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Prueitt RL, Meakin CJ, Drury NL, Goodman JE. Evaluation of neural reflex activation as a potential mode of action for respiratory and cardiovascular effects of fine particulate matter. Inhal Toxicol 2024; 36:125-144. [PMID: 38488087 DOI: 10.1080/08958378.2024.2324033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/20/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Mortality from respiratory and cardiovascular health conditions contributes largely to the total mortality that has been associated with exposure to PM2.5 in epidemiology studies. A mode of action (MoA) for these underlying morbidities has not been established, but it has been proposed that some effects of PM2.5 occur through activation of neural reflexes. MATERIALS AND METHODS We critically reviewed the experimental studies of PM2.5 (including ambient PM2.5, diesel exhaust particles, concentrated ambient particles, diesel exhaust, and cigarette smoke) and neural reflex activation, and applied the principles of the International Programme on Chemical Safety (IPCS) MoA/human relevance framework to assess whether they support a biologically plausible and human-relevant MoA by which PM2.5 could contribute to cardiovascular and respiratory causes of death. We also considered whether the evidence from these studies supports a non-threshold MoA that operates at low, human-relevant PM2.5 exposure concentrations. RESULTS AND DISCUSSION We found that the proposed MoA of neural reflex activation is biologically plausible for PM2.5-induced respiratory effects at high exposure levels used in experimental studies, but further studies are needed to fill important data gaps regarding the relevance of this MoA to humans at lower PM2.5 exposure levels. A role for the proposed MoA in PM2.5-induced cardiovascular effects is plausible for some effects but not others. CONCLUSIONS Further studies are needed to determine whether neural reflex activation is the MoA by which PM2.5 could cause either respiratory or cardiovascular morbidities in humans, particularly at the ambient concentrations associated with total mortality in epidemiology studies.
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Jermendy G, Rokszin G, Fábián I, Kempler P, Wittmann I. Morbidity and mortality of patients with diabetic neuropathy treated with pathogenetically oriented alpha-lipoic acid versus symptomatic pharmacotherapies - a nationwide database analysis from Hungary. Diabetes Res Clin Pract 2023:110734. [PMID: 37257759 DOI: 10.1016/j.diabres.2023.110734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
AIMS Diabetic neuropathy is associated with increased risk of morbidity and all-cause mortality. It is unclear whether these outcomes differ in patients with diabetic neuropathy treated with pathogenetically oriented vs symptomatic pharmacotherapies. METHODS We performed a retrospective (2009-2019) database analysis of patients treated with pathogenetically oriented alpha-lipoic acid (ALA) or symptomatic pharmacotherapies for diabetic neuropathy. We investigated clinical outcomes in propensity score matched patients in Hungary. Changes in hazard ratios and annualized event rates were assessed and sensitivity analyses performed. RESULTS Hazard ratios favored treatment with ALA vs symptomatic pharmacotherapies regarding acute myocardial infarction (HR 0.73, 95%CI: 0.60-0.89, p = 0.0016), stroke (HR 0.71, 95%CI: 0.62-0.82, p<0.0001), hospitalization for heart failure (HR 0.72, 95%CI: 0.66-0.78, p<0.0001), cancer events (HR 0.83, 95% CI: 0.76-0.92, p = 0.0002) and all-cause mortality (HR 0.55, 95% CI: 0.49-0.61, p<0.0001), but not for lower limb amputation (HR 1.05, 95%CI: 0.89-1.25, p = 0.5455). This association was supported by results of evaluating annual event rates and sensitivity analyses. CONCLUSIONS This retrospective database analysis revealed a lower occurrence of cardio- and cerebrovascular morbidity, cancer events and all-cause mortality in patients with diabetic neuropathy treated with pathogenetically oriented ALA vs symptomatic pharmacotherapies. This hypothesis-generating result requires further investigations.
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Affiliation(s)
- György Jermendy
- Bajcsy-Zsilinszky Hospital, 3(rd) Department of Medicine, Maglódi út 89-91, 1106, Budapest, Hungary.
| | - György Rokszin
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | - Ibolya Fábián
- RxTarget Ltd., Bacsó Nándor út 10, 5000 Szolnok, Hungary.
| | - Péter Kempler
- Semmelweis University, Faculty of Medicine, Department of Medicine and Oncology, Korányi Sándor út 2, 1083 Budapest, Hungary.
| | - István Wittmann
- University of Pécs, Medical School, 2(nd) Department of Medicine, Nephrology-Diabetes Center, Pacsirta út 1, 7624 Pécs, Hungary.
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Al Saikhan L, Park C, Tillin T, Jones S, Francis D, Mayet J, Chaturvedi N, Hughes AD. Sex-differences in associations of LV structure and function measured by echocardiography with long-term risk of mortality and cardiovascular morbidity. Front Cardiovasc Med 2023; 10:1144964. [PMID: 37180770 PMCID: PMC10166834 DOI: 10.3389/fcvm.2023.1144964] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Three-dimensional echocardiography (3DE) measures of the left ventricle (LV) predict outcomes in high risk individuals, but their prognostic value in the general population is unknown. We aimed to establish whether 3DE was associated with mortality and morbidity in a multi-ethnic community-based sample, if associations differed by sex, and explored potential mechanisms explaining sex differences. Methods 922 individuals (69.7 ± 6.2 years; 717 men) from the SABRE study underwent a health examination including echocardiography. Associations between 3DE LV measures (ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), LV remodeling index (LVRI) and LV sphericity index (LVSI), and all-cause mortality and a composite cardiovascular endpoint [comprising new onset (non)fatal coronary heart disease, heart failure hospitalization, new-onset arrhythmias and cardiovascular mortality] were determined using multivariable Cox regression over a median follow-up of 8 years (all-cause mortality) and 7 years (composite cardiovascular endpoint). Results There were 123 deaths and 151 composite cardiovascular endpoints. Lower EF, higher LV volumes and LVSI were associated with increased all-cause mortality, and higher LV volumes were associated with the composite cardiovascular endpoint independent of potential confounders. Associations between LV volumes, LVRI, LVSI, and mortality differed by sex (p interaction <0.1). In men increased LV volumes and LVSI and decreased LVRI and EF were associated with higher mortality, but associations were null or reversed in women (hazard ratios (95% CI) men vs. women: EDV 1.25 (1.05, 1.48) vs. 0.54 (0.26, 1.10); ESV, 1.36 (1.12, 1.63) vs. 0.59 (0.33, 1.04); LVRI, 0.79 (0.64, 0.96) vs. 1.70 (1.03, 2.80); LVSI, 1.27 (1.05, 1.54) vs. 0.61 (0.32, 1.15); and EF, 0.78 (0.66, 0.93) vs. 1.27 (0.69, 2.33). Similar sex differences were observed for associations with the composite cardiovascular outcome. Adjustment for LV diastolic stiffness and arterial stiffness marginally attenuated these differences. Conclusions 3DE measures of LV volume and remodeling are associated with all-cause mortality and cardiovascular morbidity; however, some associations differ by sex. Sex-differences in LV remodeling patterns may influence mortality and morbidity risk in the general population.
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Affiliation(s)
- Lamia Al Saikhan
- Department of Cardiac Technology, College of Applied Medial Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Siana Jones
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Darrel Francis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Alun D. Hughes
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
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Dellborg M, Giang KW, Eriksson P, Liden H, Fedchenko M, Ahnfelt A, Rosengren A, Mandalenakis Z. Adults With Congenital Heart Disease: Trends in Event-Free Survival Past Middle Age. Circulation 2023; 147:930-938. [PMID: 36571845 PMCID: PMC10022672 DOI: 10.1161/circulationaha.122.060834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The survival of children with congenital heart disease has increased substantially over the past decades, with 97% currently reaching adulthood. The total effect of advanced treatment on future mortality and morbidity in adult survivors with congenital heart disease (CHD) is less well described. METHODS We used data from the Swedish National Inpatient, Outpatient, and Cause of Death Register to identify patients with CHD who were born between 1950 and 1999 and were alive at 18 years of age. Ten controls identified from the Total Population Register were matched for year of birth and sex and with each patient with CHD. Follow-up was from 1968 and 18 years of age until death or at the end of the study (2017). Survival percentage with 95% CI for all-cause mortality were performed with Kaplan-Meier survival function. Cox proportional hazard regression models with hazard ratios (HRs) and 95% CI were used to estimate the risk of all-cause mortality. RESULTS We included 37 278 patients with adult CHD (ACHD) and 412 799 controls. Mean follow-up was 19.2 years (±13.6). Altogether, 1937 patients with ACHD (5.2%) and 6690 controls (1.6%) died, a death rate of 2.73 per 1000 person-years and 0.84 per 1000 person years, respectively. Mortality was 3.2 times higher (95% CI, 3.0-3.4; P<0.001) among patients with ACHD compared with matched controls. Up to the maximum of 50 years of follow-up, >75% of patients with ACHD were still alive. Mortality was highest among patients with conotruncal defects (HR, 10.13 [95% CI, 8.78-11.69]), but also significantly higher for the more benign lesions, with the lowest risk in patients with atrial septal defects (HR, 1.36 [95% CI, 1.19-1.55]). At least 75% of patients with ACHD alive at 18 years of age lived past middle age and became sexagenerians. CONCLUSIONS In this large, nationwide, register-based cohort study of patients with ACHD surviving to 18 years of age, the risk of mortality up to 68 years of age was >3 times higher compared with matched controls without ACHD. Despite this, at least 75% of patients with CHD alive at 18 years of age lived past middle age and became sexagenerians. A notable risk decline in the mortality for patients with ACHD was seen for those born after 1975.
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Affiliation(s)
- Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.D., K.W.G., P.E., M.F., A.A., A.R., Z.M.)
- Adult Congenital Heart Disease Unit (M.D., P.E., A.A., Z.M.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kok Wai Giang
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.D., K.W.G., P.E., M.F., A.A., A.R., Z.M.)
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.D., K.W.G., P.E., M.F., A.A., A.R., Z.M.)
- Adult Congenital Heart Disease Unit (M.D., P.E., A.A., Z.M.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Liden
- Department of Pediatrics, Queen Silvias Pediatric Hospital (H.L.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Fedchenko
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.D., K.W.G., P.E., M.F., A.A., A.R., Z.M.)
| | - Anders Ahnfelt
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.D., K.W.G., P.E., M.F., A.A., A.R., Z.M.)
- Adult Congenital Heart Disease Unit (M.D., P.E., A.A., Z.M.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Rosengren
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.D., K.W.G., P.E., M.F., A.A., A.R., Z.M.)
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.D., K.W.G., P.E., M.F., A.A., A.R., Z.M.)
- Adult Congenital Heart Disease Unit (M.D., P.E., A.A., Z.M.), Sahlgrenska University Hospital, Gothenburg, Sweden
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Kero AE, Taskinen M, Volin L, Löyttyniemi E, Itälä-Remes M, Lähteenmäki PM. Cardiovascular morbidity following conventional therapy versus allogeneic hematopoietic stem cell transplantation after childhood, adolescent, and young adult leukemia in Finland. Int J Cancer 2023; 152:2292-2302. [PMID: 36760204 DOI: 10.1002/ijc.34469] [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: 04/05/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 02/11/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (aHSCT) represents a therapeutic choice for high-risk and relapsed leukemia at a young age. In this retrospective population-based study, we evaluated cardiovascular complications after aHSCT (N = 272) vs conventional therapy (N = 1098) among patients diagnosed with acute lymphoblastic or acute myeloid leukemia below 35 years between 1985 and 2004. Additionally, siblings from a prior comparison group served as population controls (N = 39 217). Childhood leukemia and aHSCT was associated with a 16-fold HR for developing arterial hypertension (HR 16.8, 95%CI 1.5-185.5) compared with conventional therapy. A 2-fold HR for any cardiovascular complication was observed after AYA leukemia and aHSCT vs conventional treatment (HR 2.7, 95% CI 1.4-5.1). After AYA leukemia and aHSCT, the HR of cardiac arrhythmia was significantly elevated vs conventional therapy (HR 14.4, 95% CI 1.5-125.2). Moreover, after aHSCT in childhood, elevated hazard ratios (HRs) were found for cardiomyopathy/ cardiac insufficiency (HR 105.0, 95% CI 10.0-1100.0), cardiac arrhythmia, and arterial hypertension (HR 20.1, 95%CI 2.5-159.7 and HR 20.0, 95%CI 4.1-97.4) compared with healthy controls. After adolescent and young adult (AYA) leukemia and aHSCT, markedly increased HRs were observed for cardiac arrhythmia (HR 29.2, 95%CI 6.6-129.2), brain vascular thrombosis/ atherosclerosis and cardiomyopathy/cardiac insufficiency (HR 23.4, 95%CI 7.1-77.4 and HR 19.2, 95%CI 1.5-245.2) compared with healthy controls. As the cumulative incidence for cardiovascular complications rose during the follow-up of childhood and AYA leukemia patients, long-term cardiovascular surveillance is warranted to optimize the quality of life after childhood and AYA leukemia following both conventional treatment and aHSCT.
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Affiliation(s)
- Andreina E Kero
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, and Turku University, Turku, Finland
| | - Mervi Taskinen
- New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Liisa Volin
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Maija Itälä-Remes
- Department of Internal Medicine, Turku University Hospital, Turku, Finland
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, and Turku University, Turku, Finland
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Yu BH, Chen YC, Li YD, Chiou WY, Chen YC. No dose-response relationship of clarithromycin utilization on cardiovascular outcomes in patients with stable coronary heart disease: Analysis of Taiwan's national health insurance claims data. Front Cardiovasc Med 2022; 9:1018194. [PMID: 36386302 PMCID: PMC9645004 DOI: 10.3389/fcvm.2022.1018194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/06/2022] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Clarithromycin is widely used to treat various bacterial infections and has been reported to have potential cardiovascular risk. However, it is uncertain whether this association was dose dependent and confounded by indication bias in patients with stable coronary heart disease (CHD). METHODS This cohort study retrospectively analyzed a national health insurance claims data from Taiwan's 2005 Longitudinal Generation Tracking Database. We used a new-user design and 1:1 propensity score matching. A total of 9,631 eligible clarithromycin users and 9,631 non-users in 2004-2015 were subject to final analysis. All patients were followed-up after receiving clarithromycin or on the matched corresponding date until occurrence of cardiovascular morbidity in the presence of competing mortality, all-cause and cause-specific mortality, or through the end of 2015. The effect of cumulative dose, exposure duration, and indications of clarithromycin on cardiovascular outcomes were also addressed. RESULTS Clarithromycin use, compared with non-use, was associated with higher risk for all-cause [adjusted hazard ratios (aHR), 1.43; 95% confidence interval, 1.29-1.58], cardiovascular (1.35; 1.09-1.67), and non-cardiovascular (1.45; 1.29-1.63) mortality, but not for overall cardiovascular morbidity. Further analysis of individual cardiovascular morbidity demonstrated major risk for heart events (1.25; 1.04-1.51) in clarithromycin users than non-users. However, there was no relationship of cumulative dose, exposure duration, and indications of clarithromycin on cardiovascular outcomes. Analyses of the effects over time showed that clarithromycin increased cardiovascular morbidity (1.21; 1.01-1.45), especially heart events (1.39; 1.10-1.45), all-cause (1.57; 1.38-1.80), cardiovascular (1.58; 1.20-2.08), and non-cardiovascular (1.57; 1.35-1.83) mortality during the first 3 years. Thereafter, clarithromycin effect on all outcomes almost dissipated. CONCLUSION Clarithromycin use was associated with increased risk for short-term cardiovascular morbidity (especially, heart events) and mortality without a dose-response relationship in patients with stable CHD, which was not dose dependent and confounded by indications. Hence, patients with stable CHD while receiving clarithromycin should watch for these short-term potential risks.
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Affiliation(s)
- Ben-Hui Yu
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yen-Chun Chen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Da Li
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Cardiology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Wen-Yen Chiou
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Chun Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
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Goldbart A, Pariente G, Sheiner E, Wainstock T. Identifying risk factors for placental abruption in subsequent pregnancy without a history of placental abruption. Int J Gynaecol Obstet 2022; 161:406-411. [PMID: 36083780 DOI: 10.1002/ijgo.14446] [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: 04/02/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify first pregnancy risk factors for placental abruption in subsequent pregnancy. METHODS In a population-based nested case-control study, cases were defined as women with placental abruption in their second pregnancy, and controls as women without abruption. A total of 43,328 women were included in the study, 0.4%(n=186) of second pregnancies had placental abruption. Multivariable logistic models were used to study the association between first pregnancy complications and placental abruption in subsequent pregnancy. RESULTS Having either small for gestational age, preterm delivery, preeclampsia or caesarian delivery during first pregnancy were independently associated with increased risk for placental abruption, and the risk was higher with any additional complication (age adjusted OR=2.00; 95%CI 1.46-2.74, adjusted OR=3.61; 95%CI 2.23-5.86, and adjusted OR=3.86; 95%CI 1.56-9.56, for 1, 2 and ≥3 complications, respectively). CONCLUSION First pregnancy may serve as a window of opportunity to identify women at risk for future placental abruption.
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Affiliation(s)
- Adi Goldbart
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Esposito D, Olsson DS, Franzén S, Miftaraj M, Nåtman J, Gudbjörnsdottir S, Johannsson G. Effect of Diabetes on Morbidity and Mortality in Patients With Acromegaly. J Clin Endocrinol Metab 2022; 107:2483-2492. [PMID: 35779017 PMCID: PMC9387713 DOI: 10.1210/clinem/dgac400] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Diabetes is a major risk factor for cardiovascular disease and death but its effect on outcomes in acromegaly is unknown. OBJECTIVE This work aimed to study whether diabetes affects morbidity and mortality in patients with acromegaly. METHODS A nationwide (Sweden), observational, matched-cohort study was conducted. Patients diagnosed with acromegaly between 1987 and 2020 were identified in the Swedish National Patient Registry and those with concomitant type 2 diabetes in the National Diabetes Registry and Drug Registry. The risk of overall mortality, and cardiovascular mortality and morbidity were estimated using Cox regression. RESULTS The study included 254 patients with acromegaly and concomitant type 2 diabetes (ACRO-DM group) and 532 without diabetes (ACRO group). Mean (SD) age at baseline was 62.6 (11.4) and 60.0 (12.1) years (P = .004) and the mean (SD) duration of acromegaly was 6.8 (8.1) and 6.0 (6.2) years (P = .098) in the ACRO-DM and ACRO groups, respectively. Overall mean follow-up was 9.2 years. The unadjusted overall mortality rate per 1000 person-years was 35.1 (95% CI, 27.2-44.7) and 20.1 (95% CI, 16.5-24.3) in the respective groups. The hazard ratio (HR) for overall mortality adjusted for multiple confounders was 1.58 (95% CI, 1.12-2.23) in the ACRO-DM group compared with the ACRO group. Cardiovascular mortality (HR 2.11; 95% CI, 1.09-4.10) and morbidity (HR 1.49; 95% CI, 1.21-1.82) were also increased in the ACRO-DM group. CONCLUSION The presence of diabetes in patients with acromegaly was associated with increased overall mortality as well as increased cardiovascular mortality and morbidity.
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Affiliation(s)
- Daniela Esposito
- Correspondence: Daniela Esposito, MD, PhD, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology at Sahlgrenska University Hospital, Gröna Stråket 8, 41345 Gothenburg, Sweden.
| | - Daniel S Olsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Stefan Franzén
- Health Metrics Group, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Mervete Miftaraj
- National Diabetes Register, Centre of Registers, 41345 Gothenburg, Sweden
| | - Jonatan Nåtman
- National Diabetes Register, Centre of Registers, 41345 Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- National Diabetes Register, Centre of Registers, 41345 Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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Grassi G, Fowler B, Scali B, Rossi F, Motto E, Pieruzzi F, Mancia G. Sympathetic activation and heart rate thresholds for cardiovascular risk in chronic kidney disease. J Hypertens 2022; 40:1530-1536. [PMID: 35792492 PMCID: PMC10860883 DOI: 10.1097/hjh.0000000000003179] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 03/07/2022] [Revised: 04/07/2022] [Accepted: 02/07/2022] [Indexed: 01/20/2023]
Abstract
AIM The current study was designed at assessing whether the sympathetic cardiovascular drive (SNS) is differently activated in chronic kidney disease (CKD) patients displaying less or more elevated resting heart rate (HR) values. It was also designed at determining at which HR cutoff value the SNS displays a greater activation. METHODS In 95 CKD middle-age patients we evaluated muscle sympathetic nerve activity (MSNA, microneurography) and venous plasma norepinephrine (HPLC assay), subdividing the patients in different groups according to their resting clinic and 24-h HR. RESULTS In CKD progressively greater values of clinic or 24-h HR were associated with a progressive increase in both MSNA and norepinephrine. HR cutoff values indicated by large-scale clinical trials for determining cardiorenal risk, that is more than 80 bpm, were associated with MSNA values significantly greater than the ones detected in patients with lower HR, this being the case also for norepinephrine. Both MSNA and norepinephrine were significantly related to clinic ( r = 0.47, P < 0.0001 and r = 0.26, P < 0.0001, respectively) and 24-h ( r = 0.42, P < 0.0001 and r = 0.27, P < 0.0001, respectively) HR. MSNA, norepinephrine, but not HR, were significantly and inversely related to estimated glomerular filtration rate (eGFR) values ( r = -0.47, r = -0.23, P < 0.0001 and P < 0.02, respectively). CONCLUSION In CKD both clinic and 24-h HR values greater than 80 bpm are associated with an enhanced sympathetic activation, which parallelles for magnitude the HR elevations. The sensitivity of HR as sympathetic marker is limited; however, no significant relationship being detected between HR and eGFR or left ventricular mass index.
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Affiliation(s)
| | | | | | | | | | - Federico Pieruzzi
- Clinica Nefrologica, Department of Medicine and Surgery, University Milano-Bicocca
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10
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Sudano I. Hypertension and Hypercholesterolemia: Let's Make Therapy Easy and Efficient. Praxis (Bern 1994) 2022; 111:558-563. [PMID: 35920009 DOI: 10.1024/1661-8157/a003894] [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: 06/15/2023]
Abstract
Arterial hypertension and hypercholesterolemia increase the risk of cardiovascular morbidity and mortality. Effectively reducing both blood pressure and circulating low-density lipoprotein cholesterol may considerably reduce cardiovascular risk. As this is particularly true if the intervention starts early, it is very important to identify and treat hypertension and hypercholesterolemia as early as possible. By improving adherence, a single-pill formulation that offers a combination of different drugs could be an effective way to manage patients with multiple cardiovascular risks.
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Affiliation(s)
- Isabella Sudano
- University Heart Centre, Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
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11
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Arnold L, Bacova M, Dalla-Pozza R, Haas NA, Oberhoffer FS. Physical Activity and Diet Quality: Effects on Cardiovascular Morbidity in Women with Turner Syndrome-Results from an Online Patient Survey. J Clin Med 2021; 11:167. [PMID: 35011908 PMCID: PMC8745768 DOI: 10.3390/jcm11010167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 01/04/2023] Open
Abstract
Turner syndrome (TS) is a rare chromosomal disease with increased cardiovascular morbidity and mortality. The aim of this study was to investigate the influence of physical activity and diet quality on cardiovascular morbidity in German TS women. An anonymous online questionnaire was established. The questionnaire was based on the 2020 WHO recommendations on physical activity and sedentary behaviour and included the 14-Item Mediterranean Diet Assessment Tool. In addition, TS patients were asked about existing cardiovascular conditions. In total, 83 TS women were included in the final analysis. The achievement of <600 Metabolic Equivalent-minutes per week for recreational activities was significantly associated with the presence of arterial hypertension (p = 0.006). High adherence to the Mediterranean diet was achieved by only 20.5% of TS subjects and tended to be inversely associated with the presence of lipid metabolism disorders (p = 0.063). Only 37.3% of TS participants received nutritional counselling. Given the increased cardiovascular risk, specific counselling for lifestyle optimisation may play an important role in the management of TS. Further studies are required to evaluate the effects of regular aerobic physical training and different nutritional programs on cardiovascular morbidity in TS.
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Affiliation(s)
| | | | | | | | - Felix Sebastian Oberhoffer
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, Ludwig Maximilians University Munich, 81377 Munich, Germany; (L.A.); (M.B.); (R.D.-P.); (N.A.H.)
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12
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Mahsin MD, Cabaj J, Saini V. Respiratory and cardiovascular condition-related physician visits associated with wildfire smoke exposure in Calgary, Canada, in 2015: a population-based study. Int J Epidemiol 2021; 51:166-178. [PMID: 34561694 DOI: 10.1093/ije/dyab206] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We studied the impact of fine particulate matter (PM2.5) exposure due to a remote wildfire event in the Pacific Northwest on daily outpatient respiratory and cardiovascular physician visits during wildfire (24-31 August, 2015) and post-wildfire period (1-30 September, 2015) relative to the pre-wildfire period (1-23 August, 2015) in the city of Calgary, Canada. METHODS A quasi-Poisson regression model was used for modelling daily counts of physician visits due to PM2.5 while adjusting for day of the week (weekday versus weekend or public holiday), wildfire exposure period (before, during, after), methane, relative humidity, and wind direction. A subgroup analysis of those with pre-existing diabetes or hypertension was performed. RESULTS An elevated risk of respiratory disease morbidity of 33% (relative risk: RR) [95% confidence interval (CI): 10%-59%] and 55% (95% CI: 42%-69%) was observed per 10µg/m3 increase in PM2.5 level during and after wildfire, respectively, relative to the pre-wildfire time period. Increased risk was observed for children aged 0-9 years during (RR = 1.57, 95% CI: 1.21-2.02) and after the wildfire (RR = 2.11, 95% CI: 1.86-2.40) especially for asthma, acute bronchitis and acute respiratory infection. The risk of physician visits among seniors increased by 11% (95% CI: 3%-21%), and 19% (95% CI: 7%-33%) post-wildfire for congestive heart failure and ischaemic heart disease, respectively. Individuals with pre-existing diabetes had an increased risk of both respiratory and cardiovascular morbidity in the post-wildfire period (RR = 1.35, 95% CI: 1.09-1.67; RR = 1.22, 95% CI: 1.01-1.46, respectively). CONCLUSIONS Wildfire-related PM2.5 exposure led to increased respiratory condition-related outpatient physician visits during and after wildfires, particularly for children. An increased risk of physician visits for congestive heart failure and ischaemic heart disease among seniors in the post-wildfire period was also observed.
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Affiliation(s)
- M D Mahsin
- Research and Innovation-Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Jason Cabaj
- Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vineet Saini
- Research and Innovation-Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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13
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Brodowski L, Schröder-Heurich B, von Hardenberg S, Richter K, von Kaisenberg CS, Dittrich-Breiholz O, Meyer N, Dörk T, von Versen-Höynck F. MicroRNA Profiles of Maternal and Neonatal Endothelial Progenitor Cells in Preeclampsia. Int J Mol Sci 2021; 22:ijms22105320. [PMID: 34070163 PMCID: PMC8158476 DOI: 10.3390/ijms22105320] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023] Open
Abstract
Preeclampsia is associated with an increased cardiovascular morbidity of mother and offspring, thus contributing to a substantial burden in women and children’s health. It has been proven that endothelial progenitor cell (EPC) numbers and functional characteristics are impaired in cardiovascular disease and preeclampsia, although causative factors for the latter have remained elusive. MicroRNA (miRNA) modifications are a potential mechanism through which exposure to an altered environment translates into the development of chronic disease. In this study, we examined whether development of preeclampsia corresponds to alterations of miRNAs in maternal- and cord-blood-derived EPC. To test this end, we analyzed maternal and neonatal miRNAs via RNA sequencing from endothelial cells of preeclamptic and healthy controls in different cell culture passages. We were able to demonstrate differentially represented miRNAs in all groups. Hsa-miR-1270 showed significantly different levels in cord blood EPC from preeclampsia versus control and was negatively correlated with mRNA levels of its predicted targets ANGPTL7 and TFRC. Transfection with an hsa-miR-1270 inhibitor decreased the tube formation capacity and chemotactic motility but did not change proliferation in vitro. Target predictions and gene set enrichment analyses identified alternative splicing as a significantly enriched pathway for hsa-miR-1270. The top miRNAs in three other groups were predicted to target transcriptional and developmental pathways. Here, we showed for the first time significantly different levels of miRNAs and differently represented mRNA levels of predicted target genes in EPC derived from preeclampsia. Understanding the effects of preeclampsia on the epigenetic mechanisms of EPC will be crucial and may provide initial insights for further evaluation of the benefits of therapies targeting this cell population.
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Affiliation(s)
- Lars Brodowski
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany;
| | - Bianca Schröder-Heurich
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
| | - Sandra von Hardenberg
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
| | - Katja Richter
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
| | - Constantin S. von Kaisenberg
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany;
| | - Oliver Dittrich-Breiholz
- Research Core Unit Genomics, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany;
| | - Nadia Meyer
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
| | - Thilo Dörk
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
| | - Frauke von Versen-Höynck
- Gynecology Research Unit, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany; (L.B.); (B.S.-H.); (S.v.H.); (K.R.); (N.M.); (T.D.)
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany;
- Correspondence: ; Tel.: +49-511-532-8703; Fax: +49-511-532-6081
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14
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Bielopolski D, Rahamimov R, Zingerman B, Chagnac A, Azulay-Gitter L, Rozen Zvi B. Microalbuminuria After Kidney Transplantation Predicts Cardiovascular Morbidity. Front Med (Lausanne) 2021; 8:635847. [PMID: 33912576 PMCID: PMC8071984 DOI: 10.3389/fmed.2021.635847] [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: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Microalbuminuria is a well-characterized marker of kidney malfunction, both in diabetic and non-diabetic populations, and is used as a prognostic marker for cardiovascular morbidity and mortality. A few studies implied that it has the same value in kidney transplanted patients, but the information relies on spot or dipstick urine protein evaluations, rather than the gold standard of timed urine collection. Methods: We revisited a cohort of 286 kidney transplanted patients, several years after completing a meticulously timed urine collection and assessed the prevalence of major cardiovascular adverse events (MACE) in relation to albuminuria. Results: During a median follow up of 8.3 years (IQR 6.4–9.1) 144 outcome events occurred in 101 patients. By Kaplan-Meier analysis microalbuminuria was associated with increased rate of CV outcome or death (p = 0.03), and this was still significant after stratification according to propensity score quartiles (p = 0.048). Time dependent Cox proportional hazard analysis showed independent association between microalbuminuria and CV outcomes 2 years following microalbuminuria detection (HR 1.83, 95% CI 1.07–2.96). Conclusions: Two years after documenting microalbuminuria in kidney transplanted patients, their CVD risk was increased. There is need for primary prevention strategies in this population and future studies should address the topic.
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Affiliation(s)
- Dana Bielopolski
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ruth Rahamimov
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Boris Zingerman
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avry Chagnac
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Limor Azulay-Gitter
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Benaya Rozen Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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15
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Selvi I. Comment on "A multicenter prospective study for overactive bladder patient treatment satisfaction with mirabegron after being unsatisfied with antimuscarinic therapy (FAVOR study)". Neurourol Urodyn 2021; 40:735-736. [PMID: 33508150 DOI: 10.1002/nau.24611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Ismail Selvi
- Department of Urology, Başakşehir Çam & Sakura City Hospital, Istanbul, Turkey
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16
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Melissaropoulos K, Bogdanos D, Dimitroulas T, Sakkas LI, Kitas GD, Daoussis D. Primary Sjögren's Syndrome and Cardiovascular Disease. Curr Vasc Pharmacol 2020; 18:447-454. [PMID: 31995009 DOI: 10.2174/1570161118666200129125320] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/21/2019] [Revised: 11/19/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
Sjögren's syndrome is a rheumatic autoimmune disease that primarily affects middle-aged women and runs a slowly progressing course with sicca symptoms being the prevalent manifestation. Premature atherosclerosis and increased cardiovascular (CV) morbidity and mortality are frequently encountered in rheumatic diseases characterized by significant systemic inflammation, such as the inflammatory arthritides, systemic vasculitides and systemic lupus erythematosus. In the same context, chronic inflammation and immune aberrations underlying Sjögren's syndrome are also reported to be associated with augmented risk of atherosclerosis. Increased CV disease (CVD) frequency has been found in recent meta-analyses. The involvement of the CV system is not a common feature of Sjögren's syndrome; however, specific manifestations, such as autoantibody-mediated heart block, pericarditis, pulmonary arterial hypertension and dysautonomia, have been described. This review focuses on studies addressing CV morbidity in Sjögren's syndrome and presents current data regarding distinct CV features of the disease.
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Affiliation(s)
| | - Dimitrios Bogdanos
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41 110, Greece
| | - Theodoros Dimitroulas
- 4th Department of Internal Medicine Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lazaros I Sakkas
- Department of Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41 110, Greece
| | - George D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, United Kingdom
| | - Dimitrios Daoussis
- Department of Rheumatology, Patras University Hospital, University of Patras Medical School, Patras, Greece
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17
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Selvi I, Baydilli N, Akinsal EC. The effect of cardiovascular morbidity on clinical response provided by tadalafil in patients with erectile dysfunction. Andrologia 2020; 53:e13904. [PMID: 33244832 DOI: 10.1111/and.13904] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022] Open
Abstract
We aimed to investigate the association between erectile dysfunction and severity of cardiovascular morbidity and to assess clinical responses to tadalafil of patients in different cardiovascular risk groups. Between November 2019 and August 2020, a total of 258 male patients aged 45-70 years with ED were included. They were divided into three groups according to the Framingham risk score: low-risk (n: 86, 33.3%), intermediate-risk (n: 103, 39.9%) and high-risk (n: 69, 26.8%). At admission, all domains of the International Index of Erectile Function score were worse in high-risk group compared to other risk groups (p < .001). After a 12-week follow-up, a more significant improvement was observed in all domains of erectile function in all risk groups, but high-risk group had lower sexual scores (p < .001). The lowest rate for complete responsiveness to tadalafil was observed in the high-risk group (37.7%). The rate of failure in complete responsiveness was found to be 4.127 times greater with higher Framingham score and 3.102 times greater with higher erectile dysfunction severity at admission. Our preliminary findings show that more severe sexual disorders are observed in high-risk patients with cardiovascular morbidity. Individualised treatment may be important in high-risk group since they may benefit less from tadalafil, and failure in complete responsiveness can be more common in this group.
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Affiliation(s)
- Ismail Selvi
- Department of Urology, Karabük University Training and Research Hospital, Karabük, Turkey.,Department of Urology, Başakşehir Çam ve Sakura City Hospital, Istanbul, Turkey
| | - Numan Baydilli
- Department of Urology, Erciyes University Medical School, Kayseri, Turkey
| | - Emre Can Akinsal
- Department of Urology, Erciyes University Medical School, Kayseri, Turkey
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18
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Galin S, Wainstock T, Sheiner E, Landau D, Walfisch A. Elective cesarean delivery and long-term cardiovascular morbidity in the offspring - a population-based cohort analysis. J Matern Fetal Neonatal Med 2020; 35:2708-2715. [PMID: 32731780 DOI: 10.1080/14767058.2020.1797668] [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: 02/07/2023]
Abstract
OBJECTIVE To evaluate the impact of cesarean delivery (CD) on offspring risk for long-term cardiovascular morbidity. STUDY DESIGN A population-based cohort analysis was performed, including all singleton term deliveries occurring between 1991 and 2014 at a single tertiary medical center. A comparison was performed between children delivered via CD and those delivered vaginally. Fetuses with cardiac or other congenital malformations were excluded, as were cases of urgent CD and pregnancies involving preeclampsia, gestational diabetes, placenta previa, labor induction, fetal growth restriction, preterm PROM, and instrumental deliveries. Hospitalizations of the offspring up to 18 years of age involving cardiovascular morbidity were compared between the two study groups. A Kaplan-Meier survival curve compared cumulative cardiovascular morbidity incidence and a Cox regression model controlled for confounders. RESULTS Of the 132,054 term deliveries who met the inclusion criteria; 8.9% were CDs (n = 11,746) and 91.1% (n = 120,308) were vaginal deliveries. Cardiovascular hospitalization incidence per 1000 person follow up years was 0.742 in the CD group and 0.054 in the comparison group (HR = 1.3, 95%CI 1.051-1.710, p = .018). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of cardiovascular morbidity following CD (log rank p = .018). In the Cox proportional hazards model, CD was noted as an independent risk factor for offspring long-term pediatric cardiovascular morbidity (adjusted HR = 1.295, CI 1.005-1.668, p = .04) when controlling for maternal age, obesity, ethnicity, gestational age, newborn gender, low birthweight, maternal preexisting cardiovascular disease, and deliveries occurring after 2008. CONCLUSION Singletons delivered by CD at term have an increased risk of long-term cardiovascular morbidity.
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Affiliation(s)
- Shaked Galin
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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19
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Gasbarrino K, Labos C, Mastropietro V, Hales L, Khan N, Rabi D, Daskalopoulou SS. Sex differences in the efficacy of antihypertensive treatment in preventing cardiovascular outcomes and reducing blood pressure: protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e036128. [PMID: 32169929 PMCID: PMC7069325 DOI: 10.1136/bmjopen-2019-036128] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hypertension is a leading cause of mortality worldwide and its prevalence is expected to rise over the next decade. Sex differences exist in the epidemiology and pathophysiology of hypertension. It is well established that antihypertensive treatment can significantly reduce the risk for stroke and other cardiovascular disease events. However, it remains unclear whether this effect is dependent on sex. In this protocol, we outlined a systematic review and meta-analysis to evaluate the effects of antihypertensive therapy in (1) reducing blood pressure and (2) preventing cardiovascular morbidity and mortality outcomes for each sex separately. METHODS AND ANALYSIS The following electronic databases will be searched: Medline, Embase, The Cochrane Library, PubMed, Cumulative Index of Nursing and Allied Health Literature Plus, Web of Science, grey literature (Google Scholar) and several trial registries. Search strategies will be designed to identify human adult (≥18) randomised (and non-randomised) controlled trials, prospective and retrospective cohort studies, and case-control studies concerning 'sex-specific differences associated with the efficacy of antihypertensive treatment'. A preliminary search strategy was developed for Medline (1946-16 September 2019). Two investigators will independently review each article included in the final analysis. Primary outcomes investigated are cardiovascular morbidity and mortality and systolic and diastolic blood pressure. Pooled analyses will be conducted using the random-effects model. Publication bias will be assessed by visual inspection of funnel plots and by Begg's and Egger's statistical tests. Between-studies heterogeneity will be measured using the I2 test (p<0.10). Sources of heterogeneity will be explored by sensitivity, subgroup and metaregression analyses. ETHICS AND DISSEMINATION This is the first meta-analysis that will comprehensively compare the efficacy of antihypertensive treatment regimens between men and women. Findings will be shared through scientific conferences and societies, social media and consumer advocacy groups. Results will be used to inform the current guidelines for management of hypertension in men and women by demonstrating the importance of implementing sex-specific recommendations. Ethical considerations are not applicable for this protocol.
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Affiliation(s)
- Karina Gasbarrino
- Medicine, Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | | | - Lindsay Hales
- Medical Library, McGill University Health Centre, Montreal, Canada
| | - Nadia Khan
- Medicine, The University of British Columbia, Vancouver, Canada
| | - Doreen Rabi
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Canada
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20
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Wang H, Liang L, Cai P, Zhao J, Guo L, Ma H. Associations of cardiovascular disease morbidity and mortality in the populations watching major football tournaments: A systematic review and meta-analysis of observational studies. Medicine (Baltimore) 2020; 99:e19534. [PMID: 32195956 PMCID: PMC7220255 DOI: 10.1097/md.0000000000019534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Whether or not increased hospitalizations and/or deaths due to cardiovascular disease during major football tournaments (MFTs) remains controversial. We undertook a systematic review and meta-analysis of published studies to assess the relationships of cardiovascular events and MFTs. METHODS Observational studies reporting relationship of cardiovascular disease morbidity and mortality with MFTs during the days of games or within 2 weeks after game season were included. Relative risk ratios (RR) with 95% confidence interval (CI) were pooled and analyzed using a random/fixed-effects model. RESULTS Nineteen cross-sectional observational studies that examined the association between MFTs and non-fetal cardiovascular events and mortality were found to be eligible from 3419 references, for inclusion in the systematic review and meta-analysis. Of the 10 studies reported hospitalizations due to non-fetal acute cardiovascular events, the pooled RR was 1.17 (95% CI 1.01-1.36). Of the 10 studies reported cardiovascular mortality the pooled RR was 1.03 (95% CI 1.00-1.05). Of the studies examining the mortality, 6 studies reported the lost or win of the national team. Pooling of four studies where their national teams lost the MFTs produced a RR for the mortality of 1.19 (95% CI: 1.09-1.30), and 4 studies of the 6 whose national teams won produced a pooled RR for cardiovascular mortality of 0.88 (0.79-0.98). CONCLUSION This systematic review and meta-analysis showed an increased risk of hospitalization due to non-fetal acute cardiovascular events and cardiovascular mortality with watching MFTs.
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Affiliation(s)
- Huajun Wang
- The People's Hospital of Luoding, Affiliated Luoding Hospital of Guangdong Medical University, Luoding
| | - Lunchang Liang
- The People's Hospital of Luoding, Affiliated Luoding Hospital of Guangdong Medical University, Luoding
| | - Ping Cai
- The People's Hospital of Luoding, Affiliated Luoding Hospital of Guangdong Medical University, Luoding
| | - Jianli Zhao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou
| | - Lan Guo
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huan Ma
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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21
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Bayó J, Dalfó A, Barceló MA, Saez M, Roca C, Pallozzi J, Coll-de-Tuero G. The Role First-Day Readings Play in a 3-Day Schedule of Self-Monitoring Home Blood Pressure Based on Prognostic Data. VAMPAHICA Study. Am J Hypertens 2020; 33:154-160. [PMID: 32086520 DOI: 10.1093/ajh/hpz178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/19/2019] [Accepted: 11/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The optimal schedule for self-monitoring home BP (SMHBP) readings is enormously important in the diagnosis of different phenotypes related to hypertension. The aim of this study was to determine the prognostic capacity of a 3-day SMHBP schedule when using or suppressing the first-day measurements in compiling the results. METHODS A total of 767 newly diagnosed, nontreated patients with no history of cardiovascular disease (CVD) were followed for 6.2 years. As a baseline, office BP measurements were taken for all the patients who then went on to follow a 3-day SMHBP schedule, taking 2 readings in the morning and 2 in the evening. The prognostic calculation was performed with CVD variables. The prognostic capacity of the 3-day schedule was evaluated with and without the first-day readings (12 and 8 readings). RESULTS A total of 223 normotensive subjects (NT), 271 subjects with sustained hypertension (SHT), and 184 white-coat hypertensive subjects (WCH) were followed. The distribution of 98 (14.4%) nonfatal CV events during the follow-up was as follows: WCH 21 (11.4%), NT 9 (4.0%), and SHT 68 (25.1%). No statistically significant differences were observed in the risk of CV events (OR) for the 2 groups of hypertensives, irrespective of the schedule of readings used (SHT with vs. without first-day readings: 8.81 (4.28-18.15) vs. 8.61 (4.15-17.85) and WCH with vs. without first-day readings: 2.71(1.13-6.47) vs. 3.40 (1.49-7.78)). CONCLUSIONS Our findings show that first-day readings do not need to be discarded in order to calculate the final value of an SMHBP schedule.
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Affiliation(s)
- Joan Bayó
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
- CAP El Clot. SAP Litoral. Institut Català de la Salut. Barcelona. Spain
| | - Antoni Dalfó
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Maria A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
| | - Carme Roca
- CAP El Clot. SAP Litoral. Institut Català de la Salut. Barcelona. Spain
| | - Julia Pallozzi
- CAP El Clot. SAP Litoral. Institut Català de la Salut. Barcelona. Spain
| | - Gabriel Coll-de-Tuero
- MEHTARISC Group. Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
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Santilli F, Zaccardi F, Liani R, Petrucci G, Simeone P, Pitocco D, Tripaldi R, Rizzi A, Formoso G, Pontecorvi A, Angelucci E, Pagliaccia F, Golato M, De Leva F, Vitacolonna E, Rocca B, Consoli A, Patrono C. In vivo thromboxane-dependent platelet activation is persistently enhanced in subjects with impaired glucose tolerance. Diabetes Metab Res Rev 2020; 36:e3232. [PMID: 31671234 DOI: 10.1002/dmrr.3232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/02/2019] [Accepted: 10/13/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Impaired glucose tolerance (IGT) is associated with increased cardiovascular morbidity and mortality. Enhanced thromboxane (TX)-dependent platelet activation plays a pivotal role in atherothrombosis and characterizes type 2 diabetes mellitus (DM). Whether this also pertains to IGT is currently unknown. We investigated whether TXA2 -dependent platelet activation, as reflected by 11-dehydro-TXB2 (TXM) urinary excretion, is comparably abnormal in IGT as in DM, is persistent over long-term follow-up, changes as a function of metabolic disease progression, and is influenced by food intake. METHODS We prospectively investigated subjects with IGT (n = 48) and two control groups with DM diagnosed either less than 12 months (n = 60) or 12 months or more (n = 58). RESULTS Baseline TXM excretion was comparable between subjects with IGT and DM, with no evidence of a circadian variation. During a 36-month follow-up, urinary TXM excretion was stable over time in the DM groups, while tended to increase in subjects with IGT. Increasing urinary TXM excretion over time was observed in the subjects who progressed to diabetes vs nonprogressors. CONCLUSIONS We conclude that TXA2 -dependent platelet activation was at least as high in IGT as in patients with DM and further increased over time, especially in those who progressed to overt diabetes.
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Affiliation(s)
- Francesca Santilli
- Department of Medicine and Aging and Center of Aging Science and Translational Medicine (CESI-Met), University of Chieti "G. D'Annunzio" School of Medicine, Chieti, Italy
| | - Francesco Zaccardi
- Diabetes Care Unit, Catholic University School of Medicine and Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Rossella Liani
- Department of Medicine and Aging and Center of Aging Science and Translational Medicine (CESI-Met), University of Chieti "G. D'Annunzio" School of Medicine, Chieti, Italy
| | - Giovanna Petrucci
- Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Paola Simeone
- Department of Medicine and Aging and Center of Aging Science and Translational Medicine (CESI-Met), University of Chieti "G. D'Annunzio" School of Medicine, Chieti, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Catholic University School of Medicine and Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Romina Tripaldi
- Department of Medicine and Aging and Center of Aging Science and Translational Medicine (CESI-Met), University of Chieti "G. D'Annunzio" School of Medicine, Chieti, Italy
| | - Alessandro Rizzi
- Diabetes Care Unit, Catholic University School of Medicine and Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gloria Formoso
- Department of Medicine and Aging and Center of Aging Science and Translational Medicine (CESI-Met), University of Chieti "G. D'Annunzio" School of Medicine, Chieti, Italy
| | - Alfredo Pontecorvi
- Institute of Endocrinology, Catholic University School of Medicine and Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Ermanno Angelucci
- Department of Clinical Medicine, Chieti University Hospital, Chieti, Italy
| | | | - Maria Golato
- Department of Clinical Pathology, Chieti University Hospital, Chieti, Italy
| | - Francesca De Leva
- Diabetes Care Unit, Catholic University School of Medicine and Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging and Center of Aging Science and Translational Medicine (CESI-Met), University of Chieti "G. D'Annunzio" School of Medicine, Chieti, Italy
| | - Bianca Rocca
- Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Agostino Consoli
- Department of Medicine and Aging and Center of Aging Science and Translational Medicine (CESI-Met), University of Chieti "G. D'Annunzio" School of Medicine, Chieti, Italy
| | - Carlo Patrono
- Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy
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Abstract
INTRODUCTION Drug-induced QT prolongation is associated with higher cardiovascular mortality. MATERIAL AND METHODS We conducted a protocol-based comprehensive review of antidepressant-induced QT prolongation in people with mental disorders. RESULTS Based on findings from 47 published randomized controlled trials (RCTs), 3 unpublished RCTs, 14 observational studies, 662 case reports of torsades de pointes, and 168 cases of QT prolongation, we conclude that all antidepressants should be used only with licensed doses, and that all patients receiving antidepressants require monitoring of QT prolongation and clinical symptoms of cardiac arrhythmias. Large observational studies suggest increased mortality associated with all antidepressants (RR = 1.62, 95% CI: 1.60-1.63, number of adults: 1,716,552), high doses of tricyclic antidepressants (OR = 2.11, 85% CI 1.10-4.22), selective serotonin reuptake inhibitors (OR = 2.78, 95% CI: 1.24-6.24), venlafaxine (OR = 3.73, 95% CI: 1.33-10.45, number of adults: 4,040), and nortriptyline (OR = 4.60, 95% CI: 1.20-18.40, number of adults: 5,298). CONCLUSIONS Evidence regarding the risk of QT prolongation in children is sparse.
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Affiliation(s)
- Wilbert S. Aronow
- Department of Medicine and Cardiology Research, Westchester Medical Center and New York Medical College, New York, USA
| | - Tatyana A. Shamliyan
- Elsevier, Clinical Solutions, Philadelphia, USA
- Corresponding author: Tatyana A. Shamliyan MD, MS, Elsevier Clinical Solutions, 1600 Kennedy Blvd, 19103 Philadelphia, USA, Phone: 2675004863, E-mail:
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24
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Kiss Z, Rokszin G, Abonyi-Tóth Z, Jermendy G, Kempler P, Barkai L, Wittmann I. Young adult patients with type 1 diabetes have a higher risk of mortality than those of similar age with type 2 diabetes: A nationwide analysis in Hungary. Diabetes Metab Res Rev 2019; 35:e3190. [PMID: 31140677 DOI: 10.1002/dmrr.3190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/11/2019] [Accepted: 05/22/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are few papers comparing complications of type 1 diabetes with those of a similarly young age with type 2 diabetes. The aim of our nationwide study was to compare the risks of mortality and morbidities between the two types of diabetes (age ≤ 40). METHODS We identified all young adult patients with type 1 diabetes who were recorded in the database of the Hungarian National Health Insurance Fund between 2001 and 2014 (n = 11 863) and compared them with a population of similar age with young adult type 2 diabetes (n = 47 931). The incidence of all-cause mortality, myocardial infarction, stroke, any type of cancer, diabetic ketoacidosis, and hypoglycemia was followed from the onset of diabetes to the date of death or end of study period. RESULTS The risks of all-cause mortality were significantly higher in patients with type 1 compared with patients with type 2 diabetes (hazard ratio, 95%CI; 2.17, 1.95-2.41; P < .0001). The risks of myocardial infarction (0.90, 0.71-1.13; P = 0.36) and stroke (1.06, 0.87-1.29; P = .582) were not significantly different in type 1 compared with type 2. In contrast, the risk of cancer (1.35, 1.15-1.59; P = .0003), dialysis (2.20, 1.76-2.75; P < .0001), hypoglycemia (7.70, 6.45-9.18; P < .0001), and ketoacidosis (22.12, 19.60-25.00; P < .0001) was higher among patients with type 1 compared with those with type 2 diabetes. CONCLUSIONS A comparatively higher incidence of diabetic ketoacidosis and hypoglycemia and higher risk of cancer and dialysis in patients with type 1 diabetes than in those with type 2 may play a role in the higher risk of mortality.
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Affiliation(s)
- Zoltán Kiss
- 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- University of Veterinary Medicine, Budapest, Hungary
| | | | - Péter Kempler
- 1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - László Barkai
- Institute of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Miskolc, Hungary
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - István Wittmann
- 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pécs, Hungary
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25
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Bush A, Sonnappa S. No fire without smoke: Are the children really out of the woods? Respirology 2019; 25:128-129. [PMID: 31297931 DOI: 10.1111/resp.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew Bush
- Department of Paediatrics, Imperial College, London, UK.,Paediatric Respiratory Medicine, National Heart and Lung Institute, London, UK.,Department of Paediatric Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
| | - Samatha Sonnappa
- Paediatric Respiratory Medicine, National Heart and Lung Institute, London, UK.,Department of Paediatric Respiratory Medicine, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
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26
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Ackerman CM, Platner MH, Spatz ES, Illuzzi JL, Xu X, Campbell KH, Smith GN, Paidas MJ, Lipkind HS. Severe cardiovascular morbidity in women with hypertensive diseases during delivery hospitalization. Am J Obstet Gynecol 2019; 220:582.e1-582.e11. [PMID: 30742823 DOI: 10.1016/j.ajog.2019.02.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/04/2019] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of pregnancy-related death in the United States. Identification of short-term indicators of cardiovascular morbidity has the potential to alter the course of this devastating disease among women. It has been established that hypertensive disorders of pregnancy are associated with increased risk of cardiovascular disease 10-30 years after delivery; however, little is known about the association of hypertensive disorders of pregnancy with cardiovascular morbidity during the delivery hospitalization. OBJECTIVE We aimed to identify the immediate risk of cardiovascular morbidity during the delivery hospitalization among women who experienced a hypertensive disorder of pregnancy. MATERIALS AND METHODS This retrospective cohort study of women, 15-55 years old with a singleton gestation between 2008 and 2012 in New York City, examined the risk of severe cardiovascular morbidity in women with hypertensive disorders of pregnancy compared with normotensive women during their delivery hospitalization. Women with a history of chronic hypertension, diabetes mellitus, or cardiovascular disease were excluded. Mortality and severe cardiovascular morbidity (myocardial infarction, cerebrovascular disease, acute heart failure, heart failure or arrest during labor or procedure, cardiomyopathy, cardiac arrest and ventricular fibrillation, or conversion of cardiac rhythm) during the delivery hospitalization were identified using birth certificates and discharge record coding. Using multivariable logistic regression, we assessed the association between hypertensive disorders of pregnancy and severe cardiovascular morbidity, adjusting for relevant sociodemographic and pregnancy-specific clinical risk factors. RESULTS A total of 569,900 women met inclusion criteria. Of those women, 39,624 (6.9%) had a hypertensive disorder of pregnancy: 11,301 (1.9%) gestational hypertension; 16,117 (2.8%) preeclampsia without severe features; and 12,206 (2.1%) preeclampsia with severe features, of whom 319 (0.06%) had eclampsia. Among women with a hypertensive disorder of pregnancy, 431 experienced severe cardiovascular morbidity (10.9 per 1000 deliveries; 95% confidence interval, 9.9-11.9). Among normotensive women, 1780 women experienced severe cardiovascular morbidity (3.4 per 1000 deliveries; 95% confidence interval, 3.2-3.5). Compared with normotensive women, there was a progressively increased risk of cardiovascular morbidity with gestational hypertension (adjusted odds ratio, 1.18; 95% confidence interval, 0.92-1.52), preeclampsia without severe features (adjusted odds ratio, 1.96; 95% confidence interval, 1.66-2.32), preeclampsia with severe features (adjusted odds ratio, 3.46; 95% confidence interval, 2.99-4.00), and eclampsia (adjusted odds ratio, 12.46; 95% confidence interval, 7.69-20.22). Of the 39,624 women with hypertensive disorders of pregnancy, there were 15 maternal deaths, 14 of which involved 1 or more cases of severe cardiovascular morbidity. CONCLUSION Hypertensive disorders of pregnancy, particularly preeclampsia with severe features and eclampsia, are significantly associated with cardiovascular morbidity during the delivery hospitalization. Increased vigilance, including diligent screening for cardiac pathology in patients with hypertensive disorders of pregnancy, may lead to decreased morbidity for mothers.
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27
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Chaiyasothi T, Nathisuwan S, Dilokthornsakul P, Vathesatogkit P, Thakkinstian A, Reid C, Wongcharoen W, Chaiyakunapruk N. Effects of Non-statin Lipid-Modifying Agents on Cardiovascular Morbidity and Mortality Among Statin-Treated Patients: A Systematic Review and Network Meta-Analysis. Front Pharmacol 2019; 10:547. [PMID: 31191304 PMCID: PMC6540916 DOI: 10.3389/fphar.2019.00547] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/01/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Currently, there is a lack of information on the comparative efficacy and safety of non-statin lipid-lowering agents (NST) in cardiovascular (CV) disease risk reduction when added to background statin therapy (ST). This study determine the relative treatment effects of NST on fatal and non-fatal CV events among statin-treated patients. Methods: A network meta-analysis based on a systematic review of randomized controlled trials (RCTs) comparing non-statin lipid-modifying agents among statin-treated patients was performed. PubMed, EMBASE, CENTRAL, and Clinicaltrial.gov were searched up to April 10, 2018. The primary outcomes were CV and all-cause mortalities. Secondary CV outcomes were coronary heart disease (CHD) death, non-fatal myocardial infarction (MI), any stroke, and coronary revascularization. Risks of discontinuations were secondary safety outcomes. Results: Sixty-seven RCTs including 259,429 participants with eight interventions were analyzed. No intervention had significant effects on the primary outcomes (CV mortality and all-cause mortality). For secondary endpoints, proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK) plus statin (PCSK/ST) significantly reduced the risk of non-fatal MI (RR 0.82, 95% CI 0.72–0.93, p = 0.003), stroke (RR 0.74, 95% CI 0.65–0.85, p < 0.001), coronary revascularization (RR 0.84, 95% CI 0.75–0.94, p = 0.003) compared to ST. Combinations of ST and all NST except PCSK and ezetimibe showed higher rate of discontinuation due to adverse events compared to ST. Conclusions: None of NST significantly reduced CV or all-cause death when added to ST. PCSKs and to a lesser extent, ezetimibe may help reduce cardiovascular events with acceptable tolerability profile among broad range of patients.
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Affiliation(s)
- Thanaputt Chaiyasothi
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.,Department of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Surakit Nathisuwan
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Piyameth Dilokthornsakul
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
| | - Prin Vathesatogkit
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Christopher Reid
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| | - Wanwarang Wongcharoen
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.,School of Pharmacy, University of Wisconsin, Madison, WI, United States.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Malaysia
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28
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Izkhakov E, Meyerovitch J, Barchana M, Shacham Y, Stern N, Keinan-Boker L. Long-term cardiovascular and cerebrovascular morbidity in Israeli thyroid cancer survivors. Endocr Connect 2019; 8:398-406. [PMID: 30865929 PMCID: PMC6454303 DOI: 10.1530/ec-19-0038] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/13/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Thyroid cancer (TC) survivors may be at risk of subsequent cardiovascular and cerebrovascular (CaV&CeV) morbidity. The 2009 American Thyroid Association (ATA) guidelines recommended less aggressive treatment for low-risk TC patients. The aim of this study was to assess the atherosclerotic CaV&CeV outcome of Israeli TC survivors compared to individuals with no thyroid disease, and the atherosclerotic CaV&CeV outcome before (2000-2008) and after (2009-2011) implementation of the 2009 ATA guidelines. METHODS All members of the largest Israeli healthcare organization who were diagnosed with TC from 1/2000 to 12/2014 (study group) and age- and sex-matched members with no thyroid disease (controls) were included. Adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards models. RESULTS The mean follow-up was 7.6 ± 4.2 and 7.8 ± 4.1 years for the study (n = 5,677, 79% women) and control (n = 23,962) groups, respectively. The former had an increased risk of new atherosclerotic CaV&CeV events (adjusted HR 1.26, 95% CI 1.15-1.39). The 5-year incidence of CaV&CeV was lower (adjusted HR 0.49, 95% CI 0.38-0.62) from 2009 to 2011 compared to 2000 to 2008, but remained higher in the study group than in the control group (adjusted HR 1.5, 95% CI 1.14-1.69). CONCLUSIONS This large Israeli population-based cohort study showed greater atherosclerotic CaV&CeV morbidity in TC survivors compared to individuals with no thyroid diseases. There was a trend toward a decreased 5-year incidence of atherosclerotic CaV&CeV events among TC survivors following the implementation of the 2009 ATA guidelines, but it remained higher compared to the general population.
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Affiliation(s)
- Elena Izkhakov
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Correspondence should be addressed to E Izkhakov:
| | - Joseph Meyerovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Community Division, Clalit Health Services, Tel Aviv, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Micha Barchana
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Yacov Shacham
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Israel, Ramat Gan, Israel
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29
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Coll-de-Tuero G, Saez M, Rodriguez-Poncelas A, Bayó-Llibre J, Beltran-Vilella M, Reyes-Negre C, Dalfó-Baqué A, Barceló M. What is the optimal cut-off threshold in self-home blood pressure measurement?: A cohort study according to STROBE statement. Medicine (Baltimore) 2019; 98:e14817. [PMID: 30855506 PMCID: PMC6417491 DOI: 10.1097/md.0000000000014817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 10/27/2022] Open
Abstract
Two aspects arise concerning the use of self-measured blood pressure monitoring to diagnose white-coat hypertension (WCH): the presence of target organ damage (TOD) and the normal cut-off threshold. This study aims to evaluate the cardiovascular risk of WCH according to different self-measured blood pressure normal cut-off thresholds and the influence of TOD at baseline.In all, 678 patients were followed for 6.2 years; 223 normotensive patients, 271 patients with sustained hypertension (HT), and 184 with WCH. TOD was defined as: left ventricular hypertrophy according to ECG, albuminuria, or low estimated glomerular filtration rate. The risk for different cutting points of self-measured blood pressure (<135/85 mm Hg, <130/85 mm Hg, and <130/80 mm Hg) has been determined.The patients with HT experienced an increase in cardiovascular risk and death higher than the normotensive patients (odds ratio [OR] 7.9, 95% confidence interval [CI] 3.8-16.2 for sustained HT; and OR 3.5, 95% CI 1.6-7.4 for WCH). This was observed for all the cut-off thresholds analyzed. In white-coat hypertensive patients (cut-off <135/85 mm Hg) with TOD, the risk was higher than in normotensive patients (OR 4.5; 95% CI 1.9-10.6). Using a self-monitoring blood pressure cut-off threshold of <130/80 mm Hg without TOD at baseline, the WCH cases exhibited no differences in risk to the normotensive patients (OR 2.0, 95% CI 0.5-7.7).The decisions being taken for patients with WCH based on the presence of TOD and a self-administered home monitoring blood pressure measurement cut-off point probably lower than the one that is currently recommended.
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Affiliation(s)
- Gabriel Coll-de-Tuero
- METHARISC Group, USR Girona, IdIAP Gol i Gorina
- Department of Medical Sciences, University of Girona
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | | | | | | | | | - MªAntonia Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Ergun T, Yazici V, Yavuz D, Seckin-Gencosmanoglu D, Ozen G, Salman A, Direskeneli H, Inanc N. Advanced Glycation End Products, a Potential Link between Psoriasis and Cardiovascular Disease: A Case-control Study. Indian J Dermatol 2019; 64:201-206. [PMID: 31148858 PMCID: PMC6537697 DOI: 10.4103/ijd.ijd_396_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Context Advanced glycation end products (AGEs) promote oxidative stress and inflammation by altering structure and function of proteins. They are excessively produced mainly in hyperglycemia, chronic inflammation and are involved in the development of atherosclerosis and cardiovascular disease. Aims The aim of this study was to investigate whether skin AGEs levels were increased and had relation to premature atherosclerosis in patients with psoriasis. Subjects and Methods Fifty-two psoriasis patients and 20 healthy controls (HC) were included. AGEs were determined by skin autofluorescence (SAF) analysis. High-sensitive C-reactive protein (hsCRP) and carotid intima-media thickness (CIMT) were also investigated. Physical activity and dietary patterns were determined. Statistical Analysis Used Fisher's exact test, two-sample t-tests, Mann-Whitney-U test, Pearson correlation, Spearman correlation, and Wilcoxon test. Results SAFs were increased in psoriasis patients (1.8 arbitrary units [AUs]) compared to that in HC (1.6 AUs) (P = 0.057). Median CIMT values of HC and psoriasis groups were 0.43 (0.28-0.79), and 0.59 (0.44-0.98) respectively and the differences were significant (P = 0.001); hsCRP levels were not different between groups. Conclusions Skin AGE accumulation was found to have a correlation with CIMT in psoriasis patients providing evidence for the role of AGEs in premature atherosclerosis.
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Affiliation(s)
- Tulin Ergun
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Vildan Yazici
- Department of Dermatology, Gebze Medical Park Hospital, Kocaeli, Turkey
| | - Dilek Yavuz
- Department of Endocrinology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Gulsen Ozen
- Department of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Andac Salman
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haner Direskeneli
- Department of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nevsun Inanc
- Department of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
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Maji S, Ghosh S, Ahmed S. Association of air quality with respiratory and cardiovascular morbidity rate in Delhi, India. Int J Environ Health Res 2018; 28:471-490. [PMID: 29963909 DOI: 10.1080/09603123.2018.1487045] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 06/06/2018] [Indexed: 05/28/2023]
Abstract
UNLABELLED The present study reports short-term impact of poor air quality on cardiovascular and respiratory morbidity rate in Delhi. The data on monthly count of patients visiting Out Patient Department (OPD) and hospital admission due to respiratory and cardiovascular illnesses from hospitals along with daily air quality data from air quality monitoring stations of Central Pollution Control Board (CPCB), Government of India, across Delhi were collected for the period 2008 to 2012. A semi-parametric Quasi-Poisson regression model was used to examine the association of high pollution episodes with relative risk of hospital OPD visit and hospital admission due to respiratory and cardiovascular diseases. This study has confirmed the substantial adverse health effects due to air pollution across criterion air pollutants. The study reports the short-term effects of air pollution on morbidity from a time-series study first time in India. The study findings illustrate the evidence of adverse health impact of air pollution from India to the global pool and can influence the policy makers to implement better air quality management system for Indian cities. ABBREVIATIONS OPD: Out Patient Department; IPD: Inpatient Department; RD: Respiratory Disease; CVD: Cardiovascular Disease; COPD: Chronic Obstructive Pulmonary Disease; CPCB: Central Pollution Control Board; NAAQMP: National Ambient Air Quality Monitoring Programme; NAAQS: National Ambient Air Quality Standards; RR; Relative Risk; IMD: Indian Meteorological Department; PM10: Particulate Matter less than 10 μm in aerodynamic diameter; SO2: Sulphur dioxide; NO2: Nitrogen dioxide; CO: Carbon Monoxide; O3: Ozone; DCE: Delhi College of Engineering; GTB Hospital: Guru Teg Bahadur Hospital; VPCH: Vallabhbhai Patel Chest Hospital; RMLH: Ram Manohar Lohia Hospital; SJH: Safdarjung Hospital; LNJPH: Lok Narayan Jai Prakash Hospital; GTBH: Guru Teg Bahadur Hospital; AH: Ambedkar Hospital; HRH: Hindu Rao Hospital; ESIH: ESI Hospital; SGRH: Sir Ganga Ram Hospital.
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Affiliation(s)
- Sanjoy Maji
- a Faculty of Engineering and Technology , Jamia Millia Islamia (Central University) , New Delhi , India
| | - Santu Ghosh
- b Department of Biostatistics , St. Johns Medical College , Bangalore , India
| | - Sirajuddin Ahmed
- a Faculty of Engineering and Technology , Jamia Millia Islamia (Central University) , New Delhi , India
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Reinecke H, Jürgensmeyer S, Engelbertz C, Gerss J, Kirchhof P, Breithardt G, Bauersachs R, Wanner C. Design and rationale of a randomised controlled trial comparing apixaban to phenprocoumon in patients with atrial fibrillation on chronic haemodialysis: the AXADIA-AFNET 8 study. BMJ Open 2018; 8:e022690. [PMID: 30206088 PMCID: PMC6144324 DOI: 10.1136/bmjopen-2018-022690] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/30/2018] [Accepted: 07/25/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Patients with end-stage kidney disease requiring maintenance haemodialysis treatment experience a dramatic cardiovascular morbidity and mortality. Due to the high atherosclerotic and arteriosclerotic burden and profound alterations in haemostasis, they frequently suffer and die from both thromboembolic and bleeding events. This is a particular concern in patients on haemodialysis with atrial fibrillation (AF). Controlled trials on the optimal anticoagulation in patients with AF on haemodialysis are not available. The randomised controlled phase IIIb AXADIA-AFNET 8 trial will evaluate the safety and efficacy of the factor Xa inhibitor apixaban in patients with AF requiring haemodialysis. METHODS AND ANALYSIS A total of 222 patients will be randomised in an open-labelled, 1:1 design to receive either apixaban 2.5 mg twice daily or dose-adjusted vitamin K antagonist therapy (target international normalised ratio 2.0-3.0). All patients will be treated and followed up for a minimum of 6 months up to a maximum of 24 months. The primary outcome is major or clinically relevant, non-major bleedings or death of any cause. Secondary outcomes include stroke, cardiovascular death and other thromboembolic events, thus exploring the efficacy of apixaban. The first patient was randomised in June 2017. ETHICS AND DISSEMINATION The study protocol was approved by the Ethical Committee of the Landesaertzekammer, Westfalen-Lippe and the Medical Faculty of the University of Muenster, Muenster, Germany (reference number: 2016-598 f-A). Written informed consent will be obtained from all patients prior to study participation, including their consent for long-term follow-up. AXADIA-AFNET 8 is an investigator-initiated trial. Sponsor is AFNET, Muenster, Germany. Study findings will be disseminated to Bristol-Myers Squibb, Munich, Germany, and Pfizer, Berlin, Germany, to the participating centres, at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBERS NCT02933697,Pre-results.
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Affiliation(s)
- Holger Reinecke
- Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | | | - Christiane Engelbertz
- Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Paulus Kirchhof
- Atrial Fibrillation NETwork, Muenster, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, and SWBH and UHB NHS Trusts, Birmingham, UK
| | - Günter Breithardt
- Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, Germany
| | - Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, Germany
- Center for Thrombosis and Hemostasis, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, Wuerzburg University Clinic, Wuerzburg, Germany
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Mayrovitz HN. Inter-arm systolic blood pressure dependence on hand dominance. Clin Physiol Funct Imaging 2018; 39:35-41. [PMID: 29938907 DOI: 10.1111/cpf.12536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/06/2018] [Indexed: 12/23/2022]
Abstract
Inter-arm systolic blood pressure differences (SBP-DIFF) ≥ 10 mmHg have been reported useful to predict future cardiovascular-related morbidities. Although well studied in patients, there is little information on healthy young adults and the role of hand-dominance as a factor affecting SBP-DIFF. As dominant arms (DOM) tend to have greater girth and muscle development than nondominant arms (NDOM) it was reasoned that cuff pressures needed to obtain SBP may be greater on DOM causing DOM SBP to be greater. To test this hypothesis and also provide typical values, SBP was measured in left and right-handers (29·4 ± 10·4 years) in whom handedness was clearly defined. Handedness was determined by a multi-question form in 90 young adults (45 male) and SBP-DIFF determined via simultaneous measurements done in triplicate on seated subjects. The percentage of left-handers in male and female sub-groups were equal at 37·8%. Results show that the absolute SBP-DIFF in left-handers (mean ± SD) was 4·4 ± 3·8 mmHg and for right-handers was 5·0 ± 4·2 mmHg (P = 0·362). There was also no statistically significant difference among 1st, 2nd and 3rd measured SBP-DIFF for either right or left-handers or differences between right and left-handers. Results show no evidence of a higher SBP in DOM and thus clarifies the hand-dominance issue as a factor not generally needing to be considered in clinical assessments. A potentially useful secondary outcome was the finding that 14·8% of this group had at least one measured SBP-DIFF ≥ 10 mmHg a fact that may have future relevance.
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Affiliation(s)
- Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
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Van Oekelen O, Vermeersch K, Everaerts S, Vandenberk B, Willems R, Janssens W. Significance of prolonged QTc in acute exacerbations of COPD requiring hospitalization. Int J Chron Obstruct Pulmon Dis 2018; 13:1937-1947. [PMID: 29942126 PMCID: PMC6005315 DOI: 10.2147/copd.s157630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background A prolonged QT interval is associated with increased risk of Torsade de Pointes and cardiovascular death. The prevalence and clinical relevance of QT prolongation in acute exacerbations of COPD (AECOPD), with high risk for cardiac morbidity and mortality, is currently unclear. Methods A dual cross-sectional study strategy was therefore designed. A retrospective study evaluated 140 patients with an AECOPD requiring hospitalization, half of which had prolonged QTc on the admission ECG. Univariate and multivariate analyses were conducted to determine associated factors; Kaplan–Meier and Cox regression analyses to assess prognostic significance. A prospective study evaluated 180 pulmonary patients with acute respiratory problems requiring hospitalization, to determine whether a prolonged QTc at admission represents an AECOPD-specific finding and to investigate the change in QTc-duration during hospitalization. Results Retrospectively, hypokalemia, cardiac troponin T and conductance abnormalities on ECG were significantly and independently associated with QTc prolongation. A prolonged QTc was associated with increased all-cause mortality (HR 2.698 (95% CI 1.032–7.055), p=0.043), however, this association was no longer significant when corrected for age, FEV1 and cardiac troponin T. Prospectively, QTc prolongation was observed in 1/3 of the patients diagnosed with either an AECOPD, lung cancer, pulmonary infection or miscellaneous acute pulmonary disease, and was not more prevalent in AECOPD. The QTc-duration decreased significantly during hospitalization in patients with and without COPD. Conclusion A prolonged QTc is a marker of underlying cardiovascular disease during an AECOPD. It is not COPD-specific, but a common finding during the acute phase of a pulmonary disease requiring urgent hospital admission.
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Affiliation(s)
- Oliver Van Oekelen
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Kristina Vermeersch
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Stephanie Everaerts
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
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Aronow WS, Shamliyan TA. Blood pressure targets for hypertension in patients with type 2 diabetes. Ann Transl Med 2018; 6:199. [PMID: 30023362 PMCID: PMC6035980 DOI: 10.21037/atm.2018.04.36] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/19/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clinical guidelines vary in determining optimal blood pressure targets in adults with diabetes mellitus. METHODS We systematically searched PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov in March 2018; conducted random effects frequentist meta-analyses of direct aggregate data; and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS From eligible 14 meta-analyses and 95 publications of randomized controlled trials (RCT), only 6 RCTs directly compared lower versus higher blood pressure targets; remaining RCTs aimed at comparative effectiveness of hypotensive drugs. In adults with diabetes mellitus and elevated systolic blood pressure (SBP), direct evidence (2 RCTs) suggests that intensive target SBP <120-140 mmHg decreases the risk of diabetes-related mortality [relative risk (RR) =0.68; 95% confidence interval (CI), 0.50-0.92], fatal (RR =0.41; 95% CI, 0.20-0.84) or nonfatal stroke (RR =0.60; 95% CI, 0.43-0.83), prevalence of left ventricular hypertrophy and electrocardiogram (ECG) abnormalities, macroalbuminuria, and non-spine bone fractures, with no differences in all-cause or cardiovascular mortality or falls. In adults with diabetes mellitus and elevated diastolic blood pressure (DBP) ≥90 mmHg, direct evidence (2 RCTs) suggests that intensive DBP target ≤80 versus 80-90 mmHg decreases the risk of major cardiovascular events. Published meta-analyses of aggregate data suggested a significant association between lower baseline and attained blood pressure and increased cardiovascular mortality. CONCLUSIONS We concluded that in adults with diabetes mellitus and arterial hypertension, in order to reduce the risk of stroke, clinicians should target blood pressure at 120-130/80 mmHg, with close monitoring for all drug-related harms.
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Affiliation(s)
- Wilbert S. Aronow
- Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Tatyana A. Shamliyan
- Quality Assurance, Evidence-Based Medicine Center, Elsevier, Philadelphia, PA, USA
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Siri SRA, Braaten T, Jacobsen BK, Melhus M, Eliassen BM. Distribution of risk factors for cardiovascular disease and the estimated 10-year risk of acute myocardial infarction or cerebral stroke in Sami and non-Sami populations: The SAMINOR 2 Clinical Survey. Scand J Public Health 2018; 46:638-646. [PMID: 29806547 PMCID: PMC6094547 DOI: 10.1177/1403494818773534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to assess and compare the distribution of cardiovascular risk factors and the estimated 10-year risk of fatal or non-fatal acute myocardial infarction (AMI) or cerebral stroke (CS) among the Sami and non-Sami populations of Northern Norway. Methods: The SAMINOR 2 Clinical Survey is a cross-sectional survey conducted in 10 municipalities in the counties of Finnmark, Troms and Nordland in rural Northern Norway in 2012–2014. All inhabitants aged 40–79 years were invited to participate, and 6004 (48.2%) accepted. The NORRISK 2 model was used to estimate the 10-year risk of fatal or non-fatal AMI or CS. Sex and age were included in the model, as well as the following risk factors for cardiovascular disease (CVD): serum total cholesterol, serum high-density lipoprotein cholesterol, systolic blood pressure, smoking habits and anti-hypertensive treatment. Results: Only minor ethnic differences were observed between Sami and non-Sami populations in a number of individual risk factors for CVDs. Overall, the NORRISK 2 model revealed no ethnic differences in the 10-year risk of AMI or CS. Conclusions:There were no differences in 10-year risk of AMI or CS between the Sami and non-Sami populations in 10 selected municipalities in Northern Norway.
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Affiliation(s)
- Susanna R A Siri
- 1 Centre for Sami Health Research, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tonje Braaten
- 2 Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjarne K Jacobsen
- 2 Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marita Melhus
- 1 Centre for Sami Health Research, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bent-Martin Eliassen
- 1 Centre for Sami Health Research, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Dragovic JT, Popovic J, Djuric P, Bulatovic A, Jankovic A, Buzadzic I, Dimkovic N. The 5A Allele of the MMP3-Gene Promoter Polymorphism Is a Risk Factor for Poor Outcome of Hemodialysis Patients. TOHOKU J EXP MED 2018; 242:273-279. [PMID: 28781337 DOI: 10.1620/tjem.242.273] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiovascular morbidity is the leading cause of death in dialysis patients and many risk factors have been involved in its pathogenesis. Genetic susceptibility may be of importance including polymorphism for matrix metalloproteinase 3 (MMP3), which is an enzyme that catalyzes the degradation of collagen, proteoglycans, fibronectin, laminine and elastin. The MMP3 gene promoter contains an insertion/deletion polymorphism characterised by an array of 5 or 6 adenosine residues (5A/6A) at -1612 position. Literature data show that the 5A or 6A allele of the MMP3 gene shows different risk for cardiovascular and overall outcome in general population. The aim was to analyze the -1612 5A/6A promoter polymorphism in a group of hemodialysis patients and to correlate the findings with cardiovascular morbidity and 7-year all-cause and cardiovascular mortality. This study included 196 patients on hemodialysis for longer than six months at University Medical Center Zvezdara. The leading causes of end stage renal disease were hypertension and diabetes mellitus. Venous blood was collected on midweek dialysis session and genotype analysis was performed by using polymerase chain reaction-restriction fragment length polymorphism method. Among the 198 hemodialysis patients, there were 142 (72%) 5A/6A heterozygotes, 12 (6%) 5A/5A homozygotes, and 44 (22%) 6A/6A homozygotes. These data are consistent with Hardy-Weinberg equilibrium. After 7-year follow-up, the 5A homozygotes showed the lowest all-cause and cardiovascular survival, while the 6A homozygotes showed the highest cardiovascular survival. The 5A allele of the MMP3-gene promoter polymorphism is a potential risk factor in the poor outcome of hemodialysis patients.
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Affiliation(s)
| | - Jovan Popovic
- Clinical Department for Renal Diseases, Zvezdara University Medical Center
| | - Petar Djuric
- Clinical Department for Renal Diseases, Zvezdara University Medical Center
| | - Ana Bulatovic
- Clinical Department for Renal Diseases, Zvezdara University Medical Center
| | | | - Ivana Buzadzic
- Departmant of Human Genetics and Prenatal Diagnostics, Zvezdara University Medical Center
| | - Nada Dimkovic
- Clinical Department for Renal Diseases, Zvezdara University Medical Center.,Faculty of Medicine, University of Belgrade
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Tadic M, Quarti-Trevano F, Bombelli M, Facchetti R, Cuspidi C, Mancia G, Grassi G. The importance of pulse pressure on cardiovascular risk and total mortality in the general population: Is sex relevant? J Clin Hypertens (Greenwich) 2018; 20:1001-1007. [PMID: 29701009 DOI: 10.1111/jch.13300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/20/2018] [Accepted: 04/02/2018] [Indexed: 11/27/2022]
Abstract
The aim of the present study is to investigate the predictive value of pulse pressure (PP) on cardiovascular events in the general population and in both sexes, separately. The study involved 2045 participants from the PAMELA study who underwent 24-hour ambulatory blood pressure (BP) monitoring. The participants were followed from the initial medical visit for a time interval of 137 ± 23 months. It was found that office, home, and 24-hour blood pressures were significantly higher in the individuals who experienced cardiovascular (CV) events. Office, 24-hour, and daytime PP were independent predictors of CV events after adjustment for main demographic and clinical parameters in the whole study population. Nighttime PP was an additional independent predictor in men. In conclusion, PP represents an important predictor of cardiovascular events in the general population, particularly among men. Daytime and 24-hour PP have greater predictive importance than nighttime PP in the general population.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michele Bombelli
- Department of Medicine and Surgery, University of Milan-Bicocca, Meda, Italy
| | - Rita Facchetti
- Department of Medicine and Surgery, University of Milan-Bicocca, Meda, Italy
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milan-Bicocca, Meda, Italy.,Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milan-Bicocca, Meda, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milan-Bicocca, Meda, Italy
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Rashid AKMM, Sultana H, Islam T, Bishwas P. Lipid Profile of Children Suffering from Pediatric Rheumatic Diseases (pRDS). Curr Rheumatol Rev 2018; 14:74-77. [PMID: 28828986 DOI: 10.2174/1573397113666170821165854] [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: 06/04/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Aim of this study was to assess the lipid status of the patients of pediatric rheumatologic diseases (pRDS). METHODS This observational study was carried out in the department of pediatrics, Khulna medical college hospital, Bangladesh for a period of one year. Total 23 patients were included in this study. These new cases were diagnosed according to the ILAR, ACR, and EULAR criteria. Early morning blood samples were sent to the laboratory for the assessment of lipid status (TC, TG, HDL, and LDL). These values were collected and statistically recorded. RESULTS Total new cases of pRDS were 23. Among them JIA was 15, SLE 4, and Vasculitis 4 in number. HSP was in 3 and KD in 1 cases of vasculitis group. Male/ Female ratio is 1.6:1. Mean age of the diseases were 8.54 years. TC, and TG was found in significant level in 4(17.4%), and 12(52.8%) pRDS cases respectively. HDL was observed of risk level in 4(17.3%) patients. LDL was observed normal in all the patients. TG was found of significant level in 7(46.7%) JIA, 3(75%) SLE and 2 (50%) vasculitis patients. CONCLUSION TG was the lipid observed in significant level in majority of the new pRDS cases. Elevated TG might be considered as an index of disease activity in all cases of pRDS. Measures could be adopted in all pRDS to control the lipid status from the beginning of illness to reduce the complications from dyslipidemia like atherosclerosis and cardiovascular morbidity and mortality in future.
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Affiliation(s)
| | - Habiba Sultana
- Department of Pediatrics, Khulna Medical College, Khulna, Bangladesh
| | - Tasnuva Islam
- Department of Pediatrics, Khulna Medical College, Khulna, Bangladesh
| | - Palash Bishwas
- Department of Pediatrics, Khulna Medical College, Khulna, Bangladesh
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Abstract
Background Drug-induced QT prolongation is associated with higher risk of cardiac arrhythmias and cardiovascular mortality. We investigated the effects of atypical antipsychotic drugs on QT interval in children and adults with mental disorders. Methods We conducted random-effects direct frequentist meta-analyses of aggregate data from randomized controlled trials (RCT) and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our search in PubMed, EMBASE, the Cochrane Library, clinicaltrials.gov, and PharmaPendium up to October 2017 identified studies that examined aripiprazole, quetiapine, risperidone, olanzapine, ziprasidone and brexpiprazole. Results Low quality evidence suggests that aripiprazole (four meta-analyses and twelve RCTs), brexpiprazole (one systematic review and four RCTs) or olanzapine (five meta-analyses and twenty RCTs) do not increase QT interval. Low quality evidence suggests that ziprasidone (five meta-analyses and 11 RCTs) increases QT interval and the rates of QT prolongation while risperidone (four meta-analyses, 70 RCTs) and quetiapine (two meta-analyses and seven RCTs) are associated with QT prolongation and greater odds of torsades de pointes ventricular tachycardia especially in cases of drug overdose. Conclusions The main conclusion of our study is that in people with mental disorders and under treatment with atypical antipsychotic drugs, in order to avoid QT prolongation and reduce the risk of ventricular tachycardia clinicians may recommend aripiprazole, brexpiprazole or olanzapine in licensed doses. Long-term comparative safety needs to be established.
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Affiliation(s)
- Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Tatyana A Shamliyan
- Quality Assurance, Evidence-Based Medicine Center, Elsevier, Philadelphia, PA, USA
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Kostaki S, Papadopoulou M, Angelopoulou SM, Margariti E, Savopoulos C, Hatzitolios AI. Effect of antihypertensive treatment on the long-term outcome of patients discharged after acute ischemic stroke. Clin Exp Hypertens 2017; 39:246-250. [PMID: 28448189 DOI: 10.1080/10641963.2016.1246561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We aimed to evaluate the effects of the five main classes of antihypertensive agents on the long-term outcome of 313 consecutive patients discharged after acute ischemic stroke (36.4% males, age 78.5 ± 6.3 years). One year after discharge, the functional status [evaluated with the modified Rankin scale (mRS)], the occurrence of cardiovascular events, and vital status were recorded. Patients prescribed angiotensin receptor blockers (ARBs) had lower mRS than patients not prescribed ARBs (1.7 ± 2.0 vs. 2.9 ± 2.5, respectively; p = 0.006). The rates of adverse outcome (mRS 2-6) and cardiovascular events did not differ between patients prescribed each one of the major classes of antihypertensive agents and those not prescribed the respective class. Patients who were prescribed ARBs had lower risk of death during follow-up than patients who did not receive ARBs (9.4 and 26.9%, respectively; p < 0.05). In binary logistic regression analysis, the only independent predictor of all-cause mortality during follow-up was the mRS at discharge (relative risk 1.69, 95% confidence interval 1.25-2.28; p < 0.001). In conclusion, in patients discharged after acute ischemic stroke, administration of ARBs appears to have a more beneficial effect on long-term functional outcome and all-cause mortality than treatment with other classes of antihypertensive agents.
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Affiliation(s)
- Konstantinos Tziomalos
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Vasilios Giampatzis
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Stella D Bouziana
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Marianna Spanou
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Stavroula Kostaki
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Maria Papadopoulou
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Stella-Maria Angelopoulou
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Eleni Margariti
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Christos Savopoulos
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
| | - Apostolos I Hatzitolios
- a First Propaedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
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Shapiro M, Levy Y. The association between hydroxychloroquine treatment and cardiovascular morbidity among rheumatoid arthritis patients. Oncotarget 2018; 9:6615-22. [PMID: 29464097 DOI: 10.18632/oncotarget.23570] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/05/2017] [Indexed: 12/20/2022] Open
Abstract
Objectives To examine the independent effect of hydroxychloroquine (HCQ) treatment on cardiovascular morbidity among RA patients. Materials and Methods A retrospective cohort study of RA patients treated at Meir medical center between 2003-2013 was conducted. Patients were divided into two groups, those who had been treated with HCQ during the course of their disease and those who had never received it. The two groups were compared for possible confounding factors. Study endpoints included arterial and venous thrombotic events. Results A total of 514 suitable RA patients were identified, 241 HCQ-treated and 273 non-treated patients. Of the HCQ-treated patients, 32 (13.3%) suffered from cardiovascular events compared to 104 (38.1%) of the non-treated group. HCQ treatment had a significant protective effect for all cardiovascular events examined (HR = 0.456 CI 0.287 to 0.726) as well as arterial events alone (HR = 0.461 CI 0.274 to 0.778). A dose of 400 mg HCQ per day demonstrated a protective effect for any cardiovascular event (HR = 0.432 CI 0.243 to 0.768), while the lower dose of 200 mg per day showed no significant protective effect. Conclusions The use of HCQ is independently associated with decreased risk for cardiovascular morbidity among RA patients, particularly with a higher dose of 400 mg per day. This newly demonstrated effect of HCQ should be considered in the overall management of RA.
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Aronow WS, Shamliyan TA. Comparative effectiveness and safety of empagliflozin on cardiovascular mortality and morbidity in adults with type 2 diabetes. Ann Transl Med 2017; 5:455. [PMID: 29285488 DOI: 10.21037/atm.2017.08.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Based on a single placebo-controlled randomized clinical trial, empagliflozin is licensed to reduce cardiovascular death in diabetes and comorbid cardiovascular disease. Methods We examined the comparative effectiveness of empagliflozin on mortality and cardiovascular morbidity in type 2 diabetes. We conducted random-effects direct frequentist meta-analyses of aggregate data and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our search in PubMed, EMBASE, the Cochrane Library, clinicaltrials.gov, and PharmaPendium up to May 2017 identified 11 meta-analyses, multiple publications, and unpublished data from 29 randomized controlled trials (RCTs). Results Empagliflozin reduces all-cause mortality [relative risk (RR) of death, 0.69; 95% confidence interval (CI): 0.58-0.82; number needed to treat (NNT) to postpone mortality in one patient, 39; 95% CI: 26-79; 1 RCT of 7,020 patients) in patients with but not without (RR, 0.90; 95% CI: 0.36-2.23; 14 RCTs of 7,707 patients) established cardiovascular disease when compared with placebo. Empagliflozin reduces cardiovascular mortality (RR, 0.62; 95% CI: 0.50-0.78; NNT, 45; 95% CI: 30-90; 1 RCT of 7,020 patients) in patients with but not without (RR, 0.98; 95% CI: 0.29-3.33; 10 RCTs of 5,429 patients) established cardiovascular disease when compared with placebo. There are no differences in cardiovascular morbidity and mortality and all-cause mortality between empagliflozin and metformin (4 RCTs of 1,344 patients), glimepiride (1 RCT of 1,549 patients), linagliptin (2 RCTs of 1,348 patients), or sitagliptin (3 RCTs of 1,483 patients). Two network meta-analyses concluded that sodium-glucose cotransporter 2 (SGLT2) inhibitors, mostly due to empagliflozin, decrease all-cause and cardiovascular mortality but increase the risk of nonfatal stroke, genital infection, and volume depletion. Conclusions We conclude that empagliflozin reduces all-cause and cardiovascular mortality in patients with established cardiovascular disease and type 2 diabetes. Sparse direct evidence suggests no difference in mortality between empagliflozin and metformin, glimepiride, linagliptin, or sitagliptin. Long-term comparative safety needs to be established.
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Affiliation(s)
- Wilbert S Aronow
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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Shafi T, Hostetter TH, Meyer TW, Hwang S, Hai X, Melamed ML, Banerjee T, Coresh J, Powe NR. Serum Asymmetric and Symmetric Dimethylarginine and Morbidity and Mortality in Hemodialysis Patients. Am J Kidney Dis 2017; 70:48-58. [PMID: 28089476 DOI: 10.1053/j.ajkd.2016.10.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 07/03/2016] [Accepted: 10/26/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Asymmetric (ADMA) and symmetric dimethylarginine (SDMA) are putative uremic toxins that may exert toxicity by a number of mechanisms, including impaired nitric oxide synthesis and generation of reactive oxygen species. The study goal was to determine the association between these metabolites and cardiovascular outcomes in hemodialysis patients. STUDY DESIGN Post hoc analysis of the Hemodialysis (HEMO) Study. SETTING & PARTICIPANTS 1,276 prevalent hemodialysis patients with available samples 3 to 6 months after randomization. PREDICTOR ADMA and SDMA measured in stored specimens. OUTCOMES Cardiac death, sudden cardiac death, first cardiovascular event, and any-cause death. Association with predictors analyzed using Cox regression adjusted for potential confounders (including demographics, clinical characteristics, comorbid conditions, albumin level, and residual kidney function). RESULTS Mean age of patients was 57±14 (SD) years, 63% were black, and 57% were women. Mean ADMA (0.9±0.2μmol/L) and SDMA levels (4.3±1.4μmol/L) were moderately correlated (r=0.418). Higher dialysis dose or longer session length were not associated with lower predialysis ADMA or SDMA concentrations. In fully adjusted models, each doubling of ADMA level was associated with higher risk (HR per 2-fold higher concentration; 95% CI) of cardiac death (1.83; 1.29-2.58), sudden cardiac death (1.79; 1.19-2.69), first cardiovascular event (1.50; 1.20-1.87), and any-cause death (1.44; 1.13-1.83). Compared to the lowest ADMA quintile (<0.745 μmol/L), the highest ADMA quintile (≥1.07μmol/L) was associated with higher risk (HR; 95% CI) of cardiac death (2.10; 1.44-3.05), sudden cardiac death (2.06; 1.46-2.90), first cardiovascular event (1.75; 1.35-2.27), and any-cause death (1.56; 1.21-2.00). SDMA level was associated with higher risk for cardiac death (HR, 1.40; 95% CI, 1.03-1.92), but this was no longer statistically significant after adjusting for ADMA level (HR, 1.20; 95% CI, 0.86-1.68). LIMITATIONS Single time-point measurement of ADMA and SDMA. CONCLUSIONS ADMA and, to a lesser extent, SDMA levels are associated with cardiovascular outcomes in hemodialysis patients.
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Affiliation(s)
- Tariq Shafi
- Department of Medicine, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD.
| | - Thomas H Hostetter
- Department of Medicine, Case Western University School of Medicine, Cleveland, OH
| | - Timothy W Meyer
- Department of Medicine, Palo Alto Veterans Affairs Health Care System and Stanford University, Palo Alto, CA
| | | | - Xin Hai
- Department of Medicine, Case Western University School of Medicine, Cleveland, OH
| | - Michal L Melamed
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | - Josef Coresh
- Department of Medicine, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Neil R Powe
- Department of Medicine, University of California, San Francisco, CA
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Tosic Dragovic J, Popovic J, Djuric P, Jankovic A, Bulatovic A, Barovic M, Pravica V, Marinkovic J, Dimkovic N. Relative risk for cardiovascular morbidity in hemodialysis patients regarding gene polymorphism for IL-10, IL-6, and TNF. Can J Physiol Pharmacol 2016; 94:1106-1109. [PMID: 27580171 DOI: 10.1139/cjpp-2015-0569] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Uremia-related inflammation is prone to be a key factor to explain high cardiovascular morbidity in hemodialysis patients. Genetic susceptibility may be of importance, including IL-10, IL-6, and TNF. The aim was to analyze IL-10, IL-6, and TNF gene polymorphisms in a group of hemodialysis patients and to correlate the findings with cardiovascular morbidity. This study included 169 patients on regular hemodialysis at Zvezdara University Medical Center. Gene polymorphisms for IL-10, IL-6 and TNF were determined using PCR. These findings were correlated with the cardiovascular morbidity data from patient histories. Heterozygots for IL-10 gene showed significantly lower incidence of cardiovascular events (p = 0.05) and twice lower risk for development of myocardial infarction, but experienced twice higher risk for left ventricular hypertrophy. Regarding TNF gene polymorphism, patients with A allele had 1.5-fold higher risk for cerebrovascular accident and cardiovascular events and 2-fold higher risk for hypertension and peripheral vascular disease. Patients with G allele of IL-6 gene experienced 1.5-fold higher risks for cerebrovascular accident. We need studies with larger number of patients for definitive conclusion about the influence of gene polymorphisms on cardiovascular morbidity in hemodialysis patients and its importance in everyday clinical practice.
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Affiliation(s)
- J Tosic Dragovic
- a Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000 Belgrade, Serbia
| | - J Popovic
- a Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000 Belgrade, Serbia
| | - P Djuric
- a Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000 Belgrade, Serbia
| | - A Jankovic
- a Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000 Belgrade, Serbia
| | - A Bulatovic
- a Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000 Belgrade, Serbia
| | - M Barovic
- b Medical Faculty, Belgrade University, Dr Subotica 9, 11000 Belgrade, Serbia
| | - V Pravica
- b Medical Faculty, Belgrade University, Dr Subotica 9, 11000 Belgrade, Serbia
| | - J Marinkovic
- b Medical Faculty, Belgrade University, Dr Subotica 9, 11000 Belgrade, Serbia
| | - N Dimkovic
- a Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000 Belgrade, Serbia.,b Medical Faculty, Belgrade University, Dr Subotica 9, 11000 Belgrade, Serbia
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Scailteux LM, Naudet F, Alimi Q, Vincendeau S, Oger E. Mortality, cardiovascular risk, and androgen deprivation therapy for prostate cancer: A systematic review with direct and network meta-analyses of randomized controlled trials and observational studies. Medicine (Baltimore) 2016; 95:e3873. [PMID: 27310974 PMCID: PMC4998460 DOI: 10.1097/md.0000000000003873] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
UNLABELLED Androgen deprivation therapy (ADT) is a cornerstone therapy for advanced prostate cancer (PCa). We hypothesized that cardiovascular (CV) risk is different across the various ADT modalities to compare their effects on CV morbidity and mortality, and all-cause mortality in patients with PCa. To investigate more in depth potential CV risk heterogeneity focusing on coronary (main outcome) and cerebrovascular risk, CV, and overall mortality. We performed a Medline and Embase query, without language restriction, since 1950 up to July 2014. We included randomized controlled trials (RCTs) and observational studies providing that they compared at least 1 ADT modality to another one or to placebo and they gave data on CV event or all-cause mortality. Sixty-eight studies out of 3419 met our eligibility criteria. Eleven observational studies were analyzed. Direct meta-analyses showed that antiandrogen was associated with a 30% decrease risk for myocardial infarction (MI) compared to GnRH agonists (RR, 0.70 [0.54-0.91]); combined androgen blockade (CAB) was associated with a 10% increase risk for stroke when compared to antiandrogen (RR, 1.10 [1.02-1.19]). With regard to RCTs, 57 were included: direct meta-analyses suggested that CAB was associated with a 10% decrease of all-cause mortality when compared to GnRH agonist (RR, 0.90 [0.82-1.00]). Network analysis could only be performed for all-cause mortality and it remains difficult to disentangle benefit (positive impact on cancer survival) and risk (including CV risk). The impact of the ADT modalities on CV morbidity remains difficult to quantify and more detailed prospective collection is required. REGISTRATION PROSPERO, CRD42014010598.
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Affiliation(s)
- Lucie-Marie Scailteux
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France
| | - Florian Naudet
- Clinical Investigation Center, INSERM 1414, Rennes University Hospital and University of Rennes 1, Rennes, France
| | - Quentin Alimi
- Urology Department, Rennes University Hospital, Rennes, France
| | | | - Emmanuel Oger
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France
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Paul N, Vuddanda V, Mujib M, Aronow WS. Advances in our understanding of the influence of gender on patient outcomes with peripheral arterial disease co-occurring with diabetes. Expert Rev Endocrinol Metab 2016; 11:271-279. [PMID: 30058932 DOI: 10.1080/17446651.2016.1175936] [Citation(s) in RCA: 3] [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] [Indexed: 10/22/2022]
Abstract
Peripheral arterial disease is an important predictor of cardiovascular morbidity and mortality. Patients with peripheral arterial disease are at a higher risk of myocardial infarction and stroke. The well-known coronary artery disease risk factors such as diabetes, hypertension, smoking and dyslipidemia are also risk factors for peripheral arterial disease. Hyperglycemia is an important mediator in the pathogenesis of this disease in diabetics, more so in women. The morbidity and poor outcomes associated with peripheral arterial disease in women are emerging. Women are more likely to present at an older age are often asymptomatic and have poorer outcomes with revascularization. Women experience specific sex-related challenges in the various diagnostic methods which could lead to a delay in diagnosis. This is a group which needs close attention and aggressive risk factor modification.
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Affiliation(s)
- Neha Paul
- a Department of Medicine , New York Medical College , Valhalla , NY , USA
| | - Venkat Vuddanda
- a Department of Medicine , New York Medical College , Valhalla , NY , USA
| | - Marjan Mujib
- a Department of Medicine , New York Medical College , Valhalla , NY , USA
| | - Wilbert S Aronow
- b Division of Cardiology , New York Medical College , Valhalla , NY , USA
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Muslimovic A, Rasic S, Tulumovic D, Hasanspahic S, Rebic D. Inflammatory Markers and Procoagulants in Chronic Renal Disease Stages 1-4. Med Arch 2015; 69:307-10. [PMID: 26622082 PMCID: PMC4639342 DOI: 10.5455/medarh.2015.69.307-310] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 08/25/2015] [Accepted: 10/05/2015] [Indexed: 01/07/2023] Open
Abstract
Introduction: Starting from the point that the chronic kidney disease (CKD) is chronic, inflammatory and hypercoagulable state characterized by an increase in procoagulant and inflammatory markers high cardiovascular morbidity and mortality in these patients could be explained. Aim: The aim of the research was to monitor inflammatory markers and procoagulants in various stages of kidney disease (stage 1-4). Materials and Methods: The research included 120 subjects older than 18 years with CKD stages 1-4 examined and monitored in Clinic of Nephrology, University Clinical Centre Sarajevo over a period of 24 months. The research included determining the following laboratory parameters: serum creatinine, serum albumin, C-reactive protein, leukocytes in the blood, plasma fibrinogen, D-dimer, antithrombin III, coagulation factors VII (FC VII) and coagulation factor VIII (FC VIII). Results: With the progression of kidney disease (CKD stages 1-4), there was a significant increase of inflammatory and procoagulant markers: CRP, fibrinogen and coagulation factor VIII, and an increase in the average values of leukocytes and a reduction in the value of antithrombin III, but without statistical significance. Also, there were no significant differences in the values of D-dimer and coagulation factor VII. Conclusion: The progression of kidney disease is significantly associated with inflammation, which could in the future be useful in prognostic and therapeutic purposes. Connection of CKD with inflammation and proven connection of inflammation with cardiovascular risk indicates the potential value of some biomarkers, which could in the future identify as predictors of outcome and could have the benefit in the early diagnosis and treatment of cardiovascular disease in CKD.
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Affiliation(s)
- Alma Muslimovic
- Clinic of Nephrology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Senija Rasic
- Clinic of Nephrology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Denijal Tulumovic
- Department of Nephrology, Dialysis and Kidney Transplantation, University Clinical Center Tuzla, Tuzla, Bosna and Herzegovina
| | - Senad Hasanspahic
- Clinic of Nephrology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Damir Rebic
- Clinic of Nephrology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
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Ramesh S, Mann MC, Holroyd-Leduc JM, Wilton SB, James MT, Seely EW, Ahmed SB. The effect of hormone therapy on all-cause and cardiovascular mortality in women with chronic kidney disease: protocol for a systematic review and meta-analysis. Syst Rev 2015; 4:44. [PMID: 25874808 PMCID: PMC4414431 DOI: 10.1186/s13643-015-0020-8] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/25/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease affects approximately one in ten North Americans and is associated with a high risk of cardiovascular disease. Chronic kidney disease in women is characterized by an abnormal sex hormone profile and low estradiol levels. Since low estradiol levels are associated with an increased cardiovascular risk in healthy women, our objective is to determine the effect of hormone therapy on all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in women with chronic kidney disease. METHODS/DESIGN Studies examining hormone therapy for adult women with chronic kidney disease will be included. The primary outcome is all-cause or cardiovascular mortality and morbidity. We will search electronic bibliographic databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL)) along with relevant conference proceedings, table of contents of journals, and review articles. Two investigators will independently screen identified abstracts and select observational cohort studies, case-control studies, and randomized controlled trials examining hormone therapy in women with chronic kidney disease. These investigators will also independently abstract data from relevant full-text journal articles and assess risk of bias. Where possible, these data will be summarized using pooled or combined estimates for the risk ratio or hazard ratio of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in women with chronic kidney disease with and without hormone therapy. A random effects model will be used, and meta-regression and subgroup analyses will be used to explore potential source of heterogeneity. DISCUSSION Given the high burden of cardiovascular disease in women with chronic kidney disease, this study will help guide clinical practice by summarizing current evidence on the use of hormone therapy for prevention of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in this population. SYSTEMATIC REVIEW REGISTRATION The final protocol was registered with PROSPERO ( CRD42014014566) .
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Affiliation(s)
- Sharanya Ramesh
- Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Alberta, Canada. .,Libin Cardiovascular Institute of Alberta, 1403 29 Street NW, Calgary, T2N 2T9, Alberta, Canada.
| | - Michelle C Mann
- Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Alberta, Canada. .,Libin Cardiovascular Institute of Alberta, 1403 29 Street NW, Calgary, T2N 2T9, Alberta, Canada.
| | - Jayna M Holroyd-Leduc
- Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Alberta, Canada.
| | - Stephen B Wilton
- Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Alberta, Canada. .,Libin Cardiovascular Institute of Alberta, 1403 29 Street NW, Calgary, T2N 2T9, Alberta, Canada.
| | - Matthew T James
- Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Alberta, Canada. .,Libin Cardiovascular Institute of Alberta, 1403 29 Street NW, Calgary, T2N 2T9, Alberta, Canada. .,Alberta Kidney Disease Network, 1403-29th St. NW, C210, Calgary, T2N 2T9, Alberta, Canada.
| | - Ellen W Seely
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
| | - Sofia B Ahmed
- Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Alberta, Canada. .,Libin Cardiovascular Institute of Alberta, 1403 29 Street NW, Calgary, T2N 2T9, Alberta, Canada. .,Alberta Kidney Disease Network, 1403-29th St. NW, C210, Calgary, T2N 2T9, Alberta, Canada.
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Muslimovic A, Tulumovic D, Hasanspahic S, Hamzic-Mehmedbasic A, Temimovi R. Serum cystatin C - marker of inflammation and cardiovascular morbidity in chronic kidney disease stages 1-4. Mater Sociomed 2015; 27:75-8. [PMID: 26005379 PMCID: PMC4404983 DOI: 10.5455/msm.2015.27.75-78] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 03/10/2015] [Accepted: 04/03/2015] [Indexed: 01/01/2023] Open
Abstract
Aim: The aim of the research was to compare the relationship between inflammatory biomarkers and procoagulants with kidney function assessed by using cystatin C, serum creatinine, and eGFR and determine the sensitivity of cystatin C, serum creatinine and eGFR to total cardiovascular morbidity in patients with CKD stages 1-4. Methods: The research included 120 patients older than 18 years with CKD stages 1-4 monitored over a period of 24 months. Results: Serum cystatin C correlates with fibrinogen (p<0.01), serum albumin (p<0.01), D-dimer (p<0.05), antithrombin III (p<0.01) strongly in relation to the evaluation of kidney function based on serum creatinine and eGFR. By following cystatin C, creatinine and eGFR with comparison of ROC to total cardiovascular morbidity, the highest sensitivity in relation to the presence of cardiovascular morbidity shows cystatin C, then eGFR and the lowest, creatinine, with a significant difference between cystatin C and serum creatinine (p<0.05). Conclusion: Serum cystatin C is more strongly correlated with some biomarkers (fibrinogen, serum albumin, D-dimer, antithrombin III), while simultaneously showing a stronger sensitivity in relation to total cardiovascular morbidity compared with the assessment of kidney function based on serum creatinine and eGFR.
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Affiliation(s)
- Alma Muslimovic
- Clinic of Nephrology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Denijal Tulumovic
- Department of Nephrology, Dialysis and Kidney Transplantation, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Senad Hasanspahic
- Clinic of Nephrology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Ramajana Temimovi
- Institute for Occupational Medicine of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina
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