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Espíldora-Hernández J, Díaz-Antonio T, Olmedo-Llanes J, Zarzuela León J, Rioja J, Valdivielso P, Sánchez-Chaparro MÁ, Ariza MJ. Clinical characterization and detection of subclinical atherosclerosis in subjects with extreme hyperalphalipoproteinemia. Clin Investig Arterioscler 2024:S0214-9168(24)00035-4. [PMID: 38702206 DOI: 10.1016/j.arteri.2024.03.005] [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] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION AND OBJECTIVES The association between HDL cholesterol (HDL-C) levels and death from cardiovascular disease follows a U-shaped pattern, increasing at the extremes. The objective of the study was to characterize a sample of subjects with extreme hyperalphalipoproteinemia (HAE). MATERIAL AND METHODS 53 cases with HAE were recruited, 24 women (HDL-C>135mg/ dL) and 29 men (HDL-C>116mg/ dL). A detailed medical history was taken and questionnaires on adherence to the Mediterranean diet and physical activity were collected. Carotid ultrasounds were performed to detect the presence of suclinical atherosclerosis. RESULTS The most prevalent cardiovascular risk factor (CVRF) was dyslipidemia (64%) with no significant differences between men and women, unlike hypertension (21% in women, versus 55% in men, p=0.01) and others CVRF, for example, diabetes. 7% of the series had previous cardiovascular disease, women had higher LDL cholesterol (p=0.002) and HDL-C than men (without significant differences). Plaque was detected in 53% of cases, being more prevalent in men. Patients with plaque were older, drank more alcohol and smoked more (p<0.05). CONCLUSIONS Men had a higher prevalence of CVRF than women, except for dyslipidemia. Subclinical atherosclerosis occurred in more than half of the series. Age, alcohol consumption and smoking were independently associated with the presence of plaque, however, our data do not show a significant influence of HDL-C levels.
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Affiliation(s)
- Javier Espíldora-Hernández
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España; Laboratorio de Lípidos y Arteriosclerosis, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España.
| | - Tania Díaz-Antonio
- Servicio de Radiodiagnóstico., Hospital Universitario Virgen de la Victoria, Málaga, España
| | | | - Jesús Zarzuela León
- Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - José Rioja
- Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Málaga, España; Laboratorio de Lípidos y Arteriosclerosis, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España
| | - Pedro Valdivielso
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España; Laboratorio de Lípidos y Arteriosclerosis, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España; Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - Miguel Ángel Sánchez-Chaparro
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España; Laboratorio de Lípidos y Arteriosclerosis, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España; Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - María José Ariza
- Laboratorio de Lípidos y Arteriosclerosis, Centro de Investigaciones Médico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), Universidad de Málaga, Málaga, España; Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Málaga, España
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Frías Vargas M, Jarauta E. Detection of subclinical atherosclerosis using vascular ultrasound as a vascular risk assessment method. Simplified protocol. Clin Investig Arterioscler 2024:S0214-9168(24)00024-X. [PMID: 38584065 DOI: 10.1016/j.arteri.2024.03.003] [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] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
Cardiovascular disease secondary to atherosclerosis is the main cause of morbidity and mortality in the world. Cardiovascular risk stratification has proven to be an insufficient approach to detect those subjects who are going to suffer a cardiovascular event, which is why for years other markers have been sought to help stratify each individual with greater precision. Two-dimensional vascular ultrasound is a excellent method for vascular risk assessment.
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Affiliation(s)
- Manuel Frías Vargas
- Departamento de Medicina, Universidad Complutense de Madrid, Centro de Salud San Andrés, Madrid, España.
| | - Estíbaliz Jarauta
- Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Hospital Universitario Miguel Servet, Zaragoza, España
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Espiño-Álvarez A, Vargas-Tirado M, Royuela M, Gil-Díaz A, Fuente-Cosío S, Cornejo-Saucedo MÁ, Tejero-Delgado MA, Novo-Veleiro I, Bellver-Álvarez TM, Gullón A. Characteristics and treatment of nonagenarian patients with vascular disease admitted to internal medicine services. NONAVASC-2 registry. Rev Clin Esp 2023; 223:569-577. [PMID: 37717922 DOI: 10.1016/j.rceng.2023.09.005] [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: 05/18/2023] [Accepted: 08/27/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Vascular disease (VD) is the most frequent cause of morbidity and mortality and its prevalence increases with age. Old patients are not included in studies on VD, their characteristics and treatments being unknown. OBJECTIVE Know the clinical characteristics of nonagenarian patients hospitalized in Internal Medicine services with a diagnosis of established VD and the adequacy of their pharmacological management. MATERIAL AND METHODS The NONAVASC-2 registry is an observational, prospective, multicentre study. Hospitalized patients for any cause were included. Data collection was carried out through an anonymous online database with sociodemographic, clinical, analytical, therapeutic and evolutionary parameters. RESULTS One thousand forty-nine patients with a mean age of 93.14 years (57.8% women) were included. The prevalence of risk factors and VD was high: hypertension (84.9%), dyslipidemia (50.9%) and diabetes mellitus (29.4%). 33.4% presented severe-total dependency. 82.9% received antithrombotic treatment (53.7% antiplatelets, 25.4% anticoagulation and 3.8% double therapy). Only 38.2% received statins. The percentage of severe dependence (39.2% vs 24.1%; p = 0.00) and severe cognitive impairment (30.8% vs 13.8%; p = 0.00) was significantly higher among patients who did not receive them. 19% died during admission. CONCLUSIONS Nonagenarian patients with VD present high comorbidity, dependence and mortality. Despite being in secondary prevention, 17% did not receive antithrombotics and only 38% received statins. The underprescription is conditioned, among other factors, by the functional status. More studies are necessary to determine the impact of this issue on their prognosis.
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Affiliation(s)
- A Espiño-Álvarez
- Servicio de Medicina Interna, Hospital Universitario La Princesa, Madrid, Spain.
| | - M Vargas-Tirado
- Servicio de Medicina Interna, Hospital Universitario General de Villalba, Villalba, Madrid, Spain
| | - M Royuela
- Servicio de Medicina Interna, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, Spain
| | - A Gil-Díaz
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - S Fuente-Cosío
- Servicio de Medicina Interna, Hospital Universitario San Agustín, Avilés, Asturias, Spain
| | - M Á Cornejo-Saucedo
- Servicio de Medicina Interna, Hospital San Carlos, San Fernando, Cádiz, Spain
| | - M A Tejero-Delgado
- Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - I Novo-Veleiro
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - T M Bellver-Álvarez
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Hospital Virgen de la Torre, Madrid, Spain
| | - A Gullón
- Servicio de Medicina Interna, Hospital Universitario La Princesa, Madrid, Spain
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Goya M, Miserachs M, Suy Franch A, Burgos J, de la Calle M, Brotons C, Castellanos M, Cortés Rico O, Díaz Rodriguez Á, Elosúa R, Freijo MDM, González Fondado M, Gorostidi M, Grau M, Hernández Martínez AM, Lahoz C, Muñoz-Rivas N, Pallares-Carratalá V, Pedro-Botet J, Rodilla E, Goya E, Royo Bordonada MÁ, Santamaría R, Torres Fonseca M, Velescu A, Zamora A, Armario P. [Documento de consenso de la Sociedad Española de Obstetricia y Ginecologia (SEGO) y el Comité Español Interdisciplinario para la Prevención Vascular (CEIPV). Ventana de oportunidad: prevención del riesgo vascular en la mujer. Resultados adversos del embarazo y riesgo de enfermedad vascular.]. Rev Esp Salud Publica 2023; 97:e202310084. [PMID: 37921377] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 11/04/2023] Open
Abstract
This document summarises the evidence regarding the association between adverse pregnancy outcomes (APOs), such as hypertensive disorders, preterm birth, gestational diabetes, fetal growth defects (small for gestational age and/or fetal growth restriction), placental abruption, fetal loss, and the risk that a pregnant individual in developing vascular risk factors (VR) that may lead to future vascular disease (VD): coronary heart disease, stroke, peripheral vascular disease, and heart failure. Furthermore, this document emphasises the importance of recognising APOs when assessing VR in women. A history of APOs serves as a sufficient indicator for primary prevention of VD. In fact, adopting a healthy diet and increasing physical activity among women with APOs, starting during pregnancy and/or postpartum, and maintaining it throughout life are significant interventions that can reduce VR. On the other hand, breastfeeding can also reduce the future VR of women, including a lower risk of mortality. Future studies evaluating the use of aspirin, statins, and metformin, among others, in women with a history of APOs could strengthen recommendations regarding pharmacotherapy for primary prevention of VD in these patients. Various healthcare system options exist to improve the transition of care for women with APOs between different healthcare professionals and implement long-term VR reduction strategies. One potential process could involve incorporating the fourth-trimester concept into clinical recommendations and healthcare policies.
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Martín-Rioboó E, Brotons-Cuixart C, Ruiz García A, Villafañe Sanz F, Frías Vargas M, Moyá Amengual A, Divisón Garrote JA, Seoane Vicente MC, Banegas JR, Pallarés Carratalá V. [Luces y sombras de la Guía Europea esc-2021 de Prevención de la Enfermedad Cardiovascular en la Práctica Clínica.]. Rev Esp Salud Publica 2023; 97:e202308064. [PMID: 37921403 PMCID: PMC10541257] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/01/2023] [Indexed: 11/04/2023] Open
Abstract
General practitioners see in their consultation a a significant number of patients at high vascular risk (VR). The European Guidelines for Cardiovascular Disease Prevention (2021) recommend a new risk classification and intervention strategies on on vascular risk factors (RF), with the aim of providing a shared decision-making recommendations between professionals and patients. In this document we present a critical analysis of these guidelines, offering possible solutions that can be implemented in Primary Care. It should be noted that there are positive aspects (lights) such as that the SCORE2 (from forty to sixty-nine years) and SCORE2-OP models (from seventy to eighty-nine years) are based on more current cohorts and measure cardiovascular risk in a more accurately manner. In addition, it is proposed to differentiate different risk thresholds according to age-groups. For sake of practicality, cardiovascular risk can be estimated using different websites with the new computer models. However, among the negative aspects (shadows), it seems to be add complexity implementing nine subgroups of subjects according to their age or level of risk, with a defined thresholds that could cause a substantial increase in the potential number of subjects susceptible to treatment without a clear evidence that supports it. In addition, two-step RF interventions could delay achievement of therapeutic goals, especially in very high-risk patients, diabetics, or patients with cardiovascular disease. Given these limitations, in this document we propose practical recommendations in order to simplify and facilitate the implementation of the guideline in primary care.
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Affiliation(s)
- Enrique Martín-Rioboó
- Médico de Familia; Unidad de Gestión Clínica Poniente; Distrito Universitario Córdoba-Guadalquivir; Departamento de Medicina; Universidad de Córdoba. / IMIBIC; Hospital Reina Sofía. Córdoba. España
| | - Carlos Brotons-Cuixart
- Médico de familia; Instituto de Investigaciones Biomédicas Sant Pau; Equipo de Atención Primaria Sardenya. Barcelona. España
| | - Antonio Ruiz García
- Médico de familia; Universidad Europea de Madrid. / Director del Centro de Salud Universitario Pinto; Unidad de Lípidos y Prevención Cardiovascular. Pinto (Madrid). España
| | - Fátima Villafañe Sanz
- Médico especialista en Medicina familiar y comunitaria.Centro de Salud Pisuerga. Arroyo de la Encomienda (Valladolid). España
| | - Manuel Frías Vargas
- Médico de Familia; Centro de Salud San Andrés. / Departamento de Medicina; Facultad de Medicina; Universidad Complutense de Madrid. Madrid. España
| | - Ana Moyá Amengual
- Médico del trabajo; Centro de Salud Sta. Catalina. Palma de Mallorca. España
| | - Juan Antonio Divisón Garrote
- Médico de Atención Primaria; Centro de Salud de Casas Ibáñez. Albacete. España
- Facultad de Medicina; Universidad Católica de Murcia (UCAM). Murcia. España
| | | | - José R Banegas
- Departamento de Medicina Preventiva y Salud Pública, y Microbiología; Universidad Autónoma de Madrid. / CIBERESP. Madrid. España
| | - Vicente Pallarés Carratalá
- Médico de familia; Unidad de Vigilancia de la Salud; Unión de Mutuas. / Departamento de Medicina; Facultad de Ciencias de la Salud; Universitat Jaume I. Castellón. España
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Sammi MK, Fryman A, Baker E, Moloney B, Powers K, West R, Bittner F, Lane M, Martin K, Pepelyayeva Y, Anderson VC, Rooney WD, Yadav V. Vascular disease risk factors in multiple sclerosis: Effect on metabolism and brain volumes. Mult Scler Relat Disord 2023; 74:104675. [PMID: 37121104 PMCID: PMC10560072 DOI: 10.1016/j.msard.2023.104675] [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] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Vascular disease risk factors (VDRF) such as hypertension, hyperlipidemia, obesity, diabetes and heart disease likely play a role in disease progression in people with multiple sclerosis (PwMS) (Marrie, Rudick et al. 2010). Studies exploring the mechanistic connection between vascular disease and MS disease progression are scant. We hypothesized that phosphate energy metabolism impairment in PwMS with VDRFs (VDRF+) will be greater compared to PwMS without VDRFs (VDRF-) and is related to increased brain atrophy in VDRF+. To test this hypothesis, we planned to study the differences in the high energy phosphate (HEP) metabolites in cerebral gray matter as assessed by 31P magnetic resonance spectroscopic imaging (MRSI) and MRI brain volumetric in the VDRF+ and VDRF- PwMS at four different timepoints over a 3 yearlong period using a 7T MR system. We present here the results from the cross-sectional evaluation of HEP metabolites and brain volumes. We also evaluated the differences in clinical impairment, blood metabolic biomarkers and quality of life in VDRF+ and VDRF- PwMS in this cohort. METHODS Group differences in high energy phosphate metabolites were assessed from a volume of interest in the occipital region using linear mixed models. Brain parenchymal and white matter lesion volumes were determined from MR anatomic images. We present here the cross-sectional analysis of the baseline data collected as part of a longitudinal 3 yearlong study where we obtained baseline and subsequent 6-monthly clinical and laboratory data and annual 7T MRI volumetric and 31P MR spectroscopic imaging (MRSI) data on 52 PwMS with and without VDRF. Key clinical and laboratory outcomes included: body mass index (BMI), waist and thigh circumferences and disability [Expanded Disability Status Scale (EDSS)], safety (complete blood count with differential, complete metabolic), lipid panel including total cholesterol and HbA1C. We analyzed clinical and laboratory data for the group differences using student's t or χ2 test. We investigated relationship between phosphate metabolites and VDRF using mixed effect linear regression. RESULTS Complete MRI data were available for 29 VDRF+, age 56.3 (6.8) years [mean (SD)] (83% female), and 23 VDRF-, age 52.5 (7.5) years (57% female) individuals with MS. The mean value of normalized adenosine triphosphate (ATP) (calculated as the ratio of ATP to total phosphate signal in a voxel) was decreased by 4.5% (p < .05) in VDRF+ compared to VDRF- MS group. White matter lesion (WML) volume fraction in VDRF+ individuals {0.007 (0.007)} was more than doubled compared to VDRF- participants {0.003 (0.006), p= .02}. CONCLUSIONS We found significantly lower brain ATP and higher inorganic phosphate (Pi) in those PwMS with VDRFs compared to those without. ATP depletion may reflect mitochondrial dysfunction. Ongoing longitudinal data analysis from this study, not presented here, will evaluate the relationship of phosphate metabolites, brain atrophy and disease progression in PwMS with and without vascular disease.
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Affiliation(s)
- Manoj K Sammi
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA.
| | - Allison Fryman
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Veterans Affairs MS Center of Excellence-West, Portland, OR, USA
| | - Eric Baker
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Brendan Moloney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Katherine Powers
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Randy West
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Frank Bittner
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Michael Lane
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Veterans Affairs MS Center of Excellence-West, Portland, OR, USA
| | - Kayla Martin
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Veterans Affairs MS Center of Excellence-West, Portland, OR, USA
| | - Yuliya Pepelyayeva
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Valerie C Anderson
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Vijayshree Yadav
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Veterans Affairs MS Center of Excellence-West, Portland, OR, USA.
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Bernal J, Schreiber S, Menze I, Ostendorf A, Pfister M, Geisendörfer J, Nemali A, Maass A, Yakupov R, Peters O, Preis L, Schneider L, Herrera AL, Priller J, Spruth EJ, Altenstein S, Schneider A, Fliessbach K, Wiltfang J, Schott BH, Rostamzadeh A, Glanz W, Buerger K, Janowitz D, Ewers M, Perneczky R, Rauchmann BS, Teipel S, Kilimann I, Laske C, Munk MH, Spottke A, Roy N, Dobisch L, Dechent P, Scheffler K, Hetzer S, Wolfsgruber S, Kleineidam L, Schmid M, Berger M, Jessen F, Wirth M, Düzel E, Ziegler G. Arterial hypertension and β-amyloid accumulation have spatially overlapping effects on posterior white matter hyperintensity volume: a cross-sectional study. Alzheimers Res Ther 2023; 15:97. [PMID: 37226207 DOI: 10.1186/s13195-023-01243-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND White matter hyperintensities (WMH) in subjects across the Alzheimer's disease (AD) spectrum with minimal vascular pathology suggests that amyloid pathology-not just arterial hypertension-impacts WMH, which in turn adversely influences cognition. Here we seek to determine the effect of both hypertension and Aβ positivity on WMH, and their impact on cognition. METHODS We analysed data from subjects with a low vascular profile and normal cognition (NC), subjective cognitive decline (SCD), and amnestic mild cognitive impairment (MCI) enrolled in the ongoing observational multicentre DZNE Longitudinal Cognitive Impairment and Dementia Study (n = 375, median age 70.0 [IQR 66.0, 74.4] years; 178 female; NC/SCD/MCI 127/162/86). All subjects underwent a rich neuropsychological assessment. We focused on baseline memory and executive function-derived from multiple neuropsychological tests using confirmatory factor analysis-, baseline preclinical Alzheimer's cognitive composite 5 (PACC5) scores, and changes in PACC5 scores over the course of three years (ΔPACC5). RESULTS Subjects with hypertension or Aβ positivity presented the largest WMH volumes (pFDR < 0.05), with spatial overlap in the frontal (hypertension: 0.42 ± 0.17; Aβ: 0.46 ± 0.18), occipital (hypertension: 0.50 ± 0.16; Aβ: 0.50 ± 0.16), parietal lobes (hypertension: 0.57 ± 0.18; Aβ: 0.56 ± 0.20), corona radiata (hypertension: 0.45 ± 0.17; Aβ: 0.40 ± 0.13), optic radiation (hypertension: 0.39 ± 0.18; Aβ: 0.74 ± 0.19), and splenium of the corpus callosum (hypertension: 0.36 ± 0.12; Aβ: 0.28 ± 0.12). Elevated global and regional WMH volumes coincided with worse cognitive performance at baseline and over 3 years (pFDR < 0.05). Aβ positivity was negatively associated with cognitive performance (direct effect-memory: - 0.33 ± 0.08, pFDR < 0.001; executive: - 0.21 ± 0.08, pFDR < 0.001; PACC5: - 0.29 ± 0.09, pFDR = 0.006; ΔPACC5: - 0.34 ± 0.04, pFDR < 0.05). Splenial WMH mediated the relationship between hypertension and cognitive performance (indirect-only effect-memory: - 0.05 ± 0.02, pFDR = 0.029; executive: - 0.04 ± 0.02, pFDR = 0.067; PACC5: - 0.05 ± 0.02, pFDR = 0.030; ΔPACC5: - 0.09 ± 0.03, pFDR = 0.043) and WMH in the optic radiation partially mediated that between Aβ positivity and memory (indirect effect-memory: - 0.05 ± 0.02, pFDR = 0.029). CONCLUSIONS Posterior white matter is susceptible to hypertension and Aβ accumulation. Posterior WMH mediate the association between these pathologies and cognitive dysfunction, making them a promising target to tackle the downstream damage related to the potentially interacting and potentiating effects of the two pathologies. TRIAL REGISTRATION German Clinical Trials Register (DRKS00007966, 04/05/2015).
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Affiliation(s)
- Jose Bernal
- Institute of Cognitive Neurology and Dementia Research, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Stefanie Schreiber
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Department of Neurology, Medical Faculty, University Hospital Magdeburg, Magdeburg, Germany
| | - Inga Menze
- Institute of Cognitive Neurology and Dementia Research, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Anna Ostendorf
- Institute of Cognitive Neurology and Dementia Research, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Malte Pfister
- Department of Neurology, Medical Faculty, University Hospital Magdeburg, Magdeburg, Germany
| | - Jonas Geisendörfer
- Department of Neurology, Medical Faculty, University Hospital Magdeburg, Magdeburg, Germany
| | - Aditya Nemali
- Institute of Cognitive Neurology and Dementia Research, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Anne Maass
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Renat Yakupov
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin-Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Lukas Preis
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin-Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Luisa Schneider
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin-Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Ana Lucia Herrera
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin-Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
- School of Medicine, Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
- University of Edinburgh and UK DRI, Edinburgh, UK
| | - Eike Jakob Spruth
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Slawek Altenstein
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Clinic for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Clinic for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Jens Wiltfang
- German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Goettingen, Germany
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Björn H Schott
- German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, Goettingen, Germany
| | - Ayda Rostamzadeh
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | - Wenzel Glanz
- Institute of Cognitive Neurology and Dementia Research, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Katharina Buerger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Michael Ewers
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Robert Perneczky
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London, UK
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Matthias H Munk
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Clinic for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Nina Roy
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Laura Dobisch
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Peter Dechent
- MR-Research in Neurosciences, Department of Cognitive Neurology, Georg-August-University Goettingen, Göttingen, Germany
| | - Klaus Scheffler
- Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Steffen Wolfsgruber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Clinic for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Luca Kleineidam
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Clinic for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Moritz Berger
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Psychiatry, University of Cologne, Cologne, Germany
- Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Miranka Wirth
- German Center for Neurodegenerative Diseases (DZNE), Tatzberg 41, Dresden, 01307, Germany.
| | - Emrah Düzel
- Institute of Cognitive Neurology and Dementia Research, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Gabriel Ziegler
- Institute of Cognitive Neurology and Dementia Research, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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8
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Song H, Bharadwaj PK, Raichlen DA, Habeck CG, Huentelman MJ, Hishaw GA, Trouard TP, Alexander GE. Association of homocysteine-related subcortical brain atrophy with white matter lesion volume and cognition in healthy aging. Neurobiol Aging 2023; 121:129-138. [PMID: 36436304 PMCID: PMC10002471 DOI: 10.1016/j.neurobiolaging.2022.10.011] [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] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Homocysteine (Hcy) is a vascular risk factor associated with cognitive impairment and cerebrovascular disease but has also been implicated in Alzheimer's disease (AD). Using multivariate Scaled Subprofile Model (SSM) analysis, we sought to identify a network pattern in structural neuroimaging reflecting the regionally distributed association of plasma Hcy with subcortical gray matter (SGM) volumes and its relation to other health risk factors and cognition in 160 healthy older adults, ages 50-89. We identified an SSM Hcy-SGM pattern that was characterized by bilateral hippocampal and nucleus accumbens volume reductions with relative volume increases in bilateral caudate, pallidum, and putamen. Greater Hcy-SGM pattern expression was associated with greater white matter hyperintensity (WMH) volume, older age, and male sex, but not with other vascular and AD-related risk factors. Mediation analyses revealed that age predicted WMH volume, which predicted Hcy-SGM pattern expression, which, in turn, predicted cognitive processing speed performance. These findings suggest that the multivariate SSM Hcy-SGM pattern may be indicative of cognitive aging, reflecting a potential link between vascular health and cognitive dysfunction in healthy older adults.
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Affiliation(s)
- Hyun Song
- Department of Psychology, University of Arizona, Tucson, AZ, USA; Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Pradyumna K Bharadwaj
- Department of Psychology, University of Arizona, Tucson, AZ, USA; Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - David A Raichlen
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, CA, USA
| | - Christian G Habeck
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute, Columbia University, New York, NY, USA
| | - Matthew J Huentelman
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA; Neurogenomics Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Georg A Hishaw
- Department of Neurology, University of Arizona, Tucson, AZ, USA
| | - Theodore P Trouard
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA; Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
| | - Gene E Alexander
- Department of Psychology, University of Arizona, Tucson, AZ, USA; Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA; Department of Psychiatry, University of Arizona, Tucson, AZ, USA; Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, University of Arizona, Tucson, AZ, USA.
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9
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Shionoya K, Sasaki A, Moriya H, Kimura K, Nishino T, Kubota J, Sumida C, Tasaki J, Ichita C, Makazu M, Masuda S, Koizumi K, Kawachi J, Tsukiyama T, Kako M. Clinical features and progress of ischemic gastritis with high fatalities: Seven case reports. World J Clin Cases 2022; 10:8686-8694. [PMID: 36157813 PMCID: PMC9453346 DOI: 10.12998/wjcc.v10.i24.8686] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/11/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ischemic gastritis is a clinically rare and highly fatal disease that occurs when the hemodynamics of a patient with vascular risk is disrupted. Early diagnosis and treatment are possible only with upper endoscopy after symptom appearance. We report seven cases of ischemic gastritis and its clinical features, prognosis, and indicators that may help in early detection.
CASE SUMMARY Of the seven patients, six had vascular risk and five died within 2 wk of diagnosis. Their symptoms included hematemesis and hypotension. Although surgery is a choice for radical treatment, not all patients were tolerant. For such patients, conservative treatment was selected, but all of them died. In contrast, patients who underwent repeat endoscopy showed improved mucosal findings, suggesting that this improvement may not affect prognosis. Some ischemic changes such as wall thickening, mural emphysema, and fluid retention in the stomach were observed before diagnosis through endoscopy and computed tomography (CT). The CT scan can be effective for early detection, and improvement in circulatory failure and aggressive treatment may save the lives of patients with this disease.
CONCLUSION The characteristic CT findings enable early detection of ischemic gastritis. Early diagnosis increases the chance of survival if early therapeutic intervention and improvement of circulatory dynamics can be achieved in this highly fatal disease.
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Affiliation(s)
- Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Hidekazu Moriya
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Jun Kubota
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Chihiro Sumida
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Jun Kawachi
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Toshitaka Tsukiyama
- Department of Radiology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
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10
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Muzurović E, Mikhailidis DP, Mantzoros C. Non-alcoholic fatty liver disease, insulin resistance, metabolic syndrome and their association with vascular risk. Metabolism 2021; 119:154770. [PMID: 33864798 DOI: 10.1016/j.metabol.2021.154770] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [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: 02/05/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 02/07/2023]
Abstract
The prevalence of non-alcoholic fatty liver disease (NAFLD), one of the most common liver diseases, is rising. About 25% of adults worldwide are probably affected by NAFLD. Insulin resistance (IR) and fat accumulation in the liver are strongly related. The association between NAFLD, metabolic syndrome (MetS) and IR is established, but an independent impact of NAFLD on vascular risk and progression of cardiovascular (CV) disease (CVD) still needs to be confirmed. This narrative review considers the evidence regarding the link between NAFLD, IR and CVD risk. There is strong evidence for a "concomitantly rising incidence" of NAFLD, IR, MetS and CVD but there is no definitive evidence regarding whether NAFLD is, or is not, an independent and significant risk factor the development of CVD. There are also considerations that type 2 diabetes mellitus (T2DM) may be a common link between NAFLD/non-alcoholic steatohepatitis (NASH) and CVD. NAFLD may be associated with widespread abnormal peri-organ or intra-organ fat (APIFat) deposition (e.g. epicardial adipose tissue) which may further contribute to CV risk. It is clear that NAFLD patients have a greater CV risk (independent or not) which needs to be addressed in clinical practice.
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Affiliation(s)
- Emir Muzurović
- Department of Internal Medicine, Endocrinology Section, Clinical Centre of Montenegro, Ljubljanska bb, 81000 Podgorica, Montenegro; Faculty of Medicine, University of Montenegro, Kruševac bb, 81000 Podgorica, Montenegro.
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), Pond Street, London NW3 2QG, UK; Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Christos Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA 02115, USA
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11
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Hugon-Rodin J, Perol S, Plu-Bureau G. [Menopause and risk of thromboembolic events. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. Gynecol Obstet Fertil Senol 2021; 49:455-461. [PMID: 33757918 DOI: 10.1016/j.gofs.2021.03.018] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The incidence of venous thromboembolism (VTE) increases with age with an annual incidence of 1.25/1000 women in the 40-59 age group. Menopausal hormone therapy (MHT) may also increase the risk of VTE. This risk must be assessed during the first consultation before initiating MHT and assess each renewal of the MHT. MHT with oral estrogen combined (or not) with progestin increases the risk of VTE by about 70%. Using transdermal estrogen does not appear to increase the risk of VTE in women. VTE risk appears to be modulated by the type of progestin combined in MHT. The risk of VTE associated with MHT with transdermal estradiol appears to be safe in women using micronised progesterone and pregnane derivatives and higher in women using norpregnane derivatives . To limit the risk of VTE associated with MHT, transdermal estradiol use is recommended. In women at risk of VTE, MHT with oral estrogen is contraindicated. MHT with transdermal estradiol associated (or not) with micronised progesterone or dydrogesterone may be used in women with low or moderate risk of VTE.
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Affiliation(s)
- J Hugon-Rodin
- Service de gynécologie, groupe hospitalier Paris Saint-Joseph, Paris, France; Inserm U 1153, Épidémiologie obstétricale, périnatale et pédiatrique, Centre de recherche en épidémiologie et statistiques, Paris, France
| | - S Perol
- Service de gynécologie obstétrique, unité de gynécologie médicale, hôpital Port-Royal-Cochin, Paris, France; Université de Paris, Paris, France
| | - G Plu-Bureau
- Service de gynécologie obstétrique, unité de gynécologie médicale, hôpital Port-Royal-Cochin, Paris, France; Université de Paris, Paris, France; Inserm U 1153, Épidémiologie obstétricale, périnatale et pédiatrique, Centre de recherche en épidémiologie et statistiques, Paris, France.
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12
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Sarfo FS, Agyei M, Ogyefo I, Opare-Addo PA, Ovbiagele B. Factors Linked to Chronic Kidney Disease Among Stroke Survivors in Ghana. J Stroke Cerebrovasc Dis 2021; 30:105720. [PMID: 33706193 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/20/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with poor outcomes among stroke survivors. In Africa, where both stroke and CKD incidence rates are escalating, little, if anything, is known about the burden of CKD among stroke survivors. OBJECTIVE To assess the frequency and factors associated with CKD among stroke survivors by primary stroke types. METHODS Stroke registry data were prospectively collected on consecutively encountered stroke survivors seen at an out-patient clinic in Ghana between January 2018 and March 2020. We calculated estimated glomerular filtration rate (eGFR) using the CKD-EPI formula and defined CKD as eGFR <60ml/min. Factors associated with CKD were assessed using multiple logistic regression modelling. RESULTS Among 759 stroke survivors, 159 had CKD giving a prevalence of 21.0% (95%CI: 18.1% - 23.8%). The mean age of those with CKD was 61.6 ± 14.2 years compared with 57.5 ± 13.6 years, p=0.0007 among those without CKD. Five factors remained significantly associated with CKD with the following adjusted odds ratio (aOR and 95% CI). Age per decile rise 1.30 (1.13-1.50), male sex 1.99 (1.36-2.93), rural dwelling residence 1.95 (1.06-3.59), prior use of antihypertensive meds before index stroke onset 1.63 (1.08-2.47), and number of antihypertensive medication classes 1.25 (1.06-1.45). CONCLUSION 1 in 5 stroke survivors have evidence of chronic kidney disease in this Ghanaian study. Targeted interventions focusing on optimizing blood pressure control and rural dwellers may mitigate their risk for adverse outcomes.
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13
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Cox SR, Lyall DM, Ritchie SJ, Bastin ME, Harris MA, Buchanan CR, Fawns-Ritchie C, Barbu MC, de Nooij L, Reus LM, Alloza C, Shen X, Neilson E, Alderson HL, Hunter S, Liewald DC, Whalley HC, McIntosh AM, Lawrie SM, Pell JP, Tucker-Drob EM, Wardlaw JM, Gale CR, Deary IJ. Associations between vascular risk factors and brain MRI indices in UK Biobank. Eur Heart J 2020; 40:2290-2300. [PMID: 30854560 PMCID: PMC6642726 DOI: 10.1093/eurheartj/ehz100] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [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: 01/08/2019] [Revised: 01/23/2019] [Accepted: 02/19/2019] [Indexed: 12/30/2022] Open
Abstract
Aims Several factors are known to increase risk for cerebrovascular disease and dementia, but there is limited evidence on associations between multiple vascular risk factors (VRFs) and detailed aspects of brain macrostructure and microstructure in large community-dwelling populations across middle and older age. Methods and results Associations between VRFs (smoking, hypertension, pulse pressure, diabetes, hypercholesterolaemia, body mass index, and waist–hip ratio) and brain structural and diffusion MRI markers were examined in UK Biobank (N = 9722, age range 44–79 years). A larger number of VRFs was associated with greater brain atrophy, lower grey matter volume, and poorer white matter health. Effect sizes were small (brain structural R2 ≤1.8%). Higher aggregate vascular risk was related to multiple regional MRI hallmarks associated with dementia risk: lower frontal and temporal cortical volumes, lower subcortical volumes, higher white matter hyperintensity volumes, and poorer white matter microstructure in association and thalamic pathways. Smoking pack years, hypertension and diabetes showed the most consistent associations across all brain measures. Hypercholesterolaemia was not uniquely associated with any MRI marker. Conclusion Higher levels of VRFs were associated with poorer brain health across grey and white matter macrostructure and microstructure. Effects are mainly additive, converging upon frontal and temporal cortex, subcortical structures, and specific classes of white matter fibres. Though effect sizes were small, these results emphasize the vulnerability of brain health to vascular factors even in relatively healthy middle and older age, and the potential to partly ameliorate cognitive decline by addressing these malleable risk factors.
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Affiliation(s)
- Simon R Cox
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK
| | - Donald M Lyall
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK.,Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - Stuart J Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, UK
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK.,Brain Research Imaging Centre, Neuroimaging Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK
| | - Mathew A Harris
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Colin R Buchanan
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK
| | - Chloe Fawns-Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK
| | - Miruna C Barbu
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Laura de Nooij
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Lianne M Reus
- Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, VU University Amsterdam, Amsterdam UMC, De Boelelaan 1117, HV Amsterdam, The Netherlands
| | - Clara Alloza
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Xueyi Shen
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Emma Neilson
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | | | - Stuart Hunter
- NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, UK
| | - David C Liewald
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK
| | - Heather C Whalley
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Andrew M McIntosh
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Stephen M Lawrie
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - Elliot M Tucker-Drob
- Department of Psychology, University of Texas, 108 E Dean Keeton St, Austin, Texas, USA
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK.,Brain Research Imaging Centre, Neuroimaging Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK.,UK Dementia Research Institute at the University of Edinburgh, Edinburgh BioQuarter, Edinburgh, UK
| | - Catharine R Gale
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK
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14
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Elosua-Bayés I, Beloqui Ruiz Ó. Association between non alcoholic fatty liver disease, metabolic and vascular risk. Clin Investig Arterioscler 2020; 32:200-205. [PMID: 32736892 DOI: 10.1016/j.arteri.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hepatic steatosis is a public health problem with increased incidence and prevalence OBJECTIVE: To determine whether the liver steatosis, as measured by the Fatty Liver Index (FLI), is related to metabolic risk and vascular factors and, if so, to identify the clinical-metabolic factor that explains the higher vascular risk. METHODS Cross-sectional study including a sample of 531 men who came to the University of Navarra Clinic Check-up Unit. The degree of steatosis was determined by the FLI. The metabolic risk was assessed using a scale based on determinations of HDL, LDL, triglycerides, blood glucose, HOMA-IR, neutrophil/lymphocyte index, and systolic blood pressure. The vascular risk was assessed by the presence of carotid and/or femoral atheromatous plaques. The dose-response association between FLI and both risks was analysed using non-parametric models (splines) and logistic regression. RESULTS The sample studied had a mean age of 52.70years, with 49.3% having an FLI ≥60, as well as 33.6% with metabolic syndrome, and 43.9% with carotid and/or femoral atheromatous plaques. The relationship between FLI and metabolic risk and vascular was linear (metabolic: non-linear P=.097; linear P<.001; vascular: non-linear P=1.000; linear P=.028). For every 10 units of increase in FLI, the odds of presenting with atheroma plaques increased by 9.7% (OR=1.097; 95% confidence interval 1.010-1.191). When adjusting for triglyceridaemia, the association disappeared (OR=1.001). CONCLUSIONS Patients with fatty liver disease had an increased metabolic and vascular risk. The increased vascular risk is associated with the triglyceride level. On a clinical level, this study suggests that these patients could benefit from treatment of hypertriglyceridaemia.
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Affiliation(s)
- Iker Elosua-Bayés
- Unidad de Chequeos, Departamento de Medicina Interna, Clínica Universidad de Navarra, Pamplona, España.
| | - Óscar Beloqui Ruiz
- Unidad de Chequeos, Departamento de Medicina Interna, Clínica Universidad de Navarra, Pamplona, España
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Kaur R, Singh J, Kapoor R, Kaur M. Putative functional non-coding polymorphisms in SELP significantly modulate sP-selectin levels, arterial stiffness and type 2 diabetes mellitus susceptibility. BMC Endocr Disord 2020; 20:70. [PMID: 32429899 PMCID: PMC7236446 DOI: 10.1186/s12902-020-00548-x] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/10/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND P-selectin, encoded by SELP, has been implicated as an important molecule in the development of arterial stiffness, consequently leading to vascular complications in T2DM. SELP polymorphisms and increased levels of soluble P-selectin (sP-selectin) have been shown to be associated with several inflammatory diseases. The present work was designed to assess nine putative functional non-coding SELP variants in relation to sP-selectin levels and arterial stiffness in T2DM. METHODS The genetic distribution of rs3917655, rs3917657, rs3917739, rs2235302, rs3917843 was determined by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR). Genotyping of rs3917779 was performed by tetra primer amplification-refractory mutation system (ARMS)- PCR. Three SNPs i.e. rs3917853, rs3917854, rs3917855 were genotyped by Sanger sequencing. Construction of haplotypes was performed using PHASE software. The data thus obtained was analyzed by appropriate statistical tools. RESULTS Two non-coding variants i.e. rs3917657 and rs3917854 of SELP were found to be associated with 2 and 1.7 -fold risk of disease development respectively. However, one non-coding variant rs2235302 was found to provide protection against disease development. Furthermore, variant allele of rs3917854 in T2DM patients was found to be associated with 2.07-fold very high vascular risk. Non-coding haplotype GCAGGCCGC was conferring 4.14-fold risk of disease development. Furthermore, overall sP-selectin levels were higher in T2DM patients when segregated according to genotypes as well as haplotypes. Significant genotype- phenotype correlation was observed for rs3917655 as well as rs3917739 variant in patients and for rs3917854 in controls. In vascular risk categories, a significant genotype- phenotype correlation was observed for rs3917655 and rs2235302. Furthermore, patients with CCGGGCCGC haplotype in high risk category were observed with higher levels of sP-selectin as compared to other haplotypes (p < 0.05). CONCLUSIONS Non-coding SELP variants may significantly modulate sP-selectin levels, vascular risk and T2DM susceptibility.
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Affiliation(s)
- Raminderjit Kaur
- School of Medicine, Wayne State University, Detroit, Michigan USA
- Department of Molecular Biology & Biochemistry, Guru Nanak Dev University, Amritsar, Punjab India
| | - Jatinder Singh
- School of Medicine, Wayne State University, Detroit, Michigan USA
| | - Rohit Kapoor
- Carewell Heart & Superspeciality Hospital, Amritsar, Punjab India
| | - Manpreet Kaur
- School of Medicine, Wayne State University, Detroit, Michigan USA
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Ornello R, Frattale I, Caponnetto V, Pistoia F, Sacco S. Cerebral vascular reactivity and the migraine-stroke relationship: A narrative review. J Neurol Sci 2020; 414:116887. [PMID: 32407982 DOI: 10.1016/j.jns.2020.116887] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/15/2020] [Revised: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 12/26/2022]
Abstract
Migraine, and especially migraine with aura, is associated with an increased risk of stroke and vascular events; however, the reasons for this association are unclear. Several studies evaluated cerebral autoregulation and vasomotor reactivity in patients with migraine compared with non-migraineurs, with conflicting results. Our narrative review aimed at summarizing their results to find the most reliable evidence in the field. Studies which used visual stimuli to evoke vascular responses consistently showed an increased vascular reactivity in migraineurs compared with non-migraineurs, while studies which used systemic stimuli such as hyper- or hypocapnia showed inconsistent results. Therefore, central neural mechanisms might be more important than peripheral vascular mechanisms in determining the cerebral vascular responses of patients with migraine. However, a large body of evidence supports the existence of peripheral vascular dysfunction in patients with migraine. Further studies are needed to explain the complex interactions between central neural and peripheral vascular mechanisms in determining migraine and its vascular risk. Migraine preventive treatments, and especially the most recent ones with a peripheral action, might provide important insights in this field.
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Affiliation(s)
- Raffaele Ornello
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy.
| | - Ilaria Frattale
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Valeria Caponnetto
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Francesca Pistoia
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Simona Sacco
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
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Jor'dan AJ, Jacob ME, Leritz E, Bean JF. Neuromuscular Attributes are Associated with Poor Mobility in Older Adults with Vascular Risk Conditions. J Frailty Aging 2020; 9:30-36. [PMID: 32150211 DOI: 10.14283/jfa.2019.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/25/2022]
Abstract
BACKGROUND The mobility of older adults is limited by the compounding effects of vascular health conditions, or vascular risk burden. However, little is known about the role of neuromuscular attributes among those in which vascular risk burden contributes to mobility limitations. OBJECTIVE We investigated (1) the relationship between the absence/presence of type 2 diabetes, hypertension, and/or obesity and mobility measures and neuromuscular attributes, and (2) whether the association between vascular risk burden and mobility is mediated by lower limb neuromuscular attributes. DESIGN Cross-sectional analysis of baseline data from 430 older adults within the Boston RISE Study. MEASUREMENTS Measures of mobility were the Short Physical Performance Battery, habitual gait speed, and functional mobility as measured by the Late Life Function Instrument. We also evaluated lower limb neuromuscular attributes, namely leg strength, leg velocity, trunk extensor muscle endurance, knee and ankle range of motion, and sensory loss. RESULTS Participants self-reported the presence of None (n=93), One (n=179), Two (n=114), or Three (n=44) of the following conditions: diabetes, hypertension, and obesity. Multivariable regression models indicated that those with a greater vascular risk burden had worse performance on the Short Physical Performance Battery (p=0.01), slower gait speed (p=0.0003) and lower Basic and Advanced Late Life Function Instrument scores (p<0.003). These associations were independent of multiple covariates. Vascular risk burden was also found to be negatively associated with leg strength (p=0.0002) and knee flexion range of motion (p<0.0001) and an associated non-significant trend was observed with leg velocity (p=0.06). In addition, the association between vascular risk burden and mobility outcomes were found to be partially mediated by leg strength, leg velocity, and knee flexion range of motion. CONCLUSIONS Among older adults with vascular risk burden and mobility problems, neuromuscular impairments in attributes such as leg strength, leg velocity, and knee range of motion may need to be treatment priorities.
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Affiliation(s)
- A J Jor'dan
- Azizah J. Jor'dan, PhD, Instructor of Psychiatry, New England GRECC, 150 South Huntington Ave, Boston, MA 02130, Tel: 857-364-6339 Fax: 857-364-5368, E-mail:
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Cerletti C, Colucci M, Storto M, Semeraro F, Ammollo CT, Incampo F, Costanzo S, De Bartolomeo G, Portincasa P, Barone M, Di Castelnuovo A, Semeraro N, Iacoviello L, de Gaetano G. Randomised trial of chronic supplementation with a nutraceutical mixture in subjects with non-alcoholic fatty liver disease. Br J Nutr 2020; 123:190-197. [PMID: 31554528 DOI: 10.1017/s0007114519002484] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Indexed: 02/07/2023]
Abstract
A mixture of natural ingredients, namely, DHA, phosphatidylcholine, silymarin, choline, curcumin and d-α-tocopherol, was studied in subjects with non-alcoholic fatty liver disease (NAFLD). Primary endpoints were serum levels of hepatic enzymes, and other parameters of liver function, the metabolic syndrome and inflammation were the secondary endpoints. The coagulation-fibrinolysis balance was also thoroughly investigated, as NAFLD is associated with haemostatic alterations, which might contribute to increased cardiovascular risk of this condition. The present study involved a double-blind, randomised, multicentre controlled trial of two parallel groups. Subjects with NAFLD (18-80 years, either sex) received the active or control treatment for 3 months. All assays were performed on a total of 113 subjects before and at the end of supplementation. The hepatic enzymes aspartate aminotransferase (AST), alanine aminotransferase and γ-glutamyl transpeptidase decreased from 23·2 to 3·7 % after treatment, only the AST levels reaching statistical significance. However, no differences were found between control and active groups. Metabolic and inflammatory variables were unchanged, except for a slight (less than 10 %) increase in cholesterol and glucose levels after the active treatment. Coagulation-fibrinolytic parameters were unaffected by either treatment. In conclusion, chronic supplementation with the mixture of dietary compounds was well tolerated and apparently safe in NAFLD subjects. The trial failed to demonstrate any efficacy on relevant physiopathological markers, but its protocol and results may be useful to design future studies with natural compounds.
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Affiliation(s)
- Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Mario Colucci
- Laboratory for Haemostasis and Thrombosis, Department of Biomedical Sciences and Human Oncology, University "Aldo Moro", Bari, Italy
| | - Marianna Storto
- Clinical Pathology Unit, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Fabrizio Semeraro
- Laboratory for Haemostasis and Thrombosis, Department of Biomedical Sciences and Human Oncology, University "Aldo Moro", Bari, Italy
| | - Concetta T Ammollo
- Laboratory for Haemostasis and Thrombosis, Department of Biomedical Sciences and Human Oncology, University "Aldo Moro", Bari, Italy
| | - Francesca Incampo
- Laboratory for Haemostasis and Thrombosis, Department of Biomedical Sciences and Human Oncology, University "Aldo Moro", Bari, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli (IS), Italy
| | | | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University "Aldo Moro", Bari, Italy
| | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro", Bari, Italy
| | | | - Nicola Semeraro
- Laboratory for Haemostasis and Thrombosis, Department of Biomedical Sciences and Human Oncology, University "Aldo Moro", Bari, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli (IS), Italy
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Chabbert-Buffet N, Marret H, Agostini A, Cardinale C, Hamdaoui N, Hassoun D, Jonville-Bera AP, Lambert M, Linet T, Pienkowski C, Plu-Bureau G, Pragout D, Robin G, Jablonski CR, Schefler M, Vidal F, Vigoureux S, Hédon B. Clinical practice guidelines for contraception by the French National College of Gynecologists and Obstetricians (CNGOF). J Gynecol Obstet Hum Reprod 2019; 48:441-54. [PMID: 31051299 DOI: 10.1016/j.jogoh.2019.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 01/12/2023]
Abstract
The French College of Obstetrics and Gynecology (CNGOF) has released its first comprehensive recommendations for clinical practices in contraception, to provide physicians with an updated synthesis of the available data as a basis for their practice. The organizing committee and the working group adopted the objective methodological principles defined by the French Authority for Health (HAS) and selected 12 themes relevant to medical professionals' clinical practices concerning contraception. The available literature was screened through December 2017 and served as the basis of 12 texts, reviewed by experts and physicians from public and private practices, with experience in this field. These texts enabled us to develop evidence based, graded recommendations. Male and female sterilization, as well as the use of hormonal treatments not authorized for contraception ("off-label") were excluded from the scope of our review. Specific practical recommendations are provided for the management of contraception prescription, patient information concerning effectiveness, risks, and benefits of the different methods, patient follow-up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers, in women after 40, for women at high thromboembolism or cardiovascular risk, and for those at of primary cancer or relapse. The short- and mid-term future of contraception depends mainly on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, regardless of their social and clinical contexts. The objective of these guidelines is to aid in enabling this improvement.
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Chabbert-Buffet N, Marret H, Agostini A, Cardinale C, Hamdaoui N, Hassoun D, Jonville-Bera AP, Lambert M, Linet T, Pienkowski C, Plu-Bureau G, Pragout D, Robin G, Rousset-Jablonski C, Scheffler M, Vidal F, Vigoureux S, Hédon B. [Contraception: CNGOF Guidelines for Clinical Practice (Short Version)]. ACTA ACUST UNITED AC 2018; 46:760-776. [PMID: 30416023 DOI: 10.1016/j.gofs.2018.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 12/26/2022]
Abstract
The French College of Obstetrics and Gynecology (CNGOF) releases its first global recommendations for clinical practice in contraception, to provide physicians with an updated synthesis of available data as a basis for their practice. The French Health Authority (HAS) methodology was used. Twelve practical issues were selected by the organizing committee and the task force members. The available literature was screened until December 2017, and allowed the release of evidence-based, graded recommendations. This synthesis is issued from 12 developed texts, previously reviewed by experts and physicians from public and private practices, with an experience in the contraceptive field. Male and female sterilization, as well as the use of hormonal treatments without contraceptive label were excluded from the field of this analysis. Specific practical recommendations on the management of contraception prescription, patient information including efficacy, risks, and benefits of the different contraception methods, follow up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers and after 40, contraception in vascular high-risk situations, and in case of cancer risk are provided. The short/mid-term future of contraception mostly relies on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, whatever the social and clinical context. That is the goal of these recommendations.
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Affiliation(s)
- N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpitaux universitaires Est parisien, hôpital Tenon, Assistance publique des hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMRS_938, Inserm Sorbonne université, 75012 Paris, France.
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, centre hospitalier universitaire de Bretonneau, pôle de gynécologie-obstétrique, 2, boulevard Tonnellé, 37044 Tours cedex 1, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital de la Conception, boulevard Baille, 13005 Marseille, France
| | - C Cardinale
- Service de gynécologie-obstétrique, hôpital de la Conception, boulevard Baille, 13005 Marseille, France
| | - N Hamdaoui
- Service de gynécologie-obstétrique, hôpital de la Conception, boulevard Baille, 13005 Marseille, France
| | - D Hassoun
- 38, rue Turenne, 75003 Paris, France
| | - A P Jonville-Bera
- Centre régional de pharmacovigilance, centre Val-de-Loire, CHRU de Tours, 37044 Tours cedex, France
| | - M Lambert
- Service de gynécologie et de médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - T Linet
- Service de gynécologie-obstétrique, centre hospitalier de Loire-Vendée-Océan, 85302 Challans, France
| | - C Pienkowski
- Unité d'endocrinologie et de gynécologie médicale, TSA 70034, centre de référence de pathologies gynécologiques rares (PGR Toulouse), hôpital des Enfants, CHU de Toulouse, 31000 Toulouse, France
| | - G Plu-Bureau
- Unité de gynécologie endocrinienne, hôpital Port-Royal, 53, avenue de l'Observatoire, 75679 Paris, France; Université Paris Descartes, 75005 Paris, France; Inserm UMR 1153, Obstetrical, perinatal and paediatric epidemiology research team (Épopé), Centre for epidemiology and statistics Sorbonne Paris Cité (CRESS), 75005 Paris, France
| | - D Pragout
- Unité d'orthogénie, service de gynécologie-obstétrique, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Robin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, centre hospitalier universitaire de Lille, hôpital Jeanne de Flandre, 59000 Lille, France; EA 4308, gamétogenèse et qualité du gamète, centre hospitalier universitaire de Lille, 59000 Lille, France
| | - C Rousset-Jablonski
- Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France; Centre hospitalier de Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - M Scheffler
- Service de gynécologie, CHU, 10, rue du Dr-Heydenreich, 54000 Nancy, France
| | - F Vidal
- CHU de Purpan, hôpital Paule-de-Viguier, pôle femme-mère-couple, 330, avenue Grande-Bretagne, 31059 Toulouse, France
| | - S Vigoureux
- Service de gynécologie-obstétrique, hôpital Bicêtre, Assistance publique des Hôpitaux de Paris (AP-HP), 94276 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France; U1018, Inserm, reproduction and child development, Centre for research in epidemiology and population health (CESP), 94805 Villejuif, France
| | - B Hédon
- Département de gynécologie-obstétrique, faculté de médecine université de Montpellier (France), centre hospitalier universitaire Arnaud-de-Villeneuve, 34000 Montpellier, France
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Stojkovic T, Stefanova E, Soldatovic I, Markovic V, Stankovic I, Petrovic I, Agosta F, Galantucci S, Filippi M, Kostic V. Exploring the relationship between motor impairment, vascular burden and cognition in Parkinson's disease. J Neurol 2018; 265:1320-1327. [PMID: 29572571 DOI: 10.1007/s00415-018-8838-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 02/06/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine frequency and type of cognitive disorders in cross-sectional analysis of a Parkinson's disease (PD) cohort, and explore its relations to motor symptoms, modifiable vascular risk factors and white matter lesions (WML) volume. METHODS In a group of 133 PD patients, mild cognitive impairment (PD-MCI) and dementia (PDD) were diagnosed according to Movement Disorders Society Task Force criteria (level 2 for PD-MCI). Detailed motor measurements were applied, including rigidity, axial, bradykinesia, tremor and postural instability gait disorders (PIGD) scores. Vascular risk was estimated by the Framingham General Cardiovascular Disease risk scoring algorithm and WML volume was measured for whole brain and frontal lobe. RESULTS Sixty-one (46.9%) patients fulfilled criteria for PD-MCI, and 23 (17.7%) for PDD. Non-amnestic multiple domain MCI was most frequent (52% of PD-MCI patients). Motor scores were significantly higher in cognitively impaired patients, but only axial score discriminated between MCI and dementia. High vascular risk was related to impaired cognition, bradykinesia, axial, PIGD and freezing of gait (FOG) score, while whole brain WML volume was associated with PDD, FOG and attention deficits. Furthermore, high vascular risk was identified as a potential predictor of both MCI and dementia in PD. Additionally, age and bradykinesia score were independently associated with PD-MCI and age, axial score and whole brain WML volume with PDD. CONCLUSION Cognitive disorders in PD are associated with more severe, predominantly axial motor deficits and increased, but partly modifiable vascular burden, thus opening a possibility for development of preventive strategies in PD.
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Affiliation(s)
- Tanja Stojkovic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
- School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Elka Stefanova
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Soldatovic
- Institute of Medical Statistics, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladana Markovic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Iva Stankovic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Petrovic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Sebastiano Galantucci
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Vladimir Kostic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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Teijido Ó, Carril JC, Cacabelos R. Population-based Study of Risk Polymorphisms Associated with Vascular Disorders and Dementia. Curr Genomics 2017; 18:430-441. [PMID: 29081698 PMCID: PMC5635648 DOI: 10.2174/1389202918666170608093833] [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: 03/30/2016] [Revised: 04/12/2016] [Accepted: 04/29/2016] [Indexed: 12/27/2022] Open
Abstract
Introduction: Cardiovascular and neurodegenerative disorders are among the major causes of mortality in the developed countries. Population studies evaluate the genetic risk, i.e. the probability of an individual carrying a specific disease-associated polymorphism. Identification of risk polymorphisms is essential for an accurate diagnosis or prognosis of a number of pathologies. Aims: The aim of this study was to characterize the influence of risk polymorphisms associated with lipid metabolism, hypertension, thrombosis, and dementia, in a large population of Spanish individuals affected by a variety of brain and vascular disorders as well as metabolic syndrome. Material & Method: We performed a cross-sectional study on 4415 individuals from a widespread regional distribution in Spain (48.15% males and 51.85% females), with mental, neurodegenerative, cerebrovascular, and metabolic disorders. We evaluated polymorphisms in 20 genes involved in obesity, vascular and cardiovascular risk, and dementia in our population and compared it with representative Spanish and European populations. Risk polymorphisms in ACE, AGT(235), IL6(573), PSEN1, and APOE (specially the APOE-ε4 allele) are representative of our population as compared to the reference data of Spanish and European individuals. Conclusion: The significantly higher distribution of risk polymorphisms in PSEN1 and APOE-ε4 is characteristic of a representative number of patients with Alzheimer’s disease; whereas polymorphisms in ACE, AGT(235), and IL6(573), are most probably related with the high number of patients with metabolic syndrome or cerebrovascular damage.
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Affiliation(s)
- Óscar Teijido
- EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, 15165-Bergondo, Corunna, Spain.,Genomic Medicine, Camilo José Cela University, 28692-Madrid, Spain
| | - Juan Carlos Carril
- EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, 15165-Bergondo, Corunna, Spain.,Genomic Medicine, Camilo José Cela University, 28692-Madrid, Spain
| | - Ramón Cacabelos
- EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, 15165-Bergondo, Corunna, Spain.,Genomic Medicine, Camilo José Cela University, 28692-Madrid, Spain
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Carril JC, Cacabelos R. Genetic Risk Factors in Cerebrovascular Disorders and Cognitive Deterioration. Curr Genomics 2017; 18:416-429. [PMID: 29081697 PMCID: PMC5635647 DOI: 10.2174/1389202918666170426165226] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/12/2016] [Accepted: 04/29/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The study of variations in genes involved in the different events that trigger the atherogenic process, such as lipid metabolism (modification of LDL-cholesterol), endothelial function and hypertension, immune response (recruitment of macrophages and foam cell formation) and stability of atherosclerotic plaques (thrombosis), established the risk for suffering a vascular disorder. A total of 2455 cases over 50 years of age were genotyped for a panel of 19 SNPs in 15 genes encoding for proteins involved in the atherogenic process. This study shows the relevance of polymorphisms in APOB (odds ratio (OR), 1.17; 95% confidence interval (95% CI), 0.74-1.85), APOC3 (OR, 1.33; 95% CI, 0.82-2.17) and APOE (OR, 1.75; 95% CI, 1.09-2.80), as genetic risk markers for hypercholesterolemia; polymorphisms in ACE (OR, 1.68; 95% CI, 0.32-8.77) and AGT (OR, 1.74; 95% CI, 0.97-3.14) for hypertension; and in APOE*3/*4 (OR, 2.06; 95% CI, 1.70-2.51) and APOE*4/*4 (OR, 3.08; 95% CI, 1.85-5.12) as unambiguous markers of dementia. RESULT Our results also showed the transversal importance of proinflammatory cytokines in different stages of atherogenesis, with special relevance of IL6 (OR, 1.39; 95% CI, 0.56-3.49) and TNF (OR, 1.40; 95% CI, 0.92-2.15) related to hypercholesterolemia and hypertension. The set of markers involved in this genetic risk panel makes it a powerful tool in the management of patients with different vascular disorders.
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Affiliation(s)
- Juan C. Carril
- EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine. 15165-Bergondo, Corunna, Spain; Genomic Medicine. Camilo José Cela University 28692-Madrid, Spain
| | - Ramón Cacabelos
- EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine. 15165-Bergondo, Corunna, Spain; Genomic Medicine. Camilo José Cela University 28692-Madrid, Spain
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Lo RY, Lo YC, Chen SC, Li YY, Yang YL, Chang YL, Sung HC, Chiu THT, Goh JOS. Vascular burden and brain aging in a senior volunteer cohort: A pilot study. Ci Ji Yi Xue Za Zhi 2017; 29:91-97. [PMID: 28757773 PMCID: PMC5509202 DOI: 10.4103/tcmj.tcmj_21_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: To test the feasibility of establishing a senior volunteer cohort and describe vascular risks, cognitive function, and brain aging indices in a pilot study. Materials and Methods: We enrolled 40 senior volunteers from the Tzu Chi Foundation and other organizations in Hualien in 2014–2015. We conducted in-person interviews to collect information on demographic features, physical fitness, dietary habits, comorbidities, and narratives of aging. Vascular risks including blood pressure, body mass index (BMI), serum glucose level, and lipid profile were examined. Each participant underwent a comprehensive battery of neuropsychological tests and structural brain magnetic resonance imaging (MRI). Descriptive statistics and tabulation were applied to characterize this pilot cohort. Results: There were more volunteers from the Tzu Chi Foundation (n = 25) than other organizations. The mean age was 66.7 years (standard deviation = 5.1) and there was a female predominance (M:F = 13:27). The mean number of comorbid chronic diseases was 2.1 and the mean BMI was 24.5. Most participants (77.5%) engaged in outdoor walking activities every week. Nutrient intake in vegetarians (n = 18) did not differ from nonvegetarians except for lower Vitamin B12 levels (mean = 0.9 μg). All participants but one scored 26 or above in the Mini–Mental State Examination (mean = 28.4). Among the other cognitive tests, only one task related to inhibition and switching abilities was at the low average level. The mean values of vascular risk markers were within the normal ranges. The most common genotype of apolipoprotein E was ɛ3/ɛ3 (n = 32). The quality of MRI was sufficient for volumetric analysis. Conclusion: It is feasible to establish a volunteer-based cohort to study brain aging in Taiwan. The senior volunteers were physically active and cognitively healthy. Vascular risks were well distributed among these participants. Future longitudinal study will allow us to observe changes in these markers over time and provide dynamic evidence about vascular health and cognitive aging.
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Affiliation(s)
- Raymond Y Lo
- Memory and Aging Center, Department of Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Yen-Chieh Lo
- Department of Journalism, Chinese Culture University, Taipei, Taiwan
| | - Shu-Cin Chen
- Memory and Aging Center, Department of Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Yu-Ying Li
- Memory and Aging Center, Department of Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Ya-Ling Yang
- Society for Comprehensive Medicine, Hualien, Taiwan
| | - Yu-Ling Chang
- Department of Psychology, National Taiwan University, Taipei, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
| | - Huei-Chuan Sung
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | | | - Joshua O S Goh
- Department of Psychology, National Taiwan University, Taipei, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan
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25
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Saxena Y, Saxena V, Mittal M, Srivastava M, Raghuvanshi S. Age-Wise Association of Carotid Intima Media Thickness in Ischemic Stroke. Ann Neurosci 2017; 24:5-11. [PMID: 28588353 DOI: 10.1159/000464417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/22/2016] [Accepted: 08/31/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ischemic stroke is often a sequel of atherosclerotic risk factors. Carotid intima-media thickness (CIMT) is a surrogate marker of early atherosclerotic changes. PURPOSE It was hypothesized that CIMT is associated with ischemic stroke in adults across all ages. METHODS A case control study was performed on 163 diagnosed cases of first-time ischemic stroke and age-(±1 SD) and gender-matched healthy control attendants reporting at a tertiary care hospital. Data were collected on atherosclerotic risk factors for ischemic stroke. CIMT from both the carotids was measured using carotid vascular Doppler. The demographic profile and CIMT with atherosclerotic risk factors of cases and controls across different age groups were compared using unpaired t test if they passed the test of normality, else the Mann-Whitney test was used. OR for vascular risk factors for the development of stroke was calculated. The relationship of CIMT to atherosclerotic risk factors was analyzed by using Spearman correlation and regression analysis. The level of significance was set at 0.05. RESULTS Age-specific value of CIMT was significantly higher in stroke cases than in age-matched controls across all age groups. Right CIMT, along with the history of hypertension (HTN; OR 2.3), are important risk factors for ischemic stroke in the younger age group (20-40 years). With increasing age along with the history of HTN and right CIMT (OR >7), presence of plaque (OR 6.3) and daily smoking (OR 5.1) are also significant risk factors. CIMT is significantly related to the daily alcohol and smoking intake and the presence of plaques. Right CIMT is positively related to increasing age in normal population (R2 = 0.041; p < 0.001). CONCLUSIONS Right CIMT and comorbid HTN are significant risk factors associated with the development of ischemic stroke across all adult age groups.
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Affiliation(s)
- Yogesh Saxena
- Department of Physiology, Himalayan Institute of Medical Sciences, SRH University, Dehradun, India
| | | | - Manish Mittal
- Department of Neurology, Himalayan Institute of Medical Sciences, SRH University, Dehradun, India
| | - Malini Srivastava
- Department of Psychology, Himalayan Institute of Medical Sciences, SRH University, Dehradun, India
| | - Shailendra Raghuvanshi
- Department of Radio-Diagnosis, Himalayan Institute of Medical Sciences, SRH University, Dehradun, India
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26
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Cox SR, Ritchie SJ, Dickie DA, Pattie A, Royle NA, Corley J, Aribisala BS, Harris SE, Valdés Hernández M, Gow AJ, Muñoz Maniega S, Starr JM, Bastin ME, Wardlaw JM, Deary IJ. Interaction of APOE e4 and poor glycemic control predicts white matter hyperintensity growth from 73 to 76. Neurobiol Aging 2017; 54:54-8. [PMID: 28324763 PMCID: PMC5407886 DOI: 10.1016/j.neurobiolaging.2017.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 02/13/2017] [Accepted: 02/19/2017] [Indexed: 11/22/2022]
Abstract
We examined whether apolipoprotein E (APOE) status interacts with vascular risk factors (VRFs) to predict the progression of white matter hyperintensities (WMHs) on brain MRI scans over a specific period of life in older age when the risk of dementia increases. At age 73 years, baseline VRFs were assessed via self-reported history of diabetes, hypertension, smoking, and hypercholesterolemia, and via objective measures of blood HbA1c, body mass index, diastolic and systolic blood pressure, and blood high-density lipoprotein to total cholesterol (HDL) ratio. APOE e4 allele was coded as either present or absent. WMH progression was measured on MRI over 3 years in 434 older adults, in a same-year-of-birth cohort. APOE e4 carriers with either a self-reported diagnosis of diabetes (β = 0.160, p = 0.002) or higher glycated hemoglobin levels (β = 0.114, p = 0.014) exhibited greater WMH progression, and the former survived correction for multiple testing. All other APOE-VRF interactions were nonsignificant (βinteraction < 0.056, p > 0.228). The results suggest that carrying the APOE “risk” e4 allele increases the risk of greater age-related WMH progression over the early part of the eighth decade of life, when combined with poorer glycemic control. The interaction effect was robust to co-occurring VRFs, suggesting a possible target for mitigating brain and cognitive aging at this age.
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27
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Towfighi A, Cheng EM, Ayala-Rivera M, McCreath H, Sanossian N, Dutta T, Mehta B, Bryg R, Rao N, Song S, Razmara A, Ramirez M, Sivers-Teixeira T, Tran J, Mojarro-Huang E, Montoya A, Corrales M, Martinez B, Willis P, Macias M, Ibrahim N, Wu S, Wacksman J, Haber H, Richards A, Barry F, Hill V, Mittman B, Cunningham W, Liu H, Ganz DA, Factor D, Vickrey BG. Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED). BMC Neurol 2017; 17:24. [PMID: 28166784 PMCID: PMC5294765 DOI: 10.1186/s12883-017-0792-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 05/10/2016] [Accepted: 01/09/2017] [Indexed: 01/13/2023] Open
Abstract
Background Recurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population. Methods/design In this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP <130 mmHg) at 1 year. Secondary outcomes include: (1) mean change in systolic BP; (2) control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost-effectiveness of the intervention versus usual care. Discussion If this multi-component interdisciplinary intervention is shown to be effective in improving risk factor control after stroke, it may serve as a model that can be used internationally to reduce race/ethnic and socioeconomic disparities in stroke in resource-constrained settings. Trial registration ClinicalTrials.gov Identifier NCT01763203.
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Affiliation(s)
- Amytis Towfighi
- Los Angeles County Department of Health Services, Los Angeles, California, USA. .,University of Southern California, Los Angeles, California, USA. .,Rancho Los Amigos National Rehabilitation Center, Downey, California, USA.
| | - Eric M Cheng
- University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Monica Ayala-Rivera
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA.,University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Heather McCreath
- University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Nerses Sanossian
- University of Southern California, Los Angeles, California, USA.,Los Angeles County-University of Southern California (USC) Medical Center, Los Angeles, California, USA
| | - Tara Dutta
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA.,Kaiser Permanente, Sacramento, California, USA
| | - Bijal Mehta
- University of California, Los Angeles (UCLA), Los Angeles, California, USA.,Harbor-UCLA Medical Center, Torrance, California, USA
| | - Robert Bryg
- University of California, Los Angeles (UCLA), Los Angeles, California, USA.,Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Neal Rao
- University of California, Los Angeles (UCLA), Los Angeles, California, USA.,Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Shlee Song
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Ali Razmara
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA.,Kaiser Permanente, Irvine, California, USA
| | - Magaly Ramirez
- Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, California, USA
| | - Theresa Sivers-Teixeira
- University of Southern California, Los Angeles, California, USA.,Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Jamie Tran
- Harbor-UCLA Medical Center, Torrance, California, USA
| | - Elizabeth Mojarro-Huang
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA.,Los Angeles County-University of Southern California (USC) Medical Center, Los Angeles, California, USA
| | - Ana Montoya
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA.,Harbor-UCLA Medical Center, Torrance, California, USA.,Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Marilyn Corrales
- Los Angeles County Department of Health Services, Los Angeles, California, USA.,Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Beatrice Martinez
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA.,Harbor-UCLA Medical Center, Torrance, California, USA
| | - Phyllis Willis
- Watts Labor Community Action Committee, Watts, California, USA
| | - Mireya Macias
- Worker Education and Resource Center, Los Angeles, California, USA
| | - Nancy Ibrahim
- Esperanza Community Housing, Los Angeles, California, USA
| | - Shinyi Wu
- School of Social Work, Edward R. Roybal Institute on Aging, and Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, California, USA.,RAND Corporation, Santa Monica, California, USA
| | | | | | - Adam Richards
- University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Frances Barry
- University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Valerie Hill
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Brian Mittman
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - William Cunningham
- University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Honghu Liu
- University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - David A Ganz
- University of California, Los Angeles (UCLA), Los Angeles, California, USA.,RAND Corporation, Santa Monica, California, USA.,Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Diane Factor
- Worker Education and Resource Center, Los Angeles, California, USA
| | - Barbara G Vickrey
- University of California, Los Angeles (UCLA), Los Angeles, California, USA.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
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28
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Damoiseaux JS, Viviano RP, Yuan P, Raz N. Differential effect of age on posterior and anterior hippocampal functional connectivity. Neuroimage 2016; 133:468-476. [PMID: 27034025 DOI: 10.1016/j.neuroimage.2016.03.047] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 02/09/2016] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 01/27/2023] Open
Abstract
Aging is associated with declines in cognitive performance and multiple changes in the brain, including reduced default mode functional connectivity (FC). However, conflicting results have been reported regarding age differences in FC between hippocampal and default mode regions. This discrepancy may stem from the variation in selection of hippocampal regions. We therefore examined the effect of age on resting state FC of anterior and posterior hippocampal regions in an adult life-span sample. Advanced age was associated with lower FC between the posterior hippocampus and three regions: the posterior cingulate cortex, medial prefrontal cortex, and lateral parietal cortex. In addition, age-related reductions of FC between the left and right posterior hippocampus, and bilaterally along the posterior to anterior hippocampal axis were noted. Age differences in medial prefrontal and inter-hemispheric FC significantly differed between anterior and posterior hippocampus. Older age was associated with lower performance in all cognitive domains, but we observed no associations between FC and cognitive performance after controlling for age. We observed a significant effect of gender and a linear effect of COMT val158met polymorphism on hippocampal FC. Females showed higher FC of anterior and posterior hippocampus and medial prefrontal cortex than males, and the dose of val allele was associated with lower posterior hippocampus - posterior cingulate FC, independent of age. Vascular and metabolic factors showed no significant effects on FC. These results suggest differential age-related reduction in the posterior hippocampal FC compared to the anterior hippocampus, and an age-independent effect of gender and COMT on hippocampal FC.
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Affiliation(s)
- Jessica S Damoiseaux
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, MI, USA.
| | - Raymond P Viviano
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Peng Yuan
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Naftali Raz
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, MI, USA
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29
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Bingham KS, Whyte EM, Meyers BS, Mulsant BH, Rothschild AJ, Banerjee S, Flint AJ; STOP-PD Study Group. Relationship Between Cerebro vascular Risk, Cognition, and Treatment Outcome in Late-Life Psychotic Depression. Am J Geriatr Psychiatry 2015; 23:1270-5. [PMID: 26560512 DOI: 10.1016/j.jagp.2015.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/29/2015] [Accepted: 08/12/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine whether cerebrovascular risk, executive function, and processing speed are associated with acute treatment outcome of psychotic depression in older adults. METHODS The authors analyzed data from 142 persons aged 60 years or older with major depression with psychotic features who participated in a 12-week randomized controlled trial (RCT) comparing olanzapine plus sertraline with olanzapine plus placebo. The independent variables were baseline cerebrovascular risk (Framingham Stroke Risk Score), baseline executive function (Stroop interference score and the initiation/perseveration subscale of the Mattis Dementia Rating Scale), and baseline processing speed (color and word reading components of the Stroop). The outcome variable was change in severity of depression, measured by the 17-item Hamilton Depression Rating Scale total score, during the course of the RCT. RESULTS Greater baseline cerebrovascular risk was significantly associated with less improvement in depression severity over time, after controlling for pertinent covariates. Neither executive function nor processing speed predicted outcome. CONCLUSION This study suggests an association of cerebrovascular risk, but not executive function or processing speed, with treatment outcome of major depression with psychotic features in older adults.
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30
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Prabhakar P, Chandra SR, Supriya M, Issac TG, Prasad C, Christopher R. Vitamin D status and vascular dementia due to cerebral small vessel disease in the elderly Asian Indian population. J Neurol Sci 2015; 359:108-11. [PMID: 26671097 DOI: 10.1016/j.jns.2015.10.050] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/19/2015] [Accepted: 10/14/2015] [Indexed: 12/28/2022]
Abstract
Vitamin D plays vital roles in human health and recent studies have shown its beneficial effect on brain functioning. The present study was designed to evaluate the association of vitamin D with vascular dementia (VaD) due to cerebral small vessel disease (SVD) in Asian Indian population. 140 VaD patients aged ≥ 60 years with neuroimaging evidence of SVD, and 132 age and gender-matched controls, were investigated. Vitamin D status was estimated by measuring serum 25-hydroxy vitamin D. Logistic regression model revealed that deficient levels of vitamin D (<12 ng/ml) were associated with 2.2-fold increase in odds of VaD after adjustment with covariates. Hypertension was independently associated with 11.3-fold increased odds of VaD. In hypertensives with vitamin D deficiency and insufficiency (12-20 ng/ml), the odds were increased to 31.6-fold and 14.4-fold, respectively. However, in hypertensives with vitamin D sufficiency (>20 ng/ml), the odds of VaD were increased by 3.8-fold only. Pearson correlation showed that serum vitamin D was inversely associated with systolic and diastolic blood pressure (r=-0.401 and -0.411, p<0.01, respectively) in vitamin D-deficient subjects. Since the combined presence of hypertension and vitamin D deficiency increases the probability of developing VaD, screening for vitamin D status in addition to regular monitoring of blood pressure, could reduce the risk of VaD associated with cerebral SVD in the elderly Asian Indian subjects.
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Affiliation(s)
- Puttachandra Prabhakar
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | | | - Manjunath Supriya
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | - Thomas Gregor Issac
- Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India.
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Hermida RC, Moyá A, Ayala DE. Ambulatory blood pressure monitoring in diabetes for the assessment and control of vascular risk. ACTA ACUST UNITED AC 2015; 62:400-10. [PMID: 26404624 DOI: 10.1016/j.endonu.2015.03.012] [Citation(s) in RCA: 5] [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: 02/19/2015] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
Abstract
The diagnosis of hypertension and the clinical decisions regarding its treatment are usually based on daytime clinic blood pressure (BP) measurements. However, the correlation between BP levels and target organ damage, cardiovascular (CV) risk, and long-term prognosis, is higher for ambulatory (ABPM) than clinic measurements, both in the general population as well as in patients with diabetes. Moreover, there is consistent evidence in numerous studies that the asleep BP better predicts CV events than either the awake or 24h means. The prevalence of abnormal BP pattern and sleep-time hypertension is extensive in diabetes, often leading to inaccurate diagnoses of hypertension and its therapeutic control in the absence of complete and careful assessment of the entire 24h, i.e., daytime and night-time, BP pattern. Accordingly, ABPM should be the preferred method to comprehensively assess and decide the optimal clinical management of patients with diabetes directed to properly reduce elevated sleep-time BP, which might also lead to a significant reduction of CV events.
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Affiliation(s)
- Ramón C Hermida
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), Universidad de Vigo, Vigo, España.
| | - Ana Moyá
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), Universidad de Vigo, Vigo, España; Centro de Salud de Lérez, Gerencia Única Integrada Pontevedra-Salnés, Servicio Galego de Saúde (SERGAS), Pontevedra, España
| | - Diana E Ayala
- Laboratorio de Bioingeniería y Cronobiología, Atlantic Research Center for Information and Communication Technologies (AtlantTIC), Universidad de Vigo, Vigo, España
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32
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Kesse-Guyot E, Lassale C, Assmann KE, Andreeva VA, Julia C, Blacher J, Fezeu L, Hercberg S, Galan P. Are different vascular risk scores calculated at midlife uniformly associated with subsequent poor cognitive performance? Atherosclerosis 2015; 243:286-92. [PMID: 26409628 DOI: 10.1016/j.atherosclerosis.2015.09.023] [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: 05/26/2015] [Revised: 08/25/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Research concerning the link between individual vascular risk factors and cognition is plentiful but few studies have investigated the role of global vascular risk. We examined the cross-time associations of several vascular risk scores with cognitive performance during aging. METHODS Using data from the French SU.VI.MAX cohort, we studied a sample of 3061 participants. Framingham coronary heart disease, cardiovascular and stroke risk profiles were computed using baseline data (1994-1996). Cognitive performance was assessed after a mean of 13 years via a battery of six validated instruments. Principal component analysis identified scores for verbal memory and working memory. Associations between risk profiles (as continuous variables and in quartiles (Q)) and subsequent poor performance (defined as cognitive score ≤10th percentile) were examined via logistic regression (odds ratios, 95% CI) and analysis of covariance. RESULTS All continuous-scale Framingham risk scores assessed at midlife were inversely and uniformly associated with subsequent poor global cognitive performance, and especially in terms of verbal memory. Considering risk score Q, higher Q were associated with poorer performance in verbal memory: The fully-adjusted odds ratios (95% CI), comparing Q4 versus Q1, were 2.84 (1.70, 4.75), 2.31 (1.43, 3.73) and 1.77 (1.13, 2.76) for Framingham coronary heart disease, cardiovascular and stroke risk profiles, respectively. Similar findings were observed when modeling cognitive outcomes as continuous variables using covariance analyses. CONCLUSION This study supports the existence of an inverse cross-time association between midlife vascular risk profiles and subsequent poor cognitive performance, especially in the verbal memory domain. Beyond their importance as regards vascular risk, such risk scores may help primary prevention efforts in identifying and targeting middle-aged individuals at high risk of cognitive aging.
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Affiliation(s)
- Emmanuelle Kesse-Guyot
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France.
| | - Camille Lassale
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
| | - Karen E Assmann
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
| | - Valentina A Andreeva
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
| | - Chantal Julia
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France; Département de Santé Publique, Hôpital Avicenne, Bobigny, France
| | - Jacques Blacher
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France; Université Paris-Descartes, Faculté de médecine, Hôpital Hôtel-Dieu, AP-HP, Centre de diagnostic et de thérapeutique, Paris, France
| | - Léopold Fezeu
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
| | - Serge Hercberg
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France; Département de Santé Publique, Hôpital Avicenne, Bobigny, France
| | - Pilar Galan
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
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Cuende JI, Lahoz C, Armario P, García-Alegría J, Ena J, García de Casasola G, Mostaza JM. Cardiovascular news 2013/2014. Rev Clin Esp 2014; 215:33-42. [PMID: 25439172 DOI: 10.1016/j.rce.2014.07.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
During 2013 and the first months of 2014, numerous studies have been published in the cardiovascular field. New guidelines have appeared for managing arterial hypertension and reducing cardiovascular risk by lowering cholesterol levels. New data have emerged on the considerable lipid-lowering efficacy of monoclonal antibodies against PCSK-9, in contrast, however, to the clinical trials directed towards raising HDL-cholesterol with nicotinic acid, which have not shown a reduction in the rate of cardiovascular complications. In the field of hypertension, neither stent placement in patients with renovascular hypertension nor sympathetic denervation in patients with resistant hypertension has been shown to be effective in reducing blood pressure. In terms of antithrombotic treatment, the pharmacogenetic tests do not seem useful for maintaining patients anticoagulated with warfarin within the therapeutic range for longer periods. Moreover, there is increasing evidence that, for patients with coronary artery disease and atrial fibrillation, antiplatelet therapy adds no benefit to anticoagulation therapy and is associated with a greater risk of bleeding. Lastly, a Mediterranean diet could prevent the onset of diabetes, while bariatric surgery could be a reasonable option for improving the disease in patients with obesity. Many of these studies have immediate practice applications in daily clinical practice.
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Affiliation(s)
- J I Cuende
- Servicio de Medicina Interna, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - C Lahoz
- Servicio de Medicina Interna, Hospital Carlos III, Madrid, España
| | - P Armario
- Servicio de Medicina Interna, Hospital Transversal (Moisès Broggi, Hospital General de l'Hospitalet), Consorci Sanitari Integral, Barcelona, España
| | - J García-Alegría
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España
| | - J Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante, España
| | | | - J M Mostaza
- Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
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Cotter TG, Dinneen SF, Healy DA, Bell MJ, Cunningham A, O'Shea PM, Dunne F, O'Brien T, Finucane FM. Glycaemic control is harder to achieve than blood pressure or lipid control in Irish adults with type 1 diabetes. Diabetes Res Clin Pract 2014; 106:e56-9. [PMID: 25451911 DOI: 10.1016/j.diabres.2014.09.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/05/2014] [Revised: 09/09/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
Abstract
We sought to determine the attainment of targets for glycaemic control and vascular risk reduction in an Irish cohort of T1DM adults. Of 797 patients (53% male, mean age 40.3 ± 14.8 years, HbA1c 8.5 ± 1.6% (69.6 ± 17.8 mmol mol(-1))), 15%, 68% and 62% achieved targets for HbA1c, blood pressure and LDL cholesterol, respectively.
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Affiliation(s)
- T G Cotter
- Galway Diabetes Research Centre, HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - S F Dinneen
- Galway Diabetes Research Centre, HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - D A Healy
- University Hospital Limerick, Limerick, Ireland
| | - M J Bell
- Galway Diabetes Research Centre, HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - A Cunningham
- Galway Diabetes Research Centre, HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - P M O'Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Ireland
| | - F Dunne
- Galway Diabetes Research Centre, HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - T O'Brien
- Galway Diabetes Research Centre, HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland
| | - F M Finucane
- Galway Diabetes Research Centre, HRB Clinical Research Facility, National University of Ireland, Galway, Galway, Ireland.
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Öz O, Korkmaz M, Alay S, Tasdemir S, Cetiz A, Demirkaya S. Asymmetric dimethylarginine and vascular risk in patients treated with antiepileptic drugs. Epilepsy Res 2014; 108:1960-1. [PMID: 25178671 DOI: 10.1016/j.eplepsyres.2014.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 11/23/2022]
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36
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Pintó X. [Indications for the combination of pravastatin and fenofibrate according to the cardio vascular risk level. Common clinical situations]. Clin Investig Arterioscler 2014; 26 Suppl 1:35-9. [PMID: 25043546 DOI: 10.1016/s0214-9168(14)70025-7] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In diabetes, metabolic syndrome, some types of familial dyslipidemia, ischemic pathology of atheromatous origin and renal failure, the presence of mixed dyslipidemia is common. In other words, there is an excess of cholesterol and triglycerides, associated or not with HDL-c deficiency. These clinical conditions are associated with high to very high cardiovascular risk. It is appropriate when treating these conditions to achieve an overall control of lipid metabolism abnormalities, in terms of excess cholesterol carried by atherogenic lipoproteins (LDL-c and non-HDL-c) and triglyceride excess and deficit of HDL-c. To achieve this overall control is necessary to correct the potential causes of secondary dyslipidemia, improve lifestyle habits and use a drug from the statin family, and it is often necessary to combine a drug from the fibrate family. This combination has been shown to be effective and safe in the overall control of dyslipidemia and the cardiovascular risk prevention in patients at high risk. This combination has been shown to have a favorable eff ect in the population with diabetes and microangiopathy, both in the retina and in the glomerulus. For patients with moderate renal failure, the use of fibrates is controversial, and there are marked disagreements between the recommendations issued by various organizations and expert consensus groups.
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Affiliation(s)
- Xavier Pintó
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona, España. CIBERobn, FIPEC, IDIBELL, Universitat de Barcelona, Barcelona, España.
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Bangen KJ, Nation DA, Delano-Wood L, Weissberger GH, Hansen LA, Galasko DR, Salmon DP, Bondi MW. Aggregate effects of vascular risk factors on cerebrovascular changes in autopsy-confirmed Alzheimer's disease. Alzheimers Dement 2014; 11:394-403.e1. [PMID: 25022538 DOI: 10.1016/j.jalz.2013.12.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/21/2013] [Accepted: 12/17/2013] [Indexed: 01/02/2023]
Abstract
We examined the relationships of antemortem vascular risk factors to postmortem cerebrovascular and Alzheimer's disease (AD) pathologies. Eighty-four AD patients underwent an assessment of vascular risk (blood pressure, cholesterol, smoking, cardiovascular disease, diabetes, atrial fibrillation, transient ischemic attack [TIA], or stroke) and later underwent brain autopsy. Given our aim to examine mild cerebrovascular changes (CVCs), individuals were excluded if autopsy revealed large stroke. The most common forms of CVC were circle of Willis atherosclerosis followed by arteriosclerosis, lacunes, and microinfarcts. Excluding the history of TIA/clinical stroke, individual vascular risk factors were not associated with CVC. However, the presence of multiple vascular risk factors was associated with CVC. Furthermore, the presence of CVC was associated with lower Braak and Braak stage. These findings highlight the importance of aggregate risk in the vascular contribution to dementia. Interventions designed to maintain cerebrovascular health may represent important opportunities for preventing or delaying dementia, even when AD is the dominant pathology.
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Affiliation(s)
- Katherine J Bangen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Daniel A Nation
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Lisa Delano-Wood
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Gali H Weissberger
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lawrence A Hansen
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA; Department of Pathology, University of California, San Diego, La Jolla, CA, USA
| | - Douglas R Galasko
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - David P Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Mark W Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
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Pearce SHS, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, Wemeau JL. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J 2013; 2:215-28. [PMID: 24783053 PMCID: PMC3923601 DOI: 10.1159/000356507] [Citation(s) in RCA: 418] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/07/2013] [Indexed: 01/08/2023] Open
Abstract
Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroid-stimulating hormone (TSH) level: mildly increased TSH levels (4.0-10.0 mU/l) and more severely increased TSH value (>10 mU/l). An initially raised serum TSH, with FT4 within reference range, should be investigated with a repeat measurement of both serum TSH and FT4, along with thyroid peroxidase antibodies, preferably after a 2- to 3-month interval. Even in the absence of symptoms, replacement therapy with L-thyroxine is recommended for younger patients (<65-70 years) with serum TSH >10 mU/l. In younger SCH patients (serum TSH <10 mU/l) with symptoms suggestive of hypothyroidism, a trial of L-thyroxine replacement therapy should be considered. For such patients who have been started on L-thyroxine for symptoms attributed to SCH, response to treatment should be reviewed 3 or 4 months after a serum TSH within reference range is reached. If there is no improvement in symptoms, L-thyroxine therapy should generally be stopped. Age-specific local reference ranges for serum TSH should be considered in order to establish a diagnosis of SCH in older people. The oldest old subjects (>80-85 years) with elevated serum TSH ≤10 mU/l should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. If the decision is to treat SCH, then oral L-thyroxine, administered daily, is the treatment of choice. The serum TSH should be re-checked 2 months after starting L-thyroxine therapy, and dosage adjustments made accordingly. The aim for most adults should be to reach a stable serum TSH in the lower half of the reference range (0.4-2.5 mU/l). Once patients with SCH are commenced on L-thyroxine treatment, then serum TSH should be monitored at least annually thereafter.
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Affiliation(s)
- Simon H S Pearce
- Institute of Genetic Medicine, Newcastle University, UK ; Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Georg Brabant
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Leonidas H Duntas
- Endocrine Unit, Evgenidion Hospital, University of Athens, Athens, Greece
| | - Fabio Monzani
- Department of Clinical and Experimental Medicine, Università di Pisa, Pisa, Italy
| | - Robin P Peeters
- Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Salman Razvi
- Institute of Genetic Medicine, Newcastle University, UK ; Queen Elizabeth Hospital, Gateshead, UK
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Aine CJ, Sanfratello L, Adair JC, Knoefel JE, Qualls C, Lundy SL, Caprihan A, Stone D, Stephen JM. Characterization of a normal control group: are they healthy? Neuroimage 2013; 84:796-809. [PMID: 24060318 DOI: 10.1016/j.neuroimage.2013.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 04/12/2013] [Revised: 08/28/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022] Open
Abstract
We examined the health of a control group (18-81years) in our aging study, which is similar to control groups used in other neuroimaging studies. The current study was motivated by our previous results showing that one third of the elder control group had moderate to severe white matter hyperintensities and/or cortical volume loss which correlated with poor performance on memory tasks. Therefore, we predicted that cardiovascular risk factors (e.g., hypertension, high cholesterol) within the control group would account for significant variance on working memory task performance. Fifty-five participants completed 4 verbal and spatial working memory tasks, neuropsychological exams, diffusion tensor imaging (DTI), and blood tests to assess vascular risk. In addition to using a repeated measures ANOVA design, a cluster analysis was applied to the vascular risk measures as a data reduction step to characterize relationships between conjoint risk factors. The cluster groupings were used to predict working memory performance. The results show that higher levels of systolic blood pressure were associated with: 1) poor spatial working memory accuracy; and 2) lower fractional anisotropy (FA) values in multiple brain regions. In contrast, higher levels of total cholesterol corresponded with increased accuracy in verbal working memory. An association between lower FA values and higher cholesterol levels were identified in different brain regions from those associated with systolic blood pressure. The conjoint risk analysis revealed that Risk Cluster Group 3 (the group with the greatest number of risk factors) displayed: 1) the poorest performance on the spatial working memory tasks; 2) the longest reaction times across both spatial and verbal memory tasks; and 3) the lowest FA values across widespread brain regions. Our results confirm that a considerable range of vascular risk factors are present in a typical control group, even in younger individuals, which have robust effects on brain anatomy and function. These results present a new challenge to neuroimaging studies both for defining a cohort from which to characterize 'normative' brain circuitry and for establishing a control group to compare with other clinical populations.
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Affiliation(s)
- C J Aine
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.
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Stiefel P, Sánchez-Armengol MA, Villar J, Vallejo-Vaz A, Moreno-Luna R, Capote F. Obstructive sleep apnea syndrome, vascular pathology, endothelial function and endothelial cells and circulating microparticles. Arch Med Res 2013; 44:409-14. [PMID: 24051041 DOI: 10.1016/j.arcmed.2013.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
Accelerated atherosclerosis and increased cardiovascular risk are frequently reported in patients with obstructive sleep apnea (OSA) syndrome. In this article the authors attempt a review of the current understanding of the relationship between vascular risk and OSA syndrome based on large cohort studies that related the disease to several cardiovascular risk factors and vascular pathologies. We also discuss the pathophysiological mechanisms that may be involved in this relationship, starting with endothelial dysfunction and its mediators. These include an increased oxidative stress and inflammation as well as several disorders of coagulation and lipid metabolism. Moreover, circulating microparticles from activated leukocytes (CD62L_MPs) are higher in patients with OSA and there is a positive correlation between circulating levels of CD62L_MPs and nocturnal hypoxemia severity. Finally, circulating level of endothelial microparticles and circulating endothelial cells seem to be increased in patients with OSA. Also, endothelial progenitor cells are reduced and plasma levels of the vascular endothelial growth factor are increased.
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Affiliation(s)
- Pablo Stiefel
- Unidad Clinico Experimental de Riesgo Vascular (UCAMI-UCERV), Instituto de Biomedicina de Sevilla (IBIS) SAS, CEIC, Universidad de Sevilla, Seville, Spain.
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Paneni F, Costantino S, Volpe M, Lüscher TF, Cosentino F. Epigenetic signatures and vascular risk in type 2 diabetes: a clinical perspective. Atherosclerosis. 2013;230:191-197. [PMID: 24075743 DOI: 10.1016/j.atherosclerosis.2013.07.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 07/07/2013] [Indexed: 12/15/2022]
Abstract
Risk of diabetic complications continues to escalate overtime despite a multifactorial intervention with glucose-lowering drugs, anti-hypertensive agents and statins. In this perspective, a mechanisms-based therapeutic approach to vascular disease in diabetes represents a major challenge. Epigenetic signatures are emerging as important determinants of vascular disease in this setting. Methylation and acetylation of DNA and histones is a reversible process leading to dysregulation of oxidant and inflammatory genes such as mitochondrial adaptor p66(Shc) and transcription factor NF-kB p65. Epigenetic modifications associated with diabetes may contribute to the early identification of high risk individuals. Ongoing epigenomic analyses will be instrumental in identifying the epigenetic variations that are specifically associated with cardiovascular disease in patients with diabetes. Here, we describe a complex scenario of epigenetic changes and their putative link with diabetic vascular disease. Pharmacological reprogramming of diabetes-induced epigenetic signatures may be a promising option to dampen oxidative stress and inflammation, and thus prevent cardiovascular complications in this setting.
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Katsiki N, Athyros VG, Karagiannis A. Single-pill combinations: a therapeutic option or necessity for vascular risk treatment? J Drug Assess 2013; 2:67-71. [PMID: 27536439 PMCID: PMC4937652 DOI: 10.3109/21556660.2013.801605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 02/06/2023] Open
Affiliation(s)
- Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, ThessalonikiGreece
| | - Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, ThessalonikiGreece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, ThessalonikiGreece
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