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Stewart S, Patel SK, Lancefield TF, Rodrigues TS, Doumtsis N, Jess A, Vaughan-Fowler ER, Chan YK, Ramchand J, Yates PA, Kwong JC, McDonald CF, Burrell LM. Vulnerability to environmental and climatic health provocations among women and men hospitalized with chronic heart disease: insights from the RESILIENCE TRIAL cohort. Eur J Cardiovasc Nurs 2024; 23:278-286. [PMID: 37625011 DOI: 10.1093/eurjcn/zvad076] [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: 05/03/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
AIMS We aimed to recruit a representative cohort of women and men with multi-morbid chronic heart disease as part of a trial testing an innovative, nurse-co-ordinated, multi-faceted intervention to lower rehospitalization and death by addressing areas of vulnerability to external challenges to their health. METHODS AND RESULTS The prospective, randomized open, blinded end-point RESILIENCE Trial recruited 203 hospital inpatients (mean age 75.7 ± 10.2 years) of whom 51% were women and 94% had combined coronary artery disease, heart failure, and/or atrial fibrillation. Levels of concurrent multi-morbidity were high (mean Charlson Index of Comorbidity Score 6.5 ± 2.7), and 8.9% had at least mild frailty according to the Rockwood Clinical Frailty Scale. Including the index admission, 19-20% of women and men had a pre-existing pattern of seasonally linked hospitalization (seasonality). Detailed phenotyping revealed that 48% of women and 40% of men had ≥3 physiological factors, and 15% of women and 16% of men had ≥3 behavioural factors likely to increase their vulnerability to external provocations to their health. Overall, 61-62% of women and men had ≥4 combined factors indicative of such vulnerability. Additional factors such as reliance on the public health system (63 vs. 49%), lower education (30 vs. 14%), and living alone (48 vs. 29%) were more prevalent in women. CONCLUSION We successfully recruited women and men with multi-morbid chronic heart disease and bio-behavioural indicators of vulnerability to external provocations to their health. Once completed, the RESILIENCE TRIAL will provide important insights on the impact of addressing such vulnerability (promoting resilience) on subsequent health outcomes. REGISTRATION ClinicalTrials.org: NCT04614428.
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Affiliation(s)
- Simon Stewart
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
- Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Sheila K Patel
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
| | - Terase F Lancefield
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Thalys S Rodrigues
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
| | - Nicholas Doumtsis
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
| | - Ashleigh Jess
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
| | - Emily-Rose Vaughan-Fowler
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
| | - Yih-Kai Chan
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Jay Ramchand
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Paul A Yates
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
- Department of Aged Care, Austin Health, Melbourne, Victoria, Australia
| | - Jason C Kwong
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
- Department of Microbiology & Immunology, University of Melbourne at the Doherty Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Doherty Institute, Melbourne, Victoria, Australia
| | - Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
- The Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Louise M Burrell
- Department of Medicine, Austin Health, University of Melbourne, 145 Studley Road Heidelberg, Victoria 3084, Australia
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
- The Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
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Murphy AC, Lancefield TF, Chao M, Foroudi F, Koshy AN, Undrill S, Horrigan M, Yeo B, Yudi MB, Kearney L, Farouque O. Assessment of Cardiac Function in Chemotherapy Naive Women With Breast Cancer Undergoing Contemporary Radiation Therapy. JACC CardioOncol 2020; 2:509-510. [PMID: 34396259 PMCID: PMC8352316 DOI: 10.1016/j.jaccao.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Dawson LP, Cole JA, Lancefield TF, Ajani AE, Andrianopoulos N, Thrift AG, Clark DJ, Brennan AL, Freeman M, O'Brien J, Sebastian M, Chan W, Shaw JA, Dinh D, Reid CM, Duffy SJ. Incidence and risk factors for stroke following percutaneous coronary intervention. Int J Stroke 2020; 15:909-922. [PMID: 32248767 DOI: 10.1177/1747493020912607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/17/2022]
Abstract
BACKGROUND Stroke rates and risk factors may change as percutaneous coronary intervention practice evolves and no data are available comparing stroke incidence after percutaneous coronary intervention to the general population. AIMS This study aimed to identify the incidence and risk factors for inpatient and subsequent stroke following percutaneous coronary intervention with comparison to age-matched controls. METHODS Data were prospectively collected from 22,618 patients undergoing percutaneous coronary intervention in the Melbourne Interventional Group registry (2005-2015). The cohort was compared to the North-East Melbourne Stroke Incidence Study population-based cohort (1997-1999) and predefined variables assessed for association with inpatient or outpatient stroke. RESULTS Inpatient stroke occurred in 0.33% (65.3% ischemic, 28.0% haemorrhagic, and 6.7% cause unknown), while outpatient stroke occurred in 0.55%. Inpatient and outpatient stroke were associated with higher rates of in-hospital major adverse cardiovascular outcomes (p < 0.0001) and mortality (p < 0.0001), as well as 12-month mortality (p < 0.0001). Factors independently associated with inpatient stroke were renal impairment, ST-elevation myocardial infarction, previous stroke, left ventricular ejection fraction 30-45%, and female sex, while those associated with outpatient stroke were previous stroke, chronic lung disease, previous myocardial infarction, rheumatoid arthritis, female sex, and older age. Compared to the age-standardized population-based cohort, stroke rates in the 12 months following discharge were higher for percutaneous coronary intervention patients <65 years old, but lower for percutaneous coronary intervention patients ≥65 years old. CONCLUSIONS Risk of inpatient stroke following percutaneous coronary intervention appears to be largely associated with clinical status at presentation, while outpatient stroke relates more to age and chronic disease. Compared to the general population, outpatient stroke rates following percutaneous coronary intervention are higher for younger, but not older, patients.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Justin A Cole
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Jessica O'Brien
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia
| | - Martin Sebastian
- Department of Cardiology, University Hospital Geelong, Geelong, Australia
| | - William Chan
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - James A Shaw
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,School of Public Health, Curtin University, Perth, Australia
| | - Stephen J Duffy
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Lancefield TF, Patel SK, Freeman M, Velkoska E, Wai B, Srivastava PM, Horrigan M, Farouque O, Burrell LM. The Receptor for Advanced Glycation End Products (RAGE) Is Associated with Persistent Atrial Fibrillation. PLoS One 2016; 11:e0161715. [PMID: 27627677 PMCID: PMC5023161 DOI: 10.1371/journal.pone.0161715] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 04/04/2016] [Accepted: 08/10/2016] [Indexed: 12/02/2022] Open
Abstract
Objective Upregulation of the receptor for advanced glycation end products (RAGE) has been proposed as a pathophysiological mechanism underlying the development of atrial fibrillation (AF). We sought to investigate if soluble RAGE levels are associated with AF in Caucasian patients. Methods Patients (n = 587) were prospectively recruited and serum levels of soluble RAGE (sRAGE) and endogenous secretory RAGE (esRAGE) measured. The patients included 527 with sinus rhythm, 32 with persistent AF (duration >7 days, n = 32) and 28 with paroxysmal AF (duration <7 days, n = 28). Results Patients with AF were older and had a greater prevalence of heart failure than patients in sinus rhythm. Circulating RAGE levels were higher in patients with persistent AF [median sRAGE 1190 (724–2041) pg/ml and median esRAGE 452 (288–932) pg/ml] compared with paroxysmal AF [sRAGE 799 (583–1033) pg/ml and esRAGE 279 (201–433) pg/ml, p ≤ 0.01] or sinus rhythm [sRAGE 782 (576–1039) pg/ml and esRAGE 289 (192–412) pg/ml, p < 0.001]. In multivariable logistic regression analysis, independent predictors of persistent AF were age, heart failure, sRAGE [odds ratio 1.1 per 100 pg/ml, 95% confidence interval (CI) 1.0–1.1, p = 0.001] and esRAGE [odds ratio 1.3 per 100 pg/ml, 95% CI 1.1–1.4, p < 0.001]. Heart failure and age were the only independent predictors of paroxysmal AF. In AF patients, sRAGE [odds ratio 1.1 per 100 pg/ml, 95% CI 1.1–1.2, p = 0.007] and esRAGE [odds ratio 1.3 per 100 pg/ml, 95% CI 1.0–1.5, p = 0.017] independently predicted persistent compared with paroxysmal AF. Conclusions Soluble RAGE is elevated in Caucasian patients with AF, and both sRAGE and esRAGE predict the presence of persistent AF.
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Affiliation(s)
- Terase F. Lancefield
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
- * E-mail:
| | - Sheila K. Patel
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Melanie Freeman
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
- Department of Cardiology, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Elena Velkoska
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Bryan Wai
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Piyush M. Srivastava
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Omar Farouque
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Louise M. Burrell
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
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Patel SK, Velkoska E, Freeman M, Wai B, Lancefield TF, Burrell LM. From gene to protein-experimental and clinical studies of ACE2 in blood pressure control and arterial hypertension. Front Physiol 2014; 5:227. [PMID: 25009501 PMCID: PMC4067757 DOI: 10.3389/fphys.2014.00227] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/02/2014] [Indexed: 12/13/2022] Open
Abstract
Hypertension is a major risk factor for stroke, coronary events, heart and renal failure, and the renin-angiotensin system (RAS) plays a major role in its pathogenesis. Within the RAS, angiotensin converting enzyme (ACE) converts angiotensin (Ang) I into the vasoconstrictor Ang II. An “alternate” arm of the RAS now exists in which ACE2 counterbalances the effects of the classic RAS through degradation of Ang II, and generation of the vasodilator Ang 1-7. ACE2 is highly expressed in the heart, blood vessels, and kidney. The catalytically active ectodomain of ACE2 undergoes shedding, resulting in ACE2 in the circulation. The ACE2 gene maps to a quantitative trait locus on the X chromosome in three strains of genetically hypertensive rats, suggesting that ACE2 may be a candidate gene for hypertension. It is hypothesized that disruption of tissue ACE/ACE2 balance results in changes in blood pressure, with increased ACE2 expression protecting against increased blood pressure, and ACE2 deficiency contributing to hypertension. Experimental hypertension studies have measured ACE2 in either the heart or kidney and/or plasma, and have reported that deletion or inhibition of ACE2 leads to hypertension, whilst enhancing ACE2 protects against the development of hypertension, hence increasing ACE2 may be a therapeutic option for the management of high blood pressure in man. There have been relatively few studies of ACE2, either at the gene or the circulating level in patients with hypertension. Plasma ACE2 activity is low in healthy subjects, but elevated in patients with cardiovascular risk factors or cardiovascular disease. Genetic studies have investigated ACE2 gene polymorphisms with either hypertension or blood pressure, and have produced largely inconsistent findings. This review discusses the evidence regarding ACE2 in experimental hypertension models and the association between circulating ACE2 activity and ACE2 polymorphisms with blood pressure and arterial hypertension in man.
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Affiliation(s)
- Sheila K Patel
- Department of Medicine, Austin Health, University of Melbourne Heidelberg, VIC, Australia
| | - Elena Velkoska
- Department of Medicine, Austin Health, University of Melbourne Heidelberg, VIC, Australia
| | - Melanie Freeman
- Department of Medicine, Austin Health, University of Melbourne Heidelberg, VIC, Australia
| | - Bryan Wai
- Department of Medicine, Austin Health, University of Melbourne Heidelberg, VIC, Australia ; Department of Cardiology, Austin Health, University of Melbourne Heidelberg, VIC, Australia
| | - Terase F Lancefield
- Department of Medicine, Austin Health, University of Melbourne Heidelberg, VIC, Australia
| | - Louise M Burrell
- Department of Medicine, Austin Health, University of Melbourne Heidelberg, VIC, Australia ; Department of Cardiology, Austin Health, University of Melbourne Heidelberg, VIC, Australia ; Department of Cardiology, The Northern Hospital, University of Melbourne Epping, VIC, Australia
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Sugumar H, Lancefield TF, Andrianopoulos N, Duffy SJ, Ajani AE, Freeman M, Buxton B, Brennan AL, Yan BP, Dinh DT, Smith JA, Charter K, Farouque O, Reid CM, Clark DJ. Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention. Int J Cardiol 2014; 172:442-9. [PMID: 24521692 DOI: 10.1016/j.ijcard.2014.01.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 06/12/2013] [Revised: 01/11/2014] [Accepted: 01/19/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Comorbidities, such as diabetes, affect revascularization strategy for coronary disease. We sought to determine if the degree of renal impairment affected long-term mortality after percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) in patients with multi-vessel coronary disease (MVD). METHODS AND RESULTS 8970 patients with MVD undergoing revascularization between 2004 and 2008, in two multi-center parallel PCI and CABG Australian registries were assigned to three groups based on their estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m2 (n=1678:839), 30-59 mL/min/1.73 m2 (n=452:226) and <30 mL/min/1.73 m2 (n=74:37). We used 2:1 propensity matching to compare 3306 patients undergoing primary CABG versus PCI. Shock, myocardial infarction (MI)<24 h, previous CABG, valve surgery or PCI were exclusions. Long-term mortality (mean 3.1 years) was compared with Cox-proportional hazard-adjusted modeling. Observed long-term mortality rates (CABG vs. PCI) were 4.5% vs. 4.3% p=0.84, 12.8% vs. 17.3% p=0.12, and 23.0% vs. 40.5% p=0.05 in the three strata, respectively. In patients with eGFR≥60 mL/min/1.73 m2, long-term mortality between PCI and CABG (HR 0.99, 95% CI 0.65-1.49, p=0.95) was similar. However, amongst patients with eGFR 30-59 mL/min/1.73 m2, there was a significant mortality hazard with PCI (HR 2.00, 95% CI 1.32-3.04, p=0.001). In patients with eGFR<30 mL/min/1.73 m2, there was a trend for hazard with PCI (HR 1.66, 95% CI 0.80-3.46, p=0.17). CONCLUSION Long-term mortality in MVD patients with preserved renal function was very low and similar between PCI and CABG. However there was a long-term mortality hazard associated with PCI amongst patients with moderate renal impairment.
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Affiliation(s)
- Hariharan Sugumar
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | | | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Brian Buxton
- Department of Cardiac Surgery, Austin Hospital, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bryan P Yan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong; Department of Cardiology, Prince of Wales Hospital, Hong Kong, China
| | - Diem T Dinh
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Julian A Smith
- Department of Surgery, Monash University, Melbourne, Victoria, Australia; Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Kerrie Charter
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David J Clark
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
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Lancefield TF, Wai B, Patel SK, Velkoska E, Sourris KC, Grant S, Ord M, Forbes JM, Srivastava PM, Burrell LM. 795 Are Advanced Glycation End Products Associated with Elevated Filling pressures in Diabetes? J Hypertens 2012. [DOI: 10.1097/01.hjh.0000420789.73128.1c] [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: 11/25/2022]
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