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Alonso R, Arroyo-Olivares R, Muniz-Grijalvo O, Diaz-Diaz JL, Sanchez Munoz-Torrero J, Zambon D, Fuentes-Jimenez F, Romero MJ, Aguado R, Alvarez-Banos P, Manas MD, Arrieta F, Gonzalez-Bustos P, Argueso R, Mata P. Persistence to long-term PCSK9 inhibitors treatment and its effectiveness in familial hypercholesterolemia: data from the SAFEHEART study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Most patients with heterozygous familial hypercholesterolemia (FH) do not achieve current LDL-C goals proposed by European guidelines with conventional lipid-lowering therapy (LLT). Chronic use of PCSK9 inhibitors (PCSK9i) have shown to reduce LDL-C levels up to 61% on top of statins. Persistence to chronic LLT is important to reduce the burden of atherosclerotic cardiovascular disease (ASCVD).
Purpose
To analyze persistence and effectiveness of PCSK9i in clinical practice setting in FH patients from the SAFEHEART register with long-term follow-up.
Methods
SAFEHEART is an open, long-term prospective study of a cohort of subjects with molecular diagnosis of FH. Follow-up is carried out every year through a standardized phone-call to collect clinical conditions, persistence to medications, lipid profile, and cardiovascular events. This study analyses subjects ≥18 years of age on stable LLT who have received PCSK9i.
Results
696 individuals (46% females), median age 56.4 years (IQR 49–66) started with PCSK9i (49% alirocumab and 51% evolocumab). Out of them 38% had history of ASCVD, and 89% were on maximum LLT. Median LDL-C at the moment of starting PCSK9i was 145 mg/dL (IQR, 123–177), representing a poor 2016 & 2019 ESC/EAS guidelines achievement (3% and 0.1% respectively). After a median follow-up of 3.7 years (IQR, 2.3–4.8), 669 patients (96%) remained on PCSK9i treatment during entire follow-up. Only 27 patients (4%) discontinued, 5 temporarily (0.7%) and 22 permanently (3.2%). Most common reasons for PCSK9i treatment interruption were medical decision (n=6), adverse event (AE) (n=5), patient decision not related with AE (n=5) and comorbidity (n=5). Median time to permanent discontinuation was 15 months (IQR, 4–33).
Median LDL-C levels observed and % of LDL-C reduction obtained after 1 year of treatment and in the last follow-up visit were: 63 mg/dL (IQR, 43–88), 61 mg/dL (IQR, 44–82), 57.6% (IQR, 39.5–69) and 58% (IQR, 44–68), respectively. 2016 ESC/EAS guidelines LDL-C goals was achieved by 70% of patients at year 1 and 77% in the last follow-up visit after the introduction of PCSK9i (p<0.001). 2019 ESC/EAS goals were achieved by 44.5% and 48% (p=0.1).
Conclusion
Long-term persistence to PCSK9i treatment in FH patients is very high (96%) and reasons for discontinuation are diverse. This study shows that COVID-19 pandemic did not affected persistence to treatment. Effectiveness in LDL-C reduction and LDL-C goal achievement improved significantly with introduction of PCSK9i in clinical practice setting.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AMGEN
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Affiliation(s)
- R Alonso
- Center for Advanced Metabolic Medicine and Nutrition , Santiago , Chile
| | | | - O Muniz-Grijalvo
- Hospital Virgen del Rocio, Internal Medicine, Lipid Unit , Sevilla , Spain
| | - J L Diaz-Diaz
- Hospital Abente y Lago, Internal Medicine , A Coruna , Spain
| | | | - D Zambon
- Hospital Clinic de Barcelona, Endocrinology , Barcelona , Spain
| | - F Fuentes-Jimenez
- Hospital Reina Sofia, Lipid Unit and Atherosclerosis , Cordoba , Spain
| | - M J Romero
- Hospital Infanta Elena, Internal Medicine , Huelva , Spain
| | - R Aguado
- Hospital Universitario de Leon, Endocrinology , Leon , Spain
| | - P Alvarez-Banos
- Hospital Universitario de Burgos, Endocrinology , Burgos , Spain
| | - M D Manas
- Hospital General Universitario, Internal Medicine , Ciudad Real , Spain
| | - F Arrieta
- Hospital Ramon y Cajal, Endocrinology , Madrid , Spain
| | - P Gonzalez-Bustos
- Hospital Universitario Virgen de las Nieves, Vascular Risk Unit, Internal Medicine , Granada , Spain
| | - R Argueso
- Hospital Lucus Augusti, Endocrinology , Lugo , Spain
| | - P Mata
- Fundaciόn Hipercolesterolemia Familiar , Madrid , Spain
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Gallo A, De Isla LP, Charrière S, Vimont A, Alonso R, Muñiz-Grijalvo O, Diaz-Diaz J, Zambon D, Moulin P, Bruckert E, Mata P, Azar Y. Coronary artery calcium score and safeheart-risk equation for risk stratification in primary prevention familial hypercholesterolemia. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mata N, Alonso R, Banegas JR, Zambon D, Brea A, Mata P. Quality of life in a cohort of familial hypercholesterolemia patients from the south of Europe. Eur J Public Health 2012; 24:221-5. [DOI: 10.1093/eurpub/cks174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Alonso R, Villar J, Fuentes F, Zambon D, Mata P. Abstract: 530 GENETIC DIAGNOSIS OF FAMILIAL HYPERCHOLESTEROLEMIA (FH) AND LDL-CHOLESTEROL GOAL ACHIEVEMENT. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70272-7] [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: 10/20/2022]
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Junyent M, Mateo R, Gilabert R, Cofan M, Nunez I, Pocovi M, Mallen M, Zambon D, Tejedor D, Vega J, Almagro F, Civeira F, Ros E. Abstract: P842 IMPACT OF LDL RECEPTOR MUTATIONAL CLASS ON CAROTID ATHEROSCLEROSIS IN FAMILIAL HYPERCHOLESTEROLEMIA (FH). ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71196-1] [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: 11/16/2022]
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Ros E, Zambon D, Junyent M, Gilabert R, Nuñez I, Sala-Vila A, Domenech M, Cofan M. Abstract: 544 CROSS-SECTIONAL EVALUATION OF CAROTID INTIMA-MEDIA THICKNESS (IMT) IN RELATION TO PRIOR CHOLESTEROLLOWERING DRUG TREATMENT IN A CLINICAL SETTING. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70281-8] [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: 11/29/2022]
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Mbarek A, Graia M, Chadeyron G, Zambon D, Bouaziz J, Fourati M. Synthesis and crystal structure determination of yttrium ultraphosphate YP5O14. J SOLID STATE CHEM 2009. [DOI: 10.1016/j.jssc.2008.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Junyent M, Gilabert R, Nunez I, Pocovi M, Mallen M, Zambon D, Jarauta E, Civeira F, Vega J, Almagro F, Ros E. IMPACT OF LOW-DENSITY LIPOPROTEIN RECEPTOR (LDLR) MUTATIONAL CLASS ON CAROTID ATHEROSCLEROSIS IN PATIENTS WITH FAMILIAL HYPERCHOLESTEROLEMIA (FH). ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70452-5] [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: 11/28/2022]
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Junyent M, Gilabert R, Zambon D, Pocovi M, Mallen M, Cofan M, Nunez I, Civeira F, Tejedor D, Ros E. FEMORAL ATHEROSCLEROSIS IN HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA. INFLUENCE OF THE GENETIC DEFECT. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70122-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cofán F, Cofan M, Rosich E, Campos B, Casals E, Zambon D, Ros E, Oppenheimer F, Campistol JM. Effect of apolipoprotein E polymorphism on renal transplantation. Transplant Proc 2007; 39:2217-8. [PMID: 17889142 DOI: 10.1016/j.transproceed.2007.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Dyslipidemia is an important cardiovascular risk factor and is implicated in the pathogenesis of chronic graft failure in renal transplant recipients. Apolipoprotein E (apoE), a hepatic glycoprotein involved in lipid metabolism, has been associated with hypercholesterolemia and premature coronary disease. AIM This study assessed the impact of apoE polymorphism on the evolution of renal transplant recipients. METHODS A total of 517 patients (age, 47 +/- 14 years; 62% men), who had undergone renal transplantation at least 12 months before enrollment, were assessed (mean follow-up, 5.4 +/- 2.2 years). ApoE polymorphisms (E2, E3, and E4 alleles) were analyzed using polymerase chain reaction (PCR) using genomic DNA. Donor-recipient clinical variables were assessed using univariate methods and Cox multivariate regression model. RESULTS Genotype frequency was as follows: E2/E2 <1%, E2/E3 10%, E3/E3 71%, E2/E4 2%, E3/E4 16%, and E4/E4 1%, with no differences between sexes. In the univariate study, E2/E4, E3/E4, and E4/E4 genotypes were related with poorer patient survival (P = .0045). In the multivariate study, the E4 allele was associated with a higher independent risk of graft loss (odds ratio [OR], 3.23; 95% confidence interval [CI], 1.44-7.21; P < .0001) and death of the patient (OR, 16.03; 95% CI, 3.28-75.18; P < .0001), but only in patients older than 60 years of age. In patients with the E4 allele, 45% of deaths were due to cardiovascular causes. CONCLUSIONS The genetic polymorphism of apoE (E4 allele) has an independent negative impact on patient and graft survival in the long term, particularly in older patients.
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Affiliation(s)
- F Cofán
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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Junyent M, Gilabert R, Nunez I, Cofan M, Zambon D, Ros E. PO14-384 INFLUENCE OF THE APOLIPOPROTEIN B/APOLIPOPROTEIN AI RATIO ON PRECLINICAL CAROTID ATHEROSCLEROSIS IN FAMILIAL COMBINED HYPERLIPIDEMIA AND POLYGENIC HYPERCHOLESTEROLEMIA. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71394-6] [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: 10/23/2022]
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Ros E, Junyent M, Gilabert R, Nunez I, Pocovi M, Cofan M, Zambon D. WO8-OR-4 LOW-DENSITY LIPOPROTEIN RECEPTOR (LDLR) GENOTYPE IN FAMILIAL HYPERCHOLESTEROLEMIA (FH). ASSOCIATION WITH PRECLINICAL CAROTID AND FEMORAL ATHEROSCLEROSIS AND TENDON XANTHOMAS. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)70976-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cofan M, Cofan F, Campos B, Casals E, Zambon D, Ros E, Campistol JM, Oppenheimer F. Effect of apolipoprotein polymorphisms in renal transplant recipients. Transplant Proc 2003; 35:1725-6. [PMID: 12962772 DOI: 10.1016/s0041-1345(03)00629-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiovascular disease (CVD) is the main cause of mortality among long-term renal transplant recipients (RTR). On the other hand, allograft chronic nephropathy is the primary cause of graft loss among long-term RTR. Hyperlipidemia is a predisposing factor for both conditions. Polymorphisms of the apolipoproteins modulate lipid metabolism. The aim of the study was to evaluate the effect of apo A-I, apo A-IV and apo C-III genotypes on the long-term results of renal transplantation. Clinical assessment (renal allograft and patient survival) and genotyping for apo A-I (+83C/T), apo C-III (Sst I), and apo A-IV (Thr347Ser and Gln360His) polymorphisms were evaluated in 516 kidney transplant patients and correlated with the clinical evolution over 12 months. The distribution of the apo A-I (+83C/T) polymorphisms was: CC 91.9%, CT 7.9%, and TT 0.2%. The apo C-III genotype showed: S1S1 84.4%, S1S2 15.2%, and S2S2 0.4%. The apo A-IV (Pvu II) polymorphism was: GG 82%, GT 18%, and 0% TT. Finally, the frequency of apo A-IV (Hinf I) polymorphism was: AA 69%, AT 27%, and TT 4%. The frequency of polymorphisms was similar between men and women. In conclusion, there was no significant influence of apolipoprotein polymorphisms on renal and patient survival.
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Affiliation(s)
- M Cofan
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
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14
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Pappolla MA, Bryant-Thomas TK, Herbert D, Pacheco J, Fabra Garcia M, Manjon M, Girones X, Henry TL, Matsubara E, Zambon D, Wolozin B, Sano M, Cruz-Sanchez FF, Thal LJ, Petanceska SS, Refolo LM. Mild hypercholesterolemia is an early risk factor for the development of Alzheimer amyloid pathology. Neurology 2003; 61:199-205. [PMID: 12874399 DOI: 10.1212/01.wnl.0000070182.02537.84] [Citation(s) in RCA: 227] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Epidemiologic and experimental data suggest that cholesterol may play a role in the pathogenesis of AD. Modulation of cholesterolemia in transgenic animal models of AD strongly alters amyloid pathology. OBJECTIVE To determine whether a relationship exists between amyloid deposition and total cholesterolemia (TC) in the human brain. METHODS The authors reviewed autopsy cases of patients older than 40 years and correlated cholesterolemia and presence or absence of amyloid deposition (amyloid positive vs amyloid negative subjects) and cholesterolemia and amyloid load. Amyloid load in human brains was measured by immunohistochemistry and image analysis. To remove the effect of apoE isoforms on cholesterol levels, cases were genotyped and duplicate analyses were performed on apoE3/3 subjects. RESULTS Cholesterolemia correlates with presence of amyloid deposition in the youngest subjects (40 to 55 years) with early amyloid deposition (diffuse type of senile plaques) (p = 0.000 for all apoE isoforms; p = 0.009 for apoE3/3 subjects). In this group, increases in cholesterolemia from 181 to 200 almost tripled the odds for developing amyloid, independent of apoE isoform. A logistic regression model showed consistent results (McFadden rho2 = 0.445). The difference in mean TC between subjects with and without amyloid disappeared as the age of the sample increased (>55 years: p = 0.491), possibly reflecting the effect of cardiovascular deaths among other possibilities. TC and amyloid load were not linearly correlated, indicating that there are additional factors involved in amyloid accumulation. CONCLUSIONS Serum hypercholesterolemia may be an early risk factor for the development of AD amyloid pathology.
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Cofan F, Zambon D, Laguna JC, Ros E, Casals E, Cofan M, Campistol JM, Oppenheimer F. Fatty acid composition of low-density lipoprotein in renal transplant recipients treated with cyclosporine. Transplant Proc 2002; 34:374-6. [PMID: 11959334 DOI: 10.1016/s0041-1345(01)02809-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Cofan
- Renal Transplant Unit, Lipid Section, Biochemistry Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Cofan F, Zambon D, Laguna JC, Casals E, Ros E, Cofan M, Campistol JM, Oppenheimer F. Pravastatin improves low-density lipoprotein oxidation in renal transplantation. Transplant Proc 2002; 34:389-91. [PMID: 11959339 DOI: 10.1016/s0041-1345(01)02814-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- F Cofan
- Renal Transplant Unit, Lipid Section, Biochemistry Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Cofan F, Gilabert R, Nunez I, Zambon D, Ros E, Casals E, Cofan M, Muray S, Campistol JM, Bru C, Oppenheimer F. Influence of renal posttransplantation dyslipidemia on the degree and severity of carotid and femoral atherosclerosis evaluated by B-mode ultrasound. Transplant Proc 2002; 34:412-4. [PMID: 11959349 DOI: 10.1016/s0041-1345(01)02822-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- F Cofan
- Renal Transplant Unit, Biochemistry Department Hospital Clinic, University of Barcelona, Barcelona, Spain
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Cofan F, Zambon D, Laguna JC, Ros E, Casals E, Cofan M, Campistol JM, Oppenheimer F. Oxidation of low-density lipoproteins in renal transplant recipients treated with tacrolimus. Transplant Proc 2002; 34:377-8. [PMID: 11959335 DOI: 10.1016/s0041-1345(01)02810-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- F Cofan
- Renal Transplant Unit, Lipid Section, Biochemistry Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Cofan F, Gilabert R, Zambon D, Nunez I, Ros E, Cofan M, Campistol JM, Bru C, Oppenheimer F. Effect of pravastatin treatment on the evolution of extracoronary atherosclerosis in renal transplant patients. Transplant Proc 2002; 34:384-8. [PMID: 11959338 DOI: 10.1016/s0041-1345(01)02813-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- F Cofan
- Renal Transplant Unit, Radiology Department, Hospital Clinic, University of Barcelona, Spain
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Cofan F, Nuñez I, Gilabert R, Zambon D, Ros E, Cofan M, Muray S, Mansilla E, Bru C, Oppenheimer F. Increased prevalence of carotid and femoral atherosclerosis in renal transplant recipients. Transplant Proc 2001; 33:1254-6. [PMID: 11267281 DOI: 10.1016/s0041-1345(00)02409-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- F Cofan
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, Spain
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Cofan F, Zambon D, Rodriguez C, Laguna JC, Vazquez M, Casals E, Torregrosa J, Ros E, Oppenheimer F. Fatty acid composition in low-density lipoproteins from renal transplant recipients. Transplant Proc 1999; 31:2330-2. [PMID: 10500603 DOI: 10.1016/s0041-1345(99)00364-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- F Cofan
- Renal Transplant Unit, Hospital Clínic, Barcelona, Spain
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Cofan F, Zambon D, Rodriguez C, Laguna JC, Vazquez M, Casals E, Torregrosa J, Ros E, Oppenheimer F. Oxidation of low-density lipoproteins in renal transplant recipients. Transplant Proc 1999; 31:2333-4. [PMID: 10500604 DOI: 10.1016/s0041-1345(99)00365-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F Cofan
- Renal Transplant Unit, Hospital Clínic, Barcelona, Spain
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Abstract
OBJECTIVES The aim of the study was investigate the prevalence of abnormal values of cardiac troponin T (cTnT) and cardiac troponin I (cTnI) in patients with chronic renal failure (CRF) and their clinical significance. DESIGN AND METHODS We investigated the concentrations of cTnT and cTnI in 49 CRF patients without heart disease or diabetes. Cardiac TnT values were measured with a second generation immunoassay and cTnI with two immunoassays with different analytical sensitivity. All CRF patients underwent regular clinical follow-up over a 18-month period. RESULTS No patients with CRF had elevated values of cTnI when measured with one assay and only 2 patients displayed minimally elevated values with the second assay. In contrast, 23 CRF patients (47%) displayed cTnT concentrations elevated above the upper reference limit. The elevated cTnT values observed were below the values detected in acute myocardial infarction and were not associated with adverse cardiac events during follow-up. CONCLUSIONS Mildly elevated cTnT concentrations are common in patients with CRF and do not appear to be associated with adverse coronary events.
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Affiliation(s)
- P Musso
- Department of Cardiology, Ospedale Civile, Ivrea, Italy.
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Brugnone F, Perbellini L, Romeo L, Bianchin M, Tonello A, Pianalto G, Zambon D, Zanon G. Benzene in environmental air and human blood. Int Arch Occup Environ Health 1998; 71:554-9. [PMID: 9860165 DOI: 10.1007/s004200050323] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the blood benzene levels resulting from environmental and occupational benzene exposure. METHODS Benzene in venous blood was measured in 243 nonoccupationally exposed subjects ("normal" people) and in 167 workers occupationally exposed to benzene. All exposed workers gave blood samples at the end of the work shift and on the following morning before resuming work. Blood benzene was assayed by gas chromatography (GC)-mass spectrometry. Occupational benzene exposure was monitored by environmental personal samplers and measured by GC analysis. RESULTS The mean occupational benzene exposure for all 167 workers studied was 186 ng/l (58 ppb; range 5 1535 ng/l, 2-500 ppb). Overall, the mean blood benzene level of all workers was 420 ng/1 at the end of the shift and 287 ng/l on the morning thereafter. The blood benzene levels measured the morning after turned out to be significantly lower (t=3.6; P < 0.0001) than those measured at the end of the shift. The mean blood benzene level of the 243 "normal" subjects was 165 ng/l, which was significantly lower than that measured in the workers on the morning thereafter (t=5.8: P < 0.0000001). The mean blood benzene concentration was significantly higher in smokers than in nonsmokers in both the general population (264 versus 123 ng/l) and in the exposed workers. In the group of nonsmoking workers, whose workplace exposure to benzene was lower than 100 ng/l, blood benzene levels were similar (210-202 ng/l) to those measured in the nonsmoking general population (165 ng/l). End-of-shift blood benzene correlated significantly with environmental exposure (y=0.91x + 251; r=0.581; n=162; P < 0.00001). Finally, there was also a significant correlation between blood benzene measured at the end of the shift and that determined on the morning thereafter (y=0.45x + 109; r=0.572; n=156; P < 0.00001). CONCLUSION Nonsmoking workers occupationally exposed to benzene at environmental levels lower than 100 ng/l (mean 35 ng/l) and the nonsmoking general population exposed to ubiquitous benzene pollution have similar blood benzene concentrations. This suggests that it is impossible to distinguish between occupational and environmental exposure when the benzene level in the workplace is less than 100 ng/l.
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Affiliation(s)
- F Brugnone
- Institute of Occupational Medicine, University of Verona, Italy
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Abstract
The results of cholecystectomy in terms of symptomatic improvement were prospectively evaluated in 124 unselected gall stone patients interviewed before and two years after elective surgery. Indications for cholecystectomy were biliary pain (n = 65), previous complications of gall stone disease (n = 52), and flatulent dyspepsia (n = 7). At two years 93 patients could be re-evaluated, of whom only 49 (53%) were completely symptom free. Postcholecystectomy symptoms occurring in the remaining 44 patients were mainly flatulent dyspepsia (which had relapsed in 22 of 46 patients who suffered it preoperatively), dull abdominal pain or diarrhoea. Incisional hernia was present in five patients and one had recurrence of pain because of retained common bile duct stones. Symptomatic cures after cholecystectomy decreased with the duration of the preoperative history. The results reconfirm that cholecystectomy eradicates specific symptoms and complications of gall stone disease, but they also show that nearly one half of operated patients are dissatisfied with the procedure because of mild but distressing 'postcholecystectomy' symptoms. These are probably caused by previously undiagnosed functional gut disease associated with, but unrelated to, gall stones. A systemic approach to multisymptomatic patients with gall stones is recommended.
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Affiliation(s)
- E Ros
- Gastroenterology Service, Hospital Clínic i Provincial, Faculty of Medicine, Barcelona, Spain
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