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Ikdahl E, Semb AG, Kerola AM. No sign of elevated cardiovascular risk in patients with seropositive rheumatoid arthritis who remain on stable antirheumatic therapy: results from the nationwide Norwegian Cardio-Rheuma Register. Ann Rheum Dis 2024:ard-2024-225758. [PMID: 38653532 DOI: 10.1136/ard-2024-225758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Eirik Ikdahl
- REMEDY Center for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- REMEDY Center for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne M Kerola
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Sayour NV, Paál ÁM, Ameri P, Meijers WC, Minotti G, Andreadou I, Lombardo A, Camilli M, Drexel H, Grove EL, Dan GA, Ivanescu A, Semb AG, Savarese G, Dobrev D, Crea F, Kaski JC, de Boer RA, Ferdinandy P, Varga ZV. Heart failure pharmacotherapy and cancer: pathways and pre-clinical/clinical evidence. Eur Heart J 2024; 45:1224-1240. [PMID: 38441940 PMCID: PMC11023004 DOI: 10.1093/eurheartj/ehae105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/08/2024] [Accepted: 02/07/2024] [Indexed: 04/08/2024] Open
Abstract
Heart failure (HF) patients have a significantly higher risk of new-onset cancer and cancer-associated mortality, compared to subjects free of HF. While both the prevention and treatment of new-onset HF in patients with cancer have been investigated extensively, less is known about the prevention and treatment of new-onset cancer in patients with HF, and whether and how guideline-directed medical therapy (GDMT) for HF should be modified when cancer is diagnosed in HF patients. The purpose of this review is to elaborate and discuss the effects of pillar HF pharmacotherapies, as well as digoxin and diuretics on cancer, and to identify areas for further research and novel therapeutic strategies. To this end, in this review, (i) proposed effects and mechanisms of action of guideline-directed HF drugs on cancer derived from pre-clinical data will be described, (ii) the evidence from both observational studies and randomized controlled trials on the effects of guideline-directed medical therapy on cancer incidence and cancer-related outcomes, as synthetized by meta-analyses will be reviewed, and (iii) considerations for future pre-clinical and clinical investigations will be provided.
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Affiliation(s)
- Nabil V Sayour
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, H-1085 Budapest, Üllői út 26, Hungary
- HCEMM-SU Cardiometabolic Immunology Research Group, H-1089 Budapest, Nagyvárad tér 4, Hungary
- MTA-SE Momentum Cardio-Oncology and Cardioimmunology Research Group, H-1089 Budapest, Nagyvárad tér 4, Hungary
| | - Ágnes M Paál
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, H-1085 Budapest, Üllői út 26, Hungary
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiology Network, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Wouter C Meijers
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Giorgio Minotti
- University Campus Bio-Medico, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Ioanna Andreadou
- Laboratory of Pharmacology, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonella Lombardo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimiliano Camilli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Gheorghe Andrei Dan
- Carol Davila University of Medicine and Pharmacy, Colentina University Hospital, Bucharest, Romania
- Cardiology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Andreea Ivanescu
- Carol Davila University of Medicine and Pharmacy, Colentina University Hospital, Bucharest, Romania
- Cardiology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Anne Grete Semb
- Division of Research and Innovation, REMEDY-Centre for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, USA
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Juan-Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s University of London, London, United Kingdom
| | - Rudolf A de Boer
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, H-1085 Budapest, Üllői út 26, Hungary
- Pharmahungary Group, Szeged, Hungary
- MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Zoltán V Varga
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, H-1085 Budapest, Üllői út 26, Hungary
- HCEMM-SU Cardiometabolic Immunology Research Group, H-1089 Budapest, Nagyvárad tér 4, Hungary
- MTA-SE Momentum Cardio-Oncology and Cardioimmunology Research Group, H-1089 Budapest, Nagyvárad tér 4, Hungary
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Tamargo J, Agewall S, Borghi C, Ceconi C, Cerbai E, Dan GA, Ferdinandy P, Grove EL, Rocca B, Magavern E, Sulzgruber P, Semb AG, Sossalla S, Niessner A, Kaski JC, Dobrev D. New pharmacological agents and novel cardiovascular pharmacotherapy strategies in 2023. Eur Heart J Cardiovasc Pharmacother 2024:pvae013. [PMID: 38379024 DOI: 10.1093/ehjcvp/pvae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Although cardiovascular diseases are the leading cause of death worldwide, their pharmacotherapy remains suboptimal. Thus, there is a clear unmet need to develop more effective and safer pharmacological strategies. In this review, we summarize the most relevant advances in cardiovascular pharmacology in 2023, including the approval of first-in-class drugs that open new avenues for the treatment of atherosclerotic cardiovascular disease and heart failure. The new indications of drugs already marketed (repurposing) for the treatment of obstructive hypertrophic cardiomyopathy, hypercholesterolemia, type 2 diabetes, obesity and heart failure, the impact of polypharmacy on guideline-directed drug use is highlighted as well as results from negative clinical trials. Finally, we end with a summary of the most important phase 2 and 3 clinical trials assessing the efficacy and safety of cardiovascular drugs under development for the prevention and treatment of cardiovascular diseases.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto De Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Stefan Agewall
- Institute of Clinical Science, Oslo University, Oslo, Norvay
- Institute of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm Sweden
| | - Claudio Borghi
- Department of Cardiovascular Medicine, University of Bologna-IRCCS AOU S. Orsola, Bologna, Italy
| | - Claudio Ceconi
- Unit of Cardiologia, ASST Garda, Desenzano del Garda, Italy
| | - Elisabetta Cerbai
- Department Neurofarba, Section of Pharmacology and Toxicology, University of Florence, Italy
| | - Gheorghe A Dan
- Carol Davila. University of Medicine, Colentina University Hospital, Bucharest, Romania
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Bianca Rocca
- Department Neurofarba, Section of Pharmacology and Toxicology, University of Florence, Italy
- Section of Pharmacology, Department of Safety and Bioethics, Catholic University School of Medicine, Rome, Italy
| | - Emma Magavern
- William Harvey Research Institute, Centre of Clinical Pharmacology and Precision Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Patrick Sulzgruber
- Department of Medicine, Division of Cardiology, Medical University of Vienna, Austria
| | - Anne Grete Semb
- Preventive Cario-Rheuma clinic, Division of Research and Innovation, REMEDY centre, Diakonhjemmet Hospital, Oslo, Norway
| | - Samuel Sossalla
- Medical Clinic I, Cardiology and Angiology, Justus-Liebig-University, Giessen and Department of Cardiology, Kerckhoff-Clinic/DZHK, Bad Nauheim, Germany
- Abt. Kardiologie, Campus Kerckhoff der Justus-Liebig-Universität Gießen, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Dobromir Dobrev
- Institute of Pharmacology, West-German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, USA
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Nordén KR, Semb AG, Dagfinrud H, Hisdal J, Sexton J, Fongen C, Bakke E, Ødegård S, Skandsen J, Blanck T, Metsios GS, Tveter AT. Effect of high-intensity interval training in physiotherapy primary care for patients with inflammatory arthritis: the ExeHeart randomised controlled trial. RMD Open 2024; 10:e003440. [PMID: 38242550 PMCID: PMC10806524 DOI: 10.1136/rmdopen-2023-003440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/25/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVES To assess the effect of high-intensity interval training (HIIT) delivered in physiotherapy primary care on the primary outcome of cardiorespiratory fitness (CRF) in patients with inflammatory arthritis (IA). Additionally, to explore the effects of HIIT on secondary outcomes, including cardiovascular disease (CVD) risk factors and disease activity. METHODS Single-blinded randomised controlled trial with 60 patients randomly assigned to either a control group receiving usual care or an exercise group receiving usual care and 12 weeks of individualised HIIT at 90%-95% peak heart rate. Outcomes were assessed at baseline, 3 months and 6 months post baseline and included CRF measured as peak oxygen uptake (VO2peak), classic CVD risk factors, disease activity, anthropometry and patient-reported physical activity, pain, fatigue, disease impact and exercise beliefs and self-efficacy. RESULTS Intention-to-treat analysis demonstrated a significant between-group difference in VO2peak at 3 months (2.5 mL/kg/min, 95% CI 0.9 to 4.0) and 6 months (2.6 mL/kg/min, 95% CI 0.8 to 4.3) in favour of the exercise group. A beneficial change in self-reported physical activity in favour of the exercise group was observed at 3 and 6 months. The HIIT intervention was well-tolerated with minimal adverse events and no apparent impact on disease activity. Differences in secondary outcomes related to CVD risk factors, disease impact, pain, fatigue and exercise beliefs and self-efficacy were generally small and non-significant. CONCLUSION After 12 weeks of supervised HIIT delivered in physiotherapy primary care, patients with IA demonstrated a favourable improvement in CRF, with sustained effects at 6-month follow-up. TRIAL REGISTRATION NUMBER NCT04922840.
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Affiliation(s)
- Kristine Røren Nordén
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Hanne Dagfinrud
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Camilla Fongen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Emilie Bakke
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
| | - Sigrid Ødegård
- Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, Diakonhjemmet Hospital, Oslo, Norway
| | - Jon Skandsen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Thalita Blanck
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - George S Metsios
- Department of Nutrition and Dietetics, University of Thessaly, Volos, Greece
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Health Services Research and Innovation Unit, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Health Sciences, Institute of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Akershus, Norway
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Ikdahl E, Rollefstad S, Kazemi A, Provan SA, Larsen TL, Semb AG. Non-steroidal anti-inflammatory drugs and risk of pulmonary embolism in patients with inflammatory joint disease-results from the nationwide Norwegian Cardio-rheuma registry. Eur Heart J Cardiovasc Pharmacother 2024; 10:27-34. [PMID: 37881093 PMCID: PMC10766907 DOI: 10.1093/ehjcvp/pvad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/04/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023]
Abstract
AIMS Patients with inflammatory joint diseases (IJD), including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) have increased rates of pulmonary embolism (PE). Non-steroidal anti-inflammatory drugs (NSAIDs) use is associated with PE in the general population. Our aim was to evaluate the association between NSAIDs use and PE in IJD patients. METHODS AND RESULTS Using individual-level registry data from the whole Norwegian population, including data from the Norwegian Patient Registry and the Norwegian Prescription Database, we: (1) evaluated PE risk in IJD compared to non-IJD individuals, (2) applied the self-controlled case series method to evaluate if PE risks were associated with use of traditional NSAIDs (tNSAIDs) and selective cox-2 inhibitors (coxibs). After a one-year wash-out period, we followed 4 660 475 adults, including 74 001 with IJD (RA: 39 050, PsA: 20 803, and axSpA: 18 591) for a median of 9.0 years. Crude PE incidence rates per 1000 patient years were 2.02 in IJD and 1.01 in non-IJD individuals. Age and sex adjusted hazard ratios for PE events were 1.57 for IJD patients compared to non-IJD. Incidence rate ratios (IRR) [95% confidence interval (CI)] for PE during tNSAIDs use were 0.78 (0.64-0.94, P = 0.010) in IJD and 1.68 (1.61-1.76, P < 0.001) in non-IJD. IRR (95% CI) for PE during coxibs use was 1.75 (1.10-2.79, P = 0.018) in IJD and 2.80 (2.47-3.18, P < 0.001) for non-IJD. CONCLUSION Pulmonary embolism rates appeared to be higher in IJD than among non-IJD subjects in our study. Traditional NSAIDs may protect against PE in IJD patients, while coxibs may associated with increased PE risk.
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Affiliation(s)
- Eirik Ikdahl
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Silvia Rollefstad
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Amirhossein Kazemi
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Sella A Provan
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, 0319 Oslo, Norway
- Department Public Health and Sport Sciences, Inland Norway University of Applied Sciences, 2406 Elverum, Norway
| | - Trine-Lise Larsen
- Department Hematology, Medical Division, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Anne Grete Semb
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, 0319 Oslo, Norway
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Ullensvang G, Kringeland E, Ikdahl E, Provan S, Berg IJ, Rollefstad S, Dagfinrud H, Gerdts E, Semb AG, Midtbø H. Cardiovascular organ damage in relation to hypertension status in patients with ankylosing spondylitis. Blood Press 2023; 32:2205956. [PMID: 37132420 DOI: 10.1080/08037051.2023.2205956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE Hypertension is a major cardiovascular (CV) risk factor in ankylosing spondylitis (AS) patients. Less is known about the prevalence of CV organ damage in relation to hypertension status in AS patients. MATERIALS AND METHODS CV organ damage was assessed by echocardiography, carotid ultrasound and pulse wave velocity (PWV) by applanation tonometry in 126 AS patients (mean age 49 ± 12 years, 39% women) and 71 normotensive controls (mean age 47 ± 11 years, 52% women). CV organ damage was defined as presence of abnormal left ventricular (LV) geometry, LV diastolic dysfunction, left atrial (LA) dilatation, carotid plaque or high pulse wave velocity (PWV). RESULTS Thirty-four percent of AS patients had hypertension. AS patients with hypertension were older and had higher C-reactive protein (CRP) levels compared to AS patients without hypertension and controls (p < 0.05). The prevalence of CV organ damage was 84% in AS patients with hypertension, 29% in AS patients without hypertension and 30% in controls (p < 0.001). In multivariable logistic regression analyses, having hypertension was associated with a fourfold increased risk of CV organ damage independent of age, presence of AS, gender, body mass index, CRP, and cholesterol (odds ratio (OR) 4.57, 95% confidence interval (CI) 1.53 to 13.61, p = 0.006). In AS patients, presence of hypertension was the only covariable significantly associated with presence of CV organ damage (OR 4.40, 95% CI 1.40 to 13.84, p = 0.011). CONCLUSIONS CV organ damage in AS was strongly associated with hypertension, pointing to the importance of guideline-based hypertension management in AS patients.
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Affiliation(s)
- Gyda Ullensvang
- Center for research on cardiac disease in women, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ester Kringeland
- Center for research on cardiac disease in women, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Sella Provan
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Inger Jorid Berg
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Hanne Dagfinrud
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Eva Gerdts
- Center for research on cardiac disease in women, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Helga Midtbø
- Center for research on cardiac disease in women, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Nordén KR, Dagfinrud H, Semb AG, Hisdal J, Metsios GS, Sexton J, Fongen C, Bakke EA, Tveter AT. Criterion Validity and Responsiveness of Estimated Cardiorespiratory Fitness Models in Patients with Inflammatory Joint Disease. J Clin Med 2023; 12:6753. [PMID: 37959219 PMCID: PMC10650593 DOI: 10.3390/jcm12216753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Cardiorespiratory fitness (CRF) is an excellent marker of overall health. This study aimed to assess criterion validity and responsiveness of estimated CRF models (eCRF) in patients with inflammatory joint disease (IJD). CRF was measured directly as peak oxygen uptake (VO2peak) by a Cardiopulmonary Exercise Test (CPET), while one generic eCRF model (eCRFGEN) and two disease-specific eCRF models (eCRFALT and eCRFPGA) were used to estimate CRF at baseline and after 3 months in 55 Norwegian patients with IJD. Moderate correlations were observed between eCRFGEN, eCRFALT, eCRFPGA, and VO2peak at baseline (ICC 0.60, 0.64 and 0.62, respectively) and 3 months (ICC 0.62, 0.65 and 0.57, respectively). All eCRF models overestimated measured VO2peak, and there was large variability in agreement of individual measurements at baseline and at 3 months. Weak correlations were observed for responsiveness of eCRFGEN (ICC 0.39), eCRFALT (ICC 0.40) and eCRFPGA (ICC 0.39). Mean differences between change in eCRF models and change in VO2peak were small, but the wide limits of agreement exceeded the pre-defined clinically acceptable margins. The eCRF models possessed adequate ability to detect ≥3.5 mL/kg/min improvement in VO2peak. eCRF may suffice for group-level assessment, but caution is advised when applying eCRF to individual patients with IJD.
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Affiliation(s)
- Kristine Røren Nordén
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
- Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Hanne Dagfinrud
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Division of Rheumatology and Research, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Jonny Hisdal
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway;
- Department of Vascular Surgery, Oslo University Hospital—Aker, 0586 Oslo, Norway
| | - George S. Metsios
- Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Division of Rheumatology and Research, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Camilla Fongen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Emilie Andrea Bakke
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Anne Therese Tveter
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 0319 Oslo, Norway
- Faculty of Health Sciences, Institute of Rehabilitation Science and Health Technology, Oslo Metropolitan University, 0166 Oslo, Norway
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Semb AG, Vesterbekkmo EK, Retterstøl K, Atar D, Solberg EE, Schirmer H, Løchen ML, Kask A, Grimsmo J, Ingul CB, Munkhaugen J. PCSK9-hemmere på blå resept for hvem? Tidsskr Nor Laegeforen 2023; 143:23-0191. [PMID: 37254976 DOI: 10.4045/tidsskr.23.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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9
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Tamargo J, Agewall S, Borghi C, Ceconi C, Cerbai E, Dan GA, Ferdinandy P, Grove EL, Rocca B, Sulzgruber P, Semb AG, Sossalla S, Niessner A, Kaski JC, Dobrev D. New pharmacological agents and novel cardiovascular pharmacotherapy strategies in 2022. Eur Heart J Cardiovasc Pharmacother 2023; 9:pvad034. [PMID: 37169875 PMCID: PMC10236523 DOI: 10.1093/ehjcvp/pvad034] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/10/2023] [Accepted: 05/10/2023] [Indexed: 05/13/2023]
Abstract
Cardiovascular diseases (CVD) remain the leading cause of death worldwide and pharmacotherapy of most of them is suboptimal. Thus, there is a clear unmet clinical need to develop new pharmacological strategies with greater efficacy and better safety profiles. In this review, we summarize the most relevant advances in cardiovascular pharmacology in 2022 including the approval of first-in-class drugs that open new avenues for the treatment of obstructive hypertrophic cardiomyopathy (mavacamten), type 2 diabetes mellitus (tirzepatide), and heart failure (HF) independent of left ventricular ejection fraction (sodium-glucose cotransporter 2 inhibitors). We also dealt with fixed dose combination therapies repurposing different formulations of "old" drugs with well-known efficacy and safety for the treatment of patients with acute decompensated HF (acetazolamide plus loop diuretics), atherosclerotic cardiovascular disease (moderate-dose statin plus ezetimibe), Marfan syndrome (angiotensin receptor blockers plus β-blockers), and secondary cardiovascular prevention (i.e. low-dose aspirin, ramipril and atorvastatin), thereby filling existing gaps in knowledge, and opening new avenues for the treatment of CVD. Clinical trials confirming the role of dapagliflozin in patients with HF and mildly reduced or preserved ejection fraction, long-term evolocumab to reduce the risk of cardiovascular events, vitamin K antagonists for stroke prevention in patients with rheumatic heart disease-associated atrial fibrillation, antibiotic prophylaxis in patients at high risk for infective endocarditis before invasive dental procedures, and vutrisiran for the treatment of hereditary transthyretin-related amyloidosis with polyneuropathy were also reviewed. Finally, we briefly discuss recent clinical trials suggesting that FXIa inhibitors may have the potential to uncouple thrombosis from hemostasis and attenuate/prevent thromboembolic events with minimal disruption of hemostasis.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, Plaza de Ramón y Cajal s/n, Madrid 28040, Spain
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norvay
| | - Claudio Borghi
- Department of Cardiovascular Medicine, University of Bologna-IRCCS AOU S. Orsola, Bologna, Italy
| | - Claudio Ceconi
- Unit of Cardiologia, ASST Garda, Desenzano del Garda, Italy
| | - Elisabetta Cerbai
- Department Neurofarba, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Gheorghe A Dan
- “Carol Davila” University of Medicine, Colentina University Hospital, Bucharest, Romania
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Bianca Rocca
- Section of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Patrick Sulzgruber
- Department of Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Anne Grete Semb
- Preventive Cario-Rheuma Clinic, Division of Research and Innovation, REMEDY Centre, Diakonhjemmet Hospital, Oslo, Norway
| | - Samuel Sossalla
- Department of Internal Medicine II, University Regensburg, Regensburg, Germany
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Dobromir Dobrev
- Institute of Pharmacology, West-German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Canada
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, USA
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10
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Nordén KR, Semb AG, Dagfinrud H, Hisdal J, Ødegård S, Sexton J, Fongen C, Skandsen J, Blanck T, Metsios GS, Tveter AT. Associations between cardiovascular risk factors, disease activity and cardiorespiratory fitness in patients with inflammatory joint disease: a cross-sectional analysis. BMC Sports Sci Med Rehabil 2023; 15:63. [PMID: 37085935 PMCID: PMC10120183 DOI: 10.1186/s13102-023-00678-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/19/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Inflammatory joint diseases (IJD) are accompanied by an increased risk of cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) is a modifiable CVD risk factor and low levels of CRF associate with an elevated CVD risk. This study aimed to investigate the associations between CVD risk factors, disease activity and CRF in patients with IJD and to explore differences between patients with normal versus low levels of CRF. METHODS CRF was measured as peak oxygen uptake (VO2peak) with a cardiopulmonary exercise test. Participants were also evaluated for: Body composition, blood pressure, blood lipids, inflammatory markers and disease activity. Patient-reported use of cigarettes/snuff, medication, disease duration, pain, fatigue, CVD history, habitual physical activity and exercise beliefs and self-efficacy were collected by questionnaire. Cross-sectional associations between CVD risk factors, disease-related factors and CRF were analyzed by multiple linear regression. CRF was categorized to normal CRF (VO2peak ≥ 80%) or low CRF (VO2peak < 80%) according to age- and gender-stratified reference data. Differences in demographic, CVD and disease-related factors between patients with normal versus low CRF were explored. RESULTS In 60 Norwegian patients with IJD [34 females, age 59 years (IQR: 52-63)], mean VO2peak was 30.2 (± 6.9) mL/kg/min, corresponding to 83% (± 18) of normative reference values. Age (coefficient: - 0.18 years, p = 0.01) and fat mass (coefficient: - 0.67 %, p < 0.001) were inversely associated with CRF, while physical activity index (coefficient: 0.13 points, p = 0.05) was positively associated with CRF (R2 = 0.66). There were no significant associations between CRF, classical CVD risk factors and disease-related variables. Compared to patients with low CRF (n = 30), patients with normal CRF (n = 30) had higher peak oxygen uptake (+ 9.4 mL/kg/min, p < 0.001), high-density lipoprotein cholesterol (+ 0.5 mmol L-1, p < 0.001), and exercise self-efficacy (+ 6.9, p < 0.01) as well as lower fat mass (- 8.7%, p < 0.001), resting heart rate (- 8.0 beats/min, p < 0.01) and triglycerides (- 0.5 mmol L-1, p < 0.01). CONCLUSIONS In this sample of IJD-patients, age, fatmass and physical activity level were associated with CRF. CRF was lower than reference values and patients with normal CRF presented with a more favorable health profile. There is a continued need for exercise interventions to improve CRF in patients with IJD. TRIAL REGISTRATION NCT04922840.
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Affiliation(s)
- Kristine Røren Nordén
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway.
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.
| | - Anne Grete Semb
- The Preventive Cardio-Rheuma Clinic, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Hanne Dagfinrud
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo University Hospital-Aker, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigrid Ødegård
- Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway
| | - Camilla Fongen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Jon Skandsen
- Patient Advisory Board, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Thalita Blanck
- Patient Advisory Board, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - George S Metsios
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, Thessaly, Greece
| | - Anne Therese Tveter
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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11
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Kerola AM, Rollefstad S, Kazemi A, Wibetoe G, Sexton J, Mars N, Kauppi M, Kvien TK, Haavardsholm EA, Semb AG. Psoriatic arthritis, axial spondyloarthritis and rheumatoid arthritis in Norway: nationwide prevalence and use of biologic agents. Scand J Rheumatol 2023; 52:42-50. [PMID: 35014920 DOI: 10.1080/03009742.2021.1997436] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To estimate the prevalence of psoriatic arthritis (PsA), axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA) and the use of biologic agents in these diseases in Norway. METHODS From the Norwegian Patient Registry (NPR), we identified as PsA, axSpA and RA patients ≥18 years those with ≥2 recorded episodes with diagnostic coding for index disease (L40.5, M07.0-M07.3 for PsA; M45, M46.0, M46.1, M46.8 and M46.9 for axSpA; M05-M06 for RA). We calculated the point prevalence of PsA, axSpA and RA as per the 1st of January 2017 in the Norwegian adult population (age ≥18). Dispensed disease-modifying antirheumatic drug (DMARD) prescriptions were obtained from the Norwegian Prescription Database and biologic DMARDs given in hospitals from the NPR. RESULTS The point prevalence of PsA, axSpA, RA, and any of these diseases in total was 0.46%, 0.41%, 0.78%, and 1.56%, respectively. Among women, the prevalence of PsA, axSpA, and RA was 0.50%, 0.37%, and 1.10%, and among men 0.43%, 0.45%, and 0.46%, respectively. In 2017, 27.3% of RA patients, 25.7% of PsA patients and 35.1% of axSpA patients used biologic DMARDs. Treatment with biologics was more frequent in younger age groups in all three diseases, and became more infrequent especially after age ≥55 years. CONCLUSION In Norway, the combined prevalence of PsA, axSpA, and RA was over 1.5%. Reflecting the good overall access to highly effective but costly biologic treatments, more than a fourth of these patients used biologic agents, which corresponds to over 0.4% of Norwegian adult population.
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Affiliation(s)
- A M Kerola
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - S Rollefstad
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - A Kazemi
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - G Wibetoe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - J Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - N Mars
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - M Kauppi
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.,Clinicum, University of Helsinki, Helsinki, Finland
| | - T K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - E A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A G Semb
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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12
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Krychtiuk KA, Ahrens I, Drexel H, Halvorsen S, Hassager C, Huber K, Kurpas D, Niessner A, Schiele F, Semb AG, Sionis A, Claeys MJ, Barrabes J, Montero S, Sinnaeve P, Pedretti R, Catapano A. Acute LDL-C reduction post ACS: strike early and strike strong: from evidence to clinical practice. A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. Eur Heart J Acute Cardiovasc Care 2022; 11:939-949. [PMID: 36574353 DOI: 10.1093/ehjacc/zuac123] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 12/28/2022]
Abstract
After experiencing an acute coronary syndrome (ACS), patients are at a high risk of suffering from recurrent ischaemic cardiovascular events, especially in the very early phase. Low density lipoprotein-cholesterol (LDL-C) is causally involved in atherosclerosis and a clear, monotonic relationship between pharmacologic LDL-C lowering and a reduction in cardiovascular events post-ACS has been shown, a concept termed 'the lower, the better'. Current ESC guidelines suggest an LDL-C guided, step-wise initiation and escalation of lipid-lowering therapy (LLT). Observational studies consistently show low rates of guideline-recommended LLT adaptions and concomitant low rates of LDL-C target goal achievement, leaving patients at residual risk, especially in the vulnerable post-ACS phase. In addition to the well-established 'the lower, the better' approach, a 'strike early and strike strong' approach in the early post-ACS phase with upfront initiation of a combined lipid-lowering approach using high-intensity statins and ezetimibe seems reasonable. We discuss the rationale, clinical trial evidence and experience for such an approach and highlight existing knowledge gaps. In addition, the concept of acute initiation of PCSK9 inhibition in the early phase is reviewed. Ultimately, we focus on hurdles and solutions to provide high-quality, evidence-based follow-up care in post-ACS patients.
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Affiliation(s)
- Konstantin A Krychtiuk
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, 1180 Vienna, Austria.,Duke Clinical Research Institute, Durham, NC 27701, USA
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Academic Teaching Hospital University of Cologne, 50678 Cologne, Germany
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Sigrun Halvorsen
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Unit, Wilhelminenhospital, 1160 Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria.,Medical School, Sigmund Freud University, 1020 Vienna, Austria
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Alexander Niessner
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, 1180 Vienna, Austria
| | - Francois Schiele
- Department of Cardiology, University Hospital Besancon, University of Franche-Comté, France and EA3920, Besancon, France
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Division of Innovation and Research, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER-CV, Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - José Barrabes
- Acute Cardiac Care Unit, Cardiology Service, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERC-V, Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peter Sinnaeve
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Roberto Pedretti
- Director of Cardiovascular Department, Head of Cardiology Unit, IRCCS MultiMedica, Milan, Italy
| | - Alberico Catapano
- Professor of Pharmacology, Director Center of Epidemiology and Preventive Pharmacology, Director Laboratory of Lipoproteins, Immunity and Atherosclerosis Department of Pharmacological and Biomolecular Sciences Director Center for the Study of Atherosclerosis at Bassini Hospital University of Milan, Milan, Italy
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13
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Semb AG, Rollefstad S, Sexton J, Ikdahl E, Crowson CS, van Riel P, Kitas G, Graham I, Kerola AM. Oral anticoagulant treatment in rheumatoid arthritis patients with atrial fibrillation results of an international audit. Int J Cardiol Heart Vasc 2022; 42:101117. [PMID: 36118256 PMCID: PMC9479366 DOI: 10.1016/j.ijcha.2022.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022]
Abstract
Objective To describe the prevalence of atrial fibrillation (AF) in patients with rheumatoid arthritis (RA), and to evaluate the proportion of patients with AF receiving guideline-recommended anticoagulation for prevention of stroke, based on data from a large international audit. Methods The cohort was derived from the international audit SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) which collected data from 17 countries during 2014-2019. We evaluated the prevalence of AF across world regions and explored factors associated with the presence of AF with multivariable logistic regression models. The proportion of AF patients at high risk of stroke (CHA2DS2-VASc ≥ 2 in males and ≥ 3 in females) receiving anticoagulation was examined. Results Of the total SURF-RA cohort (n = 14,503), we included RA cases with data on whether the diagnosis of AF was present or not (n = 7,665, 75.1% women, mean (SD) age 58.7 (14.1) years). A total of 288 (3.8%) patients had a history of AF (4.4% in North America, 3.4% in Western Europe, 2.8% in Central and Eastern Europe and 1.5% in Asia). Factors associated with the presence of AF were older age, male sex, atherosclerotic cardiovascular disease, heart failure and hypertension. Two-hundred and fifty-five (88.5%) RA patients had a CHA2DS2-VASc score indicating recommendation for oral anticoagulant treatment, and of them, 164 (64.3%) were anticoagulated. Conclusion Guideline-recommended anticoagulant therapy for prevention of stroke due to AF may not be optimally implemented among RA patients, and requires special attention.
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Affiliation(s)
- Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, REMEDY, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Cynthia S Crowson
- Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, MN, USA
| | - Piet van Riel
- IQ Healthcare, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - George Kitas
- Department of Rheumatology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Ian Graham
- Cardiology, The University of Dublin Trinity College, Dublin, Ireland
| | - Anne M Kerola
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.,Inflammation Center, Helsinki University Hospital, Helsinki, Finland
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14
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Kerola AM, Semb AG, Juonala M, Palomäki A, Rautava P, Kytö V. Long-term cardiovascular prognosis of patients with type 1 diabetes after myocardial infarction. Cardiovasc Diabetol 2022; 21:177. [PMID: 36068573 PMCID: PMC9450422 DOI: 10.1186/s12933-022-01608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background To explore long-term cardiovascular prognosis after myocardial infarction (MI) among patients with type 1 diabetes. Methods Patients with type 1 diabetes surviving 90 days after MI (n = 1508; 60% male, mean age = 62.1 years) or without any type of diabetes (n = 62,785) in Finland during 2005–2018 were retrospectively studied using multiple national registries. The primary outcome of interest was a combined major adverse cardiovascular event (MACE; cardiovascular death, recurrent MI, ischemic stroke, or heart failure hospitalization) studied with a competing risk Fine-Gray analyses. Median follow-up was 3.9 years (maximum 12 years). Differences between groups were balanced by multivariable adjustments and propensity score matching (n = 1401 patient pairs). Results Cumulative incidence of MACE after MI was higher in patients with type 1 diabetes (67.6%) compared to propensity score-matched patients without diabetes (46.0%) (sub-distribution hazard ratio [sHR]: 1.94; 95% confidence interval [CI]: 1.74–2.17; p < 0.0001). Probabilities of cardiovascular death (sHR 1.81; p < 0.0001), recurrent MI (sHR 1.91; p < 0.0001), ischemic stroke (sHR 1.50; p = 0.0003), and heart failure hospitalization (sHR 1.98; p < 0.0001) were higher in patients with type 1 diabetes. Incidence of MACE was higher in diabetes patients than in controls in subgroups of men and women, patients aged < 60 and ≥ 60 years, revascularized and non-revascularized patients, and patients with and without atrial fibrillation, heart failure, or malignancy. Conclusions Patients with type 1 diabetes have notably poorer long-term cardiovascular prognosis after an MI compared to patients without diabetes. These results underline the importance of effective secondary prevention after MI in patients with type 1 diabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01608-3.
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Affiliation(s)
- Anne M Kerola
- Inflammation Center, Rheumatology, Helsinki University Hospital, Helsinki, Finland. .,Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Palomäki
- Department of Medicine, University of Turku, Turku, Finland.,Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Center, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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15
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Rollefstad S, Ikdahl E, Wibetoe G, Sexton J, Crowson CS, van Riel P, Kitas GD, Graham I, Dahlqvist SR, Karpouzas G, Myasoedova E, Gonzalez-Gay MA, Sfikakis PP, Tektonidou MG, Lazarini A, Vassilopoulos D, Kuriya B, Hitchon CA, Stoenoiu MS, Durez P, Pascual-Ramos V, Galarza-Delgado DA, Faggiano P, Misra DP, Borg A, Mu R, Mirrakhimov EM, Gheta D, Myasoedova S, Krougly L, Popkova T, Tuchyňová A, Tomcik M, Vrablik M, Lastuvka J, Horák P, Medková H, Semb AG. An international audit of the management of dyslipidaemia and hypertension in patients with rheumatoid arthritis: results from 19 countries. European Heart Journal - Cardiovascular Pharmacotherapy 2022; 8:539-548. [PMID: 34232315 DOI: 10.1093/ehjcvp/pvab052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 01/05/2023]
Abstract
AIMS To assess differences in estimated cardiovascular disease (CVD) risk among rheumatoid arthritis (RA) patients from different world regions and to evaluate the management and goal attainment of lipids and blood pressure (BP). METHODS AND RESULTS The survey of CVD risk factors in patients with RA was conducted in 14 503 patients from 19 countries during 2014-19. The treatment goal for BP was <140/90 mmHg. CVD risk prediction and lipid goals were according to the 2016 European guidelines. Overall, 21% had a very high estimated risk of CVD, ranging from 5% in Mexico, 15% in Asia, 19% in Northern Europe, to 31% in Central and Eastern Europe and 30% in North America. Of the 52% with indication for lipid-lowering treatment (LLT), 44% were using LLT. The lipid goal attainment was 45% and 18% in the high and very high risk groups, respectively. Use of statins in monotherapy was 24%, while 1% used statins in combination with other LLT. Sixty-two per cent had hypertension and approximately half of these patients were at BP goal. The majority of the patients used antihypertensive treatment in monotherapy (24%), while 10% and 5% as a two- or three-drug combination. CONCLUSION We revealed considerable geographical differences in estimated CVD risk and preventive treatment. Low goal attainment for LLT was observed, and only half the patients obtained BP goal. Despite a high focus on the increased CVD risk in RA patients over the last decade, there is still substantial potential for improvement in CVD preventive measures.
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Affiliation(s)
- Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Joe Sexton
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - George D Kitas
- Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
| | | | | | - George Karpouzas
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Petros P Sfikakis
- Joint Rheumatology Program, First Department of Propaedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- Joint Rheumatology Program, First Department of Propaedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyro Lazarini
- Joint Rheumatology Program, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bindee Kuriya
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maria Simona Stoenoiu
- Rheumatology Department, Cliniques Universitaires Saint Luc, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Patrick Durez
- Rheumatology Department, Cliniques Universitaires Saint Luc, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | | | | | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | | | - Rong Mu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | | | - Diane Gheta
- Tallagh University Hospital, Dublin, Ireland
| | | | - Lev Krougly
- Center of Cardiology of Russian Ministry of Healthcare, Moscow, Russia
| | - Tatiana Popkova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Alena Tuchyňová
- National Institute of Rheumatic Diseases, 92101 Piešťany, Slovensko, Slovakia
| | - Michal Tomcik
- Institute of Rheumatology, Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Vrablik
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, First Medical Faculty, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Jiri Lastuvka
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, First Medical Faculty, Charles University and General Faculty Hospital, Prague, Czech Republic
- First Medical Faculty, Charles University, Prague, Czech Republic
| | - Pavel Horák
- Iii Interna klinika fn Olomouc, Olomouc, Czech Republic
| | - Helena Medková
- Division of Rheumatology, 2nd Department of Internal Medicine-Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
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16
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Kerola AM, Juonala M, Palomäki A, Semb AG, Rautava P, Kytö V. Case Fatality of Patients With Type 1 Diabetes After Myocardial Infarction. Diabetes Care 2022; 45:1657-1665. [PMID: 35679070 PMCID: PMC9274223 DOI: 10.2337/dc22-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes is a risk factor for myocardial infarction (MI). We aimed to evaluate the case fatality in patients with type 1 diabetes after MI. RESEARCH DESIGN AND METHODS Consecutive patients experiencing MI with type 1 diabetes (n = 1,935; 41% female; mean age 62.5 years) and without diabetes (n = 74,671) admitted to 20 hospitals in Finland from 2005 to 2018 were studied using national registries. The outcome of interest was death within 1 year after MI. Differences between groups were balanced by multivariable adjustments and propensity score matching. RESULTS Case fatality was higher in patients with type 1 diabetes than in propensity score-matched controls without diabetes at 30 days (12.8% vs. 8.5%) and at 1 year (24.3% vs. 16.8%) after MI (hazard ratio 1.55; 95% CI 1.32-1.81; P < 0.0001). Patients with type 1 diabetes had poorer prognosis in subgroups of men and women and of those with and without ST-elevation MI, with and without revascularization, with and without atrial fibrillation, and with and without heart failure. The relative fatality risk in type 1 diabetes was highest in younger patients. Older age, heart failure, peripheral vascular disease, renal failure, and no revascularization were associated with worse prognosis after MI. The case fatality among patients with type 1 diabetes decreased during the study period, but outcome differences compared with patients without diabetes remained similar. CONCLUSIONS Patients with type 1 diabetes are at higher risk of death after MI than patients without diabetes. Our findings call for attention to vigorous cardiovascular disease prevention in patients with type 1 diabetes.
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Affiliation(s)
- Anne M Kerola
- Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Palomäki
- Department of Medicine, University of Turku, Turku, Finland.,Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Center, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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17
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Hammer HB, Rollefstad S, Semb AG, Jensen G, Karoliussen LF, Terslev L, Haavardsholm EA, Kvien TK, Uhlig T. Urate crystal deposition is associated with inflammatory markers and carotid artery pathology in patients with intercritical gout: results from the NOR-Gout study. RMD Open 2022; 8:rmdopen-2022-002348. [PMID: 35863863 PMCID: PMC9310249 DOI: 10.1136/rmdopen-2022-002348] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/29/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Gout is of unknown reason associated with cardiovascular disease. Ultrasound is sensitive for detecting crystal deposition and plasma calprotectin is a sensitive inflammatory marker. This study explores the associations between crystal deposition, inflammation and carotid artery pathology. METHOD A cross-sectional analysis of baseline assessments from the NOR-Gout study was undertaken. Crystal deposition was assessed by ultrasound (double contour, tophi, aggregates) and dual-energy CT (DECT) and laboratory assessments included plasma calprotectin. The carotid arteries were bilaterally examined for carotid intima-media thickness (cIMT) and presence of plaques. Spearman correlations, Mann-Whitney tests and linear regression analyses were used to explore associations between crystal deposition, inflammatory markers,and carotid pathology. RESULTS 202 patients with intercritical gout (95.5% men, mean (SD) age 56.5 (13.8) years, disease duration 7.9 (7.7) years) were included. Calprotectin was correlated with all scores of crystal deposition by ultrasound (r=0.26-0.32, p<0.001) and DECT (r=0.15, p<0.05). cIMT was correlated with sum score aggregates (r=0.18-0.22, p<0.05). Patients with large tophi had higher levels of calprotectin as well as more frequent carotid plaque (p<0.05). CONCLUSIONS Study findings point towards crystal deposition contributing to subclinical inflammation with subsequent vascular implications. However, future longitudinal studies are needed to confirm such causal relationships.
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Affiliation(s)
- Hilde Berner Hammer
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Silvia Rollefstad
- Peventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Peventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Gro Jensen
- Clinical chemical laboratory, Diakonhjemmet Hospital, Oslo, Norway
| | | | - L Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Espen A Haavardsholm
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Till Uhlig
- Dept of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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18
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Koskinas KC, Dendale P, Halle M, Caselli S, Cornelissen V, Kavousi M, Kurpas D, Osto E, Raupach T, Semb AG, Pedretti RF. Introducing the new Task Force on Cardiovascular Risk Factors of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:1718-1720. [PMID: 35708728 DOI: 10.1093/eurjpc/zwac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/06/2022] [Indexed: 11/12/2022]
Affiliation(s)
| | - Paul Dendale
- Heart Centre Hasselt and Hasselt University, 3500 Hasselt, Belgium
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital rechts der Isar, Technical University Munich, German Centre for Cardiovascular Research, Munich, Germany
| | - Stefano Caselli
- Cardiovascular Center Zurich, Hirslanden Klinik im Park, Seestrasse 247, 8038 Zurich, Switzerland
| | - Veronique Cornelissen
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Donata Kurpas
- Department of Family Medicine, Wrocław Medical University, Poland
| | - Elena Osto
- University of Zurich and University Hospital Zurich, Institute of Clincal Chemistry, SchlierenSwitzerland
| | - Tobias Raupach
- Institute for Medical Education, University Hospital Bonn, Bonn, Germany
| | - Anne Grete Semb
- Preventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hopsital, Oslo, Norway
| | - Roberto Fe Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni, Milano, Italy
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19
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Tamargo J, Kjeldsen KP, Delpón E, Semb AG, Cerbai E, Dobrev D, Savarese G, Sulzgruber P, Rosano G, Borghi C, Wassman S, Torp-Pedersen CT, Agewall S, Drexel H, Baumgartner I, Lewis B, Ceconi C, Kaski JC, Niessner A. Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. Eur Heart J Cardiovasc Pharmacother 2022; 8:406-419. [PMID: 35092425 DOI: 10.1093/ehjcvp/pvac005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/28/2021] [Accepted: 01/27/2022] [Indexed: 11/12/2022]
Abstract
Population ageing has resulted in an increasing number of older people living with chronic diseases (multimorbidity) requiring five or more medications daily (polypharmacy). Ageing produces important changes in the cardiovascular system and represents the most potent single cardiovascular risk factor. Cardiovascular diseases (CVDs) constitute the greatest burden for older people, their caregivers, and healthcare systems. Cardiovascular pharmacotherapy in older people is complex because age-related changes in body composition, organ function, homeostatic mechanisms, and comorbidities modify the pharmacokinetic and pharmacodynamic properties of many commonly used cardiovascular and non-cardiovascular drugs. Additionally, polypharmacy increases the risk of adverse drug reactions and drug interactions, which in turn can lead to increased morbi-mortality and healthcare costs. Unfortunately, evidence of drug efficacy and safety in older people with multimorbidity and polypharmacy is limited because these individuals are frequently underrepresented/excluded from clinical trials. Moreover, clinical guidelines are largely written with a single-disease focus and only occasionally address the issue of coordination of care, when and how to discontinue treatments, if required, or how to prioritize recommendations for patients with multimorbidity and polypharmacy. This review analyses the main challenges confronting healthcare professionals when prescribing in older people with CVD, multimorbidity, and polypharmacy. Our goal is to provide information that can contribute to improving drug prescribing, efficacy, and safety, as well as drug adherence and clinical outcomes.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Keld Per Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Copenhagen, and Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Eva Delpón
- Department of Pharmacology and Toxicology, School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid,Spain
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemme Hospital, Oslo, Norway
| | - Elisabetta Cerbai
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Hospital, Rome, Italy
| | - Claudio Borghi
- Medicine and Surgery Science Department, University of Bologna, Bologna, Italy
| | - Seven Wassman
- Cardiology Pasing, Munich, and Faculty of Medicine, University of the Saarland, Homburg/Saar, Germany
| | - Christian Tobias Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, and Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Heinz Drexel
- Department of Internal Medicine and Cardiology, VIVIT Institute, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Basil Lewis
- Department of Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Claudio Ceconi
- UO Cardiologia, Ospedale di Desenzano del Garda, Desenzano del Garda, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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20
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Semb AG, Ikdahl E, Kerola AM, Wibetoe G, Sexton J, Crowson CS, van Riel P, Kitas G, Graham I, Rollefstad S. A Clinical Audit of Cardiovascular Risk Factors and Disease in Patients with Rheumatoid Arthritis - SURF-RA. Mediterr J Rheumatol 2022; 33:201-217. [PMID: 36128215 PMCID: PMC9450194 DOI: 10.31138/mjr.33.2.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/23/2022] [Accepted: 04/05/2022] [Indexed: 11/04/2022] Open
Abstract
Background and aims Rheumatoid arthritis (RA) patients are at a high risk of atherosclerotic cardiovascular disease (ASCVD). This implies a need for meticulous CVD risk factor recording and control. Objectives The aim was to evaluate the international prevalence of ASCVD in RA patients and to audit the prevalence and control of CVD risk factors. Methods A SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) was performed at 53 centres in 19 countries in three continents between 2014 and 2019. CVD risk factors, medication, and physical and laboratory measurements were recorded. CVD risk was estimated using the ESC's SCORE system. Results Among 14503 RA patients in Western (n=8493) and Central and Eastern (n=923) Europe, Mexico (n=407), North America (n=4030) and Asia (n=650) (mean age 59.9 years, 74.5% female), ASCVD was present in 15%, varying from 2.5% in Mexico to 21% in Central and Eastern Europe. Sixty-two percent reported hypertension and 63% had a LDL-c of > 2.5 mmol/L. Mean BMI was 27.4 kg/m2 in the total cohort, highest in North America (29.7 kg/m2), and lowest in Asia (23.8 kg/m2). A sixth of patients were current smokers, and 13% had diabetes mellitus. Approximately 45% had an estimated high or very high risk of fatal CVD according to SCORE algorithm, and ¾ of patients had only ≤4/6 CVD risk factors at recommended target. Conclusion Among RA patients across three continents, established CVD and CVD risk factors are common, although geographical variation exists. Furthermore, CVD risk factors often remain inadequately controlled.
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Affiliation(s)
- Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
| | - Anne M. Kerola
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
| | - Cynthia S. Crowson
- Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, Minnesota, United States of America
| | - Piet van Riel
- IQ Healthcare, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - George Kitas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, United Kingdom
| | - Ian Graham
- Cardiology, Trinity College Dublin, Dublin, Ireland
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases [REMEDY], Diakonhjemmet Hospital, Oslo, Norway
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21
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Kerola AM, Kazemi A, Rollefstad S, Lillegraven S, Sexton J, Wibetoe G, Haavardsholm EA, Kvien TK, Semb AG. All-cause and cause-specific mortality in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: a nationwide registry study. Rheumatology (Oxford) 2022; 61:4656-4666. [PMID: 35377442 PMCID: PMC9707036 DOI: 10.1093/rheumatology/keac210] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/24/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To explore mortality and causes of death among Norwegian patients with RA, PsA and axial spondyloarthritis (axSpA) compared with the general population by conducting a nationwide registry-based cohort study. METHODS Patients with RA, PsA and axSpA were identified from the Norwegian Patient Registry based on ICD-10 codes between 2008 and 2017. Using age as the time variable, all-cause and cause-specific mortality were estimated between 2010 and 2017 with the Kaplan-Meier estimator and the cumulative incidence competing risk method, respectively. Sex-, education level-, health region- and age group-adjusted hazard ratios (HRs) for mortality were estimated using Cox regression models. RESULTS We identified 36 095 RA, 18 700 PsA and 16 524 axSpA patients (70%, 53% and 45% women, respectively). RA and axSpA were associated with increased all-cause mortality (HR 1.45 [95% CI: 1.41, 1.48] and HR 1.38 [95% CI: 1.28, 1.38], respectively). Women but not men with PsA had a slightly increased mortality rate (HR 1.10 [95% CI: 1.00, 1.21] among women and 1.02 [95% CI: 0.93, 1.11] among men). For all patient groups as well as for the general population, the three leading causes of death were cardiovascular diseases, neoplasms and respiratory diseases. RA patients had increased mortality from all of these causes, while axSpA patients had increased mortality from cardiovascular and respiratory diseases. CONCLUSION Even in the era of modern treatments for IJDs, patients with RA and axSpA still have shortened life expectancy. Our findings warrant further attention to the prevention and management of comorbidities.
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Affiliation(s)
- Anne M Kerola
- Correspondence to: Anne Kerola, Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway. E-mail:
| | | | - Silvia Rollefstad
- Preventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Espen A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital
| | - Anne Grete Semb
- Preventive Cardio-Rheuma clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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22
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Nordén KR, Dagfinrud H, Semb AG, Hisdal J, Viktil KK, Sexton J, Fongen C, Skandsen J, Blanck T, Metsios GS, Tveter AT. Effect of high-intensity exercise on cardiorespiratory fitness, cardiovascular disease risk and disease activity in patients with inflammatory joint disease: protocol for the ExeHeart randomised controlled trial. BMJ Open 2022; 12:e058634. [PMID: 35177467 PMCID: PMC8860070 DOI: 10.1136/bmjopen-2021-058634] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Inflammatory joint disease (IJD) is associated with increased risk of cardiovascular disease (CVD) fostered by systemic inflammation and a high prevalence of CVD risk factors. Cardiorespiratory fitness (CRF) is an important health parameter and CRF-measures are advocated in routine health evaluations. CRF associates with CVD risk, and exercise modalities such as high intensity interval training (HIIT) can increase CRF and mitigate CVD risk factors. In IJD, exercise is rarely used in CVD risk management and the cardioprotective effect of HIIT is unclear. Furthermore, the clinical applicability of HIIT to primary care settings is largely unknown and warrants investigation. The primary aim is to assess the effect of a HIIT programme on CRF in patients with IJD. Second, we will evaluate the effect of HIIT on CVD risk and disease activity in patients with IJD, feasibility of HIIT in primary care and validity of non-exercise algorithms to detect change in CRF. METHODS AND ANALYSIS ExeHeart is a single-blinded, randomised controlled trial. Sixty patients with IJD will be recruited from the Preventive Cardio-Rheuma clinic at Diakonhjemmet Hospital, Norway. Patients will be assigned to receive standard care (relevant lifestyle advice and cardio-preventive medication) or standard care plus a 12-week HIIT intervention by physiotherapists in primary care. HIIT sessions will be prescribed at 90%-95% of peak heart rate. Outcomes include CRF (primary outcome), CVD risk factors, anthropometric measures, disease activity and patient-reported outcomes related to pain, fatigue, disease, physical activity and exercise and will be assessed at baseline, 3 months (primary endpoint) and 6 months postbaseline. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Regional Committee for Medical and Health Research Ethics (201227). Participants are required to sign a written informed consent form. Results will be discussed with patient representatives, submitted to peer-reviewed journals and presented at relevant platforms. TRIAL REGISTRATION NUMBER NCT04922840.
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Affiliation(s)
- Kristine Røren Nordén
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Dagfinrud
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Jonny Hisdal
- Department of vascular surgery, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Kirsten K Viktil
- Department of Pharmacy, University of Oslo, Oslo, Norway
- Diakonhjemmet Hospital Pharmacy, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Camilla Fongen
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Jon Skandsen
- Patient advisory board, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Thalita Blanck
- Patient advisory board, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - George S Metsios
- Department of Nutrition and Dietetics, University of Thessaly, Volos, Thessaly, Greece
| | - Anne Therese Tveter
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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23
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Magavern EF, Kaski JC, Turner RM, Drexel H, Janmohamed A, Scourfield A, Burrage D, Floyd CN, Adeyeye E, Tamargo J, Lewis BS, Kjeldsen KP, Niessner A, Wassmann S, Sulzgruber P, Borry P, Agewall S, Semb AG, Savarese G, Pirmohamed M, Caulfield MJ. Challenges in Cardiovascular Pharmacogenomics Implementation: A viewpoint from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. Eur Heart J Cardiovasc Pharmacother 2021; 8:100-103. [PMID: 34463331 DOI: 10.1093/ehjcvp/pvab063] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/05/2021] [Accepted: 02/24/2021] [Indexed: 11/14/2022]
Abstract
Pharmacogenomics promises to advance cardiovascular therapy, but there remain pragmatic barriers to implementation. These are particularly important to explore within Europe, as there are differences in the populations, availability of resources and expertise, as well as in ethico-legal frameworks. Differences in healthcare delivery across Europe present a challenge, but also opportunities to collaborate on PGx implementation. Clinical work force upskilling is already in progress but will require substantial input. Digital infrastructure and clinical support tools are likely to prove crucial. It is important that widespread implementation serves to narrow rather than widen any existing gaps in health equality between populations. This viewpoint supplements the working group position paper on cardiovascular pharmacogenomics to address these important themes.
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Affiliation(s)
- E F Magavern
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Department of Clinical Pharmacology, Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - J C Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, United Kingdom
| | - R M Turner
- The Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - H Drexel
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), Feldkirch, A Private University of the Principality of Liechtenstein, Triesen, FL.,Drexel University College of Medicine, Philadelphia, USA
| | - A Janmohamed
- Department of Clinical Pharmacology, St George's, University of London, United Kingdom
| | - A Scourfield
- Department of Clinical Pharmacology, University College London Hospital Foundation Trust, UK
| | - D Burrage
- Whittington Health NHS Trust, London, UK
| | - C N Floyd
- King's College London British Heart Foundation Centre, School of Cardiovascular Medicine and Sciences, London, UK.,Department of Clinical Pharmacology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - E Adeyeye
- Department of Clinical Pharmacology, Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - J Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Madrid, Spain
| | - B S Lewis
- Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Keld Per Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Copenhagen, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - A Niessner
- Department of Internal Medicine II, Division of Cardiology Medical University of Vienna
| | - S Wassmann
- Cardiology Pasing, Munich, Germany and University of the Saarland, Homburg/Saar, Germany
| | - P Sulzgruber
- Medical University of Vienna, Department of Medicine II, Division of Cardiology
| | - P Borry
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Leuven Institute for Human Genetics and Society, Leuven, Belgium
| | - S Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - A G Semb
- Preventive Cardio-Rheuma clinic, department of rheumatology, innovation and research, Diakonhjemmet hospital, Oslo, Norway
| | - G Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - M Pirmohamed
- The Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Liverpool Health Partners, Liverpool, UK
| | - M J Caulfield
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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24
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Semb AG, Rollefstad S, Ikdahl E, Wibetoe G, Sexton J, Crowson C, van Riel P, Kitas G, Graham I, Rantapää-Dahlqvist S, Karpouzas GA, Myasoedova E, Gonzalez-Gay MA, Sfikakis PP, Tektonidou MGG, Lazarini A, Vassilopoulos D, Kuriya B, Hitchon C, Stoenoiu MS, Durez P, Pascual-Ramos V, Galarza-Delgado DA, Faggiano P, Misra DP, Borg AA, Mu R, Mirrakhimov EM, Gheta D, Douglas K, Agarwal V, Myasoedova S, Krougly L, Valentinovna Popkova T, Tuchyňová A, Tomcik M, Vrablik M, Lastuvka J, Horak P, Medkova HK, Kerola AM. Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis: an international audit. RMD Open 2021; 7:rmdopen-2021-001724. [PMID: 34244381 PMCID: PMC8268901 DOI: 10.1136/rmdopen-2021-001724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/20/2021] [Indexed: 01/21/2023] Open
Abstract
Aim The objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention. Methods The cohort was derived from the Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis from 53 centres/19 countries/3 continents during 2014–2019. We evaluated the prevalence of cardiovascular disease (CVD) among RA-DM and RAwoDM. The study population was divided into those with and without ASCVD, and within these groups we compared risk factors and CVD preventive treatment between RA-DM and RAwoDM. Results The study population comprised of 10 543 patients with RA, of whom 1381 (13%) had DM. ASCVD was present in 26.7% in RA-DM compared with 11.6% RAwoDM (p<0.001). The proportion of patients with a diagnosis of hypertension, hyperlipidaemia and use of lipid-lowering or antihypertensive agents was higher among RA-DM than RAwoDM (p<0.001 for all). The majority of patients with ASCVD did not reach the lipid goal of low-density lipoprotein cholesterol <1.8 mmol/L. The lipid goal attainment was statistically and clinically significantly higher in RA-DM compared with RAwoDM both for patients with and without ASCVD. The systolic BP target of <140 mm Hg was reached by the majority of patients, and there were no statistically nor clinically significant differences in attainment of BP targets between RA-DM and RAwoDM. Conclusion CVD preventive medication use and prevalence of ASCVD were higher in RA-DM than in RAwoDM, and lipid goals were also more frequently obtained in RA-DM. Lessons may be learnt from CVD prevention programmes in DM to clinically benefit patients with RA.
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Affiliation(s)
- Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Cindy Crowson
- Health Sciences Research, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Piet van Riel
- Rheumatology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - George Kitas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, UK
| | - Ian Graham
- Cardiology, Trinity College Dublin, Dublin, Ireland
| | - Solbritt Rantapää-Dahlqvist
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå Universitet Medicinska Fakulteten, Umea, Sweden
| | | | - Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Petros P Sfikakis
- First Department of Propedeutic Medicine, Medical School of University of Athens, Athens, Greece
| | - Maria G G Tektonidou
- First Department of Propaedeutic Internal Medicine, University of Athens, Athens, Greece
| | - Argyro Lazarini
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Bindee Kuriya
- Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Carol Hitchon
- Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Patrick Durez
- Rheumatology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Virginia Pascual-Ramos
- Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Pompilio Faggiano
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Durga Prasanna Misra
- Krajska zdravotni a.s, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Andrew A Borg
- First Medical Faculty, Charles University, Praha, Czech Republic
| | - Rong Mu
- Department of Internal Medicine III-Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Olomoucký, Czech Republic
| | - Erkin M Mirrakhimov
- Division of Rheumatology, 2nd Department of Internal Medicine-Gastroenterology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Diane Gheta
- Medicine, Tallaght University Hospital, Dublin, Ireland
| | - Karen Douglas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Svetlana Myasoedova
- Rheumatology, Ivanovo State Medical Academy, Ivanovo, Ivanovskaa oblast', Russian Federation
| | - Lev Krougly
- Rheumatology, FSBI National Medical and Surgical Center named after N I Pirogov of the Ministry of Healthcare of the Russian Federation, Moskva, Moskva, Russian Federation
| | | | - Alena Tuchyňová
- Rheumatology, Narodny Ustav Reumatickych Chorob, Piestany, Slovakia
| | - Michal Tomcik
- Rheumatology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Michal Vrablik
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Jiri Lastuvka
- Krajska zdravotni a.s, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic.,First Medical Faculty, Charles University, Praha, Czech Republic
| | - Pavel Horak
- Department of Internal Medicine III-Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Olomoucký, Czech Republic
| | - Helena Kaspar Medkova
- Division of Rheumatology, 2nd Department of Internal Medicine-Gastroenterology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Anne M Kerola
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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25
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Kerola AM, Sexton J, Wibetoe G, Rollefstad S, Crowson CS, Mars N, Kazemi A, Haavardsholm EA, Kvien TK, Semb AG. Incidence, sociodemographic factors and treatment penetration of rheumatoid arthritis and psoriatic arthritis in Norway. Semin Arthritis Rheum 2021; 51:1081-1088. [PMID: 34450506 DOI: 10.1016/j.semarthrit.2021.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate nationwide incidence, sociodemographic associations and treatment penetration of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in Norway. METHODS The study combined data from nationwide registries on the total Norwegian adult population (age ≥ 18). From the Norwegian Patient Registry, incident RA and PsA cases during 2011-2015 were identified with records of first and second healthcare episodes listing RA/PsA diagnostic codes, and ≥ 1 episode in an internal medicine or rheumatology unit with RA/PsA code during the two-year period after the first episode. Dispensed DMARD prescriptions were obtained from the Norwegian Prescription Database. Persons with dispensed DMARD prescriptions or biologic DMARDs given in hospitals > 12 months before the index date were excluded. RESULTS Incidence of RA/PsA in Norway was 42/26 per 100,000 person-years (55/28 among women and 28/23 among men). RA peak incidence was observed at ages 70-79 in both sexes, whereas the peak incidence of PsA occurred at ages 50-59. Age- and sex-standardized incidences of RA and PsA were lower among persons with higher education levels. Within a year from the index date, 82.4/57.4% of RA/PsA patients used synthetic DMARDs while 9.4/9.5% used biologic DMARDs. CONCLUSIONS Register-based incidence estimates for RA and PsA in Norway are similar to other Nordic countries, but slightly higher than in previous Norwegian studies. Furthermore, we found that higher socioeconomic status was associated with lower incidence of both RA and PsA. Although conventional synthetic DMARDs were less often used in early PsA than RA, frequency of biologic DMARD prescriptions was comparable.
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Affiliation(s)
- Anne M Kerola
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway; Department of Rheumatology, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland.
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
| | - Grunde Wibetoe
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
| | - Silvia Rollefstad
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
| | - Cynthia S Crowson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Nina Mars
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Amirhossein Kazemi
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
| | - Espen A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
| | - Anne Grete Semb
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, Oslo 0370, Norway
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26
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Drexel H, Pocock SJ, Lewis BS, Saely CH, Kaski JC, Rosano GMC, Tautermann G, Huber K, Dopheide JF, Mader A, Niessner A, Savarese G, Schmidt TA, Semb AG, Tamargo J, Wassmann S, Clodi M, Kjeldsen KP, Agewall S. Subgroup analyses in randomized clinical trials: Value and limitations Review #3 on important aspects of randomized clinical trials in cardiovascular pharmacotherapy. Eur Heart J Cardiovasc Pharmacother 2021; 8:302-310. [PMID: 34180504 DOI: 10.1093/ehjcvp/pvab048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, 6800 Feldkirch, Austria.,Department of Medicine, County Hospital Bregenz, Carl-Pedenz-Str. 2, 6900 Bregenz, Austria.,Private University of the Principality of Liechtenstein, Dorfstr. 24. 9495 Triesen, Liechtenstein.,Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA 19129, USA
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Basil S Lewis
- Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, Michal Str. 7, 34362 Haifa, Israel and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Efron Str. 1, 31096 Haifa, Israel
| | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstr. 24. 9495 Triesen, Liechtenstein.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Res. Inst. St George's University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Giuseppe M C Rosano
- Department of Medical Sciences, IRCCS San Raffaele Hospital, Via delle Pisana 249, 00163 Rome, Italy
| | - Gerda Tautermann
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstr. 24. 9495 Triesen, Liechtenstein.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Montleartstr. 37, 1160 Vienna, Austria.,Cardiology, Sigmund Freud University, Medical School, Freudplatz 3, 1020 Vienna, Austria
| | - Joern F Dopheide
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, 6800 Feldkirch, Austria.,Department of Angiology, Cantonal Hospital of Graubünden, Loestr. 170, 7000 Chur, Switzerland
| | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstr. 24. 9495 Triesen, Liechtenstein.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
| | - Alexander Niessner
- Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gianluigi Savarese
- Cardiology Unit, Department of Medicine, Karolinska University Hospital D1:04; 171 76 Stockholm, Sweden
| | - Thomas A Schmidt
- Department of Emergency Medicine, North Zealand University Hospital, Dyrehavevey, 3400 Hillerød; Denmark
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, CIBERCV, Plaza de Ramón s/n, 28040 Madrid, Spain
| | - Sven Wassmann
- Cardiology Pasing, Institutstr. 14, 81241 Munich, Germany.,Medical Faculty, Clinical Medicine, University of the Saarland, Kirrbergerstr. 100, 66421 Homburg/Saar, Germany
| | - Martin Clodi
- Department of Medicine, St. John of God Hospital Linz, Seilerstaette 2, 4021 Linz, Austria
| | - Keld Per Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Italiensvej 1, 2300 Copenhagen, Denmark, and Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D2, 9220 Aalborg, Denmark
| | - Stefan Agewall
- Department of Cardiology, Ullevål, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway.,Institute of Clinical Sciences, Søsterhjemmet, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
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27
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Föhse FK, Rollefstad S, Ikdahl E, Wibetoe G, Sexton J, Hisdal J, Semb AG. Degree of arterial stiffness is comparable across inflammatory joint disease entities. Scand J Rheumatol 2021; 51:186-195. [PMID: 34132621 DOI: 10.1080/03009742.2021.1920169] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Inflammatory joint disease (IJD) is associated with an increased risk of developing cardiovascular disease (CVD). Arterial stiffness is both a risk factor and a surrogate marker for CVD. This study aims to compare arterial stiffness across patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, and, by extension, to explore the relationship between arterial stiffness and the estimated CVD risk by the Systematic COronary Risk Evaluation (SCORE) algorithm.Method: During the study period, from April 2017 to June 2018, 196 patients with IJD visited the Preventive Cardio-Rheuma Clinic in Oslo, Norway. A CVD risk stratification was performed, including the assessment of traditional risk factors and the measurement of arterial stiffness.Results: Thirty-six patients (18.4%) had elevated aortic pulse wave velocity (aPWV) (≥ 10 m/s). After adjustment for age and heart rate, arterial stiffness was comparable across the IJD entities (p = 0.69). Associated factors, revealed by regression analysis, were age, blood pressure, heart rate, presence of carotid plaques, establis hed CVD, non-steroidal anti-inflammatory drugs, and statin use. Furthermore, aPWV was positively correlated with estimated CVD risk (r = 0.7, p < 0.001) and patients with a very high predicted CVD risk (SCORE ≥ 10%) had significantly higher aPWV than patients at lower CVD risk (9.2 vs 7.5 m/s, p < 0.001).Conclusion: The degree of arterial stiffness was comparable across the IJD entities and was highly associated with the estimated CVD risk. Our findings support the need for an increased focus on prevention of CVD in all patients with IJD.
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Affiliation(s)
- F K Föhse
- Department of Vascular Surgery, Oslo University Hospital-Aker, Oslo, Norway.,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - G Wibetoe
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J Sexton
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J Hisdal
- Department of Vascular Surgery, Oslo University Hospital-Aker, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - A G Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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28
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Kerola AM, Rollefstad S, Semb AG. Atherosclerotic Cardiovascular Disease in Rheumatoid Arthritis: Impact of Inflammation and Antirheumatic Treatment. Eur Cardiol 2021; 16:e18. [PMID: 34040652 PMCID: PMC8145075 DOI: 10.15420/ecr.2020.44] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with rheumatoid arthritis (RA) are at approximately 1.5-fold risk of atherosclerotic cardiovascular disease (CVD) compared with the general population, a phenomenon resulting from combined effects of traditional CVD risk factors and systemic inflammation. Rheumatoid synovitis and unstable atherosclerotic plaques share common inflammatory mechanisms, such as expression of proinflammatory cytokines interleukin (IL)-1, tumour necrosis factor (TNF)-α and IL-6. RA patients are undertreated in terms of CVD prevention, and structured CVD prevention programmes are warranted. Alongside management of traditional risk factors, suppressing systemic inflammation with antirheumatic medication is fundamental for the reduction of CVD risk among this high-risk patient group. Many antirheumatic drugs, especially methotrexate, TNF-α-inhibitors and IL-6-inhibitors are associated with reduced risk of CVD in observational studies among RA patients, but randomised controlled trials with hard CVD endpoints are lacking. In patients without rheumatic disease, anti-inflammatory therapies targeting nucleotide-binding oligomerisation domain, leucine-rich repeat and pyrin domain-containing protein 3 inflammasome and the IL-1/IL-6 pathway arise as potential therapies after an atherosclerotic CVD event.
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Affiliation(s)
- Anne Mirjam Kerola
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital Oslo, Norway.,Department of Rheumatology, Päijät-Häme Joint Authority for Health and Wellbeing Lahti, Finland
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital Oslo, Norway
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29
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Krogager ML, Kragholm K, Thomassen JQ, Søgaard P, Lewis BS, Wassmann S, Baumgartner I, Ceconi C, Schmidt TA, Kaski JC, Drexel H, Semb AG, Agewall S, Niessner A, Savarese G, Kjeldsen KP, Borghi C, Tamargo J, Torp-Pedersen C. Update on management of hypokalemia and goals for the lower potassium level in patients with cardiovascular disease: A review in collaboration with the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. Eur Heart J Cardiovasc Pharmacother 2021; 7:557-567. [PMID: 33956964 DOI: 10.1093/ehjcvp/pvab038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/04/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Hypokalaemia is common in patients with cardiovascular disease. In this review, we emphasize the importance of tight potassium regulation in patients with cardiovascular disease based on findings from observational studies. To enhance the understanding, we also describe the mechanisms of potassium homeostasis maintenance, the most common causes of hypokalaemia and present strategies for monitoring and management of low potassium levels. We propose elevation of potassium in asymptomatic patients with lower normal concentrations and concurrent cardiovascular disease. These proposals are intended to assist clinicians until more evidence is available.
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Affiliation(s)
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University hospital, Aalborg, Denmark.,Department of Cardiology, Region Hospital North Jutland, Hjørring, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Qvist Thomassen
- Department of Clinical Biochemistry, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University hospital, Aalborg, Denmark
| | - Basil S Lewis
- Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
| | - Sven Wassmann
- Cardiology Pasing, Munich, Germany and University of the Saarland, Homburg/Saar, Germany
| | - Iris Baumgartner
- Department of Angiology, Bern University Hospital (Inselspital), Bern, Switzerland
| | - Claudio Ceconi
- Department of Cardiology, Desenzano Del Garda Hospital, Italy
| | - Thomas Andersen Schmidt
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,The Emergency Department, North Zealand University Hospital, Hillerød, Denmark
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Landeskrankenhaus, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Anne Grete Semb
- Preventive Cardio-Rheuma clinic, Depatment Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Stefan Agewall
- Department of Cardiology, Ullevål, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Sciences, Søsterhjemmet, University of Oslo, Oslo, Norway
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Instituttet, Stockholm, Sweden
| | - Keld Per Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Copenhagen, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, CIBERCV, University Complutense, 28040, Madrid, Spain
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Retterstøl K, Munkhaugen J, Ingul CB, Grimsmo J, Kask A, Schirmer H, Semb AG, Solberg EE. Correction: Lower treatment goals for LDL cholesterol should be introduced. Tidsskr Nor Laegeforen 2021; 141:21-0096. [PMID: 33685112 DOI: 10.4045/tidsskr.21.0096] [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: 11/02/2022] Open
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Retterstøl K, Munkhaugen J, Igul CB, Grimsmo J, Kask A, Schirmer H, Semb AG, Solberg EE. Retterstøl and colleagues respond. Tidsskr Nor Laegeforen 2021; 141:21-0122. [PMID: 33685109 DOI: 10.4045/tidsskr.21.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Magavern EF, Kaski JC, Turner RM, Drexel H, Janmohamed A, Scourfield A, Burrage D, Floyd CN, Adeyeye E, Tamargo J, Lewis BS, Kjeldsen KP, Niessner A, Wassmann S, Sulzgruber P, Borry P, Agewall S, Semb AG, Savarese G, Pirmohamed M, Caulfield MJ. The Role of Pharmacogenomics in Contemporary Cardiovascular Therapy: A position statement from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. Eur Heart J Cardiovasc Pharmacother 2021; 8:85-99. [PMID: 33638977 DOI: 10.1093/ehjcvp/pvab018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/05/2021] [Accepted: 02/24/2021] [Indexed: 12/14/2022]
Abstract
There is a strong and ever-growing body of evidence regarding the use of pharmacogenomics to inform cardiovascular pharmacology. However, there is no common position taken by international cardiovascular societies to unite diverse availability, interpretation and application of such data, nor is there recognition of the challenges of variation in clinical practice between countries within Europe. Aside from the considerable barriers to implementing pharmacogenomic testing and the complexities of clinically actioning results, there are differences in the availability of resources and expertise internationally within Europe. Diverse legal and ethical approaches to genomic testing and clinical therapeutic application also require serious thought. As direct-to-consumer genomic testing becomes more common, it can be anticipated that data may be brought in by patients themselves, which will require critical assessment by the clinical cardiovascular prescriber. In a modern, pluralistic and multi-ethnic Europe, self-identified race/ethnicity may not be concordant with genetically detected ancestry and thus may not accurately convey polymorphism prevalence. Given the broad relevance of pharmacogenomics to areas such as thrombosis and coagulation, interventional cardiology, heart failure, arrhythmias, clinical trials, and policy/regulatory activity within cardiovascular medicine, as well as to genomic and pharmacology subspecialists, this position statement attempts to address these issues at a wide-ranging level.
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Affiliation(s)
- E F Magavern
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Department of Clinical Pharmacology, Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - J C Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, United Kingdom
| | - R M Turner
- The Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - H Drexel
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT), Feldkirch, A Private University of the Principality of Liechtenstein, Triesen, FL.,Drexel University College of Medicine, Philadelphia, USA
| | - A Janmohamed
- Department of Clinical Pharmacology, St George's, University of London, United Kingdom
| | - A Scourfield
- Department of Clinical Pharmacology, University College London Hospital Foundation Trust, UK
| | - D Burrage
- Whittington Health NHS Trust, London, UK
| | - C N Floyd
- King's College London British Heart Foundation Centre, School of Cardiovascular Medicine and Sciences, London, UK.,Department of Clinical Pharmacology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - E Adeyeye
- Department of Clinical Pharmacology, Cardiovascular Medicine, Barts Health NHS Trust, London, UK
| | - J Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Madrid, Spain
| | - B S Lewis
- Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Keld Per Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Copenhagen, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - A Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna
| | - S Wassmann
- Cardiology Pasing, Munich, Germany and University of the Saarland, Homburg/Saar, Germany
| | - P Sulzgruber
- Medical University of Vienna, Department of Medicine II, Division of Cardiology
| | - P Borry
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Leuven Institute for Human Genetics and Society, Leuven, Belgium
| | - S Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - A G Semb
- Preventive Cardio-Rheuma clinic, department of rheumatology, innovation and research, Diakonhjemmet hospital, Oslo, Norway
| | - G Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - M Pirmohamed
- The Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Liverpool Health Partners, Liverpool, UK
| | - M J Caulfield
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Retterstøl K, Munkhaugen J, Ingul CB, Grimsmo J, Kask A, Schirmer H, Semb AG, Solberg EE. Lower treatment goals for LDL cholesterol should be introduced. Tidsskr Nor Laegeforen 2021; 141:20-0761. [PMID: 33528123 DOI: 10.4045/tidsskr.20.0761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Roelsgaard IK, Ikdahl E, Rollefstad S, Wibetoe G, Esbensen BA, Kitas GD, van Riel P, Gabriel S, Kvien TK, Douglas K, Wållberg-Jonsson S, Rantapää Dahlqvist S, Karpouzas G, Dessein PH, Tsang L, El-Gabalawy H, Hitchon CA, Pascual-Ramos V, Contreras-Yáñez I, Sfikakis PP, González-Gay MA, Crowson CS, Semb AG. Smoking cessation is associated with lower disease activity and predicts cardiovascular risk reduction in rheumatoid arthritis patients. Rheumatology (Oxford) 2021; 59:1997-2004. [PMID: 31782789 PMCID: PMC7382591 DOI: 10.1093/rheumatology/kez557] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives Smoking is a major risk factor for the development of both cardiovascular disease (CVD) and RA and may cause attenuated responses to anti-rheumatic treatments. Our aim was to compare disease activity, CVD risk factors and CVD event rates across smoking status in RA patients. Methods Disease characteristics, CVD risk factors and relevant medications were recorded in RA patients without prior CVD from 10 countries (Norway, UK, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico). Information on CVD events was collected. Adjusted analysis of variance, logistic regression and Cox models were applied to compare RA disease activity (DAS28), CVD risk factors and event rates across categories of smoking status. Results Of the 3311 RA patients (1012 former, 887 current and 1412 never smokers), 235 experienced CVD events during a median follow-up of 3.5 years (interquartile range 2.5–6.1). At enrolment, current smokers were more likely to have moderate or high disease activity compared with former and never smokers (P < 0.001 for both). There was a gradient of worsening CVD risk factor profiles (lipoproteins and blood pressure) from never to former to current smokers. Furthermore, former and never smokers had significantly lower CVD event rates compared with current smokers [hazard ratio 0.70 (95% CI 0.51, 0.95), P = 0.02 and 0.48 (0.34, 0.69), P < 0.001, respectively]. The CVD event rates for former and never smokers were comparable. Conclusion Smoking cessation in patients with RA was associated with lower disease activity and improved lipid profiles and was a predictor of reduced rates of CVD events.
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Affiliation(s)
- Ida K Roelsgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostup, Denmark
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Bente A Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostup, Denmark.,Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK.,Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Piet van Riel
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Sherine Gabriel
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karen Douglas
- Dudley Group NHS Foundation Trust, West Midlands, UK
| | | | | | - George Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Patrick H Dessein
- Vrije Universiteit Brussel, Brussels, Belgium.,Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Linda Tsang
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | | | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Irazú Contreras-Yáñez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Petros P Sfikakis
- First Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Miguel A González-Gay
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Universidad de Cantabria, Spain
| | - Cynthia S Crowson
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Retterstøl K, Munkhaugen J, Igul CB, Grimsmo J, Kask A, Schirmer H, Semb AG, Solberg EE. Retterstøl og medarbeidere svarer. Tidsskriftet 2021; 140:20-0122. [DOI: 10.4045/tidsskr.20.0122] [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: 11/02/2022] Open
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Os HA, Rollefstad S, Gerdts E, Kringeland E, Ikdahl E, Semb AG, Midtbø H. Preclinical cardiac organ damage during statin treatment in patients with inflammatory joint diseases: the RORA-AS statin intervention study. Rheumatology (Oxford) 2020; 59:3700-3708. [PMID: 32386421 PMCID: PMC7946801 DOI: 10.1093/rheumatology/keaa190] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Statin treatment has been associated with reduction in blood pressure and arterial stiffness in patients with inflammatory joint diseases (IJD). We tested whether statin treatment also was associated with regression of preclinical cardiac organ damage in IJD patients. METHODS Echocardiography was performed in 84 IJD patients (52 RA, 20 ankylosing spondylitis, 12 psoriatric arthritis, mean age 61 (9) years, 63% women) without known cardiovascular disease before and after 18 months of rosuvastatin treatment. Preclinical cardiac organ damage was identified by echocardiography as presence of left ventricular (LV) hypertrophy, LV concentric geometry, increased LV chamber size and/or dilated left atrium. RESULTS At baseline, hypertension was present in 63%, and 36% used biologic DMARDs (bDMARDs). Preclinical cardiac organ damage was not influenced by rosuvastatin treatment (44% at baseline vs 50% at follow-up, P = 0.42). In uni- and multivariable logistic regression analyses, risk of preclinical cardiac organ damage at follow-up was increased by higher baseline body mass index [odds ratio (OR) 1.3, 95% CI: 1.1, 1.5, P = 0.01] and presence of preclinical cardiac organ damage at baseline (OR 6.4, 95% CI: 2.2, 18.5, P = 0.001) and reduced by use of bDMARDs at follow-up (OR 0.3, 95% CI: 0.1, 0.9, P = 0.03). CONCLUSION Rosuvastatin treatment was not associated with a reduction in preclinical cardiac organ damage in IJD patients after 18 months of treatment. However, use of bDMARDS at follow-up was associated with lower risk of preclinical cardiac organ damage at study end, pointing to a possible protective cardiac effect of bDMARDs in IJD patients. CLINICALTRIALS.GOV https://clinicaltrials.gov/NCT01389388.
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Affiliation(s)
- Hanna A Os
- Department of Clinical Science, University of Bergen, Bergen
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen
| | | | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo
| | - Helga Midtbø
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Roelsgaard IK, Thomsen T, Østergaard M, Semb AG, Andersen L, Esbensen BA. How do people with rheumatoid arthritis experience participation in a smoking cessation trial: a qualitative study. Int J Qual Stud Health Well-being 2020; 15:1725997. [PMID: 32046611 PMCID: PMC7034478 DOI: 10.1080/17482631.2020.1725997] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose: The aim of this study was to gain more knowledge on how people with rheumatoid arthritis (RA) experienced participation in a randomized controlled trial (RCT) testing the effect of a smoking cessation intervention since this intervention have not been tested on an RA population before Methods: We conducted a qualitative study with semi-structured individual interviews with 12 participants from the intervention group in the RCT. Results: Through thematic analysis we identified four themes: Instilling hope for smoking cessation, referring to the initial invitation to participate in the RCT; Various components of importance in the intervention, referring to cooperation with the smoking cessation counsellor, improved carbon monoxide levels, fear of becoming addicted to nicotine replacement therapy, and suggestions for additional components in the intervention which could promote motivation; Breaking habits, referring to ongoing reflection on quitting smoking; and Increased awareness of health, arthritis and smoking, referring to the lack of information on smoking and RA from health professionals, and the impact of smoking on RA symptoms and overall health. Conclusion: The results reflect the participants’ perspective on what is meaningful to them when trying to quit smoking and adds important knowledge to future smoking cessation studies in this patient group.
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Affiliation(s)
- Ida Kristiane Roelsgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Thordis Thomsen
- Herlev Anaesthesia Critical and Emergency Care Science Unit, ACES, Department of Anesthesiology, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lena Andersen
- The Danish Rheumatism Association, Gentofte, Denmark
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kvien TK, Balsa A, Betteridge N, Buch MH, Durez P, Favalli EG, Favier G, Gabay C, Geenen R, Gouni-Berthold I, van den Hoogen F, Kent A, Klareskog L, Ostergaard M, Pavelka K, Polido Pereira J, Semb AG, Sköld M, Dougados M. Considerations for improving quality of care of patients with rheumatoid arthritis and associated comorbidities. RMD Open 2020; 6:e001211. [PMID: 32683326 PMCID: PMC7722279 DOI: 10.1136/rmdopen-2020-001211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder with a global prevalence of approximately 0.5-1%. Patients with RA are at an increased risk of developing comorbidities (eg, cardiovascular disease, pulmonary disease, diabetes and depression). Despite this, there are limited recommendations for the management and implementation of associated comorbidities. This study aimed to identify good practice interventions in the care of RA and associated comorbidities. METHODS A combination of primary research (180+ interviews with specialists across 12 European rheumatology centres) and secondary research (literature review of existing publications and guidelines/recommendations) were used to identify challenges in management and corresponding good practice interventions. Findings were prioritised and reviewed by a group of 18 rheumatology experts including rheumatologists, comorbidity experts, a patient representative and a highly specialised nurse. RESULTS Challenges throughout the patient pathway (including delays in diagnosis and referral, shortage of rheumatologists, limited awareness of primary care professionals) and 18 good practice interventions were identified in the study. The expert group segmented and prioritised interventions according to three distinct stages of the disease: (1) suspected RA, (2) recent diagnosis of RA and (3) established RA. Examples of good practice interventions included enabling self-management (self-monitoring and disease management support, for example, lifestyle adaptations); early arthritis clinic; rapid access to care (online referral, triage, ultrasound-guided diagnosis); dedicated comorbidity specialists; enhanced communication with primary care (hotline, education sessions); and integrating patient registries into daily clinical practice. CONCLUSION Learning from implementation of good practice interventions in centres across Europe provides an opportunity to more widely improved care for patients with RA and associated comorbidities.
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Affiliation(s)
- Tore K Kvien
- Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, University of Manchester, Manchester, UK
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
| | - Patrick Durez
- Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
| | | | - Guillaume Favier
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, UK
- Global Strategy Group, KPMG LLP, London, UK
| | - Cem Gabay
- Department of Internal Medicine Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Frank van den Hoogen
- Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
- Sint Maartenskliniek, Nijmegen, Netherlands
| | - Alison Kent
- Salisbury NHS Foundation Trust, Salisbury, UK
| | | | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Karel Pavelka
- Rheumatologic Clinic, Institute of Rheumatology, Prague, Czech Republic
| | | | | | - Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
| | - Maxime Dougados
- Hôpital Cochin, Rheumatology, Université Paris Descartes, Paris, France
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Wibetoe G, Sexton J, Ikdahl E, Rollefstad S, Kitas GD, van Riel P, Gabriel S, Kvien TK, Douglas K, Sandoo A, Arts EE, Wållberg-Jonsson S, Dahlqvist SR, Karpouzas G, Dessein PH, Tsang L, El-Gabalawy H, Hitchon CA, Pascual-Ramos V, Contreas-Yañes I, Sfikakis PP, González-Gay MA, Colunga-Pedraz IJ, Galarza-Delgado DA, Azpiri-Lopez JR, Crowson CS, Semb AG. Prediction of cardiovascular events in rheumatoid arthritis using risk age calculations: evaluation of concordance across risk age models. Arthritis Res Ther 2020; 22:90. [PMID: 32326974 PMCID: PMC7178602 DOI: 10.1186/s13075-020-02178-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/31/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In younger individuals, low absolute risk of cardiovascular disease (CVD) may conceal an increased risk age and relative risk of CVD. Calculation of risk age is proposed as an adjuvant to absolute CVD risk estimation in European guidelines. We aimed to compare the discriminative ability of available risk age models in prediction of CVD in rheumatoid arthritis (RA). Secondly, we also evaluated the performance of risk age models in subgroups based on RA disease characteristics. METHODS RA patients aged 30-70 years were included from an international consortium named A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA). Prior CVD and diabetes mellitus were exclusion criteria. The discriminatory ability of specific risk age models was evaluated using c-statistics and their standard errors after calculating time until fatal or non-fatal CVD or last follow-up. RESULTS A total of 1974 patients were included in the main analyses, and 144 events were observed during follow-up, the median follow-up being 5.0 years. The risk age models gave highly correlated results, demonstrating R2 values ranging from 0.87 to 0.97. However, risk age estimations differed > 5 years in 15-32% of patients. C-statistics ranged 0.68-0.72 with standard errors of approximately 0.03. Despite certain RA characteristics being associated with low c-indices, standard errors were high. Restricting analysis to European RA patients yielded similar results. CONCLUSIONS The cardiovascular risk age and vascular age models have comparable performance in predicting CVD in RA patients. The influence of RA disease characteristics on the predictive ability of these prediction models remains inconclusive.
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Affiliation(s)
- Grunde Wibetoe
- Preventive Cardio-Rheuma clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vindern, N-01319, Oslo, Norway.
| | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vindern, N-01319, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vindern, N-01319, Oslo, Norway
| | - George D Kitas
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
- Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Piet van Riel
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sherine Gabriel
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Karen Douglas
- Dudley Group NHS Foundation Trust, West Midlands, UK
| | - Aamer Sandoo
- Dudley Group NHS Foundation Trust, West Midlands, UK
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Elke E Arts
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | | | | | - George Karpouzas
- Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Patrick H Dessein
- Vrije Universiteit Brussel, Brussels, Belgium
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Linda Tsang
- Rheumatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | | | - Virginia Pascual-Ramos
- Instituto Nactional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Irazu Contreas-Yañes
- Instituto Nactional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Petros P Sfikakis
- First Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Miguel A González-Gay
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | | | | | | | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anne Grete Semb
- Preventive Cardio-Rheuma clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vindern, N-01319, Oslo, Norway
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Svanteson M, Rollefstad S, Kløw NE, Hisdal J, Ikdahl E, Sexton J, Haig Y, Semb AG. Effects of long-term statin-treatment on coronary atherosclerosis in patients with inflammatory joint diseases. PLoS One 2019; 14:e0226479. [PMID: 31830762 PMCID: PMC6908439 DOI: 10.1371/journal.pone.0226479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/26/2019] [Indexed: 12/04/2022] Open
Abstract
Background The effect of statins over time on coronary atherosclerosis in patients with inflammatory joint diseases (IJD) is unknown. Our aim was to evaluate the change in coronary plaque morphology and volume in long-term statin-treated patients with IJD. Methods Sixty-eight patients with IJD and carotid artery plaque(s) underwent coronary computed tomography angiography before and after a mean of 4.7 (range 4.0–6.0) years of statin treatment. The treatment target for low density lipoprotein cholesterol (LDL-c) was ≤1.8 mmol/L. Changes in plaque volume (calcified, mixed/soft and total) and coronary artery calcification (CAC) from baseline to follow-up were assessed using the 17-segment American Heart Association-model. Results Median (IQR) increase in CAC after statin treatment was 38 (5–236) Agatston units (p<0.001). Calcified and total plaque volume increased with 5.6 (0.0–49.1) and 2.9 (0.0–23.5) mm3, respectively (p<0.001 for both). The median (IQR) change in soft/mixed plaque volume was -10 (-7.1–0.0), p = <0.001. Patients who had obtained the LDL-c treatment target at follow-up, experienced reduced progression of both CAC and total plaque volume compared to patients with LDL-c >1.8mmol/L (21 [2–143] vs. 69 [16–423], p = 0.006 and 0.65 [-1.0–13.9] vs. 13.0 [0.0–60.8] mm3, p = 0.019, respectively). Conclusions A progression of total atherosclerotic plaque volume in statin-treated patients with IJD was observed. However, soft/mixed plaque volume was reduced, suggesting an alteration in plaque composition. Patients with recommended LDL-c levels at follow-up had reduced atherosclerotic progression compared to patients with LDL-c levels above the treatment target, suggesting a beneficial effect of treatment to guideline-recommended lipid targets in IJD patients.
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Affiliation(s)
- Mona Svanteson
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Nils-Einar Kløw
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Investigations, Oslo University Hospital, Aker, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Ylva Haig
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Sulzgruber P, Wassmann S, Semb AG, Doehner W, Widimsky P, Gremmel T, Kaski JC, Savarese G, Rosano GMC, Borghi C, Kjeldsen K, Torp-Pedersen C, Schmidt TA, Lewis BS, Drexel H, Tamargo J, Atar D, Agewall S, Niessner A. Oral Anticoagulation in patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1. Eur Heart J 2019; 40:3010-3012. [PMID: 31541549 DOI: 10.1093/eurheartj/ehz650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Sven Wassmann
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Anne Grete Semb
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Wolfram Doehner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Petr Widimsky
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Thomas Gremmel
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Juan Carlos Kaski
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Gianluigi Savarese
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Giuseppe M C Rosano
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Claudio Borghi
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Keld Kjeldsen
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Christian Torp-Pedersen
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Thomas Andersen Schmidt
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Basil S Lewis
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Heinz Drexel
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Juan Tamargo
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Dan Atar
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Stefan Agewall
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
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Agca R, Heslinga SC, Rollefstad S, Heslinga S, Södergren A, Semb AG, Kitas GD, Sattar N, Nurmohamed MT. Response to: "Influence of changes in cholesterol levels and disease activity on the 10-year cardiovascular risk estimated with different algorithms in rheumatoid arthritis patients" by Fornaro et al. Ann Rheum Dis 2019; 79:e105. [PMID: 31413003 DOI: 10.1136/annrheumdis-2019-215748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Rabia Agca
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands .,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Sjoerd C Heslinga
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - S Rollefstad
- Department of Rheumatology, Preventive Cardio-Rheuma Clinical, Diakonhjemmet Hospital, Oslo, Norway
| | - S Heslinga
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Anna Södergren
- Department of Public Health and Clinical Medicine/Rhematology, University of Umeå and Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
| | - A G Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinical, Diakonhjemmet Hospital, Oslo, Norway
| | - George D Kitas
- Head of Research and Development, Academic Affairs Dudley Group NHS Foundation Trust, Arthritis Research UK Centre for Epidemiology, University of Manchester, Russells Hall Hospital, Clinical Research Unit, Dudley, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Michael T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
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Provan SA, Rollefstad S, Ikdahl E, Mathiessen A, Berg IJ, Eeg I, Wilkinson IB, McEniery CM, Kvien TK, Hammer HB, Østerås N, Haugen IK, Semb AG. Biomarkers of cardiovascular risk across phenotypes of osteoarthritis. BMC Rheumatol 2019; 3:33. [PMID: 31410391 PMCID: PMC6686275 DOI: 10.1186/s41927-019-0081-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/24/2019] [Indexed: 01/19/2023] Open
Abstract
Background The objective of this study was to explore the associations between ultrasonographic and radiographic joint scores and levels of arterial CVD risk markers in patients with osteoarthritis (OA). Secondly, to compare the levels of arterial CVD risk markers between OA phenotypes and controls. Method The "Musculoskeletal pain in Ullensaker" Study (MUST) invited residents of Ullensaker municipality with self-reported OA to a medical examination. OA was defined according to the American College of Rheumatology (ACR) criteria and phenotyped based on joint distribution. Joints of the hands, hips and knees were examined by ultrasonography and conventional radiography, and scored for osteosteophytes. Hands were also scored for inflammation by grey scale (GS) synovitis and power Doppler (PD) signal. Control populations were a cohort of inhabitants of Oslo (OCP), and for external validation, a UK community-based register (UKPC).Pulse pressure augmentation index (AIx) and pulse wave velocity (PWV) were measured using the Sphygmocor apparatus (Atcor®). Ankel-brachial index (ABI) was estimated in a subset of patients. In separate adjusted regression models we explored the associations between ultrasonography and radiograph joint scores and AIx, PWV and ABI. CVD risk markers were also compared between phenotypes of OA and controls in adjusted analyses. Results Three hundred and sixty six persons with OA were included (mean age (range); 63.0 (42.0-75.0)), (females (%); 264 (72)). Of these, 155 (42.3%) had isolated hand OA, 111 (30.3%) had isolated lower limb OA and 100 (27.3%) had generalized OA. 108 persons were included in the OCP and 963 persons in the UKPC; (mean age (range); OCP: 57.2 (40.4-70.4), UKPC: 63.9 (40.0-75.0), females (%); OCP: 47 (43.5), UKPC: 543 (56.4%). Hand osteophytes were associated with AIx while GS and PD scores were not related to CVD risk markers. All OA phenotypes had higher levels of AIx compared to OCP in adjusted analyses. External validation against UKPC confirmed these findings. Conclusions Hand osteophytes might be related to higher risk of CVD. People with OA had higher augmented central pressure compared to controls.Words 330.
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Affiliation(s)
- S A Provan
- Department of Rheumatology, Oslo, Norway
| | - S Rollefstad
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Ikdahl
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - I J Berg
- Department of Rheumatology, Oslo, Norway
| | - I Eeg
- Department of Rheumatology, Oslo, Norway
| | - I B Wilkinson
- 3Division of Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - C M McEniery
- 3Division of Experimental Medicine and Immunotherapeutics, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - T K Kvien
- Department of Rheumatology, Oslo, Norway
| | - H B Hammer
- Department of Rheumatology, Oslo, Norway
| | - N Østerås
- 4National Resource Centre for rehabilitation in Rheumatology. Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - I K Haugen
- Department of Rheumatology, Oslo, Norway
| | - A G Semb
- 2Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Savarese G, Reiner MF, Uijl A, D’Amario D, Agewall S, Atar D, Baumgartner I, Borghi C, De Carlo M, Drexel H, Kaski JC, Kjeldsen KP, Kucher N, Lund LH, Niessner A, Semb AG, Schmidt TA, Sulzgruber P, Tamargo J, Vitale C, Wassmann S, Aboyans V, Lewis BS. Antithrombotic therapy and major adverse limb events in patients with chronic lower extremity arterial disease: systematic review and meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases. European Heart Journal - Cardiovascular Pharmacotherapy 2019; 6:86-93. [DOI: 10.1093/ehjcvp/pvz036] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/28/2019] [Accepted: 08/05/2019] [Indexed: 01/22/2023]
Abstract
Abstract
Aims
The role and selection of antithrombotic therapy to improve limb outcomes in chronic lower extremity artery disease (LEAD) is still debated. We conducted a meta-analysis to examine the efficacy and safety of antithrombotic and more intense antithrombotic therapy on limb outcomes and limb salvage in patients with chronic LEAD.
Methods and results
Study inclusion criteria were: enrolment of patients with LEAD, randomized allocation to more vs. less intense antithrombotic therapy [more vs. less intense single-antiplatelet therapy (SAPT); dual-antiplatelet therapy vs. SAPT; dual antithrombotic therapy vs. SAPT or oral anticoagulant]; enrolment of ≥200 patients; reporting of at least one of following outcomes: limb amputation or revascularization. Seven randomized studies enrolling 30 447 patients were included. Over a median follow-up of 24 months, more vs. less intense antithrombotic therapy or placebo significantly reduced the risk of limb revascularization [relative risk (RR) 0.89, 95% confidence interval (CI) 0.83–0.94] and limb amputation (RR 0.63, 95% CI 0.46–0.86), as well as stroke (RR 0.82, 95% CI 0.70–0.97). There was no statistically significant effect on the risk of myocardial infarction (RR 0.98, 95% CI 0.87–1.11), all-cause (RR 0.93, 95% CI 0.86–1.01), and cardiovascular death (RR 0.97, 95% CI 0.86–1.08). Risk of major bleeding increased (RR 1.23, 95% CI 1.04–1.44).
Conclusion
In patients with LEAD, more intense antithrombotic therapy reduces the risk of limb amputation and revascularization as well as stroke with an increase in the risk of bleeding events.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, S1:02, 171 76 Stockholm, Sweden
| | - Martin F Reiner
- Department of Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Alicia Uijl
- Division of Cardiology, Department of Medicine, Karolinska Institutet, S1:02, 171 76 Stockholm, Sweden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Domenico D’Amario
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico A. Gemelli IRCCS, UNIVERSITÀ Cattolica del Sacro Cuore, Largo A.Gemelli 8, 00168 Rome, Italy
| | - Stefan Agewall
- Department of Cardiology, Ullevål, Oslo University Hospital, and Institute of Clinical Sciences, Søsterhjemmet, University of Oslo, Oslo, Norway
| | - Dan Atar
- Department of Cardiology, Ullevål, Oslo University Hospital, and Institute of Clinical Sciences, Søsterhjemmet, University of Oslo, Oslo, Norway
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Claudio Borghi
- Medicine and Surgery Science Department, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Marco De Carlo
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa, 2, 56100 Pisa, Italy
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria
- Division of Angiology, Swiss Cardiovascular Center, Bern, Switzerland
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Keld P Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Italiensvej 1, DK-2300 Copenhagen, Denmark
- Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Fredrik Bajers Plads 7 D2, DK-9220 Aalborg, Denmark
| | - Nils Kucher
- Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, S1:02, 171 76 Stockholm, Sweden
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemme Hospital, Oslo, Norway
| | - Thomas A Schmidt
- Emergency Department, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Patrick Sulzgruber
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Juan Tamargo
- Department of Pharmaclogy and Toxicology, School of Medicine, Universidad Complutense, CIBERCV, 28040 Madrid, Spain
| | | | - Sven Wassmann
- Cardiology Pasing, Institutstr. 14, 81241 Munich, Germany
- Department of Cardiology, University of the Saarland, Kirrbergerstr. 100, 66421 Homburg/Saar, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, 2, Martin Luther King ave, 87000 Limoges, France
- Inserm 1094, Limoges School of Medicine, Limoges, France
| | - Basil S Lewis
- Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel-Institute of Technology, Haifa, Israel
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Sulzgruber P, Wassmann S, Semb AG, Doehner W, Widimsky P, Gremmel T, Kaski JC, Savarese G, Rosano GMC, Borghi C, Kjeldsen K, Torp-Pedersen C, Schmidt TA, Lewis BS, Drexel H, Tamargo J, Atar D, Agewall S, Niessner A. Oral anticoagulation in patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1: a current opinion of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Council on Stroke. European Heart Journal - Cardiovascular Pharmacotherapy 2019; 5:171-180. [DOI: 10.1093/ehjcvp/pvz016] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/17/2019] [Accepted: 05/15/2019] [Indexed: 12/26/2022]
Abstract
Abstract
Oral anticoagulation in patients presenting with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1 (CHA2DS2-VASc of 2 in women) remains a challenging approach in clinical practice. Therapeutic decisions need to balance the individual benefit of reducing thromboembolic risk against the potential harm due to an increase in bleeding risk in this intermediate risk patient population. Within the current opinion statement of the European Society of Cardiology working group of cardiovascular pharmacotherapy and the European Society of Cardiology council on stroke the currently available evidence on the anti-thrombotic management in patients presenting with a CHA2DS2-VASc of 1 is summarized. Easily applicable tools for a personalized refinement of the individual thromboembolic risk in patients with atrial fibrillation and a CHA2DS2-VASc score of 1 that guide clinicians through the question whether to anticoagulate or not are provided.
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Affiliation(s)
- Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Sven Wassmann
- Cardiology Pasing, Institutstraße 14, 81241 Munich, Germany
- University of the Saarland, Kirrberger Straße 100, 66424 Homburg, Saar, Germany
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Oudenarder Straße 16, 13316 Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University, Opletalova 38, 110 00 Staré Město, Prague, Czech Republic
| | - Thomas Gremmel
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK
| | - Gianluigi Savarese
- Cardiology Division, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Eugeniavägen 3, 171 76 Solna, Stockholm, Sweden
| | - Giuseppe M C Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Claudio Borghi
- Atherosclerosis Research Unit, Medical and Surgical Sciences Department, Sant’Orsola-Malpighi Hospital, University of Bologna, Via Zamboni, 33, 40126 Comune di Bologna BO, Italy
| | - Keld Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Hvidovre-Amager), Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Health Sciences and Technology, Aalborg University, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark
| | - Thomas Andersen Schmidt
- Emergency Department, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Basil S Lewis
- Lady Davis Carmel Medical Center, Mikhal St 7, 3436212 Haifa, Israel
- Technion-Israel Institute of Technology, Ruth and Bruce Rappaport School of Medicine, Efron St 1, 3436212 Haifa, Israel
| | - Heinz Drexel
- VIVIT Research, Landeskrankenhaus Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Dorfstrasse 24. FL-9495 Triesen, Principality of Liechtenstein
| | - Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Avda. de Séneca, 2 Ciudad Universitaria, 28040 Madrid, Spain
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Klaus Torgírds vei 3, 0372 Oslo, Norway
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Klaus Torgírds vei 3, 0372 Oslo, Norway
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Sveaas SH, Bilberg A, Berg IJ, Provan SA, Rollefstad S, Semb AG, Hagen KB, Johansen MW, Pedersen E, Dagfinrud H. High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. Br J Sports Med 2019; 54:292-297. [DOI: 10.1136/bjsports-2018-099943] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 11/04/2022]
Abstract
BackgroundExercise is considered important in the management of patients with rheumatic diseases, but the effect of high intensity exercises on disease activity is unknown.ObjectiveTo investigate the effectiveness of high intensity exercises on disease activity in patients with axial spondyloarthritis (axSpA).MethodAssessor blinded multicentre randomised controlled trial. 100 patients (aged from their 20s to their 60s) with axSpA were randomly assigned to an exercise group or to a no-intervention control group. The exercise group performed cardiorespiratory and muscular strength exercises at high intensity over 3 months. The control group received standard care and was instructed to maintain their usual physical activity level. Primary outcome was disease activity measured with the Ankylosing Spondylitis (AS) Disease Activity Scale (ASDAS, higher score=worst) and the Bath AS Disease Activity Index (BASDAI, 0–10, 10=worst). Secondary outcomes were inflammatory markers, physical function and cardiovascular (CV)-health. There was patient involvement in the design and reporting of this study.Results97 of the 100 (97%) randomised patients completed the measurements after the intervention. There was a significant treatment effect of the intervention on the primary outcome (ASDAS: −0.6 [–0.8 to –0.3], p<0.001 and BASDAI: −1.2 [–1.8 to –0.7], p<0.001). Significant treatment effects were also seen for inflammation, physical function and CV-health.ConclusionHigh intensity exercises reduced disease symptoms (pain, fatigue, stiffness) and also inflammation in patients with axSpA. It improves patients’ function and CV health. This debunks concerns that high intensity exercise might exacerbate disease activity in patients with axSpA.Trial registration numberNCT02356874.
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Ikdahl E, Wibetoe G, Rollefstad S, Salberg A, Bergsmark K, Kvien TK, Olsen IC, Soldal DM, Bakland G, Lexberg Å, Fevang BTS, Gulseth HC, Haugeberg G, Semb AG. Guideline recommended treatment to targets of cardiovascular risk is inadequate in patients with inflammatory joint diseases. Int J Cardiol 2019; 274:311-318. [DOI: 10.1016/j.ijcard.2018.06.111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/26/2018] [Accepted: 06/28/2018] [Indexed: 01/08/2023]
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Ikdahl E, Rollefstad S, Wibetoe G, Salberg A, Krøll F, Bergsmark K, Kvien TK, Olsen IC, Soldal DM, Bakland G, Lexberg Å, Gjesdal CG, Gulseth C, Haugeberg G, Semb AG. Feasibility of cardiovascular disease risk assessments in rheumatology outpatient clinics: experiences from the nationwide NOCAR project. RMD Open 2018; 4:e000737. [PMID: 30305931 PMCID: PMC6173264 DOI: 10.1136/rmdopen-2018-000737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/25/2018] [Accepted: 08/19/2018] [Indexed: 01/01/2023] Open
Abstract
Objective The European League Against Rheumatism recommends implementing cardiovascular disease (CVD) risk assessments for patients with inflammatory joint diseases (IJDs) into clinical practice. Our goal was to design a structured programme for CVD risk assessments to be implemented into routine rheumatology outpatient clinic visits. Methods The NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) started in April 2014 as a quality assurance project including 11 Norwegian rheumatology clinics. CVD risk factors were recorded by adding lipids to routine laboratory tests, self-reporting of CVD risk factors and blood pressure measurements along with the clinical joint examination. The patients’ CVD risks, calculated by the European CVD risk equation SCORE, were evaluated by the rheumatologist. Patients with high or very high CVD risk were referred to their primary care physician for initiation of CVD preventive measures. Results Data collection (autumn 2015) showed that five of the NOCAR centres had implemented CVD risk assessments. There were 8789 patients eligible for CVD risk evaluation (rheumatoid arthritis (RA), 4483; ankylosing spondylitis (AS), 1663; psoriatic arthritis (PsA), 1928; unspecified and other forms of spondyloarthropathies (SpA), 715) of whom 41.4 % received a CVD risk assessment (RA, 44.7%; AS, 43.4%; PsA, 36.3%; SpA, 30.6%). Considerable differences existed in the proportions of patients receiving CVD risk evaluations across the NOCAR centres. Conclusion Patients with IJD represent a patient group with a high CVD burden that seldom undergoes CVD risk assessments. The NOCAR project lifted the offer of CVD risk evaluation to over 40% in this high-risk patient population.
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Affiliation(s)
- Eirik Ikdahl
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Silvia Rollefstad
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Grunde Wibetoe
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Anne Salberg
- Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Frode Krøll
- Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Kjetil Bergsmark
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Dag Magnar Soldal
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
| | - Åse Lexberg
- Department of Rheumatology, Drammen Hospital, Drammen, Norway
| | - Clara G Gjesdal
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Glenn Haugeberg
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway.,Department of Rheumatology, Martina Hansen's Hospital, Bærum, Norway
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
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Fagerhøi MG, Rollefstad S, Olsen SU, Semb AG. The effect of brief versus individually tailored dietary advice on change in diet, lipids and blood pressure in patients with inflammatory joint disease. Food Nutr Res 2018; 62:1512. [PMID: 30202399 PMCID: PMC6127379 DOI: 10.29219/fnr.v62.1512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/15/2018] [Accepted: 07/12/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Patients with inflammatory joint diseases (IJD) have an increased risk of cardiovascular disease (CVD) compared to the general population. Nutritional advice has been shown to influence CVD risk factors. Our objective was to evaluate whether an individually tailored dietary counselling versus a brief standardised advice on heart-friendly diet had comparable effect on change in diet, lipids and blood pressure (BP) in patients with IJD. METHODS Thirty-one patients with IJD aged 40-80 years received a brief standardised advice (4 min) on heart-friendly diet by a physician. Sixteen of the patients were randomised to receive an additional, individually tailored, heart-friendly dietary counselling session (60 min) by a dietitian. Change in dietary habits, measured by a validated questionnaire (SmartDiet), lipids, BP and C-reactive protein (CRP) were assessed after 8 weeks of follow-up. RESULTS After 8 weeks, the average increase in SmartDiet score was 5.1 and 5.7 points in the diet group (DG) and the control group (CG), respectively ( p = 0.65). Low-density lipoprotein cholesterol (LDL-c) was reduced by 12.6% in the DG versus 2.4% in the CG ( p = 0.05). There were no significant differences between the two groups regarding change in BP, lipids or CRP. CONCLUSION Individually tailored dietary counselling resulted in more heart-friendly food choices in patients with IJD. However, the change in SmartDiet score was comparable for IJD patients receiving a brief nutritional advice and individually tailored heart-friendly dietary counselling. Further studies evaluating the longitudinal effects of dietary advice on CVD outcome in patients with IJD are warranted.
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Affiliation(s)
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Sissel Urke Olsen
- Department of Clinical Service, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Rollefstad S, Svanteson M, Kloew NE, Hisdal J, Ikdahl E, Sexton J, Haig Y, Semb AG. P3488Effects of statin treatment on coronary plaques in patients with inflammatory joint diseases. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Rollefstad
- Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway
| | - M Svanteson
- Oslo University Hospital, Division of Radiology and Nuclear Medicine, Oslo, Norway
| | - N E Kloew
- Oslo University Hospital, Division of Radiology and Nuclear Medicine, Oslo, Norway
| | - J Hisdal
- Oslo University Hospital, Department of Vascular investigations, Oslo, Norway
| | - E Ikdahl
- Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway
| | - J Sexton
- Diakonhjemmet Hospital, Department of Rheumatology, Oslo, Norway
| | - Y Haig
- Oslo University Hospital, Division of Radiology and Nuclear Medicine, Oslo, Norway
| | - A G Semb
- Diakonhjemmet Hospital, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Oslo, Norway
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