulating NT-proBNP, with physiological proteolysis between Pro2-Leu3, Leu3-Gly4, Pro6-Gly7, and Pro75-Arg76. Consistent with this result, AlphaLISA immunoassays demonstrated that antibodies targeting the extreme N or C termini measured a low apparent concentration of circulating NT-proBNP. The apparent circulating NT-proBNP concentration was increased with antibodies targeting nonglycosylated and nonterminal epitopes (P < 0.05).
CONCLUSIONS
In plasma collected from HF patients, immunoreactive NT-proBNP was present as multiple N- and C-terminally truncated fragments of the full length NT-proBNP molecule. Immunodetection of NT-proBNP was significantly improved with the use of antibodies that did not target these terminal regions. These findings support the development of a next generation NT-proBNP assay targeting nonterminal epitopes as well as avoiding the central glycosylated region of this molecule.
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Affiliation(s)
| | - Yunxia Wan
- The Australian Institute for Bioengineering and Nanotechnology
| | | | - Karam Kostner
- School of Medicine, the University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, Mater Adult Hospital, Brisbane, Queensland, Australia
| | - John Atherton
- School of Medicine, the University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Justin Cooper-White
- The Australian Institute for Bioengineering and Nanotechnology
- School of Chemical Engineering, the University of Queensland, Brisbane, Queensland, Australia
| | - Goce Dimeski
- School of Medicine, the University of Queensland, Brisbane, Queensland, Australia
- Chemical Pathology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Chamindie Punyadeera
- The Australian Institute for Bioengineering and Nanotechnology
- School of Chemical Engineering, the University of Queensland, Brisbane, Queensland, Australia
- current affiliation: Saliva Translational Research Group, The University of Queensland Diamantina Institute, Woolloongabba, Australia
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Kruger P, Bailey M, Bellomo R, Cooper DJ, Harward M, Higgins A, Howe B, Jones D, Joyce C, Kostner K, McNeil J, Nichol A, Roberts MS, Syres G, Venkatesh B. A Multicenter Randomized Trial of Atorvastatin Therapy in Intensive Care Patients with Severe Sepsis. Am J Respir Crit Care Med 2013; 187:743-50. [DOI: 10.1164/rccm.201209-1718oc] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Colquhoun D, Hamilton-Craig I, Kostner K, Woodhouse S. Fasting Glucose and HbA1c in Relationship to Coronary Heart Disease and Statin Therapy: The Need for Clear Thinking. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Singbal Y, Peiniger D, Bartlett A, Kostner K, Wahi S. Accuracy of Handheld Cardiac Ultrasound Devices in the Critical Care Setting. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Colquhoun D, Bensoussan A, Braun L, Hill K, Keech A, Kostner K, Rosenfeldt F, Walker R, Watts G. Complementary Medicines in Cardiovascular Disease – Review of the Evidence by the National Institute of Complementary Medicine 2013. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Foo JYY, Wan Y, Kostner K, Arivalagan A, Atherton J, Cooper-White J, Dimeski G, Punyadeera C. NT-ProBNP levels in saliva and its clinical relevance to heart failure. PLoS One 2012; 7:e48452. [PMID: 23119023 PMCID: PMC3485201 DOI: 10.1371/journal.pone.0048452] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 09/25/2012] [Indexed: 11/23/2022] Open
Abstract
Background Current blood based diagnostic assays to detect heart failure (HF) have large intra-individual and inter-individual variations which have made it difficult to determine whether the changes in the analyte levels reflect an actual change in disease activity. Human saliva mirrors the body’s health and well being and ∼20% of proteins that are present in blood are also found in saliva. Saliva has numerous advantages over blood as a diagnostic fluid which allows for a non-invasive, simple, and safe sample collection. The aim of our study was to develop an immunoassay to detect NT-proBNP in saliva and to determine if there is a correlation with blood levels. Methods Saliva samples were collected from healthy volunteers (n = 40) who had no underlying heart conditions and HF patients (n = 45) at rest. Samples were stored at −80°C until analysis. A customised homogeneous sandwich AlphaLISA(R) immunoassay was used to quantify NT-proBNP levels in saliva. Results Our NT-proBNP immunoassay was validated against a commercial Roche assay on plasma samples collected from HF patients (n = 37) and the correlation was r2 = 0.78 (p<0.01, y = 1.705× +1910.8). The median salivary NT-proBNP levels in the healthy and HF participants were <16 pg/mL and 76.8 pg/mL, respectively. The salivary NT-proBNP immunoassay showed a clinical sensitivity of 82.2% and specificity of 100%, positive predictive value of 100% and negative predictive value of 83.3%, with an overall diagnostic accuracy of 90.6%. Conclusion We have firstly demonstrated that NT-proBNP can be detected in saliva and that the levels were higher in heart failure patients compared with healthy control subjects. Further studies will be needed to demonstrate the clinical relevance of salivary NT-proBNP in unselected, previously undiagnosed populations.
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Affiliation(s)
- Jared Yong Yang Foo
- The Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia
| | - Yunxia Wan
- The Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia
| | - Karam Kostner
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, Mater Adult Hospital, Brisbane, Queensland, Australia
| | - Alicia Arivalagan
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, Mater Adult Hospital, Brisbane, Queensland, Australia
| | - John Atherton
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Justin Cooper-White
- The Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia
- School of Chemical Engineering, University of Queensland, Brisbane, Queensland, Australia
| | - Goce Dimeski
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Chemical Pathology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Chamindie Punyadeera
- The Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia
- School of Chemical Engineering, University of Queensland, Brisbane, Queensland, Australia
- * E-mail:
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Abstract
AIMS To determine whether incorporation of patient peer supporters in a Cardiac-Diabetes Self-Management Program (Peer-CDSMP) led to greater improvement in self-efficacy, knowledge and self-management behaviour in the intervention group compared to a control group. BACKGROUND Promoting improved self-management for those with diabetes and a cardiac condition is enhanced by raising motivation and providing a model. Peer support from former patients who are able to successfully manage similar conditions could enhance patient motivation to achieve better health outcomes and provide a model of how such management can be achieved. While studies on peer support have demonstrated the potential of peers in promoting self-management, none have examined the impact on patients with two co-morbidities. METHODS A randomized controlled trial was used to develop and evaluate the effectiveness of the Peer-CDSMP from August 2009 to December 2010. Thirty cardiac patients with type 2 diabetes were recruited. The study commenced in an acute hospital, follow-up at participants' homes in Brisbane, Australia. RESULTS While both the control and intervention groups had improved self-care behaviour, self-efficacy and knowledge, the improvement in knowledge was significantly greater for the intervention group. CONCLUSIONS Significant improvement in knowledge was achieved for the intervention group. Absence of significant improvements in self-efficacy and self-care behaviour represents an inconclusive effect; further studies with larger sample sizes are recommended.
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Affiliation(s)
- C-J Jo Wu
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
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Foo J, Kostner K, Chen C, Schulz B, Cooper-White J, Wan Y, Eng L, Arivalagan A, Punyadeera C. A Simple Saliva Test to Diagnose Heart Failure. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shafey TM, Dingle JG, Kostner K. Effect of Dietary α-tocopherol and Corn Oil on the Performance and on the Lipoproteins, Lipids, Cholesterol and α-tocopherol Concentrations of the Plasma and Eggs of Laying Hens. Journal of Applied Animal Research 2011. [DOI: 10.1080/09712119.1999.9706280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Holland DJ, Erne D, Kostner K, Leano R, Haluska BA, Marwick TH, Sharman JE. Acute elevation of triglycerides increases left ventricular contractility and alters ventricular-vascular interaction. Am J Physiol Heart Circ Physiol 2011; 301:H123-8. [PMID: 21490326 DOI: 10.1152/ajpheart.00102.2011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute elevation of circulating lipids, such as the postprandial state, contributes to increased cardiovascular risk. However, the effect of acutely elevated triglycerides on arterial and left ventricular function is not completely understood. We aimed to assess whether an acute increase in triglycerides affects ventricular-vascular interaction. Fifteen healthy men (age, 49 ± 8 yr) underwent blinded, randomized infusion of saline and intravenous fat emulsion to acutely raise plasma triglycerides. All subjects underwent both randomization trials, in random order on two separate days. Ventricular-vascular interaction measures were recorded by tonometry (central blood pressure) and echocardiography (left ventricular volumes, strain, and strain rate) at baseline and after 1 h infusion. Net ventricular-vascular interaction was defined by the effective arterial elastance (E(A))-to-left ventricular end-systolic elastance (E(LV)) ratio (E(A)/E(LV)). When compared with saline, the infusion of intravenous fat emulsion increased triglycerides and free fatty acids (ΔP < 0.001 for both) and improved left ventricular contractility (ΔE(LV), end-systolic volume and strain rate; P < 0.05 for all). However, arterial function was unchanged (ΔE(A), brachial and central blood pressure; P > 0.05 for all). Overall, E(A)/E(LV) was decreased by an infusion of intravenous fat emulsion (P = 0.004) but not saline (P > 0.05, P = 0.001 for Δ between trials). We conclude that intravenous fat emulsion and acute elevation of blood lipids (including triglycerides and free fatty acids) alter ventricular-vascular interaction by increasing left ventricular contractility without affecting arterial load. These findings may have implications for cardiovascular responses to parenteral nutrition.
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Affiliation(s)
- David J Holland
- Menzies Research Inst., Univ. of Tasmania, Medical Science 1 Bldg., Liverpool St., Hobart, 7000, Australia
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