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Joseph P, Roy A, Lonn E, Störk S, Floras J, Mielniczuk L, Rouleau JL, Zhu J, Dzudie A, Balasubramanian K, Karaye K, AlHabib KF, Gómez-Mesa JE, Branch KR, Makubi A, Budaj A, Avezum A, Wittlinger T, Ertl G, Mondo C, Pogosova N, Maggioni AP, Orlandini A, Parkhomenko A, ElSayed A, López-Jaramillo P, Grinvalds A, Temizhan A, Hage C, Lund LH, Kazmi K, Lanas F, Sharma SK, Fox K, McMurray JJV, Leong D, Dokainish H, Khetan A, Yonga G, Kragholm K, Wagdy Shaker K, Mwita JC, Al-Mulla AA, Alla F, Damasceno A, Silva-Cardoso J, Dans AL, Sliwa K, O'Donnell M, Bazargani N, Bayés-Genís A, McCready T, Probstfield J, Yusuf S. Global Variations in Heart Failure Etiology, Management, and Outcomes. JAMA 2023; 329:1650-1661. [PMID: 37191704 PMCID: PMC10189564 DOI: 10.1001/jama.2023.5942] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
Importance Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants Multinational HF registry of 23 341 participants in 40 high-income, upper-middle-income, lower-middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures HF cause, HF medication use, hospitalization, and death. Results Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper-middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower-middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper-middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower-middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper-middle-income countries (ratio = 2.4), similar in lower-middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper-middle-income countries (9.7%), then lower-middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower-middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.
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Affiliation(s)
- Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Eva Lonn
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Stefan Störk
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Department Internal Medicine, University Hospital, Würzburg, Germany
| | - John Floras
- Mount Sinai Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Mielniczuk
- University of Ottawa, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Jun Zhu
- FuWai Hospital, Beijing, China
| | - Anastase Dzudie
- Department of Global Health and Population, Lown Scholars Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kumar Balasubramanian
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Kamilu Karaye
- Bayero University and Aminu Kano Teaching Hospital, Department of Medicine, Kano, Nigeria
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Abel Makubi
- Community Development, Gender, Elderly, and Children, Ministry of Health, Dodoma, Tanzania
| | - Andrzej Budaj
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Thomas Wittlinger
- Department of Cardiology, Asklepios Hospital Goslar, Goslar, Germany
| | - Georg Ertl
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Department Internal Medicine, University Hospital, Würzburg, Germany
| | | | - Nana Pogosova
- Medical Research Center of Cardiology named after E.I. Chazov, Moscow, Russia
| | | | - Andres Orlandini
- Estudios Clínicos Latino America Collaborative Group, Rosario, Argentina
| | - Alexander Parkhomenko
- Emergency Cardiology Department, National Scientific Centre, Strazhesko Institute of Cardiology, Kiev, Ukraine
| | | | | | - Alex Grinvalds
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ahmet Temizhan
- Clinic of Cardiology, University of Health Science, Ankara City Hospital, Ankara, Türkiye
| | - Camilla Hage
- Karolinska Institutet, Department of Medicine, Cardiology Unit, Stockholm, Sweden
- Karolinska University Hospital, Heart and Vascular Theme, Heart Failure Section, Stockholm, Sweden
| | - Lars H Lund
- Karolinska Institutet, Department of Medicine, Cardiology Unit, Stockholm, Sweden
- Karolinska University Hospital, Heart and Vascular Theme, Heart Failure Section, Stockholm, Sweden
| | - Khawar Kazmi
- Department of Cardiology, Aga Khan University, Karachi, Pakistan
| | | | | | - Keith Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Darryl Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Hisham Dokainish
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Aditya Khetan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gerald Yonga
- University of Nairobi, Department of Clinical Medicine and Therapeutics, Nairobi, Nairobi City County, Kenya
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kerolos Wagdy Shaker
- Aswan Heart Center, Magdi Yacoub Foundation, Department of Cardiology, Aswan, Egypt
| | | | | | - François Alla
- Bordeaux Population Health Research Center, Université de Bordeaux, Bordeaux, France
| | | | - José Silva-Cardoso
- Faculty of Medicine, University of Porto, Porto, Portugal
- São João University Hospital Centre, Porto, Portugal
| | - Antonio L Dans
- University of the Philippines, Medicine, Quezon City, National Capital Region, Philippines
| | - Karen Sliwa
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Martin O'Donnell
- College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
| | | | - Antoni Bayés-Genís
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, CIBERCV, Spain
| | - Tara McCready
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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2
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Johansson I, Balasubramanian K, Bangdiwala S, Mielniczuk L, Hage C, Sharma SK, Branch K, Zhu J, Kragholm K, Sliwa K, Alla F, Yonga G, Roy A, Orlandini A, Grinvalds A, McCready T, Pogosova N, Störk S, McMurray JJ, Conen D, Yusuf S. Factors associated with health‐related quality of life in heart failure in 23,000 patients from 40 countries: Results of the
G‐CHF
Research Program. Eur J Heart Fail 2022; 24:1478-1490. [DOI: 10.1002/ejhf.2535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Isabelle Johansson
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
| | | | - Shrikant Bangdiwala
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
| | - Lisa Mielniczuk
- Division of Cardiology University of Ottawa Heart Institute, Ottawa Ontario
| | - Camilla Hage
- Karolinska University Hospital Heart, Vascular and Neuro Theme Heart Failure Section
- Karolinska Institutet Department of Medicine Cardiology Unit
| | | | - Kelly Branch
- Division of Cardiology University of Washington School of Medicine Seattle
| | - Jun Zhu
- 3 Fuwai Hospital, CAMS & PUMC China
| | | | - Karen Sliwa
- Cape Heart Institute, Department of Medicine and Cardiology, Faculty of Health Sciences University of Cape Town
| | - Francois Alla
- Bordeaux Population Health Research Center. Inserm Université de Bordeaux Bordeaux France
- Prevention department, CHU, Bordeaux, France. Bordeaux Population Health Research Center. Inserm Université de Bordeaux Bordeaux France
| | | | - Ambuj Roy
- Department of Cardiology All India Institute of Medical Sciences, New Delhi Delhi India
| | | | - Alex Grinvalds
- Population Health Research Institute McMaster University Hamilton Canada
| | - Tara McCready
- Population Health Research Institute McMaster University Hamilton Canada
| | - Nana Pogosova
- National Medical Research Center of Cardiology Moscow Russia
| | - Stefan Störk
- Comprehensive Heart Failure Center University and University Hospital Würzburg Würzburg Germany
| | | | - David Conen
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
| | - Salim Yusuf
- Population Health Research Institute McMaster University Hamilton Canada
- Department of Health Research Methods, Evidence, and Impact McMaster University Faculty of Health Sciences Hamilton
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3
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Eikelboom J, Rangarajan S, Jolly SS, Belley-Cote EP, Whitlock R, Beresh H, Lewis G, Xu L, Chan N, Bangdiwala S, Diaz R, Orlandini A, Hassany M, Tarhuni WM, Yusufali AM, Sharma SK, Konstsevaya A, Jaramillo PL, Avezum A, Dans AL, Wasserman S, Camilo F, Kazmi K, Pais P, Xavier D, Lopes RD, Berwanger O, Nkeshimana M, Harper W, Loeb M, Choudhri S, Farkouh ME, Bosch J, Anand SS, Yusuf S. The Anti-Coronavirus Therapy (ACT) trials: design, baseline characteristics, and challenges. CJC Open 2022; 4:568-576. [PMID: 35252829 PMCID: PMC8887957 DOI: 10.1016/j.cjco.2022.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/18/2022] [Indexed: 12/14/2022] Open
Abstract
Background Effective treatments for COVID-19 are urgently needed, but conducting randomized trials during the pandemic has been challenging. Methods The Anti-Coronavirus Therapy (ACT) trials are parallel factorial international trials that aimed to enroll 3500 outpatients and 2500 inpatients with symptomatic COVID-19. The outpatient trial is evaluating colchicine vs usual care, and aspirin vs usual care. The primary outcome for the colchicine randomization is hospitalization or death, and for the aspirin randomization, it is major thrombosis, hospitalization, or death. The inpatient trial is evaluating colchicine vs usual care, and the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily vs usual care. The primary outcome for the colchicine randomization is need for high-flow oxygen, need for mechanical ventilation, or death, and for the rivaroxaban plus aspirin randomization, it is major thrombotic events, need for high-flow oxygen, need for mechanical ventilation, or death. Results At the completion of enrollment on February 10, 2022, the outpatient trial had enrolled 3917 patients, and the inpatient trial had enrolled 2611 patients. Challenges encountered included lack of preliminary data about the interventions under evaluation, uncertainties related to the expected event rates, delays in regulatory and ethics approvals, and in obtaining study interventions, as well as the changing pattern of the COVID-19 pandemic. Conclusions The ACT trials will determine the efficacy of anti-inflammatory therapy with colchicine, and antithrombotic therapy with aspirin given alone or in combination with rivaroxaban, across the spectrum of mild, moderate, and severe COVID-19. Lessons learned from the conduct of these trials will inform planning of future trials.
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Affiliation(s)
- John Eikelboom
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Sanjit S Jolly
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Emilie P Belley-Cote
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Richard Whitlock
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Heather Beresh
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Gayle Lewis
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Lizhen Xu
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada
| | - Noel Chan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Shrikant Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Rafael Diaz
- ECLA (Estudios Clínicos Latino America) ICR (Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Andres Orlandini
- ECLA (Estudios Clínicos Latino America) ICR (Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Wadea M Tarhuni
- Dept of Medicine, University of Saskatchewan, Saskatoon , Canada.,Dept of Medicine, Western University, Clinical Skills Building London, Canada.,Windsor Cardiac Centre, Windsor, Canada
| | - A M Yusufali
- Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, UAE
| | | | - Anna Konstsevaya
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russian Federation
| | | | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Felix Camilo
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Ecuador
| | - Khawar Kazmi
- National Institute of Cardiovascular Diseases, Rafique Shaheed Road, Karachi, Pakistan
| | - Prem Pais
- St. John's Research Institute, Bangalore, India
| | - Denis Xavier
- St. John's Medical College, St. John's Research Institute, Bangalore, India
| | - Renato D Lopes
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, North Carolina, USA
| | - Otavio Berwanger
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Global Cardiovascular Coalition, Alameda Campinas, São Paulo, Brazil
| | - Menelas Nkeshimana
- Centre Hospitalier Universitaire de Kigali, Rwanda.,University of Rwanda, Dept. Of Internal Medicine, Kigali, Rwanda
| | - William Harper
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Mark Loeb
- Departments of Pathology and Molecular Medicine and Health Evidence Methods, Evidence, and Impact, McMaster University. Hamilton, Canada
| | - Shurjeel Choudhri
- Bayer Inc., Medical & Scientific Affairs, Pharmaceuticals, Mississauga, Canada
| | | | - Jackie Bosch
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Sonia S Anand
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
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4
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Chavez Caballero RD, Tuero E, Orlandini A. Evaluation of ventricular strain values in patients after coronavirus 2019 infection. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
During the first months of coronavirus disease 2019 (COVID 19) pandemic there were several reports of myocardial involvement in recovered patients despite of symptoms presented during acute phase of the infection. That information led to a rising number of recomendations of screening for myocardial damage with different methods like electrocardiogram, echocardiography, cardiac magnetic resonance and biomarkers in the pursuit of a cardiac event free return to normal activities. Because of this and knowing the capability of strain imaging to detect subclinical myocardial damage we decided to evaluate values of left ventricular global longitudinal strain (GLS) and right ventricular free wall strain (RVFWS) in patients that were derived for echocardiographic evaluation after COVID 19 infection and their evolution.
Methods
We enrolled prospectively patients derived to our laboratory for evaluation of Doppler echocardiography after confirmed COVID 19 infection if they were in the month after clinical discharge and did not have previous known structural cardiac alterations. We obtained demographic, symptoms and echocardiographic data and calculated GLS and RVFWS. Six months after the index examination we did phone calls to asess symptoms and events. Data is presented with mean and standard deviation and percentages.
Results
Of 68 patients included 38 (55,88%) were male, mean age was 42 years (+- 12,5) and half of them were sedentary. 52 had mild symptoms during infection, 15 moderate and 1 severe that required mechanical ventilation. At the time of examination 58 were asymptomatic (85,29%) and the other complaint of dyspnea (3), weakness (8) and palpitations (6). Regarding echocardiographic data, mean eyection fraction estimated by Simpson´s biplane method was 65,6% (+- 4,33) and left atrial indexed volume 25 ml/m2 (+- 5,98). 44 patients had normal left ventricular diastolic function, 21 grade 1 dysfunction and 2 had grade 2, with mean E/e´ relation 8,52 (+-2,03). Mean pulmonary artery systolic pressure estimated was 27,4 mmHg (+- 4,1) and tricuspid anular plane systolic excursion was 23,81 mm (+-3,12). Mean GLS was – 21,52% (+- 1,91) and RVFWS was – 29,15% (+- 5,4), in 2 patients we could not measure RVFWS due to bad quality of images. Only 2 patients had GLS above – 18%, thta were the patient with severe symptoms and 1 with moderate symptoms; and 10 had RVFWS above – 23%, all of them with moderate symptoms. We could contact 60 patients (88,23%) after 6 months and none of them had cardiac events or persistence of symptoms.
Conclusions
Calculation of GLS and RVFWS in this patients was feasible. We observed abnormalities in patients with severe and moderate symptoms at the time of infection, more frequently in RVFWS, but without relation to cardiac events or symptoms on follow up. Abstract Figure. GLS and RVFWS values
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Affiliation(s)
| | - E Tuero
- Cardiovascular Institute of Rosario (ICR), Rosario, Argentina
| | - A Orlandini
- Cardiovascular Institute of Rosario (ICR), Rosario, Argentina
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5
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Sathish T, Teo KK, Britz-McKibbin P, Gill B, Islam S, Paré G, Rangarajan S, Duong M, Lanas F, Lopez-Jaramillo P, Mony PK, Pinnaka L, Kutty VR, Orlandini A, Avezum A, Wielgosz A, Poirier P, Alhabib KF, Temizhan A, Chifamba J, Yeates K, Kruger IM, Khatib R, Yusuf R, Rosengren A, Zatonska K, Iqbal R, Lui W, Lang X, Li S, Hu B, Dans AL, Yusufali AH, Bahonar A, O’Donnell MJ, McKee M, Yusuf S. Variations in risks from smoking between high-income, middle-income, and low-income countries: an analysis of data from 179 000 participants from 63 countries. The Lancet Global Health 2022; 10:e216-e226. [DOI: 10.1016/s2214-109x(21)00509-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022] Open
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6
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Khetan AK, Yusuf S, Lopez-Jaramillo P, Szuba A, Orlandini A, Mat-Nasir N, Oguz A, Gupta R, Avezum Á, Rosnah I, Poirier P, Teo KK, Wielgosz A, Lear SA, Palileo-Villanueva LM, Serón P, Chifamba J, Rangarajan S, Mushtaha M, Mohan D, Yeates K, McKee M, Mony PK, Walli-Attaei M, Khansaheb H, Rosengren A, Alhabib KF, Kruger IM, Paucar MJ, Mirrakhimov E, Assembekov B, Leong DP. Variations in the financial impact of the COVID-19 pandemic across 5 continents: A cross-sectional, individual level analysis. EClinicalMedicine 2022; 44:101284. [PMID: 35106472 PMCID: PMC8794545 DOI: 10.1016/j.eclinm.2022.101284] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND COVID-19 has caused profound socio-economic changes worldwide. However, internationally comparative data regarding the financial impact on individuals is sparse. Therefore, we conducted a survey of the financial impact of the pandemic on individuals, using an international cohort that has been well-characterized prior to the pandemic. METHODS Between August 2020 and September 2021, we surveyed 24,506 community-dwelling participants from the Prospective Urban-Rural Epidemiology (PURE) study across high (HIC), upper middle (UMIC)-and lower middle (LMIC)-income countries. We collected information regarding the impact of the pandemic on their self-reported personal finances and sources of income. FINDINGS Overall, 32.4% of participants had suffered an adverse financial impact, defined as job loss, inability to meet financial obligations or essential needs, or using savings to meet financial obligations. 8.4% of participants had lost a job (temporarily or permanently); 14.6% of participants were unable to meet financial obligations or essential needs at the time of the survey and 16.3% were using their savings to meet financial obligations. Participants with a post-secondary education were least likely to be adversely impacted (19.6%), compared with 33.4% of those with secondary education and 33.5% of those with pre-secondary education. Similarly, those in the highest wealth tertile were least likely to be financially impacted (26.7%), compared with 32.5% in the middle tertile and 30.4% in the bottom tertile participants. Compared with HICs, financial impact was greater in UMIC [odds ratio of 2.09 (1.88-2.33)] and greatest in LMIC [odds ratio of 16.88 (14.69-19.39)]. HIC participants with the lowest educational attainment suffered less financial impact (15.1% of participants affected) than those with the highest education in UMIC (22.0% of participants affected). Similarly, participants with the lowest education in UMIC experienced less financial impact (28.3%) than those with the highest education in LMIC (45.9%). A similar gradient was seen across country income categories when compared by pre-pandemic wealth status. INTERPRETATION The financial impact of the pandemic differs more between HIC, UMIC, and LMIC than between socio-economic categories within a country income level. The most disadvantaged socio-economic subgroups in HIC had a lower financial impact from the pandemic than the most advantaged subgroup in UMIC, with a similar disparity seen between UMIC and LMIC. Continued high levels of infection will exacerbate financial inequity between countries and hinder progress towards the sustainable development goals, emphasising the importance of effective measures to control COVID-19 and, especially, ensuring high vaccine coverage in all countries. FUNDING Funding for this study was provided by the Canadian Institutes of Health Research and the International Development Research Centre.
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Affiliation(s)
- Aditya K Khetan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | - Patricio Lopez-Jaramillo
- Medical School, Universidad de Santander (UDES), Masira Research Institute, Bucaramanga, Colombia
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | - Andres Orlandini
- ECLA (Estudios Clínicos Latino America) Instituto Cardiovascular de Rosario, Argentina
| | - Nafiza Mat-Nasir
- Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Aytekin Oguz
- Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Rajeev Gupta
- Eternal Heart Care Center and Research Institute, Jaipur, India
| | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Ismail Rosnah
- Faculty of Medicine of UKM, UKM Medical Center, Kuala Lumpur, Malaysia
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Koon K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | | | - Scott A. Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - Pamela Serón
- Faculty of Medicine, Universidad de La Frontera, Claro Solar, Temuco, Chile
| | - Jephat Chifamba
- Department of Biomedical Sciences, Physiology Unit, Faculty of Medicine and Sciences, University of Zimbabwe, Zimbabwe
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | - Maha Mushtaha
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | - Deepa Mohan
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Marjan Walli-Attaei
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | | | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, VGR region, Sweden
| | - Khalid F Alhabib
- King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Iolanthé M Kruger
- Potchefstroom Campus, Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, South Africa
| | - María-José Paucar
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | | | | | - Darryl P Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
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7
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Khetan AK, Leong DP, Gupta R, Zhu Y, Li S, Liu W, Kruger IM, Teo KK, Wielgosz A, Yusuf R, Noor Khan NAM, Khatib R, Alhabib KF, Karsidag K, Chifamba J, Mohammadifard N, Serón P, Lopez-Jaramillo P, Orlandini A, Szuba A, Yusufali A, Nair S, Rosengren A, Yeates K, Dans AM, Iqbal R, Avezum Á, Rangarajan S, Yusuf S. Variations in the association of height with mortality, cardiovascular disease and cancer in low-, middle- and high-income countries. Int J Epidemiol 2021; 51:1304-1316. [PMID: 34939099 DOI: 10.1093/ije/dyab268] [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] [Received: 08/17/2021] [Accepted: 12/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Final adult height is a useful proxy measure of childhood nutrition and disease burden. Tall stature has been previously associated with decreased risk of all-cause mortality, decreased risk of major cardiovascular events and an increased risk of cancer. However, these associations have primarily been derived from people of European and East Asian backgrounds, and there are sparse data from other regions of the world. METHODS The Prospective Urban-Rural Epidemiology study is a large, longitudinal population study done in 21 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35-70 years. Height was measured in a standardized manner, without shoes, to the nearest 0.1 cm. During a median follow-up of 10.1 years (interquartile range 8.3-12.0), we assessed the risk of all-cause mortality, major cardiovascular events and cancer. RESULTS A total of 154 610 participants, enrolled since January 2003, with known height and vital status, were included in this analysis. Follow-up event data until March 2021 were used; 11 487 (7.4%) participants died, whereas 9291 (6.0%) participants had a major cardiovascular event and 5873 (3.8%) participants had a new diagnosis of cancer. After adjustment, taller individuals had lower hazards of all-cause mortality [hazard ratio (HR) per 10-cm increase in height 0.93, 95% confidence interval (CI) 0.90-0.96] and major cardiovascular events (HR 0.97, 95% CI 0.94-1.00), whereas the hazard of cancer was higher in taller participants (HR 1.23, 95% CI 1.18-1.28). The interaction p-values between height and country-income level for all three outcomes were <0.001, suggesting that the association with height varied by country-income level for these outcomes. In low-income countries, height was inversely associated with all-cause mortality (HR 0.88, 95% CI 0.84-0.92) and major cardiovascular events (HR 0.87, 95% CI 0.82-0.93). There was no association of height with these outcomes in middle- and high-income countries. The respective HRs for cancer in low-, middle- and high-income countries were 1.14 (95% CI 0.99-1.32), 1.12 (95% CI 1.04-1.22) and 1.20 (95% CI 1.14-1.26). CONCLUSIONS Unlike high- and middle-income countries, tall stature has a strong inverse association with all-cause mortality and major cardiovascular events in low-income countries. Improved childhood physical development and advances in population-wide cardiovascular treatments in high- and middle-income countries may contribute to this gap. From a life-course perspective, we hypothesize that optimizing maternal and child health in low-income countries may improve rates of premature mortality and cardiovascular events in these countries, at a population level.
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Affiliation(s)
- Aditya K Khetan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Darryl P Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Rajeev Gupta
- Eternal Heart Care Center and Research Institute, Jaipur, India
| | - Yibing Zhu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Sidong Li
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Weida Liu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Iolanthé M Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom Campus, South Africa
| | - Koon K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | | | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine; Advocate Aurora Health, Downers Grove, IL, USA
| | - Khalid F Alhabib
- King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kubilay Karsidag
- Department of Internal Medicine, Medical Faculty of Istanbul University, Istanbul, Turkey
| | - Jephat Chifamba
- Department of Biomedical Sciences, Physiology Unit, Faculty of Medicine and Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pamela Serón
- Faculty of Medicine, Universidad de La Frontera, Claro Solar, Temuco, Chile
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Andres Orlandini
- ECLA (Estudios Clínicos Latino America), Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Sanjeev Nair
- Health Action by People, Trivandrum and Government Medical College, Thrissur, India
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, VGR Region, Gothenburg, Sweden
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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8
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Narula N, Wong ECL, Dehghan M, Mente A, Rangarajan S, Lanas F, Lopez-Jaramillo P, Rohatgi P, Lakshmi PVM, Varma RP, Orlandini A, Avezum A, Wielgosz A, Poirier P, Almadi MA, Altuntas Y, Ng KK, Chifamba J, Yeates K, Puoane T, Khatib R, Yusuf R, Boström KB, Zatonska K, Iqbal R, Weida L, Yibing Z, Sidong L, Dans A, Yusufali A, Mohammadifard N, Marshall JK, Moayyedi P, Reinisch W, Yusuf S. Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study. BMJ 2021; 374:n1554. [PMID: 34261638 PMCID: PMC8279036 DOI: 10.1136/bmj.n1554] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD). DESIGN Prospective cohort study. SETTING 21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China). PARTICIPANTS 116 087 adults aged 35-70 years with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data (country specific validated FFQs were used to document baseline dietary intake). Participants were followed prospectively at least every three years. MAIN OUTCOME MEASURES The main outcome was development of IBD, including Crohn's disease or ulcerative colitis. Associations between ultra-processed food intake and risk of IBD were assessed using Cox proportional hazard multivariable models. Results are presented as hazard ratios with 95% confidence intervals. RESULTS Participants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (interquartile range 8.9-11.2 years), 467 participants developed incident IBD (90 with Crohn's disease and 377 with ulcerative colitis). After adjustment for potential confounding factors, higher intake of ultra-processed food was associated with a higher risk of incident IBD (hazard ratio 1.82, 95% confidence interval 1.22 to 2.72 for ≥5 servings/day and 1.67, 1.18 to 2.37 for 1-4 servings/day compared with <1 serving/day, P=0.006 for trend). Different subgroups of ultra-processed food, including soft drinks, refined sweetened foods, salty snacks, and processed meat, each were associated with higher hazard ratios for IBD. Results were consistent for Crohn's disease and ulcerative colitis with low heterogeneity. Intakes of white meat, red meat, dairy, starch, and fruit, vegetables, and legumes were not associated with incident IBD. CONCLUSIONS Higher intake of ultra-processed food was positively associated with risk of IBD. Further studies are needed to identify the contributory factors within ultra-processed foods. STUDY REGISTRATION ClinicalTrials.gov NCT03225586.
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Affiliation(s)
- Neeraj Narula
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Emily C L Wong
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Andrew Mente
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Fernando Lanas
- Department of Internal Medicine, Universidad de La Frontera, Temuco, Chile
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Universidad de Santander (UDES) Fundación Oftalmológica de Santander-FOSCAL-Bucaramanga, Colombia
| | - Priyanka Rohatgi
- Department of Nutrition and Dietetics, Apollo Hospitals, Bangalore, India
| | - P V M Lakshmi
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, SCTIMST and Health Action by People, Thiruvananthapuram, India
| | - Andres Orlandini
- Department of Cardiology, Estudios Clinicos Latinoamerica ECLA Rosario, Santa Fe, Argentina
| | - Alvaro Avezum
- International Research Centre, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil, Universidade Santo Amaro (UNISA), Sao Paulo, Brazil
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Paul Poirier
- Faculté de pharmacie, Université Laval Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Majid A Almadi
- Department of Medicine, Division of Gastroenterology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yuksel Altuntas
- University of Health Sciences, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training and Research Hospital, Clinic of Endocrinology and Metabolism Sisli/Istanbul, Turkey
| | - Kien Keat Ng
- Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
| | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Bellville. South Africa
| | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Rita Yusuf
- Advocate Research Institute, Advocate Health Care, IL, USA
- School of Life Sciences, Independent University, Bangladesh Bashundhara, Dhaka, Bangladesh
| | - Kristina Bengtsson Boström
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Romaina Iqbal
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Liu Weida
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences Mentougou District, Beijing, China
| | - Zhu Yibing
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences Mentougou District, Beijing, China
| | - Li Sidong
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences Mentougou District, Beijing, China
| | - Antonio Dans
- Section of Adult Medicine and Medical Research Unit, University of Philippines, Manila, Philippines
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Medical University, Dubai Health Authority, Dubai, United Arab Emirates
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - John K Marshall
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Paul Moayyedi
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Walter Reinisch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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9
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Wang C, Bangdiwala SI, Rangarajan S, Lear SA, AlHabib KF, Mohan V, Teo K, Poirier P, Tse LA, Liu Z, Rosengren A, Kumar R, Lopez-Jaramillo P, Yusoff K, Monsef N, Krishnapillai V, Ismail N, Seron P, Dans AL, Kruger L, Yeates K, Leach L, Yusuf R, Orlandini A, Wolyniec M, Bahonar A, Mohan I, Khatib R, Temizhan A, Li W, Yusuf S. Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries. Eur Heart J 2020; 40:1620-1629. [PMID: 30517670 DOI: 10.1093/eurheartj/ehy695] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [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: 06/23/2018] [Revised: 08/20/2018] [Accepted: 10/05/2018] [Indexed: 01/13/2023] Open
Abstract
AIMS To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. METHODS AND RESULTS We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-reported napping time and examined the associations between them and the composite outcome of deaths and major cardiovascular events in 116 632 participants from seven regions. After a median follow-up of 7.8 years, we recorded 4381 deaths and 4365 major cardiovascular events. It showed both shorter (≤6 h/day) and longer (>8 h/day) estimated total sleep durations were associated with an increased risk of the composite outcome when adjusted for age and sex. After adjustment for demographic characteristics, lifestyle behaviours and health status, a J-shaped association was observed. Compared with sleeping 6-8 h/day, those who slept ≤6 h/day had a non-significant trend for increased risk of the composite outcome [hazard ratio (HR), 1.09; 95% confidence interval, 0.99-1.20]. As estimated sleep duration increased, we also noticed a significant trend for a greater risk of the composite outcome [HR of 1.05 (0.99-1.12), 1.17 (1.09-1.25), and 1.41 (1.30-1.53) for 8-9 h/day, 9-10 h/day, and >10 h/day, Ptrend < 0.0001, respectively]. The results were similar for each of all-cause mortality and major cardiovascular events. Daytime nap duration was associated with an increased risk of the composite events in those with over 6 h of nocturnal sleep duration, but not in shorter nocturnal sleepers (≤6 h). CONCLUSION Estimated total sleep duration of 6-8 h per day is associated with the lowest risk of deaths and major cardiovascular events. Daytime napping is associated with increased risks of major cardiovascular events and deaths in those with >6 h of nighttime sleep but not in those sleeping ≤6 h/night.
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Affiliation(s)
- Chuangshi Wang
- Department of Medicine, Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, Ontario, Canada.,Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Room 101-106, Block A, Shilong West Road, Mentougou District, Beijing, China
| | - Shrikant I Bangdiwala
- Department of Medicine, Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Department of Medicine, Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, Ontario, Canada
| | - Scott A Lear
- Department of Medicine, Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Dr Mohan's Diabetes Specialities Centre, No. 6B, Conran Smith Road, Gopalapuram, Chennai, India
| | - Koon Teo
- Department of Medicine, Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, Ontario, Canada
| | - Paul Poirier
- Department of Medicine, Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, Québec, Canada
| | - Lap Ah Tse
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing Street, Sha Tin, Hong Kong SAR 96H2+9X, China
| | - Zhiguang Liu
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing Street, Sha Tin, Hong Kong SAR 96H2+9X, China
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Diagnosvägen 11, Gothenburg, Sweden
| | - Rajesh Kumar
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh, India
| | - Patricio Lopez-Jaramillo
- Research Institute, FOSCAL, Department of Medicine, Medical School, UDES, Calle 158 #20-95, local 101-102, Floridablanca, Colombia
| | - Khalid Yusoff
- Department of Medicine, UiTM Selayang, 40450 Shah Alam, Selangor Darul Ehsan, Malaysia, and UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Nahed Monsef
- Dubai Health Authority, Al Maktoum Bridge Street, Bur Dubai Area 4545, Dubai, United Arab Emirates
| | - Vijayakumar Krishnapillai
- Health Action by People, Thiruvananthapuram and Community Medicine, Department of Community Medicine, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, AIMS Ponekkara P. O., Kochi, Kerala, India
| | - Noorhassim Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Pamela Seron
- Department of Medicine, Universidad de La Frontera, Francisco Salazar 1145, Temuco, Regiæn de la Araucanía, Chile
| | - Antonio L Dans
- Department of Medicine, UP College of Medicine, University of the Philippines Manila, Padre Faura Street, Ermita, Manila, Metro Manila, Philippines
| | - Lanthé Kruger
- Africa Unit for Transdisciplinary Health Research, Department of Medicine, Faculty of Health Sciences, North-West University, Private Bag X2046 Mmabatho, South Africa
| | - Karen Yeates
- Department of Medicine, Queen's University, Office of Global Health Research, 99 University Avenue, Kingston, Ontario, Canada
| | - Lloyd Leach
- Department of Medicine, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, South Africa
| | - Rita Yusuf
- School of Life Sciences, Independent University, Academic Building, Room 10002, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka-1229, Bangladesh
| | | | - Maria Wolyniec
- Department of Social Medicine, Medical University of Wrocław, Bujwida 44 Street, 50-345 Wrocław, Poland
| | - Ahmad Bahonar
- Hypertension Research Center, Cardiovascular Research Institute, Department of Medicine, Isfahan University of Medical Sciences, Hezar-Jerib Avenue, Isfahan 81746 73461, Iran
| | - Indu Mohan
- Department of Clinical Research, EHCC, Jawahar Circle, Jaipur, India
| | - Rasha Khatib
- Departments of Neurology, Northwestern University Feinberg School of Medicine, Arthur J. Rubloff Building, 420 East Superior Street, Chicago, IL, USA
| | - Ahmet Temizhan
- Department of Cardiology, Turkiye Yuksek Ihtisas Education and Research Hospital, University of Saglik Bilimleri, Tıbbiye Cd No. 38, Selimiye Mahallesi, 34668 Üsküdar/İstanbul, Turkey
| | - Wei Li
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Room 101-106, Block A, Shilong West Road, Mentougou District, Beijing, China
| | - Salim Yusuf
- Department of Medicine, Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, Ontario, Canada
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10
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Joseph PG, Healey JS, Raina P, Connolly SJ, Ibrahim Q, Gupta R, Avezum A, Dans AL, Lopez-Jaramillo P, Yeates K, Teo K, Douma R, Bahonar A, Chifamba J, Lanas F, Dagenais GR, Lear SA, Kumar R, Kengne AP, Keskinler M, Mohan V, Mony P, Alhabib KF, Huisman H, Iype T, Zatonska K, Ismail R, Kazmi K, Rosengren A, Rahman O, Yusufali A, Wei L, Orlandini A, Islam S, Rangarajan S, Yusuf S. Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals. Cardiovasc Res 2020; 117:1523-1531. [PMID: 32777820 DOI: 10.1093/cvr/cvaa241] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. METHODS AND RESULTS Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49-3.52] and death (HR 2.97; 95% CI 2.25-3.93); with similar rates in different countries grouped by income level. CONCLUSIONS Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.
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Affiliation(s)
- Philip G Joseph
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Parminder Raina
- Canadian Longitudinal Study of Aging, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Quazi Ibrahim
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, India
| | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz and UNISA, São Paulo, Brazil
| | | | | | | | - Koon Teo
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Reuben Douma
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Ahmad Bahonar
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jephat Chifamba
- University of Zimbabwe, Department Of Physiology, Harare, Zimbabwe
| | | | | | | | - Rajesh Kumar
- Post Graduate Institute of Medical Education and Research (PGIMER) School of Public Health, Chandigarh, India
| | - Andre P Kengne
- South African Medical Research Council, Pietermaritzburg, South Africa
| | - Mirac Keskinler
- Istanbul Goztepe Training and Research Hospital, Istanbul, Turkey
| | | | - Prem Mony
- St John's Medical College & Research Institute, Bengaluru, India
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hugo Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | | | - Katarzyna Zatonska
- Department of Social Medicine, Medical University of Wroclaw, Wroclaw, Poland
| | | | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Li Wei
- Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | | | - Shofiqul Islam
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
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11
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Bhavadharini B, Dehghan M, Mente A, Rangarajan S, Sheridan P, Mohan V, Iqbal R, Gupta R, Lear S, Wentzel-Viljoen E, Avezum A, Lopez-Jaramillo P, Mony P, Varma RP, Kumar R, Chifamba J, Alhabib KF, Mohammadifard N, Oguz A, Lanas F, Rozanska D, Bengtsson Bostrom K, Yusoff K, Tsolkile LP, Dans A, Yusufali A, Orlandini A, Poirier P, Khatib R, Hu B, Wei L, Yin L, Deeraili A, Yeates K, Yusuf R, Ismail N, Mozaffarian D, Teo K, Anand SS, Yusuf S. Association of dairy consumption with metabolic syndrome, hypertension and diabetes in 147 812 individuals from 21 countries. BMJ Open Diabetes Res Care 2020; 8:8/1/e000826. [PMID: 32423962 PMCID: PMC7326257 DOI: 10.1136/bmjdrc-2019-000826] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 08/14/2019] [Revised: 01/07/2020] [Accepted: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Our aims were to assess the association of dairy intake with prevalence of metabolic syndrome (MetS) (cross-sectionally) and with incident hypertension and incident diabetes (prospectively) in a large multinational cohort study. METHODS The Prospective Urban Rural Epidemiology (PURE) study is a prospective epidemiological study of individuals aged 35 and 70 years from 21 countries on five continents, with a median follow-up of 9.1 years. In the cross-sectional analyses, we assessed the association of dairy intake with prevalent MetS and its components among individuals with information on the five MetS components (n=112 922). For the prospective analyses, we examined the association of dairy with incident hypertension (in 57 547 individuals free of hypertension) and diabetes (in 131 481 individuals free of diabetes). RESULTS In cross-sectional analysis, higher intake of total dairy (at least two servings/day compared with zero intake; OR 0.76, 95% CI 0.71 to 0.80, p-trend<0.0001) was associated with a lower prevalence of MetS after multivariable adjustment. Higher intakes of whole fat dairy consumed alone (OR 0.72, 95% CI 0.66 to 0.78, p-trend<0.0001), or consumed jointly with low fat dairy (OR 0.89, 95% CI 0.80 to 0.98, p-trend=0.0005), were associated with a lower MetS prevalence. Low fat dairy consumed alone was not associated with MetS (OR 1.03, 95% CI 0.77 to 1.38, p-trend=0.13). In prospective analysis, 13 640 people with incident hypertension and 5351 people with incident diabetes were recorded. Higher intake of total dairy (at least two servings/day vs zero serving/day) was associated with a lower incidence of hypertension (HR 0.89, 95% CI 0.82 to 0.97, p-trend=0.02) and diabetes (HR 0.88, 95% CI 0.76 to 1.02, p-trend=0.01). Directionally similar associations were found for whole fat dairy versus each outcome. CONCLUSIONS Higher intake of whole fat (but not low fat) dairy was associated with a lower prevalence of MetS and most of its component factors, and with a lower incidence of hypertension and diabetes. Our findings should be evaluated in large randomized trials of the effects of whole fat dairy on the risks of MetS, hypertension, and diabetes.
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Affiliation(s)
- Balaji Bhavadharini
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Andrew Mente
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Patrick Sheridan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Viswanathan Mohan
- Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
- Diabetology, Dr Mohan's Diabetes Specialities Centre Gopalapuram, Chennai, Tamil Nadu, India
| | | | - Rajeev Gupta
- Preventive Cardiology, Eternal Heart Care Centre & Research Institute, Jaipur, Rajasthan, India
| | - Scott Lear
- Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Alvaro Avezum
- Research Division, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | | | - Prem Mony
- St John's Medical College & Research Institute, Bengaluru, Karnataka, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, Kerala, India
| | - Rajesh Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Aytekin Oguz
- Internal Medicine, Goztepe Training and Research Hospital, Istanbul, Marmara, Turkey
| | | | | | | | - Khalid Yusoff
- Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | | | - Antonio Dans
- University of the Philippines System, Quezon City, Metro Manila, Philippines
| | | | | | - Paul Poirier
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Quebec, Quebec City, Quebec, Canada
| | - Rasha Khatib
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bo Hu
- Peking Union Medical College School of Basic Medicine, Beijing, China
| | - Li Wei
- Medical Research & Biometrics Center, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Lu Yin
- Peking Union Medical College School of Basic Medicine, Beijing, China
| | - Ai Deeraili
- Xinjiang Uighur Autonomous Region Center for Disease Control and Prevention, Wulumuqi, Xinjiang, China
| | | | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | | | - Dariush Mozaffarian
- Tufts Friedman School of Nutrition Science & Policy, Boston, Massachusetts, USA
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Murphy A, Palafox B, Walli-Attaei M, Powell-Jackson T, Rangarajan S, Alhabib KF, Avezum AJ, Calik KBT, Chifamba J, Choudhury T, Dagenais G, Dans AL, Gupta R, Iqbal R, Kaur M, Kelishadi R, Khatib R, Kruger IM, Kutty VR, Lear SA, Li W, Lopez-Jaramillo P, Mohan V, Mony PK, Orlandini A, Rosengren A, Rosnah I, Seron P, Teo K, Tse LA, Tsolekile L, Wang Y, Wielgosz A, Yan R, Yeates KE, Yusoff K, Zatonska K, Hanson K, Yusuf S, McKee M. The household economic burden of non-communicable diseases in 18 countries. BMJ Glob Health 2020; 5:e002040. [PMID: 32133191 PMCID: PMC7042605 DOI: 10.1136/bmjgh-2019-002040] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [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] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. Methods Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. Results The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. Conclusions Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs.
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Affiliation(s)
- Adrianna Murphy
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Benjamin Palafox
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Marjan Walli-Attaei
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Timothy Powell-Jackson
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | | | - Gilles Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Ontario, Canada
| | - Antonio L Dans
- Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, the Islamic Republic of Iran
| | - Rasha Khatib
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Iolanthe Marike Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, University Teknologi MARA, Beijing, China
| | | | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Prem K Mony
- St John's Medical College and Research Institute, Bangalore, India
| | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University, Gothenburg, Sweden
| | - Ismail Rosnah
- Community Health Department, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Pamela Seron
- Facultad de Medicina, Universidad de La Frontera, Temucu, Chile
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Lungiswa Tsolekile
- School of Public Health, University of the Western Cape, Bellville, Western Cape, South Africa
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ruohua Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Karen E Yeates
- Department of Medicine, Queen's University, Kingston, New Hampshire, Canada
| | - Khalid Yusoff
- UiTM, Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Martin McKee
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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13
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Dehghan M, Mente A, Rangarajan S, Sheridan P, Mohan V, Iqbal R, Gupta R, Lear S, Wentzel-Viljoen E, Avezum A, Lopez-Jaramillo P, Mony P, Varma RP, Kumar R, Chifamba J, Alhabib KF, Mohammadifard N, Oguz A, Lanas F, Rozanska D, Bostrom KB, Yusoff K, Tsolkile LP, Dans A, Yusufali A, Orlandini A, Poirier P, Khatib R, Hu B, Wei L, Yin L, Deeraili A, Yeates K, Yusuf R, Ismail N, Mozaffarian D, Teo K, Anand SS, Yusuf S. Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet 2018; 392:2288-2297. [PMID: 30217460 DOI: 10.1016/s0140-6736(18)31812-9] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. METHODS The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35-70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. FINDINGS Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95% CI 0·75-0·94; ptrend=0·0004), total mortality (0·83, 0·72-0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72-1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58-1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67-0·90; ptrend=0·0001), and stroke (0·66, 0·53-0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95% CI 0·71-1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95% CI 0·82-0·99; ptrend=0·0529) and yogurt (0·86, 0·75-0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76-1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95% CI 0·90-1·33; ptrend=0·4113). INTERPRETATION Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. FUNDING Full funding sources are listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Mahshid Dehghan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
| | - Andrew Mente
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Patrick Sheridan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Rajeev Gupta
- Department of Medicine, Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Scott Lear
- Faculty of Health Sciences, Simon Fraser University, BC, Canada
| | | | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Patricio Lopez-Jaramillo
- Research Department, Fundacion Oftalmologica de Santander, Medical School, University of Santander, Floridablanca-Santander, Colombia
| | - Prem Mony
- Division of Epidemiology and Population Health, St John's Medical College and Research Institute, Bangalore, India
| | - Ravi Prasad Varma
- Faculty of Health Sciences, Achutha Menon Centre for Health Science Studies Health Action by People, Thiruvananthapuram, Kerala, India
| | - Rajesh Kumar
- Post Graduate Institute of Medical Education and Research (PGIMER) School of Public Health, Chandigarh, India
| | - Jephat Chifamba
- College of Health Sciences, Physiology Department, University of Zimbabwe, Harare, Zimbabwe
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aytekin Oguz
- Department of Internal Medicine, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Fernando Lanas
- Department of Medicine, Universidad de La Frontera, Francisco Salazar, Temuco, Chile
| | - Dorota Rozanska
- Department of Dietetics, Wroclaw Medical University, Wroclaw, Poland
| | - Kristina Bengtsson Bostrom
- Närhälsan R&D Centre Skaraborg Primary Care Skövde and Department of Public Health and Community Medicine, Primary Health Care, the Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Khalid Yusoff
- Department of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia; Department of Medicine, UCSI University, Cheras, Selangor, Malaysia
| | - Lungiswa P Tsolkile
- School of Public Health, University of the Western Cape, Cape Town, Western Cape Province, South Africa
| | - Antonio Dans
- Department of Medicine, University of the Philippines, Manila, Philippines
| | - AfzalHussein Yusufali
- Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Paul Poirier
- Institut universitaire de cardiologie et pneumologie de Québec, Université laval, QC, Canada
| | - Rasha Khatib
- Departments of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bo Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Wei
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ai Deeraili
- Center for Disease Control and Prevention of Xinjiang Hetian, Xinjiang, China
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Rita Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Noorhassim Ismail
- Department of Community Health, University Kebangsaan Malaysia Medical Centre, Malaysia
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Sonia S Anand
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- School of Life Sciences, Independent University, Bashundhara, Dhaka, Bangladesh
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14
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Chow CK, Ramasundarahettige C, Hu W, AlHabib KF, Avezum A, Cheng X, Chifamba J, Dagenais G, Dans A, Egbujie BA, Gupta R, Iqbal R, Ismail N, Keskinler MV, Khatib R, Kruger L, Kumar R, Lanas F, Lear S, Lopez-Jaramillo P, McKee M, Mohammadifard N, Mohan V, Mony P, Orlandini A, Rosengren A, Vijayakumar K, Wei L, Yeates K, Yusoff K, Yusuf R, Yusufali A, Zatonska K, Zhou Y, Islam S, Corsi D, Rangarajan S, Teo K, Gerstein HC, Yusuf S. Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study. Lancet Diabetes Endocrinol 2018; 6:798-808. [PMID: 30170949 DOI: 10.1016/s2213-8587(18)30233-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/22/2018] [Accepted: 07/23/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Data are scarce on the availability and affordability of essential medicines for diabetes. Our aim was to examine the availability and affordability of metformin, sulfonylureas, and insulin across multiple regions of the world and explore the effect of these on medicine use. METHODS In the Prospective Urban Rural Epidemiology (PURE) study, participants aged 35-70 years (n=156 625) were recruited from 110 803 households, in 604 communities and 22 countries; availability (presence of any dose of medication in the pharmacy on the day of audit) and medicine cost data were collected from pharmacies with the Environmental Profile of a Community's Health audit tool. Our primary analysis was to describe the availability and affordability of metformin and insulin and also commonly used and prescribed combinations of two medicines for diabetes management (two oral drugs, metformin plus a sulphonylurea [either glibenclamide (also known as glyburide) or gliclazide] and one oral drug plus insulin [metformin plus insulin]). Medicines were defined as affordable if the cost of medicines was less than 20% of capacity-to-pay (the household income minus food expenditure). Our analyses included data collected in pharmacies and data from representative samples of households. Data on availability were ascertained during the pharmacy audit, as were data on cost of medications. These cost data were used to estimate the cost of a month's supply of essential medicines for diabetes. We estimated affordability of medicines using income data from household surveys. FINDINGS Metformin was available in 113 (100%) of 113 pharmacies from high-income countries, 112 (88·2%) of 127 pharmacies in upper-middle-income countries, 179 (86·1%) of 208 pharmacies in lower-middle-income countries, 44 (64·7%) of 68 pharmacies in low-income countries (excluding India), and 88 (100%) of 88 pharmacies in India. Insulin was available in 106 (93·8%) pharmacies in high-income countries, 51 (40·2%) pharmacies in upper-middle-income countries, 61 (29·3%) pharmacies in lower-middle-income countries, seven (10·3%) pharmacies in lower-income countries, and 67 (76·1%) of 88 pharmacies in India. We estimated 0·7% of households in high-income countries and 26·9% of households in low-income countries could not afford metformin and 2·8% of households in high-income countries and 63·0% of households in low-income countries could not afford insulin. Among the 13 569 (8·6% of PURE participants) that reported a diagnosis of diabetes, 1222 (74·0%) participants reported diabetes medicine use in high-income countries compared with 143 (29·6%) participants in low-income countries. In multilevel models, availability and affordability were significantly associated with use of diabetes medicines. INTERPRETATION Availability and affordability of essential diabetes medicines are poor in low-income and middle-income countries. Awareness of these global differences might importantly drive change in access for patients with diabetes. FUNDING Full funding sources listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Clara K Chow
- Faculty of Medicine and Health, University of Sydney, The George Institute for Global Health and Westmead Hospital, Sydney, NSW, Australia; Population Health Research Institute, Hamilton, ON, Canada.
| | | | - Weihong Hu
- Population Health Research Institute, Hamilton, ON, Canada
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alvaro Avezum
- Research Division, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | - Xiaoru Cheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jephat Chifamba
- College of Health Sciences, Physiology Department, University of Zimbabwe, Harare, Zimbabwe
| | - Gilles Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, QC, Canada
| | - Antonio Dans
- Department of Medicine, University of the Philippines-Manila, Ermita, Manila, Philippines
| | - Bonaventure A Egbujie
- School of PublicHealth, University of the Western Cape, Bellville, Cape Town, Western Cape Province, South Africa
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jawahar Circle, Jaipur, India
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Noorhassim Ismail
- Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mirac V Keskinler
- Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Rasha Khatib
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lanthé Kruger
- Faculty of Health Science, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Rajesh Kumar
- Post Graduate Institute of Medical Education and Research, School of Public Health, Chandigarh, India
| | - Fernando Lanas
- Department of Medicine, Universidad de La Frontera, Francisco Salazar, Temuco, Chile
| | - Scott Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Prem Mony
- Division of Epidemiology and Population Health, St John's Medical College and Research Institute, Bangalore India
| | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Östra Hospital, Gothenburg, Sweden
| | | | - Li Wei
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Khalid Yusoff
- Department of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia; University College Sedaya International (UCSI) University, Cheras, Selangor, Malaysia
| | - Rita Yusuf
- School of Life Sciences, Independent University, Bangladesh, Bashundhara, Dhaka, Bangladesh
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Health Authority, Dubai Medical University, Dubai, United Arab Emirates
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Yihong Zhou
- Wujin DistrictCenter for Disease Control and Prevention, Changzhou, Jiangsu Province, China
| | - Shariful Islam
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Daniel Corsi
- Population Health Research Institute, Hamilton, ON, Canada
| | | | - Koon Teo
- Population Health Research Institute, Hamilton, ON, Canada
| | | | - Salim Yusuf
- Population Health Research Institute, Hamilton, ON, Canada
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15
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De Servi B, Orlandini A, Caviola E, Meloni M. Amino acid and hyaluronic acid mixtures differentially regulate extra cellular matrix genes in cultured human fibroblasts. J BIOL REG HOMEOS AG 2018; 32:517-527. [PMID: 29921376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of this screening study was to evaluate the efficacy of different proprietary mixtures of amino acid and hyaluronic acid (HA) in stimulating the production of extracellular matrix (ECM) components, particularly the neo-synthesis of elastin, and in promoting a more efficient deposition of elastic fibres (elastogenesis), while at the same time maintaining the stimulation of collagen. The study has allowed identification of the optimal ratios between the amino acids (AA) for the production of collagen and elastin. Human primary dermal fibroblasts from a 44-year-old female donor were used as a test system in an experimental design based on the evaluation of the expression of relevant ECM genes using a transcriptomic dynamic approach. The expression of ECM genes was evaluated by RTqPCR from 24 to 120 hours in the presence of the test items. Moreover, the production of ECM proteins was verified by Western blot analysis after a 120 h treatment period. In addition to elastin, collagen IV, a fundamental structural component of the basal lamina responsible for epithelial and connective tissue anchoring, was analysed as potential target for the modulation of ECM protein production by human fibroblast. The first phase of the study demonstrated that alanine and valine are essential to promote production of elastin, of which they are important constituents. The second phase of the study, which was conducted to clarify the interactions between the different clusters of AA, demonstrated that it is necessary to choose a mixture that contains specific amounts of amino acids of both proteins, collagen and elastin, to give a significant response and a significant production of both. This also proves the existence of a ratio between the 2 clusters (AA elastin/AA collagen) that guarantees an adequate and balanced response to gene expression and production by fibroblasts, collagen and elastin. The study has allowed identification of the optimal ratios between the AA for the production of collagen and elastin.
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Affiliation(s)
- B De Servi
- VitroScreen In Vitro Research Laboratories, Milan, Italy
| | | | - E Caviola
- VitroScreen In Vitro Research Laboratories, Milan, Italy
| | - M Meloni
- VitroScreen In Vitro Research Laboratories, Milan, Italy
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16
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Dokainish H, Teo K, Zhu J, Roy A, AlHabib KF, ElSayed A, Palileo-Villaneuva L, Lopez-Jaramillo P, Karaye K, Yusoff K, Orlandini A, Sliwa K, Mondo C, Lanas F, Prabhakaran D, Badr A, Elmaghawry M, Damasceno A, Tibazarwa K, Belley-Cote E, Balasubramanian K, Islam S, Yacoub MH, Huffman MD, Harkness K, Grinvalds A, McKelvie R, Bangdiwala SI, Yusuf S, Campos R, Chacón C, Cursack G, Diez F, Escobar C, Garcia C, Vilamajo OG, Hominal M, Ingaramo A, Kucharczuk G, Pelliza M, Rojas A, Villani A, Zapata G, Bourke P, Lanas F, Nahuelpan L, Olivares C, Riquelme R, Ai F, Bai X, Chen X, Chen Y, Gao M, Ge C, He Y, Huang W, Jiang H, Liang T, Liang X, Liao Y, Liu S, Luo Y, Lu L, Qin S, Tan G, Tan H, Wang T, Wang X, Wei F, Xiao F, Zhang B, Zheng T, Mendoza JA, Anaya MB, Gomez E, de Salazar DM, Quiroz F, Rodríguez M, Sotomayor MS, Navas AT, León MB, Montalvo LF, Jaramillo ML, Patiño EP, Perugachi C, Trujillo Cruz F, Elmaghawry M, Wagdy K, Bhardwaj A, Chaturvedi V, Gokhale GK, Gupta R, Honnutagi R, Joshi P, Ladhani S, Negi P, Roy A, Reddy N, Abdullah A, Hassan MA, Balasinga M, Kasim S, Tan W, Yusoff K, Damasceno A, Banze R, Calua E, Novela C, Chemane J, Akintunde A, Ansa V, Gbadamosi H, Karaye K, Mbakwem A, Mohammed S, Nwafor E, Ojji D, Olunuga T, Sa'idu BOH, Umuerri E, Alcaraz J, Palileo-Villanueva L, Palomares E, Timonera MR, Badr A, Alghamdi S, Alhabib K, Almasood A, Alsaif S, Elasfar A, Ghabashi A, Mimish L, Bester F, Kelbe D, Klug E, Sliwa K, Tibarzawa K, Abdalla O, Dimitri M, Mustafa H, Osman O, Saad A, Mondo C. Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. The Lancet Global Health 2017; 5:e665-e672. [DOI: 10.1016/s2214-109x(17)30196-1] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/10/2017] [Accepted: 04/26/2017] [Indexed: 12/13/2022]
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17
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Gasparotti R, Orlandini A, Gualandi G, Scipione V, Tansini A, Gnutti P, Bonetti M, Lavezzi P, Chiesa A, Galli G, Mearini M. L'angiografia a risonanza magnetica nello studio del circolo cerebrale. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140099100400204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Le recenti acquisizioni tecniche hanno rapidamente reso l'angiografia RM una delle più importanti indagini vascolari non invasive. Scopo della nostra ricerca è verificare l'applicabilità clinica dell'angiografia RM e valutare la sua accuratezza diagnostica nei confronti dell'angiografia per via arteriosa (angiografia invasiva) nello studio degli aneurismi del circolo cerebrale. Sono stati esaminati con «Angiografia Tridimensionale a Risonanza Magnetica», basata sul fenomeno del «tempo di volo», 23 pazienti, con un numero complessivo di 25 aneurismi, di cui 4 con dimensioni superiori ad 1,5 cm (macroaneurismi). In tutti i casi sono state utilizzate sequenze ad «Eco di Gradiente» 3D con compensazione per il flusso, mentre nei 4 casi di macroaneurisma sono state impiegate anche sequenze ad «Eco di Gradiente» 2D «single slice». In tutti i pazienti l'angiografia RM è stata associata ad una valutazione con sequenze Spin-Echo del parenchima cerebrale allo scopo di documentare l'eventuale presenza di aree di sofferenza parenchimale. L'angiografia invasiva per via arteriosa era disponibile per il confronto in tutti i casi. 18 pazienti sono stati sottoposti ad intervento chirurgico di «legatura» dell'aneurisma. Nei confonti dell'angiografia invasiva la sensibilità dell'angiografia RM è risultata complessivamente dell' 88% e la specificità del 90%, con un'accuratezza diagnostica dell'89%. Lo studio dimostra come l'angiografia RM, basata sul fenomeno del «tempo di volo», sia in grado di identificare aneurismi di dimensioni fino a 3mm e possa essere utilmente impiegata nella valutazione clinica dell'encefalo come fonte di informazioni supplementari sul circolo cerebrale.
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Affiliation(s)
| | | | | | | | | | | | | | | | - A. Chiesa
- Cattedra di Radiologia, Università di Brescia
| | - G. Galli
- Divisione di Neurochirurgia Ospedale Civile, Brescia
| | - M. Mearini
- Divisione di Neurochirurgia Ospedale Civile, Brescia
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18
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Lamelas PM, Mente A, Diaz R, Orlandini A, Avezum A, Oliveira G, Lanas F, Seron P, Lopez-Jaramillo P, Camacho-Lopez P, O Donnell MJ, Rangarajan S, Teo K, Yusuf S. Association of Urinary Sodium Excretion With Blood Pressure and Cardiovascular Clinical Events in 17,033 Latin Americans. Am J Hypertens 2016; 29:796-805. [PMID: 26683344 DOI: 10.1093/ajh/hpv195] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/23/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Information on actual sodium intake and its relationships with blood pressure (BP) and clinical events in South America is limited. The aim of this cohort study was to assess the relationship of sodium intake with BP, cardiovascular (CV) events, and mortality in South America. METHODS We studied 17,033 individuals, aged 35-70 years, from 4 South American countries (Argentina, Brazil, Chile, and Colombia). Measures of sodium excretion, estimated from morning fasting urine, were used as a surrogate for daily sodium intake. We measured BP and monitored the composite outcome of death and major CV events. RESULTS Overall mean sodium excretion was 4.70±1.43g/day. A positive, nonuniform association between sodium and BP was detected, with a significant steeper slope for the relationship at higher sodium excretion levels (P < 0.001 for interaction). With a median follow-up of 4.7 years, the primary composite outcome (all-cause death, myocardial infarction, stroke, or heart failure) occurred in 568 participants (3.4%). Compared with sodium excretion of 5-6g/day (reference group), participants who excreted >7g/day had increased risks of the primary outcome (odds ratio (OR) 1.73; 95% confidence interval (CI) 1.24 to 2.40; P < 0.001), as well as death from any cause (OR 1.87; 95% CI 1.23 to 2.83; P = 0.003) and major CV disease (OR 1.77; 95% CI 1.12 to 2.81; P = 0.014). Sodium excretion of <3g/day was associated with a statistically nonsignificant increased risk of the primary outcome (OR 1.20; 95% CI 0.86 to 1.65; P = 0.26) and death from any cause (OR 1.25; 95% CI 0.81 to 1.93; P = 0.29), and a significant increased risk of major CV disease (OR 1.50; 95% CI 1.01 to 2.24; P = 0.048), as compared to the reference group. CONCLUSIONS Our results support a positive, nonuniform association between estimated urinary sodium excretion and BP, and a possible J-shaped pattern of association between sodium excretion over the entire range and clinical outcomes.
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Affiliation(s)
- Pablo M Lamelas
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada;
| | - Andrew Mente
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Rafael Diaz
- Department of Laboratory Medicine, McMaster University, Hamilton, ON, Canada; Estudios Clínicos Latinoamérica, Rosario, Argentina
| | - Andres Orlandini
- Department of Laboratory Medicine, McMaster University, Hamilton, ON, Canada; Estudios Clínicos Latinoamérica, Rosario, Argentina
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | | | | | | | - Patricio Lopez-Jaramillo
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Fundación Oftalmológica de Santander Medical School, Universidad de Santander, Floridablanca, Colombia
| | - Paul Camacho-Lopez
- Fundación Oftalmológica de Santander Medical School, Universidad de Santander, Floridablanca, Colombia
| | - Martin J O Donnell
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Koon Teo
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- The Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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19
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Savell E, Gilmore AB, Sims M, Mony PK, Koon T, Yusoff K, Lear SA, Seron P, Ismail N, Calik KBT, Rosengren A, Bahonar A, Kumar R, Vijayakumar K, Kruger A, Swidan H, Gupta R, Igumbor E, Afridi A, Rahman O, Chifamba J, Zatonska K, Mohan V, Mohan D, Lopez-Jaramillo P, Avezum A, Poirier P, Orlandini A, Li W, McKee M, Rangarajan S, Yusuf S, Chow CK. The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries. Bull World Health Organ 2015; 93:851-61G. [PMID: 26668437 PMCID: PMC4669733 DOI: 10.2471/blt.15.155846] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing. METHODS Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders. FINDINGS Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11,842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities. CONCLUSION Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.
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Affiliation(s)
- Emily Savell
- Department for Health, University of Bath, Bath, England
| | - Anna B Gilmore
- Department for Health, University of Bath, Bath, England
| | - Michelle Sims
- Department for Health, University of Bath, Bath, England
| | - Prem K Mony
- Division of Epidemiology and Population Health, St John's Medical College and Research Institute, Bangalore, India
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Khalid Yusoff
- Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Pamela Seron
- Department of Internal Medicine, Universidad de La Frontera, Temuco, Chile
| | - Noorhassim Ismail
- Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ahmad Bahonar
- Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
| | - Rajesh Kumar
- School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Annamarie Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Hany Swidan
- Primary Health Care Sector, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Ehimario Igumbor
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Asad Afridi
- Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omar Rahman
- Independent University Bangladesh, Dhaka, Bangladesh
| | - Jephat Chifamba
- Physiology Department, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Alvaro Avezum
- Research Division, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | | | - Wei Li
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Martin McKee
- ECOHOST, London School of Hygiene & Tropical Medicine, London, England
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
| | - Clara K Chow
- The George Institute for Global Health, Sydney Medical School (Westmead Campus), University of Sydney, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia
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20
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Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O, Swaminathan S, Iqbal R, Gupta R, Lear SA, Oguz A, Yusoff K, Zatonska K, Chifamba J, Igumbor E, Mohan V, Anjana RM, Gu H, Li W, Yusuf S. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015; 386:266-73. [PMID: 25982160 DOI: 10.1016/s0140-6736(14)62000-6] [Citation(s) in RCA: 1087] [Impact Index Per Article: 120.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is appealing as a simple, quick, and inexpensive means of stratifying an individual's risk of cardiovascular death. However, the prognostic value of grip strength with respect to the number and range of populations and confounders is unknown. The aim of this study was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries. METHODS The Prospective Urban-Rural Epidemiology (PURE) study is a large, longitudinal population study done in 17 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35-70 years and if household members intended to stay at that address for another 4 years. Participants were assessed for grip strength, measured using a Jamar dynamometer. During a median follow-up of 4.0 years (IQR 2.9-5.1), we assessed all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, myocardial infarction, stroke, diabetes, cancer, pneumonia, hospital admission for pneumonia or chronic obstructive pulmonary disease (COPD), hospital admission for any respiratory disease (including COPD, asthma, tuberculosis, and pneumonia), injury due to fall, and fracture. Study outcomes were adjudicated using source documents by a local investigator, and a subset were adjudicated centrally. FINDINGS Between January, 2003, and December, 2009, a total of 142,861 participants were enrolled in the PURE study, of whom 139,691 with known vital status were included in the analysis. During a median follow-up of 4.0 years (IQR 2.9-5.1), 3379 (2%) of 139,691 participants died. After adjustment, the association between grip strength and each outcome, with the exceptions of cancer and hospital admission due to respiratory illness, was similar across country-income strata. Grip strength was inversely associated with all-cause mortality (hazard ratio per 5 kg reduction in grip strength 1.16, 95% CI 1.13-1.20; p<0.0001), cardiovascular mortality (1.17, 1.11-1.24; p<0.0001), non-cardiovascular mortality (1.17, 1.12-1.21; p<0.0001), myocardial infarction (1.07, 1.02-1.11; p=0.002), and stroke (1.09, 1.05-1.15; p<0.0001). Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure. We found no significant association between grip strength and incident diabetes, risk of hospital admission for pneumonia or COPD, injury from fall, or fracture. In high-income countries, the risk of cancer and grip strength were positively associated (0.916, 0.880-0.953; p<0.0001), but this association was not found in middle-income and low-income countries. INTERPRETATION This study suggests that measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease. Further research is needed to identify determinants of muscular strength and to test whether improvement in strength reduces mortality and cardiovascular disease. FUNDING Full funding sources listed at end of paper (see Acknowledgments).
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Affiliation(s)
- Darryl P Leong
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada.
| | - Koon K Teo
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo University, Brazil
| | - Andres Orlandini
- ECLA Foundation, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | - Suad H Ahmed
- Dubai Health Authority, Dubai, United Arab Emirates
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Scott A Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Aytekin Oguz
- Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Khalid Yusoff
- Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia; UCSI University, Cheras, Kuala Kumpur, Malaysia
| | - Katarzyna Zatonska
- Department of Social Medicine, Medical University of Wrocław, Wrocław, Poland
| | | | - Ehimario Igumbor
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | | | - Hongqiu Gu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
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21
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Aronsohn A, Ancuta I, Caruntu F, Coppola C, Delic D, Digiacomo A, Dusheiko GM, Lengyel G, Marcellin P, Orlandini A, Pruthi J, Silva GF, Tallarico L, Schmitz M, Tatsch F, Korner E, Cheinquer H. Impact of age on viral kinetics of peginterferon alfa-2a/ribavirin in chronic hepatitis C: final analysis from the PROPHESYS cohort. J Viral Hepat 2014; 21:377-80. [PMID: 24131506 DOI: 10.1111/jvh.12179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 08/29/2013] [Indexed: 01/24/2023]
Abstract
The population of patients with chronic hepatitis C viral infection is ageing; however, elderly, hepatitis C-infected patients are understudied and less frequently treated. This subanalysis of data from the multinational PROPHESYS study examined associations between age (≤65 vs >65 years), on-treatment virological response and sustained virological response (SVR) in patients treated with peginterferon alfa-2a (40KD)/ribavirin in accordance with local licences. PROPHESYS comprised three cohorts studied in 19 countries according to country-specific legal and regulatory requirements. This subanalysis includes treatment-naive HCV mono-infected patients assigned to receive peginterferon alfa-2a (40KD)/ribavirin, with 6276 individuals aged ≤65 years and 349 aged >65 years. Rapid virological response (RVR) rates by Week 4 were consistently lower in older genotype (G) 1 (21.6% vs 27.2% in younger patients), G2 (80.7% vs 85.1%) and G3 (60.0% vs 74.2%) patients. SVR rates were significantly lower (29.8% vs 43.0%) and relapse rates significantly higher (43.1% vs 26.7%) in older G1 patients (P = 0.0002 vs ≤65 years). In contrast, SVR and relapse rates were similar in G2 and G3 patients regardless of age. The positive predictive value of RVR for SVR was comparable in older and younger G1 patients (66.7% vs 68.6%, respectively) and higher in older G2 (80.7% vs 75.6%) and G3 (77.8% vs 66.8%) patients. Virological response rates are generally lower in elderly CHC patients, and RVR is a reliable positive predictor of SVR in patients >65 years.
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Affiliation(s)
- A Aronsohn
- University of Chicago Medical Center, Chicago, IL, USA
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22
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Dokainish H, Rajaram M, Prabhakaran D, Afzal R, Orlandini A, Staszewsky L, Franzosi MG, Llanos J, Martinoli E, Roy A, Yusuf S, Mehta S, Lonn E. Incremental Value of Left Ventricular Systolic and Diastolic Function to Determine Outcome in Patients with Acute ST-Segment Elevation Myocardial Infarction: The Echocardiographic Substudy of the OASIS-6 Trial. Echocardiography 2013; 31:569-78. [DOI: 10.1111/echo.12452] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hisham Dokainish
- Department of Medicine; Division of Cardiology and Population Health Research Institute; McMaster University; Hamilton Ontario Canada
| | | | | | - Rizwan Afzal
- Population Health Research Institute; McMaster University; Hamilton Ontario Canada
| | | | - Lidia Staszewsky
- Department of Cardiovascular Research; Istitute for Pharmacological Research “Mario Negri”-IRCCS; Milan Italy
| | - Maria Grazia Franzosi
- Department of Cardiovascular Research; Istitute for Pharmacological Research “Mario Negri”-IRCCS; Milan Italy
| | | | - Elena Martinoli
- Department of Cardiovascular Research; Istitute for Pharmacological Research “Mario Negri”-IRCCS; Milan Italy
| | - Ambuj Roy
- All India Institute of Medical Sciences; New Delhi India
| | - Salim Yusuf
- Department of Medicine; Division of Cardiology and Population Health Research Institute; McMaster University; Hamilton Ontario Canada
| | - Shamir Mehta
- Department of Medicine; Division of Cardiology and Population Health Research Institute; McMaster University; Hamilton Ontario Canada
| | - Eva Lonn
- Department of Medicine; Division of Cardiology and Population Health Research Institute; McMaster University; Hamilton Ontario Canada
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Orlandini A, Castellana N, Pascual A, Botto F, Bahit C, Chacon C, Diaz R. Usefulness of myocardial viability tests in the decision making process to indicate revascularization in patients with left ventricular dysfunction and coronary artery disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Paternico D, Pievani M, Benussi L, Ghidoni R, Binetti G, Orlandini A, Cobelli M, Frisoni G. Pattern of Cortical Thinning in Unaffected at Risk Members of Families with Mutations in Granulin (S34.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s34.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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25
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Fisicaro P, Valdatta C, Boni C, Massari M, Mori C, Zerbini A, Orlandini A, Sacchelli L, Missale G, Ferrari C. Early kinetics of innate and adaptive immune responses during hepatitis B virus infection. Gut 2009; 58:974-82. [PMID: 19201769 DOI: 10.1136/gut.2008.163600] [Citation(s) in RCA: 230] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Innate immunity appears to be silent in acutely hepatitis B virus (HBV)-infected chimpanzees, as shown by microarray analysis of intrahepatic gene expression. Whether this observation also applies to HBV pathogenesis in man remains undefined. The aim of this study was thus to characterise natural killer (NK) and CD56(+) natural T (NT) cell responses early after human HBV infection and their relationship to the induction of adaptive immunity. METHODS Two HBV-seronegative blood donors who became hepatitis B surface antigen (HBsAg) and HBV DNA positive but had persistently normal alanine aminotransferase (ALT) were followed from a very early stage of HBV infection. The phenotype (CD69 and NKG2D) and function (cytotoxicity and interferon gamma (IFN gamma) production) of NK and NT cells were analysed. CD4- and CD8-mediated responses were studied in parallel with overlapping peptides covering the entire HBV sequence by ex vivo intracellular cytokine staining (ICS) for IFN gamma, interleukin 2 (IL2), IL4 and IL10, and by ex vivo Elispot for IFN gamma. Healthy subjects, and patients with chronic and acute HBV infection were studied for comparison. RESULTS An early induction of both innate and adaptive responses was observed. NK and NT cells showed faster kinetics than HBV-specific T cells with an earlier peak of activity, while CD4(+) and CD8(+) cell responses were mounted with a similar profile, with higher frequencies of IFN gamma-producing CD8(+) cells at the peak of the response. CONCLUSIONS The innate immune system is able to sense HBV infection, as shown by the early development of NK and NT cell responses, which probably contribute to contain the HBV infection and to allow timely induction of adaptive responses.
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Affiliation(s)
- P Fisicaro
- Laboratory of Viral Immunopathology, Unit of Infectious Diseases and Hepatology, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci, 14, 43100 Parma, Italy
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Orlandini A. Clinical trials with ST-segment elevation myocardial infarction: reply. Eur Heart J 2006. [DOI: 10.1093/eurheartj/ehl187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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27
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Ienco A, Mealli C, Orlandini A, Galindo A, Grirrane A, del Río D, Pastor A, Fernández Sanz J, Caneschi A. Supramolecular interactions as determining factors of the primary geometry of metallic building blocks. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305086824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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28
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Yakhvarov D, Sinyashin O, Barbaro P, Mañas S, Midollini S, Orlandini A, Peruzzini M, Zanobini F. Synthesis and X-ray study of the P 5-polyphosphorus rhodium complex [(dppm){Ph 2PCH 2P(Ph 2)PPPP}Rh]OTf. Acta Crystallogr A 2005. [DOI: 10.1107/s0108767305087064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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29
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Bedetti G, Pasanisi EM, Tintori G, Fonseca L, Tresoldi S, Minneci C, Jambrik Z, Ghelarducci B, Orlandini A, Picano E. Stress echo in chest pain unit: the SPEED trial. Int J Cardiol 2005; 102:461-7. [PMID: 16004892 DOI: 10.1016/j.ijcard.2004.05.058] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Accepted: 05/05/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Emergency room (ER) evaluation of patients with acute chest pain and non-diagnostic electrocardiography (ECG) remains a frequent and difficult problem. AIM To assess safety and prognostic implications of pharmacological stress echocardiography in the ER chest pain unit (CPU). METHODS A total of 552 patients (321 males, age 58+/-12.6 years) with acute chest pain, negative serial enzymes and/or troponin, and ECG recordings, and normal/unchanged resting left ventricular function were prospectively enrolled and underwent pharmacological (dipyridamole or dobutamine) stress echo. Six echo labs that had passed the preliminary quality control for stress echo reading entered the study. Follow-up was obtained in all patients after a median period of 13 months. RESULTS No significant adverse events were observed during the test. Stress echocardiography was negative in 502 patients (91%) and positive in 50 (9%). The 502 patients with negative stress echocardiography were discharged with no or unchanged anti-ischemic medications. While the 50 patients with positive stress echo were admitted to the coronary care unit, 44 of these underwent coronary angiography with the result that 42 out of 44 showed significant coronary artery disease. There were 45 events in the follow-up: six in the 502 patients with negative and 39 in the 50 patients with positive stress echo (1.2% vs. 78%, p<0.001). The negative predictive value of stress echocardiography was 98.8% for all events and 99.6% for hard events. CONCLUSIONS Stress echocardiography is a feasible, safe, and effective tool for early stratification of patients admitted to the ER with acute chest pain and non-ischemic ECG and resting echo.
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Moya-Hernández MR, Mederos A, Domínguez S, Orlandini A, Ghilardi CA, Cecconi F, González-Vergara E, Rojas-Hernández A. Speciation study of the anti-inflammatory drug tenoxicam (Htenox) with Cu(II): X-ray crystal structure of [Cu(tenox)(2)(py)(2)].EtOH. J Inorg Biochem 2003; 95:131-40. [PMID: 12763657 DOI: 10.1016/s0162-0134(03)00095-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A speciation study was carried out in aqueous solution of the anti-inflammatory drug tenoxicam (Htenox), under quasi-physiological conditions (temperature of 37 degrees C and ionic strength 0.15 M NaCl) in order to determine the acidity constants from spectrophotometric studies, the pK(a) values found being pK(1)=1.143+/-0.008 and pK(2)=4.970+/-0.004. Subsequently, the spectrophotometrical speciation of the different complexes of Cu(II) with the drug was performed under the same conditions of temperature and ionic strength, observing the formation of Cu(Htenox)(2)(2+) with log beta(212)=20.05+/-0.01, Cu(tenox)(2) with log beta(012)=13.6+/-0.1, Cu(Htenox)(2+) with log beta(111)=10.52+/-0.08, as well as Cu(tenox)(+) with log beta(011)=7.0+/-0.2, all of them in solution, and solid species Cu(tenox)(2)(s) with an estimated value of log beta(012)(s) approximately 18.7. The crystalline structure of the complex [Cu(tenox)(2)(py)(2)]. EtOH, was also determined, and it was observed that tenoxicam employs the oxygen of the amide group and the pyridyl nitrogen to bond to the cation.
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Affiliation(s)
- M R Moya-Hernández
- Universidad Autónoma Metropolitana-Iztapalapa, Depto Química, Apdo Postal 55-534-9340, D F, México, Mexico
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31
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Sacconi L, Orlandini A, Midollini S. Synthesis, properties, and structural characterizations of nonstoichiometric hydrido complexes of nickel with the tetradentate ligand tris(2-diphenylphosphinoethyl)amine. Inorg Chem 2002. [DOI: 10.1021/ic50142a017] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Bianchini C, Mealli C, Meli A, Orlandini A, Sacconi L. Mono- and dinuclear carbon disulfide metal complexes with 1,1,1-tris((diphenylphosphino)methyl)ethane. Inorg Chem 2002. [DOI: 10.1021/ic50212a025] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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33
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Ghilardi CA, Mealli C, Midollini S, Orlandini A. Tetrahedral structure of the high-spin cobalt(I) complex (np3)CoBr. A symmetry-forbidden rearrangement to five-coordination. Inorg Chem 2002. [DOI: 10.1021/ic00196a009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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34
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Orlandini A, Sacconi L. Synthesis, properties, and x-ray characterization of aquo and hydroxo complexes of cobalt(II) and nickel(II) with poly(tertiary phosphines). Inorg Chem 2002. [DOI: 10.1021/ic50155a018] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Ghilardi CA, Mealli C, Midollini S, Nefedov VI, Orlandini A, Sacconi L. Transition-metal complexes with sulfur atoms as ligands. 5. Synthesis and structural characterization of doubly sulfur-bridged binuclear complexes of cobalt with the tris(tertiary phosphine) 1,1,1-tris((diphenylphosphino)methyl)ethane. Inorg Chem 2002. [DOI: 10.1021/ic50210a053] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Cecconi F, Di Vaira M, Midollini S, Orlandini A, Sacconi L. Singlet .dblharw. quintet spin transitions of iron(II) complexes with a P4Cl2 donor set. X-ray structures of the compound FeCl2(Ph2PCH:CHPPh2)2 and of its acetone solvate at 130 and 295 K. Inorg Chem 2002. [DOI: 10.1021/ic50224a053] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Ghilardi CA, Midollini S, Orlandini A, Sacconi L. Single- and mixed-metal complexes with cyclo-triphosphorus and 1,1,1-tris((diphenylphosphino)methyl)ethane, triphos. Synthesis and structural characterization of [(triphos)Co(.eta.3-P3)] and [(triphos)Co(.mu.-(.eta.3-P3)){Cr2(CO)10}]. Inorg Chem 2002. [DOI: 10.1021/ic50204a005] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Mealli C, Orlandini A, Sacconi L, Stoppioni P. Synthesis and structural characterization of a sulfur dioxide complex of nickel with tris(2-diphenylphosphino)ethyl)amine. Inorg Chem 2002. [DOI: 10.1021/ic50189a010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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39
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Dapporto P, Midollini S, Orlandini A, Sacconi L. Complexes of cobalt, nickel, and copper with the tripod ligand 1,1,1-tris(diphenylphosphinomethyl)ethane (p3). Crystal structures of the [Co(p3)(BH4)] and [Ni(p3)(SO2)] complexes. Inorg Chem 2002. [DOI: 10.1021/ic50165a040] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Gatteschi D, Ghilardi CA, Orlandini A, Sacconi L. Low-temperature crystal structure and ESR spectra of bis(isothiocyanato)[N-(2-(diphenylphosphino)ethyl)-N',N'-diethylethylenediamine]cobalt(II), a five-coordinate complex exhibiting spin equilibrium. Inorg Chem 2002. [DOI: 10.1021/ic50189a011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Bianchini C, Meli A, Orlandini A. Reactivity of the triethylphosphine-carbon disulfide adduct (Et3P.CS2) toward cobalt(II) cations in the presence of the tris (tertiary phosphines) triphos and etriphos. X-ray crystal structure of the complex [(etriphos)Co(S2C(H)PEt3)](BPh4)2. Inorg Chem 2002. [DOI: 10.1021/ic00142a011] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Ghilardi CA, Midollini S, Orlandini A. A unidentate attachment of the tetrahydroborate group. Crystal and molecular structure of (tetrahydroborato)[1,1,1-tris((diphenylphosphino)methyl)ethane-P,P',P"]copper(I). Inorg Chem 2002. [DOI: 10.1021/ic00141a043] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Bianchini C, Meli A, Orlandini A. Chemistry of Et3P.CS2 metal complexes: synthesis of 1,1-dithiolate complexes via nucleophilic attacks on [(triphos)Co(S2CPEt3)](BPh4)2. X-ray structure of [(triphos)Co(S2CO)]. Inorg Chem 2002. [DOI: 10.1021/ic00142a012] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Bedetti G, Pasanisi E, Tintori G, Fonseca L, Tresoldi S, Minneci C, Orlandini A, Ghelarducci B, Bugiardini R, Picano E. Stress echo in chest pain unit: the SPEED (Stress Pharmacologic Echocardiography in Emergency Department) trial. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)81695-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Abstract
Spinal dysraphisms are diagnosed more frequently at birth or in infancy. We report a spinal malformation compatible with lipomyeloschisis in an elderly patient presenting with symptoms and signs of myelopathy. Magnetic resonance imaging revealed an intraspinal mass continuous with a subcutaneous lipoma. Three-dimensional computed tomography reconstructions better showed the spinal dysraphism; dermal sinus was also evident. Neuroimaging can define the precise diagnosis also in elderly patients presenting with myelopathy and can provide valuable structural details.
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Affiliation(s)
- M Manfredi
- Department of Neurology, Casa di Cura Poliambulanza, Brescia, Italy
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46
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Lugari R, Ugolotti D, Dei Cas A, Barilli AL, Iotti M, Marani B, Orlandini A, Gnudi A, Zandomeneghi R. Urinary excretion of glucagon-like peptide 1 (GLP-1) 7-36 amide in human type 2 (non-insulin-dependent) diabetes mellitus. Horm Metab Res 2001; 33:568-71. [PMID: 11561219 DOI: 10.1055/s-2001-17206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The urinary excretion of insulinotropic glucagon-like peptide 1 (GLP-1) was investigated as an indicator of renal tubular integrity in 10 healthy subjects and in 3 groups of type 2 diabetic patients with different degrees of urinary albumin excretion rate. No significant difference emerged between the groups with respect to age of the patients, known duration of diabetes, metabolic control, BMI, or residual beta-cell pancreatic function. Endogenous creatinine clearance was significantly reduced under conditions of overt diabetic nephropathy, compared with normo and microalbuminuric patients (p < 0.01). Urinary excretion of GLP-1 was significantly higher in normoalbuminuric patients compared to controls (490.4 +/- 211.5 vs. 275.5 +/- 132.1 pg/min; p < 0.05), with further increase under incipient diabetic nephropathy conditions (648.6 +/- 305 pg/min; p < 0.01). No significant difference resulted, in contrast, between macroproteinuric patients and non-diabetic subjects. Taking all patients examined into account, a significant positive relationship emerged between urinary GLP-1 and creatinine clearance (p = 0.004). In conclusion, an early tubular impairment in type 2 diabetes would occur before the onset of glomerular permeability alterations. The tubular dysfunction seems to evolve with the development of persistent microalbuminuria. Finally, the advanced tubular involvement, in terms of urinary GLP1 excretion, under overt diabetic nephropathy conditions would be masked by severe concomitant glomerular damage with the coexistence of both alterations resulting in a peptide excretion similar to control subjects.
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Affiliation(s)
- R Lugari
- Department of Endocrinology, University of Parma, Via Gramsci 14, 43100 Parma, Italy
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47
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Barbaro P, Cecconi F, Dakternieks D, Dominguez S, Duthie A, Ghilardi CA, Midollini S, Orlandini A, Vacca A. Beryllium(II) Complexes of the Kläui Tripodal Ligand Cyclopentadienyltris(diethylphosphito-P)cobaltate(−). Inorg Chem 2001; 40:2725-9. [PMID: 11375687 DOI: 10.1021/ic010021+] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The interactions of the beryllium(II) ion with the cyclopentadienyltris(diethylphosphito-P)cobaltate monoanion, L(-), have been investigated, in aqueous solution, by synthetic methods, potentiometry, ESMS, and (1)H, (31)P, and (9)Be NMR spectroscopy. L(-) has been found able to displace either two or three water molecules in the beryllium(II) coordination sphere, to form mononuclear, dinuclear, and trinuclear derivatives, in which the metal ion is pseudotetrahedrally coordinated. The species [BeL(H(2)O)](+) and [Be(2)L(2)(mu-OH)](+) have been identified in solution while complexes of formula BeL(2) and [Be(3)L(4)](ClO(4))(2) have been isolated as solid materials. The species [BeL(OPPh(2))](+), closely related to [BeL(H(2)O)](+), has been characterized in acetone solution and isolated as tetraphenylborate salt. The structure of the unusual trimeric complex [Be(3)L(4)](2+) has been elucidated by an unprecedented 2D (9)Be-(31)P NMR correlation spectrum showing the presence of a single central beryllium nucleus and two equivalent terminal beryllium nuclei. The three beryllium centers are held together by four cobaltate ligands, which display two different bonding modes: two ligands are terminally linked with all the three oxygen donors to one terminal beryllium, and the other two bridge two metal centers, sharing the oxygen donors between central and terminal beryllium atoms.
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Affiliation(s)
- P Barbaro
- Istituto per lo Studio della Stereochimica ed Energetica dei Composti di Coordinazione, CNR, Via J. Nardi 39, 50132 Firenze, Italy
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48
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Abstract
We tested the value of a stress echocardiography-based algorithm used in a chest pain center. The algorithm had superlative negative predictive value for cardiac events, allowing an early discharge.
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Affiliation(s)
- A Orlandini
- Instituto Cardiovascular de Rosario, Argentina.
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49
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Lugari R, Dell'Anna C, Ugolotti D, Dei Cas A, Barilli AL, Zandomeneghi R, Marani B, Iotti M, Orlandini A, Gnudi A. Effect of nutrient ingestion on glucagon-like peptide 1 (7-36 amide) secretion in human type 1 and type 2 diabetes. Horm Metab Res 2000; 32:424-8. [PMID: 11069208 DOI: 10.1055/s-2007-978665] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Exogenous glucagon-like peptide 1(GLP-1) bioactivity is preserved in type 2 diabetic patients, resulting the peptide administration in a near-normalization of plasma glucose mainly through its insulinotropic effect. GLP-1 also reduces meal-related insulin requirement in type 1 diabetic patients, suggesting an impairment of the entero-insular axis in both diabetic conditions. To investigate this metabolic dysfunction, we evaluated endogenous GLP-1 concentrations, both at fasting and in response to nutrient ingestion, in 16 type 1 diabetic patients (age = 40.5 +/- 14yr, HbA1C = 7.8 +/- 1.5%), 14 type 2 diabetics (age = 56.5 +/- 13yr, HbA1C = 8.1 +/- 1.8%), and 10 matched controls. In postabsorptive state, a mixed breakfast (230 KCal) was administered to all subjects and blood samples were collected for plasma glucose, insulin, C-peptide and GLP-1 determination during the following 3 hours. In normal subjects, the test meal induced a significant increase of GLP-1 (30', 60': p < 0.01), returning the peptide values towards basal concentrations. In type 2 diabetic patients, fasting plasma GLP-1 was similar to controls (102.1 +/- 1.9 vs. 97.3 +/- 4.01 pg/ml), but nutrient ingestion failed to increase plasma peptide levels, which even decreased during the test (p < 0.01). Similarly, no increase in postprandial GLP-1 occurred in type 1 diabetics, in spite of maintained basal peptide secretion (106.5 +/- 1.5 pg/ml). With respect to controls, the test meal induced in both diabetic groups a significant increase in plasma glucagon levels at 60' (p < 0.01). In conclusion, either in condition of insulin resistance or insulin deficiency chronic hyperglycemia, which is a common feature of both metabolic disorders, could induce a progressive desensitization of intestinal L-cells with consequent peptide failure response to specific stimulation.
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Affiliation(s)
- R Lugari
- Department of Endocrinology, University of Parma, Italy.
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50
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Manfredi M, Magni E, Gandolfini M, Beltramello A, Orlandini A, Donati E. Superficial siderosis of the central nervous system and anticoagulant therapy: a case report. Ital J Neurol Sci 1999; 20:247-9. [PMID: 10551912 DOI: 10.1007/s100720050039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Superficial siderosis of the central nervous system is a rare condition characterized by deposition of haemosiderin in the leptomeninges and in the subpial layers of the brain and spinal cord. With the widespread use of magnetic resonance imaging, an increasing number of cases of superficial siderosis are being discovered, secondary forms being more frequent than idiopathic ones. We report a 78-year-old man in oral anticoagulant therapy, who presented neurosensory hearing loss, gait ataxia and spastic paraparesis. Magnetic resonance imaging suggested the diagnosis of superficial siderosis of the central nervous system, without an evident bleeding source.
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Affiliation(s)
- M Manfredi
- Neuroscience Department, Neurology Unit, Poliambulanza Hospital, Brescia, Italy
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