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Dharmayat KI, Vallejo-Vaz AJ, Stevens CA, Brandts JM, Lyons AR, Groselj U, Abifadel M, Aguilar-Salinas CA, Alhabib K, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Ashavaid TF, Banach M, Béliard S, Binder C, Bourbon M, Chlebus K, Corral P, Cruz D, Descamps OS, Drogari E, Durst R, Ezhov MV, Genest J, Harada-Shiba M, Holven KB, Humphries SE, Khovidhunkit W, Lalic K, Laufs U, Liberopoulos E, Roeters van Lennep J, Lima-Martinez MM, Lin J, Maher V, März W, Miserez AR, Mitchenko O, Nawawi H, Panayiotou AG, Paragh G, Postadzhiyan A, Reda A, Reiner Ž, Reyes X, Sadiq F, Sahebkar A, Schunkert H, Shek AB, Stroes E, Su TC, Subramaniam T, Susekov A, Vázquez Cárdenas A, Huong Truong T, Tselepis AD, Vohnout B, Wang L, Yamashita S, Al-Sarraf A, Al-Sayed N, Davletov K, Dwiputra B, Gaita D, Kayikcioglu M, Latkovskis G, Marais AD, Thushara Matthias A, Mirrakhimov E, Nordestgaard BG, Petrulioniene Z, Pojskic B, Sadoh W, Tilney M, Tomlinson B, Tybjærg-Hansen A, Viigimaa M, Catapano AL, Freiberger T, Hovingh GK, Mata P, Soran H, Raal F, Watts GF, Schreier L, Bañares V, Greber-Platzer S, Baumgartner-Kaut M, de Gier C, Dieplinger H, Höllerl F, Innerhofer R, Karall D, Lischka J, Ludvik B, Mäser M, Scholl-Bürgi S, Thajer A, Toplak H, Demeure F, Mertens A, Balligand JL, Stephenne X, Sokal E, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Hegele RA, Gaudet D, Brunham L, Ruel I, McCrindle B, Cuevas A, Perica D, Symeonides P, Trogkanis E, Kostis A, Ioannou A, Mouzarou A, Georgiou A, Stylianou A, Miltiadous G, Iacovides P, Deltas C, Vrablik M, Urbanova Z, Jesina P, Tichy L, Hyanek J, Dvorakova J, Cepova J, Sykora J, Buresova K, Pipek M, Pistkova E, Bartkova I, S|ulakova A, Toukalkova L, Spenerova M, Maly J, Benn M, Bendary A, Elbahry A, Ferrières J, Ferrieres D, Peretti N, Bruckert E, Gallo A, Valero R, Mourre F, Aouchiche K, Reynaud R, Tounian P, Lemale J, Boccara F, Moulin P, Charrières S, Di Filippo M, Cariou B, Paillard F, Dourmap C, Pradignac A, Verges B, Simoneau I, Farnier M, Cottin Y, Yelnik C, Hankard R, Schiele F, Durlach V, Sultan A, Carrié A, Rabès JP, Sanin V, Schmieder R, Ates S, Rizos CV, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Skalidis E, Kolovou G, Kolovou V, Garoufi A, Koutagiar I, Polychronopoulos G, Kiouri E, Antza C, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Adamidis PS, Milionis H, Lambadiari V, Stabouli S, Filippatos T, Mollaki V, Tsaroumi A, Lamari F, Proyias P, Harangi M, Reddy LL, Shah SAV, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Hosseini S, Jamialahmadi T, Alareedh M, Shaghee F, Rhadi SH, Abduljalal M, Alfil S, Kareem H, Cohen H, Leitersdorf E, Schurr D, Shpitzen S, Arca M, Averna M, Bertolini S, Calandra S, Tarugi P, Casula M, Galimberti F, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Giorgino F, Suppressa P, Bossi AC, Borghi C, Muntoni S, Cipollone F, Scicali R, Pujia A, Passaro A, Berteotti M, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Nascimbeni F, Iughetti L, Fortunato G, Cavallaro R, Iannuzzo G, Calabrò P, Cefalù AB, Capra ME, Zambon A, Pirro M, Sbrana F, Trenti C, Minicocci I, Federici M, Del Ben M, Buonuomo PS, Moffa S, Pipolo A, Citroni N, Guardamagna O, Lia S, Benso A, Biolo GB, Maroni L, Lupi A, Bonanni L, Rinaldi E, Zenti MG, Masuda D, Mahfouz L, Jambart S, Ayoub C, Ghaleb Y, Kasim NAM, Nor NSM, Al-Khateeb A, Kadir SHSA, Chua YA, Razman AZ, Nazli SA, Ranai NM, Latif AZA, Torres MTM, Mehta R, Martagon AJ, Ramirez GAG, Antonio-Villa NE, Vargas-Vazquez A, Elias-Lopez D, Retana GG, Encinas BR, Macias JJC, Zazueta AR, Alvarado RM, Portano JDM, Lopez HA, Sauque-Reyna L, Gomez Herrera LG, Simental Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PAC, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AYR, Arriaga Cazares HE, Gonzalez Gonzalez JR, Mendez Valencia CV, Padilla Padilla FG, Prado RM, De los Rios Ibarra MO, Arjona Villica~na RD, Acevedo Rivera KJ, Carrera RA, Alvarez JA, Amezcua Martinez JC, Barrera Bustillo MDLR, Vargas GC, Chacon RC, Figueroa Andrade MH, Ortega AF, Alcala HG, Garcia de Leon LE, Guzman BG, Gardu~no Garcia JJ, Garnica Cuellar JC, Gomez Cruz JR, Garcia AH, Holguin Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Medrano Rodriguez AB, Morales Oyervides JC, Perez Vazquez DI, Reyes Rodriguez EA, Osorio MLR, Saucedo JR, Tamayo MT, Valdez Talavera LA, Vera Arroyo LE, Zepeda Carrillo EA, Galema-Boers A, Weigman A, Bogsrud MP, Malik M, Shah S, Khan SA, Rana MA, Batool H, Starostecka E, Konopka A, Lewek J, Bielecka-Dąbrowa A, Gach A, Jóźwiak J, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Hellmann M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Michalska-Grzonkowska A, Chlebus I, Kleinschmidt M, Wojtecka A, Zdrojewski T, Myśliwiec M, Hennig M, Medeiros AM, Alves AC, Almeida AF, Lopes A, Guerra A, Bilhoto C, Simões F, Silva F, Lobarinhas G, Gama G, Palma I, Salgado JM, Matos LD, Moura MD, Virtuoso MJ, Tavares M, Ferreira P, Pais P, Garcia P, Coelho R, Ribeiro R, Correia S, Sadykova D, Slastnikova E, Alammari D, Mawlawi HA, Alsahari A, Khudary AA, Alrowaily NL, Rajkovic N, Popovic L, Singh S, Rasulic I, Petakov A, Lalic NM, Peng FK, Vasanwala RF, Venkatesh SA, Raslova K, Fabryova L, Nociar J, Šaligova J, Potočňáková L, Kozárová M, Varga T, Kadurova M, Debreova M, Novodvorsky P, Gonova K, Klabnik A, Buganova I, Battelino T, Bizjan BJ, Debeljak M, Kovac J, Mlinaric M, Molk N, Sikonja J, Sustar U, Podkrajsek KT, Muñiz-Grijalvo O, Díaz-Díaz JL, de Andrés R, Fuentes-Jiménez F, Blom D, Miserez EB, Shipton JL, Ganokroj P, Futema M, Ramaswami U, Alieva RB, Fozilov KG, Khoshimov SU, Nizamov UI, Abdullaeva GJ, Kan LE, Abdullaev AA, Zakirova DV, Do DL, Nguyen MNT, Kim NT, Le TT, Le HA, Santos R, Ray KK. Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study. Lancet 2024; 403:55-66. [PMID: 38101429 DOI: 10.1016/s0140-6736(23)01842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. METHODS For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. FINDINGS Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. INTERPRETATION Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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Vallejo-Vaz AJ, Bray S, Villa G, Brandts J, Kiru G, Murphy J, Banach M, De Servi S, Gaita D, Gouni-Berthold I, Kees Hovingh G, Jozwiak JJ, Jukema JW, Gabor Kiss R, Kownator S, Iversen HK, Maher V, Masana L, Parkhomenko A, Peeters A, Clifford P, Raslova K, Siostrzonek P, Romeo S, Tousoulis D, Vlachopoulos C, Vrablik M, Catapano AL, Poulter NR, Ray KK. Implications of ACC/AHA Versus ESC/EAS LDL-C Recommendations for Residual Risk Reduction in ASCVD: A Simulation Study From DA VINCI. Cardiovasc Drugs Ther 2023; 37:941-953. [PMID: 35567726 PMCID: PMC10516778 DOI: 10.1007/s10557-022-07343-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Low-density lipoprotein cholesterol (LDL-C) recommendations differ between the 2018 American College of Cardiology/American Heart Association (ACC/AHA) and 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) (< 70 vs. < 55 mg/dl, respectively). In the DA VINCI study, residual cardiovascular risk was predicted in ASCVD patients. The extent to which relative and absolute risk might be lowered by achieving ACC/AHA versus ESC/EAS LDL-C recommended approaches was simulated. METHODS DA VINCI was a cross-sectional observational study of patients prescribed lipid-lowering therapy (LLT) across 18 European countries. Ten-year cardiovascular risk (CVR) was predicted among ASCVD patients receiving stabilized LLT. For patients with LDL-C ≥ 70 mg/dl, the absolute LDL-C reduction required to achieve an LDL-C of < 70 or < 55 mg/dl (LDL-C of 69 or 54 mg/dl, respectively) was calculated. Relative and absolute risk reductions (RRRs and ARRs) were simulated. RESULTS Of the 2039 patients, 61% did not achieve LDL-C < 70 mg/dl. For patients with LDL-C ≥ 70 mg/dl, median (interquartile range) baseline LDL-C and 10-year CVR were 93 (81-115) mg/dl and 32% (25-43%), respectively. Median LDL-C reductions of 24 (12-46) and 39 (27-91) mg/dl were needed to achieve an LDL-C of 69 and 54 mg/dl, respectively. Attaining ACC/AHA or ESC/EAS goals resulted in simulated RRRs of 14% (7-25%) and 22% (15-32%), respectively, and ARRs of 4% (2-7%) and 6% (4-9%), respectively. CONCLUSION In ASCVD patients, achieving ESC/EAS LDL-C goals could result in a 2% additional ARR over 10 years versus the ACC/AHA approach.
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Affiliation(s)
- Antonio J Vallejo-Vaz
- School of Public Health, Imperial College London, London, UK
- Department of Medicine, Faculty of Medicine, University of Seville, Seville, Spain
- Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/Universidad de Sevilla/CSIC, Seville, Spain
| | - Sarah Bray
- Global Biostatistical Science, Amgen Ltd, Cambridge, UK
| | - Guillermo Villa
- Global Health Economics, Amgen Europe (GmbH), Rotkreuz, Switzerland
| | - Julia Brandts
- Imperial Centre for Cardiovascular Disease Prevention Imperial Clinical Trials Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
- Department of Internal Medicine I, University Hospital RWTH Aachen, Aachen, Germany
| | - Gaia Kiru
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jennifer Murphy
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Maciej Banach
- Department of Hypertension, Medical University of Łódź, Łódź, Poland
- Polish Mother's Memorial Hospital-Research Institute (PMMHRI), Łódź, Poland
- Cardiovascular Research Centre, University of Zielona Góra, Zielona Góra, Poland
| | | | - Dan Gaita
- Institutul de Boli Cardiovasculare, Fundatia Cardioprevent, Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioanna Gouni-Berthold
- Centre for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Jacek J Jozwiak
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Opole, Opole, Poland
| | | | | | | | - Helle K Iversen
- Department of Neurology, Stroke Centre Rigshospitalet, Copenhagen, Rigshospitalet, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vincent Maher
- Trinity College Dublin, Dublin, Ireland
- Advanced Lipid Management and Research Centre, Tallaght University Hospital, Dublin, Ireland
| | - Luis Masana
- Universitat Rovira I Virgili, IISPV, CIBERDEM, Saint Joan University Hospital, Reus, Spain
| | | | - André Peeters
- Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Piers Clifford
- Imperial Hospitals NHS Trust (Hammersmith Campus), London, UK
| | | | | | - Stefano Romeo
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Clinical Nutrition, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dimitrios Tousoulis
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Michal Vrablik
- 1st Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention Imperial Clinical Trials Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK.
- Imperial Clinical Trials Unit, Imperial College London, London, UK.
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Maher V, Gallagher J, Agar R, Griffin D, Colwell N, O'Connor P, McAdam B, Tomkin G, Owens D, Ryan M, Tormey W, Durkan M. Abbreviated lipid guidelines for clinical practice : Based on ESC lipid guidelines 2019 and ESC cardiovascular disease prevention in clinical practice guidelines 2021. Ir J Med Sci 2023; 192:2151-2157. [PMID: 36746882 PMCID: PMC10522729 DOI: 10.1007/s11845-023-03277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lipid disorders are now considered causal for atherosclerotic cardiovascular disease (ASCVD) which remains one of the most important contributors to morbidity and mortality in the developed world. Identification and early treatment of lipid disarrays remains the cornerstone of good clinical practice to prevent, halt and even reverse ASCVD. Guidelines for lipid management are imperative to help promote good clinical practice. Given the detail involved in comprehensive guidelines and the multiple areas of knowledge required by clinical practitioners, abbreviated, easy to understand, practical versions of guidelines are required to ensure dissemination of the most important information. The recent ESC lipid guidelines 2019 and the ESC guidelines on CVD prevention in clinical practice 2021 (1,2), provide an excellent detailed summary of all the latest evidence supporting lipid interventions that reduce ASCVD. METHOD We therefore developed a single-page document with hyperlinks to help practitioners gain easy access to practical information on lipid management. It has been developed for future electronic use in clinical practice. CONCLUSION It is presented here in a tabular format together with printable versions of the associated hyperlinks that provide the additional information required in decision making. It is hoped to audit the impact of this approach to help guide future ways of disseminating the latest clinical guideline updates.
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Affiliation(s)
- Vincent Maher
- ALMAR Centre, Tallaght University Hospital, Dublin 24, Ireland.
- Department of Cardiology, Trinity College Dublin, Dublin, Ireland.
| | - Joe Gallagher
- Department of General Practice, University College Dublin, Dublin, Ireland
| | - Ruth Agar
- ALMAR Centre, Tallaght University Hospital, Dublin 24, Ireland
- Department of Cardiology, Trinity College Dublin, Dublin, Ireland
| | - Damian Griffin
- Department of Chemical Pathology, University Hospital Galway, Galway, Ireland
| | - Niall Colwell
- Tipperary University Hospital, South Tipperary General Hospital, Clonmel, Ireland
| | - Patricia O'Connor
- Department of Clinical Pharmacology, St James Hospital, Dublin, Ireland
| | - Brendan McAdam
- Beaumont Hospital Dublin, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerald Tomkin
- Department of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Daphne Owens
- Department of Biochemistry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Ryan
- Department of Endocrinology, Bon Secours Hospital, Limerick, Ireland
| | - William Tormey
- Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland
| | - Maeve Durkan
- Department of Endocrinology, Bon Secours Hospital, University College Cork, Cork, Ireland
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Abstract
There is a ubiquitous problem with medical errors and the concomitant costs it brings in terms of human suffering and financial loss for patients, families, and caregivers. Professional caregivers, including physicians, nurses, and others who have made clinical errors normally will fall under the risk management and quality improvement policies of the organization at which they are employed and subsequent investigation and response occurs internally. Sometimes further consequences can entail the caregiver being named as a defendant or codefendant in a civil lawsuit, and sometimes the caregiver can have professional licensure restricted or even revoked. More rarely, a caregiver can be prosecuted in a criminal legal action. When criminal prosecution occurred, it was usually for purposeful wrongdoing such as fraud, diversion of drugs, or even the intentional or reckless killing of elderly or other vulnerable people. The recent criminal prosecution of a Tennessee nurse for the reckless series of mistakes that led to the death of a single patient opens new considerations for nurses, physicians, and all caregivers, along with hospitals and healthcare systems that employ and/or work with them. The "dynamic tension" of encouraging all caregivers to own up to mistakes with patients as quickly as possible in healthcare organizations seems to be especially challenged now by the Vaught decision. This was mitigated somewhat by a relatively lenient sentence ordered by the judge in this noteworthy case.
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Affiliation(s)
| | - Mark Cwiek
- Central Michigan University, Mount Pleasant, MI, USA
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Offiah G, O'Connor C, Kennedy C, Gallagher J, O'Connor P, McAdam B, Ray KK, Schoonen M, Maher V. The DA VINCI study: is Ireland achieving ESC/EAS guideline-directed LDL-C goals? Ir J Med Sci 2022:10.1007/s11845-022-03050-6. [PMID: 35776266 DOI: 10.1007/s11845-022-03050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The EU-wide, cross-sectional observational study of lipid-lowering therapy (LLT) use in secondary and primary care (DA VINCI) assessed the proportion of patients achieving low-density lipoprotein cholesterol (LDL-C) goals recommended by the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines and provided an insight into regional use of LLT in Europe, including Ireland. AIMS This analysis focuses on data from patients in Ireland who participated in the DA VINCI study. METHODS The DA VINCI study enrolled patients receiving LLT at primary and secondary care sites across 18 European countries between June 2017 and November 2018. The study assessed the achievement of risk-based 2016 and 2019 ESC/EAS LDL-C goals. This subgroup analysis aimed to evaluate LDL-C goal attainment in an Irish cohort of primary and secondary care patients. RESULTS In total, 198 patients from Ireland were enrolled from three primary care and three secondary care centres. Most patients were White and male, and were receiving moderate- or high-intensity statin therapy (most frequently atorvastatin or rosuvastatin). Few patients (< 10%) were receiving combination therapy of statin and ezetimibe. Approximately 60% of patients achieved their 2016 ESC/EAC LDL-C goals while less than half the patients achieved their 2019 ESC/EAS goals. Approximately half of secondary prevention patients achieved their 2016 ESC/EAS goals and only 20% of secondary prevention patients achieved their 2019 ESC/EAS goals. CONCLUSIONS These results highlight the disparity between dyslipidaemia management in clinical practice in Ireland and guideline recommendations. TRIAL REGISTRATION ENCePP; EU PAS 22,075; date registered 06 February 2018.
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Affiliation(s)
- Gregory Offiah
- Department of Cardiology, Tallaght University Hospital, Dublin, Ireland
| | - Cormac O'Connor
- Department of Cardiology, Tallaght University Hospital, Dublin, Ireland
| | | | - Joe Gallagher
- The Palms GP Surgery, The Avenue, Gorey, Co. Wexford, Ireland
| | | | - Brendan McAdam
- Department of Cardiology, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons, Dublin, Ireland
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Vincent Maher
- Department of Cardiology, Tallaght University Hospital, Dublin, Ireland. .,Advanced Lipid Management and Research ALMAR Centre, Tallaght University Hospital, Dublin, Ireland.
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Murray P, O'Connor CT, Maher V, Moore D. Opportunities for Education in Heart Failure Pharmacotherapy Demonstrated by a Survey of Clinicians. Ir Med J 2022; 115:577. [PMID: 35695672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aim We conducted a survey of practitioners' knowledge of the clinical application of the major drug classes in HF, with reference to the European Society of Cardiology guidelines. The aim was to identify areas for practice development through education, which may improve HF morbidity and mortality. Methods We distributed a 14 item questionnaire assessing doctors knowledge of indications and contraindications for the major HF drug classes. Results Total number of responses was 127: Intern (N=21), SHO (N=64), Registrar (N=12), SpR (N=14), Consultant (N=4), GP (N=2). Consultants and GPs were excluded from analysis due to underrepresentation. Median years of practice was 4. Indications were correctly identified in a mean of 78% of responses overall. Of participants who felt comfortable with initiation and up-titration of beta blockers (N=84), only 31% (N=26) correctly identified an optimal target heart rate of less than 70 beats per minute. Forty-five percent (N=50) identified serum potassium and creatinine concentrations generally considered safe as contraindications to the initiation of MRA. Twenty-five percent of respondents (N=28) were unaware of a specialist HF service that catered to their institution, and how to refer to it, but 99% (N=110) felt that their practice would benefit from further education on HF pharmacotherapy. Conclusion Results of this survey suggest a need, and indeed a demand, for further education for clinicians in order to reduce mortality, morbidity, and hospital readmission in HF, as well as their attendant costs.
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Affiliation(s)
- P Murray
- Department of Cardiology, Tallaght University Hospital
| | - C T O'Connor
- Department of Cardiology, Tallaght University Hospital
| | - V Maher
- Department of Cardiology, Tallaght University Hospital
| | - D Moore
- Department of Cardiology, Tallaght University Hospital
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Wheen P, O'Callaghan D, Murray P, Minelli C, Byrne L, Armstrong R, Maher V, Shiels P, Fleming S, Daly C. Persisting Symptomatic Severe Secondary Mitral Regurgitation in Heart Failure Patients. Ir Med J 2022; 115:514. [PMID: 35279048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aims We aimed to assess the rate of persisting severe symptomatic secondary mitral regurgitation (MR) in a newly diagnosed heart failure (HF) population following optimisation of guideline directed medical therapy (GDMT), cardiac resynchronisation therapy (CRT) and revascularisation. Methods We assessed all new patients referred to our hospital group’s HF clinics. We retrospectively reviewed these patients at HF clinic enrolment, HF programme completion, as well as most recent follow up. Results Of the 242 new patients referred to our HF clinics, there were 10 patients (4.1%) who had either persisting symptomatic severe secondary MR at HF programme completion, or had undergone mitral valve surgery. There were no percutaneous mitral valve repairs at the time of these patients’ referrals. The rates of ACE/ARB/ARNI, BB and MRA use were 87.8%, 94.1%, and 49.8% in those with mid ranged, or reduced ejection fraction. The rates of ICD and CRT therapy were 15.1% and 4.4% at follow up. Patients with severe MR had higher time adjusted rates of death or hospitalization for heart failure. Conclusion In a well-treated newly diagnosed HF population, repeat assessment at HF programme completion suggests 4.1% of patients have a persisting indication for percutaneous mitral valve repair based on persisting severe symptomatic secondary MR.
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Affiliation(s)
- P Wheen
- School of Medicine, Trinity College, Dublin, Ireland
- St. James Hospital, James Street, Dublin 8, Ireland
- Tallaght University Hospital, Dublin 24, Ireland
| | | | - P Murray
- Tallaght University Hospital, Dublin 24, Ireland
| | - C Minelli
- Midlands Regional Hospital, Tullamore, Co. Offaly, Ireland
| | - L Byrne
- Midlands Regional Hospital, Portlaoise, Co. Laois, Ireland
| | - R Armstrong
- St. James Hospital, James Street, Dublin 8, Ireland
| | - V Maher
- Tallaght University Hospital, Dublin 24, Ireland
| | - P Shiels
- Midlands Regional Hospital, Tullamore, Co. Offaly, Ireland
| | - S Fleming
- Midlands Regional Hospital, Portlaoise, Co. Laois, Ireland
| | - C Daly
- St. James Hospital, James Street, Dublin 8, Ireland
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Vallejo-Vaz AJ, Stevens CA, Lyons AR, Dharmayat KI, Freiberger T, Hovingh GK, Mata P, Raal FJ, Santos RD, Soran H, Watts GF, Abifadel M, Aguilar-Salinas CA, Alhabib KF, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Al-Sarraf A, Al-Sayed N, Araujo F, Ashavaid TF, Banach M, Béliard S, Benn M, Binder CJ, Bogsrud MP, Bourbon M, Chlebus K, Corral P, Davletov K, Descamps OS, Durst R, Ezhov M, Gaita D, Genest J, Groselj U, Harada-Shiba M, Holven KB, Kayikcioglu M, Khovidhunkit W, Lalic K, Latkovskis G, Laufs U, Liberopoulos E, Lima-Martinez MM, Lin J, Maher V, Marais AD, März W, Mirrakhimov E, Miserez AR, Mitchenko O, Nawawi H, Nordestgaard BG, Panayiotou AG, Paragh G, Petrulioniene Z, Pojskic B, Postadzhiyan A, Raslova K, Reda A, Reiner Ž, Sadiq F, Sadoh WE, Schunkert H, Shek AB, Stoll M, Stroes E, Su TC, Subramaniam T, Susekov AV, Tilney M, Tomlinson B, Truong TH, Tselepis AD, Tybjærg-Hansen A, Vázquez Cárdenas A, Viigimaa M, Wang L, Yamashita S, Kastelein JJ, Bruckert E, Vohnout B, Schreier L, Pang J, Ebenbichler C, Dieplinger H, Innerhofer R, Winhofer-Stöckl Y, Greber-Platzer S, Krychtiuk K, Speidl W, Toplak H, Widhalm K, Stulnig T, Huber K, Höllerl F, Rega-Kaun G, Kleemann L, Mäser M, Scholl-Bürgi S, Säly C, Mayer FJ, Sablon G, Tarantino E, Nzeyimana C, Pojskic L, Sisic I, Nalbantic AD, Jannes CE, Pereira AC, Krieger JE, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Baass A, Bergeron J, Bernard S, Brisson D, Brunham LR, Cermakova L, Couture P, Francis GA, Gaudet D, Hegele RA, Khoury E, Mancini GJ, McCrindle BW, Paquette M, Ruel I, Cuevas A, Asenjo S, Wang X, Meng K, Song X, Yong Q, Jiang T, Liu Z, Duan Y, Hong J, Ye P, Chen Y, Qi J, Liu Z, Li Y, Zhang C, Peng J, Yang Y, Yu W, Wang Q, Yuan H, Cheng S, Jiang L, Chong M, Jiao J, Wu Y, Wen W, Xu L, Zhang R, Qu Y, He J, Fan X, Wang Z, Chow E, Pećin I, Perica D, Symeonides P, Vrablik M, Ceska R, Soska V, Tichy L, Adamkova V, Franekova J, Cifkova R, Kraml P, Vonaskova K, Cepova J, Dusejovska M, Pavlickova L, Blaha V, Rosolova H, Nussbaumerova B, Cibulka R, Vaverkova H, Cibickova L, Krejsova Z, Rehouskova K, Malina P, Budikova M, Palanova V, Solcova L, Lubasova A, Podzimkova H, Bujdak J, Vesely J, Jordanova M, Salek T, Urbanek R, Zemek S, Lacko J, Halamkova H, Machacova S, Mala S, Cubova E, Valoskova K, Burda L, Bendary A, Daoud I, Emil S, Elbahry A, Rafla S, Sanad O, Kazamel G, Ashraf M, Sobhy M, El-Hadidy A, Shafy MA, Kamal S, Bendary M, Talviste G, Angoulvant D, Boccara F, Cariou B, Carreau V, Carrie A, Charrieres S, Cottin Y, Di-Fillipo M, Ducluzeau PH, Dulong S, Durlach V, Farnier M, Ferrari E, Ferrieres D, Ferrieres J, Gallo A, hankard R, Inamo J, Lemale J, Moulin P, Paillard F, Peretti N, Perrin A, Pradignac A, Rabes JP, Rigalleau V, Sultan A, Schiele F, Tounian P, Valero R, Verges B, Yelnik C, Ziegler O, Haack IA, Schmidt N, Dressel A, Klein I, Christmann J, Sonntag A, Stumpp C, Boger D, Biedermann D, Usme MM, Beil FU, Klose G, König C, Gouni-Berthold I, Otte B, Böll G, Kirschbaum A, Merke J, Scholl J, Segiet T, Gebauer M, Predica F, Mayer M, Leistikow F, Füllgraf-Horst S, Müller C, Schüler M, Wiener J, Hein K, Baumgartner P, Kopf S, Busch R, Schömig M, Matthias S, Allendorf-Ostwald N, Fink B, Böhm D, Jäkel A, Koschker AC, Schweizer R, Vogt A, Parhofer K, König W, Reinhard W, Bäßler A, Stadelmann A, Schrader V, Katzmann J, Tarr A, Steinhagen-Thiessen E, Kassner U, Paulsen G, Homberger J, Zemmrich C, Seeger W, Biolik K, Deiss D, Richter C, Pantchechnikova E, Dorn E, Schatz U, Julius U, Spens A, Wiesner T, Scholl M, Rizos CV, Sakkas N, Elisaf M, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Athyros V, Skalidis E, Kolovou G, Garoufi A, Bilianou E, Koutagiar I, Agapakis D, Kiouri E, Antza C, Katsiki N, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Koutsogianni AD, Karányi Z, Harangi M, Bajnok L, Audikovszky M, Márk L, Benczúr B, Reiber I, Nagy G, Nagy A, Reddy LL, Shah SA, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Altaey M, Al-Jumaily K, Rasul D, Abdalsahib AF, Jabbar AA, Al-ageedi M, Agar R, Cohen H, Ellis A, Gavishv D, Harats D, Henkin Y, Knobler H, Leavit L, Leitersdorf E, Rubinstein A, Schurr D, Shpitzen S, Szalat A, Casula M, Zampoleri V, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Sabbà C, Bossi AC, Borghi C, Muntoni S, Cipollone F, Purrello F, Pujia A, Passaro A, Marcucci R, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Carubbi F, Iughetti L, Iannuzzi A, Iannuzzo G, Calabrò P, Averna M, Biasucci G, Zambon S, Roscini AR, Trenti C, Arca M, Federici M, Del Ben M, Bartuli A, Giaccari A, Pipolo A, Citroni N, Guardamagna O, Bonomo K, Benso A, Biolo G, Maroni L, Lupi A, Bonanni L, Zenti MG, Matsuki K, Hori M, Ogura M, Masuda D, Kobayashi T, Nagahama K, Al-Jarallah M, Radovic M, Lunegova O, Bektasheva E, Khodzhiboboev E, Erglis A, Gilis D, Nesterovics G, Saripo V, Meiere R, Upena-RozeMicena A, Terauda E, Jambart S, Khoury PE, Elbitar S, Ayoub C, Ghaleb Y, Aliosaitiene U, Kutkiene S, Kasim NA, Nor NS, Ramli AS, Razak SA, Al-Khateeb A, Kadir SH, Muid SA, Rahman TA, Kasim SS, Radzi AB, Ibrahim KS, Razali S, Ismail Z, Ghani RA, Hafidz MI, Chua AL, Rosli MM, Annamalai M, Teh LK, Razali R, Chua YA, Rosman A, Sanusi AR, Murad NA, Jamal ARA, Nazli SA, Razman AZ, Rosman N, Rahmat R, Hamzan NS, Azzopardi C, Mehta R, Martagon AJ, Ramirez GA, Villa NE, Vazquez AV, Elias-Lopez D, Retana GG, Rodriguez B, Macías JJ, Zazueta AR, Alvarado RM, Portano JD, Lopez HA, Sauque-Reyna L, Herrera LG, Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PA, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AY, Cazares HE, Gonzalez JR, Valencia CV, Padilla FG, Prado RM, De los Rios Ibarra MO, Villicaña RD, Rivera KJ, Carrera RA, Alvarez JA, Martinez JC, de los Reyes Barrera Bustillo M, Vargas GC, Chacon RC, Andrade MH, Ortega AF, Alcala HG, de Leon LE, Guzman BG, Garcia JJ, Cuellar JC, Cruz JR, Garcia AH, Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Rodriguez AB, Oyervides JC, Vazquez DI, Rodriguez EA, Osorio ML, Saucedo JR, Tamayo MT, Talavera LA, Arroyo LE, Carrillo EA, Isara A, Obaseki DE, Al-Waili K, Al-Zadjali F, Al-Zakwani I, Al-Kindi M, Al-Mukhaini S, Al-Barwani H, Rana A, Shah LS, Starostecka E, Konopka A, Lewek J, Bartłomiejczyk M, Gąsior M, Dyrbuś K, Jóźwiak J, Gruchała M, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Woś M, Michalska-Grzonkowska A, Medeiros AM, Alves AC, Silva F, Lobarinhas G, Palma I, de Moura JP, Rico MT, Rato Q, Pais P, Correia S, Moldovan O, Virtuoso MJ, Salgado JM, Colaço I, Dumitrescu A, Lengher C, Mosteoru S, Meshkov A, Ershova A, Rozkova T, Korneva V, Yu KT, Zafiraki V, Voevoda M, Gurevich V, Duplyakov D, Ragino Y, Safarova M, Shaposhnik I, Alkaf F, Khudari A, Rwaili N, Al-Allaf F, Alghamdi M, Batais MA, Almigbal TH, Kinsara A, AlQudaimi AH, Awan Z, Elamin OA, Altaradi H, Rajkovic N, Popovic L, Singh S, Stosic L, Rasulic I, Lalic NM, Lam C, Le TJ, Siang EL, Dissanayake S, I-Shing JT, Shyong TE, Jin TC, Balinth K, Buganova I, Fabryova L, Kadurova M, Klabnik A, Kozárová M, Sirotiakova J, Battelino T, Kovac J, Mlinaric M, Sustar U, Podkrajsek KT, Fras Z, Jug B, Cevc M, Pilcher GJ, Blom D, Wolmarans K, Brice B, Muñiz-Grijalvo O, Díaz-Díaz JL, de Isla LP, Fuentes F, Badimon L, Martin F, Lux A, Chang NT, Ganokroj P, Akbulut M, Alici G, Bayram F, Can LH, Celik A, Ceyhan C, Coskun FY, Demir M, Demircan S, Dogan V, Durakoglugil E, Dural IE, Gedikli O, Hacioglu A, Ildizli M, Kilic S, Kirilmaz B, Kutlu M, Oguz A, Ozdogan O, Onrat E, Ozer S, Sabuncu T, Sahin T, Sivri F, Sonmez A, Temizhan A, Topcu S, Tuncez A, Vural M, Yenercag M, Yesilbursa D, Yigit Z, Yildirim AB, Yildirir A, Yilmaz MB, Atallah B, Traina M, Sabbour H, Hay DA, Luqman N, Elfatih A, Abdulrasheed A, Kwok S, Oca ND, Reyes X, Alieva RB, Kurbanov RD, Hoshimov SU, Nizamov UI, Ziyaeva AV, Abdullaeva GJ, Do DL, Nguyen MN, Kim NT, Le TT, Le HA, Tokgozoglu L, Catapano AL, Ray KK. Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC). Lancet 2021; 398:1713-1725. [PMID: 34506743 DOI: 10.1016/s0140-6736(21)01122-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. METHODS Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. FINDINGS Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3-58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5-56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32-6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20-5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001). INTERPRETATION Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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Murray P, O'Connor C, Maher V, Moore D. Opportunities for clinician education in the pharmacotherapy of stable heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0894] [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
Introduction
Heart failure (HF) is a commonly encountered clinical entity in the developed world, and is estimated to cost 660m euro annually to the Irish exchequer. Evidence supporting the benefit of multi disciplinary care in reduction of readmission rates has prompted the establishment of specialist HF clinics, resulting in improved medication adherence and early recognition and treatment of mild decompensation, thus averting the need for hospital admission. In contrast, the role of the hospital generalist and the general practitioner in the management of stable HF is under-emphasised despite evidence that optimal medical therapy reduces readmission and its attendant costs. The aim of this survey was to assess knowledge of pharmacotherapeutic options amongst generalists, and identify opportunities for education, in order to further optimise guideline-directed medical therapy while the patient awaits specialist input.
Methods
We distributed a 14 item questionnaire regarding indications for HF medications (as per ESC guidelines) to doctors in medicine and general practice throughout Ireland.
Results
There were 127 responses from 27 centres (117 analysed). Median years of practice was 4. Table 1 depicts the breakdown of clinicians who correctly identified HFrEF as an indication for each of the major drug classes. More than 20% of clinicians at all grades failed to identify HFrEF as an indication for beta blocker therapy. There was a higher level of knowledge amongst junior doctors in the prescription of mineralocorticoid receptor antagonists (p≤0.05) but no statistical difference in knowledge of other drug classes. Only 26% of participants who felt comfortable with initiation and up-titration of beta blockers (N=89) correctly identified an optimal target heart rate of less than 70 beats per minute. Twenty-four percent of respondents (N=28) were unaware of a specialist HF service that catered to their institution. Ninety-seven percent (N=113) felt that their practice would benefit from further education on HF pharmacotherapy.
Conclusion
The high prevalence of HF in Ireland and costs associated with admission for decompensation necessitates a sound knowledge of its management amongst generalists. Results of this survey suggest a need, and indeed a demand, for further education and support surrounding pharmacotherapy of stable heart failure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Murray
- Tallaght University Hospital, Dublin, Ireland
| | | | - V Maher
- Tallaght University Hospital, Dublin, Ireland
| | - D Moore
- Tallaght University Hospital, Dublin, Ireland
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Cwiek M, Vick DJ, Osterhout K, Maher V. When Surgeons Are "Too Old" to Practice Surgery: Recommendations to Balance the Imperatives of Public Safety and Practical Necessity. Hosp Top 2021; 101:119-126. [PMID: 34519255 DOI: 10.1080/00185868.2021.1977205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Few countries have legally set a maximum age for practicing surgery. This is difficult to sustain as surgeon shortages in many localities require hospitals to grant surgical privileges based on internal peer review systems. This approach is not without problems. Some hospitals and medical societies have developed competency assessment programs. Based on the literature and the experience of various jurisdictions, the authors recommend a policy approach that does not mandate a retirement age for surgeons, but rather a mandatory age of 65 at which surgeons shall be legally subject to periodic assessment of physical dexterity, eye/hand coordination, and cognitive skills.
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Affiliation(s)
- Mark Cwiek
- Health Administration Division, School of Health Sciences, The Herbert H. & Grace A. Dow College of Health Professions, Central Michigan University, Mount Pleasant, MI, USA
| | - Dan J Vick
- Health Administration Division, School of Health Sciences, The Herbert H. & Grace A. Dow College of Health Professions, Central Michigan University, Mount Pleasant, MI, USA
| | - Krista Osterhout
- Health Administration Division, School of Health Sciences, The Herbert H. & Grace A. Dow College of Health Professions, Central Michigan University, Mount Pleasant, MI, USA
| | - Vincent Maher
- Business Administration and Healthcare Management Department, LaPenta School of Business, Iona College, New Rochelle, NY, USA
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Balfe C, O'Connor C, Giblin G, Walsh K, Casserly I, Moore D, Maher V. Presentation of Severe Rheumatic Mitral Stenosis at the Peak of the COVID-19 Pandemic and the Presumptive Treatment as Severe Coronavirus Illness. Eur J Case Rep Intern Med 2021; 7:001957. [PMID: 33457355 DOI: 10.12890/2020_001957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/23/2020] [Indexed: 11/05/2022] Open
Abstract
This case report describes a young female Caucasian patient with newly presenting severe mitral stenosis at the peak of the coronavirus pandemic in the Republic of Ireland. The initial presumptive diagnosis was of severe coronavirus illness. This case report highlights the importance of keeping an open mind to alternative diagnoses and examines some of the challenges in the diagnosis and management of a rare condition in the pandemic environment. This patient gained 10 kg of weight within 6 weeks of percutaneous balloon mitral valvuloplasty, highlighting the contribution of cardiac cachexia to her low body weight and demonstrating the exceptional benefit that this treatment can offer to patients. LEARNING POINTS To highlight mitral stenosis as a cause of cardiac cachexia and to examine the benefits gained from percutaneous balloon commissurotomy.To highlight the potential for other serious conditions to masquerade as COVID-19 and the importance of keeping an open mind to diagnoses.To examine the use of bedside echocardiography in the patient presenting with presumed coronavirus illness.
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Affiliation(s)
- Christopher Balfe
- Department of Cardiology, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Cormac O'Connor
- Department of Cardiology, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Gerard Giblin
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kevin Walsh
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ivan Casserly
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - David Moore
- Department of Cardiology, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Vincent Maher
- Department of Cardiology, Tallaght University Hospital, Tallaght, Dublin, Ireland
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Ray KK, Molemans B, Schoonen WM, Giovas P, Bray S, Kiru G, Murphy J, Banach M, De Servi S, Gaita D, Gouni-Berthold I, Hovingh GK, Jozwiak JJ, Jukema JW, Kiss RG, Kownator S, Iversen HK, Maher V, Masana L, Parkhomenko A, Peeters A, Clifford P, Raslova K, Siostrzonek P, Romeo S, Tousoulis D, Vlachopoulos C, Vrablik M, Catapano AL, Poulter NR. EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study. Eur J Prev Cardiol 2020; 28:1279-1289. [DOI: 10.1093/eurjpc/zwaa047] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
To provide contemporary data on the implementation of European guideline recommendations for lipid-lowering therapies (LLTs) across different settings and populations and how this impacts low-density lipoprotein cholesterol (LDL-C) goal achievement.
Methods and results
An 18 country, cross-sectional, observational study of patients prescribed LLT for primary or secondary prevention in primary or secondary care across Europe. Between June 2017 and November 2018, data were collected at a single visit, including LLT in the preceding 12 months and most recent LDL-C. Primary outcome was the achievement of risk-based 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) LDL-C goal while receiving stabilized LLT; 2019 goal achievement was also assessed. Overall, 5888 patients (3000 primary and 2888 secondary prevention patients) were enrolled; 54% [95% confidence interval (CI) 52–56] achieved their risk-based 2016 goal and 33% (95% CI 32–35) achieved their risk-based 2019 goal. High-intensity statin monotherapy was used in 20% and 38% of very high-risk primary and secondary prevention patients, respectively. Corresponding 2016 goal attainment was 22% and 45% (17% and 22% for 2019 goals) for very high-risk primary and secondary prevention patients, respectively. Use of moderate–high-intensity statins in combination with ezetimibe (9%), or any LLT with PCSK9 inhibitors (1%), was low; corresponding 2016 and 2019 goal attainment was 53% and 20% (ezetimibe combination), and 67% and 58% (PCSK9i combination).
Conclusion
Gaps between clinical guidelines and clinical practice for lipid management across Europe persist, which will be exacerbated by the 2019 guidelines. Even with optimized statins, greater utilization of non-statin LLT is likely needed to reduce these gaps for patients at highest risk.
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Affiliation(s)
- Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Bart Molemans
- Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA 91320, USA
| | - W Marieke Schoonen
- Center for Observational Research (CfOR), Amgen Ltd, 1 Uxbridge Business Park Sanderson Road, Uxbridge, UB8 1DH, UK
| | - Periklis Giovas
- Amgen Hellas, 4 Gravias Street, Maroussi, 15125, Athens, Greece
| | - Sarah Bray
- Global Biostatistical Science, Amgen Ltd, 240 Cambridge Science Park, Milton Road, Cambridge, CB4 0WD, UK
| | - Gaia Kiru
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Jennifer Murphy
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, 90-419 Lodz, Poland
- Polish Mother’s Memorial Hospital – Research Institute (PMMHRI), 93-338 Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Góra, 65-417 Zielona Góra, Poland
| | - Stefano De Servi
- IRCCS MultiMedica, Via Milanese, 300, 20099 Sesto San Giovanni, Milan, Italy
| | - Dan Gaita
- Institutul de Boli Cardiovasculare, Fundatia Cardioprevent, Universitatea de Medicina si Farmacie Victor Babes din Timisoara, Timişoara 300041, Romania
| | - Ioanna Gouni-Berthold
- Polyclinic for Endocrinology, Diabetes and Preventive Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - G Kees Hovingh
- University of Amsterdam Faculty of Medicine, Amsterdam, the Netherlands
| | - Jacek J Jozwiak
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Opole, Opole, Poland
| | - J Wouter Jukema
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands
| | | | - Serge Kownator
- Centre Cardiologique et Vasculaire, 36 Route de la Briquerie, 57100, Thionville, France
| | - Helle K Iversen
- Stroke Centre Rigshospitalet, Department of Neurology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vincent Maher
- Trinity College Dublin, Dublin 2, Ireland
- Advanced Lipid Management and Research Centre, Tallaght University Hospital, Dublin 24, Ireland
| | - Luis Masana
- Universitat Rovira i Virgili, IISPV, CIBERDEM, Saint Joan University Hospital, Reus, Spain
| | | | - André Peeters
- Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Piers Clifford
- Imperial Hospitals NHS Trust (Hammersmith Campus), London W12 0HS, UK
| | | | - Peter Siostrzonek
- Krankenhaus Barmherzige Schwestern Linz, Seilerstðtte 4, 4010 Seilerstätte 4, 4010 Linz, Austria
| | - Stefano Romeo
- Department of Molecular and Clinical Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden
- Clinical Nutrition, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
- Cardiology Department, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Dimitrios Tousoulis
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, IRCCS Multimedica, Via Milanese, 300, 20099 Sesto San Giovanni, Milan, Italy
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
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Abstract
BACKGROUND Abnormal cholesterol profiles are a major risk factor for cardiovascular disease and severe triglyceride disorders cause life threatening pancreatitis. Identification and treatment of these disorders are essential. AIM We evaluated the services available in Ireland to manage these problems. METHODS We contacted key personnel in 40 hospitals, 32 public and 8 private providing lipid measurements to assess investigation and treatment availability during 2017/2018. RESULTS In public hospitals, 4 had designated lipid clinics (Dublin 3, Galway 1) (2.9 times < UK), 19 had general clinics and 9 had no service. In private hospitals, 2 had designated clinics, Limerick and Cork, and others had interested physicians. Clinics were run by cardiologists, chemical pathologists, endocrinologists or clinical pharmacologists. One clinic had a lipid nurse versus 75% in the UK. All but one provided full lipid profiles, 15 ordered Lp(a), 9 apoproteins B/A-1 and 9 genetic testing. Lp(a) and apoprotein measurements were provided locally in one hospital and one provided genetic testing. Lipid-lowering drugs were used in all hospitals and 45% had access to PCSK-9 inhibitors. No hospital provided LDL apheresis or plasma exchange. Limitations for service provision included lack of physician interest n = 9, nursing support n = 22, office space n = 13, clinic space n = 22, laboratory support n = 16, nutritional support n = 12 and pharmacy support n = 5. CONCLUSIONS There are very limited resources available to manage lipid problems in the republic of Ireland relative to the under-resourced UK. Most services rely on interested physicians but ancillary resources are lacking. Where services are available, all drug treatments are utilised.
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Affiliation(s)
- Ruth Agar
- Advanced Lipid Management And Research (ALMAR) Centre, Division of Cardiology, Department of Medicine, Tallaght University Hospital, Tallaght, D24, Ireland
| | - Meabh Prendergast
- Advanced Lipid Management And Research (ALMAR) Centre, Division of Cardiology, Department of Medicine, Tallaght University Hospital, Tallaght, D24, Ireland
| | - Vincent Maher
- Advanced Lipid Management And Research (ALMAR) Centre, Division of Cardiology, Department of Medicine, Tallaght University Hospital, Tallaght, D24, Ireland.
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Maher V. A service evaluation to evidence the need to improve access to early parenteral nutrition and dietetic services for patients undergoing total pelvic exenteration. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.046] [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: 10/25/2022]
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O, Nibouche D, Zelveian PH, Siostrzonek P, Najafov R, van de Borne P, Pojskic B, Postadzhiyan A, Kypris L, Špinar J, Larsen ML, Eldin HS, Viigimaa M, Strandberg TE, Ferrieres J, Agladze R, Laufs U, Rallidis L, Bajnok L, Gudjonsson T, Maher V, Henkin Y, Gulizia MM, Mussagaliyeva A, Bajraktari G, Kerimkulova A, Latkovskis G, Hamoui O, Slapikas R, Visser L, Dingli P, Ivanov V, Boskovic A, Nazzi M, Visseren F, Mitevska I, Retterstol K, Jankowski P, Fontes-Carvalho R, Gaita D, Ezhov M, Foscoli M, Giga V, Pella D, Fras Z, Perez de Isla L, Hagstrom E, Lehmann R, Abid L, Ozdogan O, Mitchenko O, Patel RS, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Delgado V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Juni P, Katus HA, Landmesser U, Leclercq C, Lettino M, Lewis BS, Merkely B, Mueller C, Petersen S, Petronio AS, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Touyz RM. Corrigendum to "2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk" [Atherosclerosis 290 (2019) 140-205]. Atherosclerosis 2020; 294:80-82. [PMID: 31870624 DOI: 10.1016/j.atherosclerosis.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Bradshaw R, Fegredo J, Ferreira C, Savjani R, Andaya A, Barbaso I, Maher V, Nasr I. How effective is our monitoring of patients on parenteral nutrition? Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.015] [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: 10/25/2022]
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O, Nibouche D, Zelveian PH, Siostrzonek P, Najafov R, van de Borne P, Pojskic B, Postadzhiyan A, Kypris L, Špinar J, Larsen ML, Eldin HS, Viigimaa M, Strandberg TE, Ferrieres J, Agladze R, Laufs U, Rallidis L, Bajnok L, Gudjonsson T, Maher V, Henkin Y, Gulizia MM, Mussagaliyeva A, Bajraktari G, Kerimkulova A, Latkovskis G, Hamoui O, Slapikas R, Visser L, Dingli P, Ivanov V, Boskovic A, Nazzi M, Visseren F, Mitevska I, Retterstol K, Jankowski P, Fontes-Carvalho R, Gaita D, Ezhov M, Foscoli M, Giga V, Pella D, Fras Z, de Isla LP, Hagstrom E, Lehmann R, Abid L, Ozdogan O, Mitchenko O, Patel RS, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Delgado V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Juni P, Katus HA, Landmesser U, Leclercq C, Lettino M, Lewis BS, Merkely B, Mueller C, Petersen S, Petronio AS, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Touyz RM. Erratum to "2019 ESC/EAS guidelines for the management of dyslipidemias: Lipid modification to reduce cardiovascular risk" [Atherosclerosis 290 (2019) 140-205]. Atherosclerosis 2020; 292:160-162. [PMID: 31811963 DOI: 10.1016/j.atherosclerosis.2019.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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O"riordan F, Carton M, Coughlan JJ, Fahy A, Donnelly M, Moore D, Loo B, Maher V. P919 The correlation between cardiac biomarkers and findings on transthoracic echocardiography in the intensive care unit. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Trans-thoracic echo (TTE) is a commonly performed non-invasive investigation for the cardiovascular assessment of critically ill patients in the Intensive Care Unit (ICU). Raised cardiac biomarkers are commonly cited as an indication for TTE, however the significance of these biomarker elevations in the critical care setting is unclear.
PURPOSE
The aim of this study was to describe findings on TTE in an Irish ICU cohort and to determine if there was any correlation between these findings and serum N-terminal pro b-type natiuretic (NT-proBNP) and high sensitivity troponin T (HsTnT) levels.
METHODS
Patients admitted to the ICU and who received a TTE between January 2018 and February 2019 were identified. Based on TTE findings, patients were divided into two groups: ‘Normal group’ and ‘Abnormal group’. For the purpose of this study, minor abnormalities including concentric left ventricular hypertrophy, diastolic dysfunction and hyper-dynamic left ventricular function were included in the Normal group. The Abnormal group included reductions in LV function, regional wall motion abnormalities and significant valvular heart disease. Continuous variables were expressed as medians and interquartile range. The groups were compared using the z-test for continuous variables and fishers exact test for categorical variables, with a p value of < 0.05 considered significant.
RESULTS
There were 358 patients admitted to the ICU during the study period. The mean age was 59.8 ± 17 years and over half of the patients (55%) were male. One hundred and fifteen patients (32%) had a reported TTE, of which 55% were normal and 22% had minor abnormalities (Normal group). The remaining 23% showed significant abnormalities (Abnormal group).
The prevalence of a NT-proBNP result over 4 times the upper limit of normal (>4xULN) was not significantly different between groups (67% in Normal group vs 71% in Abnormal group, Fisher exact test statistic value is 0.7887, p < .05). However a HsTnT value >4xULN was more common in the Abnormal group than the Normal group (73% vs 46%, Fisher exact test statistic value is 0.0231, p < .05). Similarly, Median NT-proBNP did not differ significantly between the groups; (2254pg/mL; IQR: 11,758 in the Normal group vs 6428pg/mL; IQR: 5,789 in the Abnormal group, p = 0.52218) but Median HsTnT level was significantly higher in the Abnormal group than Normal group; (123ng/L ; IQR: 656 vs 51ng/L; IQR: 163.5 ,p = 0.0278).
CONCLUSION
TTE is performed commonly in the ICU, with one-third of ICU admissions receiving a TTE. Over 75% were reported as normal or showing only minor abnormalities. NT-Pro BNP was commonly significantly elevated but did not correlate with the subsequent diagnostic yield of significant abnormalities on echocardiography. HsTnT levels were more commonly significantly raised in patients with abnormal TTE results and the role of troponin in this setting requires further evaluation.
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Affiliation(s)
- F O"riordan
- Adelaide & Meath Hospital, Cardiology , Dublin, Ireland
| | - M Carton
- Adelaide & Meath Hospital, Cardiology , Dublin, Ireland
| | - J J Coughlan
- Adelaide & Meath Hospital, Cardiology , Dublin, Ireland
| | - A Fahy
- Adelaide & Meath Hospital, Intensive Care Unit, Dublin, Ireland
| | - M Donnelly
- Adelaide & Meath Hospital, Intensive Care Unit, Dublin, Ireland
| | - D Moore
- Adelaide & Meath Hospital, Cardiology , Dublin, Ireland
| | - B Loo
- Adelaide & Meath Hospital, Cardiology , Dublin, Ireland
| | - V Maher
- Adelaide & Meath Hospital, Cardiology , Dublin, Ireland
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Egom EE, Maher V, El Hiani Y. Evolving use of natriuretic peptide receptor type-C as part of strategies for the treatment of pulmonary hypertension due to left ventricle heart failure. Int J Cardiol 2018; 281:172-178. [PMID: 29885823 DOI: 10.1016/j.ijcard.2018.06.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/27/2018] [Accepted: 06/01/2018] [Indexed: 12/27/2022]
Abstract
Pulmonary hypertension (PH) due to left ventricular heart failure (LV-HF) is a disabling and life-threatening disease for which there is currently no single marketed pharmacological agent approved. Despite recent advances in the pathophysiological understanding, there is as yet no prospect of cure, and the majority of patients continue to progress to right ventricular failure and die. There is, therefore an urgent unmet need to identify novel pharmacological agents that will prevent or reverse the increase in pulmonary artery pressures while enhancing cardiac performance in PH due to LV-HF. In the present article, we first focused on the Natriuretic Peptide Receptor type C (NPR-C) based therapeutic strategies aimed at lowering pulmonary artery pressure. Second, we reviewed potential NPR-C therapeutic strategies to reverse or least halt the detrimental effects of diastolic dysfunction and impaired nitic oxide signalling pathways, as well as possibilities for neurohumoral modulation.
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Affiliation(s)
- Emmanuel E Egom
- St. Martha's Regional Hospital, Antigonish, Nova Scotia, Canada.
| | - Vincent Maher
- Cardiology Department, The Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Yassine El Hiani
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
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Agar R, Markham C, Prendergast M, Canning R, Maher E, Finn C, Sammon N, Fall S, Fallon N, Hanrahan E, King L, Maher V. A snapshot of lipid levels in the Republic of Ireland in 2017. Ir J Med Sci 2018; 188:241-247. [DOI: 10.1007/s11845-018-1820-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/16/2018] [Indexed: 12/26/2022]
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O'Neill HA, Tinder TT, Maher V, Rosenow M, Richards M, Santhanam R, Wei X, Domenyuk V, Miglarese MR, Spetzler D. Abstract P5-08-03: Poly-ligand profiling and target identification from formalin-fixed-paraffin embedded HER2+ breast cancer specimens. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-08-03] [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: 11/16/2022]
Abstract
Abstract
We have previously described the ADAPT Biotargeting System™as a novel platform for highly multiplexed poly-ligand profiling of complex phenotypes such as drug response. Here we report extended capabilities of the this platform for target identification directly from formalin-fixed-paraffin embedded (FFPE) tissues using aptamer libraries enriched toward HER2+ breast cancer. Standard mass spectrometry-based biomarker and drug target discovery from FFPE tissues can be challenging due to limited amounts of tissue, harsh conditions of fixation and extraction and the general problem of masking by highly abundant proteins. A single stranded-oligodeoxynucleotide aptamer library was enriched on HER2+ FFPE breast cancer specimens and conjugated with biotin as well as a label transfer reagent, Sulfo-NHS-SS-Diazirine (Sulfo-SDAD). The biotinylated-SDAD conjugated library (B-SDAD-EL) was applied to HER2+ FFPE tissues and photocrosslinked to cognate binding partners within the FFPE sample in order to preserve aptamer-protein interactions under harsh denaturing conditions required for protein extraction and sample preparation. Aptamer-protein complexes were affinity purified and the label was transferred from bound aptamers to their binding partners under reducing conditions that enable proteomic digestion and high resolution mass spectrometry detection. An open database search was performed where the precursor ion tolerance was set to ± 500 Da for database searching, which enabled identification of peptides containing the transferred label as well as additional unknown variable modifications induced by the tissue fixation process. We identified proteins with known roles in HER2+ breast cancer along with several potentially drugable targets not previously associated with HER2 positivity. Differential expression of candidate targets was orthogonally confirmed by immunohistochemistry. By nature of its extreme molecular complexity and its ability to be enriched or “trained,” toward phenotypes of interest, the ADAPT Biotargeting SystemTM can be deployed to advance precision medicine by identifying predictive biomarkers and drug targets with novel associations to complex interactomes.
Citation Format: O'Neill HA, Tinder TT, Maher V, Rosenow M, Richards M, Santhanam R, Wei X, Domenyuk V, Miglarese MR, Spetzler D. Poly-ligand profiling and target identification from formalin-fixed-paraffin embedded HER2+ breast cancer specimens [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-08-03.
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Affiliation(s)
| | | | - V Maher
- Caris Life Sciences, Phoenix, AZ
| | | | | | | | - X Wei
- Caris Life Sciences, Phoenix, AZ
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Egom EE, Shiwani HA, Pharithi RB, Canning R, Khan B, Hiani YE, Maher V. Dynamic changes of the composition of plasma HDL particles in patients with cardiac disease: Spotlight on sphingosine-1-phosphate/serum amyloid A ratio. Clin Exp Pharmacol Physiol 2017; 45:319-325. [DOI: 10.1111/1440-1681.12888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Emmanuel E Egom
- Department of Cardiology; The Adelaide and Meath Hospital Dublin; Incorporating the National Children Hospital; Dublin Ireland
| | - Haaris A Shiwani
- Department of Clinical Medicine; Education Division; Trinity College Dublin; The University of Dublin; Dublin Ireland
| | - Rebabonye B Pharithi
- Department of Cardiology; The Adelaide and Meath Hospital Dublin; Incorporating the National Children Hospital; Dublin Ireland
| | | | - Barkat Khan
- Department of Cardiology; The Adelaide and Meath Hospital Dublin; Incorporating the National Children Hospital; Dublin Ireland
| | - Yassine El Hiani
- Department of Physiology and Biophysics; Dalhousie University; Halifax Canada
| | - Vincent Maher
- Department of Cardiology; The Adelaide and Meath Hospital Dublin; Incorporating the National Children Hospital; Dublin Ireland
- Department of Clinical Medicine; Education Division; Trinity College Dublin; The University of Dublin; Dublin Ireland
- Institute of Technology Tallaght; Dublin Ireland
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Egom EEA, Feridooni T, Pharithi RB, Khan B, Shiwani HA, Maher V, El Hiani Y, Rose RA, Pasumarthi KBS, Ribama HA. Erratum: New insights and new hope for pulmonary arterial hypertension: natriuretic peptides clearance receptor as a novel therapeutic target for a complex disease. Int J Physiol Pathophysiol Pharmacol 2017; 9:164. [PMID: 29218116 PMCID: PMC5698694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 06/07/2023]
Abstract
[This corrects the article on p. 112 in vol. 9, PMID: 28951773.].
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Affiliation(s)
- Emmanuel Eroume-A Egom
- Egom Clinical & Translational Research Services Ltd.Dartmouth, NS B3H 3H3, Canada
- Department of Cardiology, The Adelaide and Meath HospitalTallaght, Dublin, Ireland
| | - Tiam Feridooni
- Department of Pharmacology, Dalhousie UniversityHalifax, Nova Scotia, Canada
| | - Rebabonye B Pharithi
- Department of Cardiology, The Adelaide and Meath HospitalTallaght, Dublin, Ireland
| | - Barkat Khan
- Department of Cardiology, The Adelaide and Meath HospitalTallaght, Dublin, Ireland
| | - Haaris A Shiwani
- Department of Cardiology, The Adelaide and Meath HospitalTallaght, Dublin, Ireland
| | - Vincent Maher
- Department of Cardiology, The Adelaide and Meath HospitalTallaght, Dublin, Ireland
| | - Yassine El Hiani
- Department of Physiology and Biophysics, Dalhousie UniversityPO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Robert A Rose
- Libin Cardiovascular Institute of Alberta, University of CalgaryCalgary, Alberta, Canada
| | | | - Hilaire A Ribama
- Egom Clinical & Translational Research Services Ltd.Dartmouth, NS B3H 3H3, Canada
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Egom EE, Pharithi RB, Shiwani HA, Khan B, Kruzliak P, El-Hiani Y, Maher V. Time to redefine body mass index categories in chronic diseases? Spotlight on obesity paradox. Int J Food Sci Nutr 2017; 69:513-523. [PMID: 29063824 DOI: 10.1080/09637486.2017.1389859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Obesity is a complex condition classically characterised by excessive body fat accumulation and represents one of the most important public health problems worldwide. Although several epidemiological studies have shown that elevated BMI is associated with higher morbidity, and with increased rate of death from all causes and from cardiovascular disease, accumulating evidence suggests that being overweight or obese may be protective (the so-called obesity paradox), at least in chronic diseases. These observations, not only question the validity of the BMI system, but also raise the intriguing question of whether we should redefine what the normal range of BMI is in individuals suffering from a chronic disease. In the present article, we review the available information on the association between elevated BMI and increased morbidity and mortality including obesity-related paradoxes, explore key aspects of the role and limitations of BMI as a measure of increased adiposity and outline potential solutions to address the current controversies regarding the impact of obesity on human health.
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Affiliation(s)
- Emmanuel E Egom
- a Jewish General Hospital and Lady Davis Institute for Medical Research , Montreal , Canada.,b Department of Cardiology , The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital , Dublin , Ireland
| | - Rebabonye B Pharithi
- b Department of Cardiology , The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital , Dublin , Ireland
| | - Haaris A Shiwani
- c Department of Clinical Medicine, Education Division , Trinity College Dublin, The University of Dublin , Dublin , Ireland
| | - Barkat Khan
- b Department of Cardiology , The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital , Dublin , Ireland
| | - Peter Kruzliak
- d International Clinical Research Center , St. Anne's University Hospital and Masaryk University , Brno , Czech Republic
| | - Yassine El-Hiani
- e Department of Physiology and Biophysics , Dalhousie University , Halifax , NS , Canada
| | - Vincent Maher
- b Department of Cardiology , The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital , Dublin , Ireland.,c Department of Clinical Medicine, Education Division , Trinity College Dublin, The University of Dublin , Dublin , Ireland
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Egom EEA, Feridooni T, Pharithi RB, Khan B, Shiwani HA, Maher V, El Hiani Y, Rose RA, Pasumarthi KBS, Ribama HA. New insights and new hope for pulmonary arterial hypertension: natriuretic peptides clearance receptor as a novel therapeutic target for a complex disease. Int J Physiol Pathophysiol Pharmacol 2017; 9:112-118. [PMID: 28951773 PMCID: PMC5592245] [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] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Pulmonary Arterial Hypertension (PAH) is a deadly and disabling disease for which there is no marketed drug that addresses the underlying disease mechanism and targets to cure patients. The lack of understanding of the disease mechanism represents the main challenges in developing curative therapies. We here report, for the first time, that mice lacking natriuretic peptides clearance receptor develop PAH. METHODS AND RESULTS Initial studies assessed cardiac structure and function in NPR-C+/+ (wild type) and age matched, littermate NPR-C-/- mice by echocardiography. Mice lacking NPR-C had right atrial dilation, tricuspid regurgitation as well as echocardiographic signs of right ventricular pressure overload, including flattening and paradoxical bulging of the septum into the left ventricle during systole, and hypertrophy of the right ventricular free wall. Among the 10 NPR-C-/- mice aged between 12 and 20 weeks studied, 8 showed the above typical echocardiographic features of PAH [80%, 95% CI: (0.4439-0.9748)], and only one had pericardial effusion [10%, 95% CI: (0.0025-0.4450)], finding that has a prognostic significance in subjects affected by this clinical entity. To confirm the presence of increased right ventricular systolic pressure (RVSP) among NPR-C-/- mice, right heart catheterization was performed. Strikingly, RVSP was significantly elevated in NPR-C-/- mice compared to their age matched, littermate NPR-C+/+ mice, at baseline (21.95±0.56 mmHg vs. 5.3±0.6 mmHg, respectively (P<0.001)). CONCLUSION The above results suggest that NPR-C-mediated signalling pathways play a critical role in the development of PAH, indicating that NPR-C is an important protective receptor in the heart rather than just being a clearance receptor.
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Affiliation(s)
- Emmanuel Eroume-A Egom
- Egom Clinical & Translational Research Services Ltd.Dartmouth, NS B3H 3H3, Canada
- Department of Cardiology, The Adelaide and Meath HospitalTallaght, Dublin, Ireland
| | - Tiam Feridooni
- Department of Pharmacology, Dalhousie UniversityHalifax, Nova Scotia, Canada
| | - Rebabonye B Pharithi
- Department of Cardiology, The Adelaide and Meath HospitalTallaght, Dublin, Ireland
| | - Barkat Khan
- Department of Cardiology, The Adelaide and Meath HospitalTallaght, Dublin, Ireland
| | - Haaris A Shiwani
- Department of Cardiology, The Adelaide and Meath HospitalTallaght, Dublin, Ireland
| | - Vincent Maher
- Department of Cardiology, The Adelaide and Meath HospitalTallaght, Dublin, Ireland
| | - Yassine El Hiani
- Department of Physiology and Biophysics, Dalhousie UniversityPO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Robert A Rose
- Libin Cardiovascular Institute of Alberta, University of CalgaryCalgary, Alberta, Canada
| | | | - Hilaire A Ribama
- Egom Clinical & Translational Research Services Ltd.Dartmouth, NS B3H 3H3, Canada
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Egom EEA, Fitzgerald R, Canning R, Pharithi RB, Murphy C, Maher V. Determination of Sphingosine-1-Phosphate in Human Plasma Using Liquid Chromatography Coupled with Q-Tof Mass Spectrometry. Int J Mol Sci 2017; 18:ijms18081800. [PMID: 28820460 PMCID: PMC5578187 DOI: 10.3390/ijms18081800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 01/17/2023] Open
Abstract
Evidence suggests that high-density lipoprotein (HDL) components distinct from cholesterol, such as sphingosine-1-phosphate (S1P), may account for the anti-atherothrombotic effects attributed to this lipoprotein. The current method for the determination of plasma levels of S1P as well as levels associated with HDL particles is still cumbersome an assay method to be worldwide practical. Recently, a simplified protocol based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the sensitive and specific quantification of plasma levels of S1P with good accuracy has been reported. This work utilized a triple quadrupole (QqQ)-based LC-MS/MS system. Here we adapt that method for the determination of plasma levels of S1P using a quadrupole time of flight (Q-Tof) based LC-MS system. Calibration curves were linear in the range of 0.05 to 2 µM. The lower limit of quantification (LOQ) was 0.05 µM. The concentration of S1P in human plasma was determined to be 1 ± 0.09 µM (n = 6). The average accuracy over the stated range of the method was found to be 100 ± 5.9% with precision at the LOQ better than 10% when predicting the calibration standards. The concentration of plasma S1P in the prepared samples was stable for 24 h at room temperature. We have demonstrated the quantification of plasma S1P using Q-Tof based LC-MS with very good sensitivity, accuracy, and precision that can used for future studies in this field.
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Affiliation(s)
- Emmanuel Eroume-A Egom
- Department of Cardiology, The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital, Tallaght, 24 Dublin, Ireland.
| | - Ross Fitzgerald
- Institute of Technology Tallaght, Blessington Road, Tallaght, 24 Dublin, Ireland.
| | - Rebecca Canning
- Institute of Technology Tallaght, Blessington Road, Tallaght, 24 Dublin, Ireland.
| | - Rebabonye B Pharithi
- Department of Cardiology, The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital, Tallaght, 24 Dublin, Ireland.
| | - Colin Murphy
- Institute of Technology Tallaght, Blessington Road, Tallaght, 24 Dublin, Ireland.
| | - Vincent Maher
- Department of Cardiology, The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital, Tallaght, 24 Dublin, Ireland.
- Institute of Technology Tallaght, Blessington Road, Tallaght, 24 Dublin, Ireland.
- Department of clinical medicine, Education Division, Trinity College Dublin, The University of Dublin, 24 Dublin, Ireland.
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Egom EEA, Feridooni T, Pharithi RB, Khan B, Shiwani HA, Maher V, El Hiani Y, Pasumarthi KBS, Ribama HA. A natriuretic peptides clearance receptor's agonist reduces pulmonary artery pressures and enhances cardiac performance in preclinical models: New hope for patients with pulmonary hypertension due to left ventricular heart failure. Biomed Pharmacother 2017; 93:1144-1150. [PMID: 28738523 DOI: 10.1016/j.biopha.2017.07.027] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In patients with left ventricular heart failure (HF), the development of pulmonary hypertension (PH) is common and represents a strong predictor of death. Despite recent advances in the pathophysiological understanding there is as yet no prospect of cure of this deadly clinical entity and the majority of patients continue to progress to right ventricular failure and die. Furthermore, there is no single medical treatment currently approved for PH related to HF. There is, therefore an urgent unmet need to identify novel pharmacological agents that will prevent the progressive increased or reverse the elevated pulmonary arterial pressures while enhancing cardiac performance in HF. METHOD AND RESULTS We here reported, for the first time, using a pressure-loop (P-V) conductance catheter system, that a specific natriuretic peptides clearance receptors' agonist, the ring-deleted atrial natriuretic peptide analogue, cANF4-23 (cANF) reduces pulmonary artery pressures. Strikingly, the administration of the cANF in these mice decreased the RVSP by 50% (n=5, F 25.687, DF 14, p<0.001) and heart rate (HR) by 11% (n=5, F 25.69, DF 14, p<0.001) as well as enhancing cardiac performance including left ventricular contractility in mice. Most strikingly, mice lacking NPR-C were much more susceptible to develop HF, indicating that NPR-C is a critical protective receptor in the heart. CONCLUSION Natriuretic peptides clearance receptors' agonists may, therefore represent a novel and attractive therapeutic strategy for PH related to HF, and ultimately improves the life expectancy and quality for millions of people around the planet.
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Affiliation(s)
- Emmanuel Eroume-A Egom
- Egom Clinical & Translational Research Services Ltd., Dartmouth, NS B2X 3H3, Canada; Cardiology Department, The Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
| | - Tiam Feridooni
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Rebabonye B Pharithi
- Cardiology Department, The Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Barkat Khan
- Cardiology Department, The Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Haaris A Shiwani
- Cardiology Department, The Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Vincent Maher
- Cardiology Department, The Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Yassine El Hiani
- Department of Physiology and Biophysics, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | | | - Hilaire A Ribama
- Egom Clinical & Translational Research Services Ltd., Dartmouth, NS B2X 3H3, Canada
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Egom E, Feridooni T, Pharithi R, Maher V, Hiani YE, Pasumarthi K, Ribama H. NEW INSIGHTS AND NEW HOPE FOR PULMONARY ARTERIAL HYPERTENSION: NATRIURETIC PEPTIDES CLEARANCE RECEPTOR AS A NOVEL THERAPEUTIC TARGET FOR A COMPLEX DISEASE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35291-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shiwani HA, Pharithi RB, Khan B, Egom CBA, Kruzliak P, Maher V, Egom EEA. An update on the 2014 Ebola outbreak in Western Africa. ASIAN PAC J TROP MED 2016; 10:6-10. [PMID: 28107867 DOI: 10.1016/j.apjtm.2016.12.008] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/20/2016] [Accepted: 12/02/2016] [Indexed: 11/28/2022] Open
Abstract
The recent Ebola outbreak in Western Africa was the most devastating outbreak witnessed in recent times. There have been remarkable local and international efforts to control the crisis. Ebola Virus Disease is the focus of immense research activity. The progression of events in the region has been evolving swiftly and it is of paramount importance to the medical community to be acquainted with the situation. Over 28000 people were inflicted with the condition, over 11000 have died. Novel data has emerged regarding modes of transmission, providing rationale for recent flare-ups. Similarly, studies on survivors are elucidating the later stages of the disease recovery process. Novel techniques for diagnosis are also discussed. Finally, the current research regarding treatment and vaccine development is reviewed, particularly the implementation of rVSV-ZEBOV vaccination programs.
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Affiliation(s)
- Haaris A Shiwani
- Department of Clinical Medicine, Education Division, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Rebabonye B Pharithi
- Department of Cardiology, The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital, Tallaght, Dublin, 24, Ireland
| | - Barkat Khan
- Department of Cardiology, The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital, Tallaght, Dublin, 24, Ireland
| | | | - Peter Kruzliak
- International Clinical Research Center, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Vincent Maher
- Department of Cardiology, The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital, Tallaght, Dublin, 24, Ireland
| | - Emmanuel Eroume-A Egom
- Department of Clinical Medicine, Education Division, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Department of Cardiology, The Adelaide and Meath Hospital Dublin, Incorporating the National Children Hospital, Tallaght, Dublin, 24, Ireland; Egom Clinical and Translational Research Services, Dartmouth, NS, Canada.
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Vallejo-Vaz AJ, Akram A, Kondapally Seshasai SR, Cole D, Watts GF, Hovingh GK, Kastelein JJP, Mata P, Raal FJ, Santos RD, Soran H, Freiberger T, Abifadel M, Aguilar-Salinas CA, Alnouri F, Alonso R, Al-Rasadi K, Banach M, Bogsrud MP, Bourbon M, Bruckert E, Car J, Ceska R, Corral P, Descamps O, Dieplinger H, Do CT, Durst R, Ezhov MV, Fras Z, Gaita D, Gaspar IM, Genest J, Harada-Shiba M, Jiang L, Kayikcioglu M, Lam CSP, Latkovskis G, Laufs U, Liberopoulos E, Lin J, Lin N, Maher V, Majano N, Marais AD, März W, Mirrakhimov E, Miserez AR, Mitchenko O, Nawawi H, Nilsson L, Nordestgaard BG, Paragh G, Petrulioniene Z, Pojskic B, Reiner Ž, Sahebkar A, Santos LE, Schunkert H, Shehab A, Slimane MN, Stoll M, Su TC, Susekov A, Tilney M, Tomlinson B, Tselepis AD, Vohnout B, Widén E, Yamashita S, Catapano AL, Ray KK. Pooling and expanding registries of familial hypercholesterolaemia to assess gaps in care and improve disease management and outcomes: Rationale and design of the global EAS Familial Hypercholesterolaemia Studies Collaboration. ATHEROSCLEROSIS SUPP 2016; 22:1-32. [PMID: 27939304 DOI: 10.1016/j.atherosclerosissup.2016.10.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The potential for global collaborations to better inform public health policy regarding major non-communicable diseases has been successfully demonstrated by several large-scale international consortia. However, the true public health impact of familial hypercholesterolaemia (FH), a common genetic disorder associated with premature cardiovascular disease, is yet to be reliably ascertained using similar approaches. The European Atherosclerosis Society FH Studies Collaboration (EAS FHSC) is a new initiative of international stakeholders which will help establish a global FH registry to generate large-scale, robust data on the burden of FH worldwide. METHODS The EAS FHSC will maximise the potential exploitation of currently available and future FH data (retrospective and prospective) by bringing together regional/national/international data sources with access to individuals with a clinical and/or genetic diagnosis of heterozygous or homozygous FH. A novel bespoke electronic platform and FH Data Warehouse will be developed to allow secure data sharing, validation, cleaning, pooling, harmonisation and analysis irrespective of the source or format. Standard statistical procedures will allow us to investigate cross-sectional associations, patterns of real-world practice, trends over time, and analyse risk and outcomes (e.g. cardiovascular outcomes, all-cause death), accounting for potential confounders and subgroup effects. CONCLUSIONS The EAS FHSC represents an excellent opportunity to integrate individual efforts across the world to tackle the global burden of FH. The information garnered from the registry will help reduce gaps in knowledge, inform best practices, assist in clinical trials design, support clinical guidelines and policies development, and ultimately improve the care of FH patients.
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Affiliation(s)
| | - Antonio J Vallejo-Vaz
- Imperial Centre for Cardiovascular Disease Prevention (ICCP), School of Public Health, Imperial College London, London, UK.
| | - Asif Akram
- Global eHealth Unit, School of Public Health, Imperial College London, London, UK; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Della Cole
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, UK
| | - Gerald F Watts
- Cardiovascular Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Frederick J Raal
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Raul D Santos
- Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Handrean Soran
- University Department of Medicine, Central Manchester University Hospitals, Manchester, UK
| | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic; Ceitec, Masaryk University, Brno, Czech Republic
| | - Marianne Abifadel
- Laboratory of Biochemistry and Molecular Therapeutics, Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
| | | | - Fahad Alnouri
- Cardiovascular Prevention and Rehabilitation Unit, Prince Sultan Cardiac Centre Riyadh, Riyadh, Saudi Arabia
| | - Rodrigo Alonso
- Lipid Clinic, Department of Nutrition, Clínica Las Condes, Santiago de Chile, Chile
| | | | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Martin P Bogsrud
- National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Norway
| | - Mafalda Bourbon
- Instituto Nacional de Saúde Doutor Ricardo Jorge and Biosystems & Integrative Sciences Institute (BioISI), Universidade de Lisboa, Portugal
| | - Eric Bruckert
- Endocrinologie, métabolisme et prévention cardiovasculaire, Institut E3M et IHU cardiométabolique (ICAN), Hôpital Pitié-Salpêtrière, Paris, France
| | - Josip Car
- Global eHealth Unit, School of Public Health, Imperial College London, London, UK; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Richard Ceska
- Charles University in Prague, Prague, Czech Republic
| | - Pablo Corral
- FASTA University, School of Medicine, Mar del Plata, Argentina
| | | | - Hans Dieplinger
- Austrian Atherosclerosis Society, c/o Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Can T Do
- Vietnam Heart Institute, Bach Mai Hospital, Hanoi, Viet Nam
| | - Ronen Durst
- Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Marat V Ezhov
- Russian Cardiology Research and Production Centre, Moscow, Russia
| | - Zlatko Fras
- University Medical Centre Ljubljana, Division of Medicine, Preventive Cardiology Unit, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes din Timisoara, Romania
| | - Isabel M Gaspar
- Medical Genetics Department, Centro Hospitalar de Lisboa Ocidental and Genetics Laboratory, Lisbon Medical School, University of Lisbon, Portugal
| | | | - Mariko Harada-Shiba
- National Cerebral and Cardiovascular Centre Research Institute, Osaka, Japan
| | - Lixin Jiang
- National Clinical Research Centre of Cardiovascular Diseases, Fuwai Hospital, National Centre for Cardiovascular Diseases, Beijing, China
| | - Meral Kayikcioglu
- Ege University Medical School, Department of Cardiology, Izmir, Turkey
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | - Gustavs Latkovskis
- Research Institute of Cardiology and Regenerative Therapy, Faculty of Medicine, University of Latvia, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | | | - Jie Lin
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Lin
- Imperial Centre for Cardiovascular Disease Prevention (ICCP), School of Public Health, Imperial College London, London, UK
| | | | | | - A David Marais
- University of Cape Town and National Health Laboratory Service, South Africa
| | - Winfried März
- Medical Clinic V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Germany
| | | | - André R Miserez
- Diagene GmbH, Research Institute, Reinach, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Olena Mitchenko
- Dyslipidaemia Department, Institute of Cardiology AMS of Ukraine, Ukraine
| | - Hapizah Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA, Malaysia
| | - Lennart Nilsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Børge G Nordestgaard
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - György Paragh
- Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Zaneta Petrulioniene
- Vilnius University Santariskiu Hospital, Centre of Cardiology and Angiology, Vilnius, Lithuania
| | | | - Željko Reiner
- Department for Metabolic Diseases, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Croatia
| | - Amirhossein Sahebkar
- Biotechnology Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lourdes E Santos
- Cardinal Santos Medical Centre, University of the Philippines - Philippine General Hospital (UP-PGH), Philippines
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Munich Heart Alliance, Germany
| | | | - M Naceur Slimane
- Research Unit on Dyslipidaemia and Atherosclerosis, Faculty of Medicine of Monastir, Tunisia
| | - Mario Stoll
- Cardiovascular Genetic Laboratory, Cardiovascular Health Commission, Montevideo, Uruguay
| | - Ta-Chen Su
- Department of Internal Medicine and Cardiovascular Centre, National Taiwan University Hospital, Taipei, Taiwan
| | - Andrey Susekov
- Department of Clinical Pharmacology and Therapeutics, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russian Federation, Russia
| | - Myra Tilney
- Faculty of Medicine & Surgery, Medical School, Mater Dei Hospital, University of Malta, Malta
| | - Brian Tomlinson
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | | | - Branislav Vohnout
- Coordination Centre for Familial Hyperlipoproteinemias, Institute of Nutrition, FOZOS, Slovak Medical University, Department of Epidemiology, School of Medicine, Comenius University, Bratislava, Slovakia
| | - Elisabeth Widén
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Shizuya Yamashita
- Rinku General Medical Centre and Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention (ICCP), School of Public Health, Imperial College London, London, UK
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Egom EEA, Bae JS, Capel R, Richards M, Ke Y, Pharithi RB, Maher V, Kruzliak P, Lei M. Effect of sphingosine-1-phosphate on L-type calcium current and Ca2+ transient in rat ventricular myocytes. Mol Cell Biochem 2016; 419:83-92. [DOI: 10.1007/s11010-016-2752-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/21/2016] [Indexed: 01/05/2023]
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Mac Ananey O, Maher V. 8.7 CHANGES IN CARDIAC FUNCTION BUT NOT STRUCTURE IN HEALTHY SUBJECTS WITH PREMATURE VASCULAR AGEING. Artery Res 2016. [DOI: 10.1016/j.artres.2016.10.063] [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] Open
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Dillinger JG, Maher V, Vitale C, Henry P, Logeart D, Manzo Silberman S, Allée G, Levy BI. Impact of Ivabradine on Central Aortic Blood Pressure and Myocardial Perfusion in Patients With Stable Coronary Artery Disease. Hypertension 2015; 66:1138-44. [PMID: 26418022 DOI: 10.1161/hypertensionaha.115.06091] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/04/2015] [Indexed: 01/22/2023]
Abstract
UNLABELLED Treatment of hypertensive patients with β-blockers reduces heart rate and decreases central blood pressure less than other antihypertensive drugs, implying that reducing heart rate without altering brachial blood pressure could increase central blood pressure, explaining the increased cardiovascular risk reported with β-blocker. We describe a randomized, double-blind study to explore whether heart rate reduction with the If inhibitor ivabradine had an impact on central blood pressure. We included 12 normotensive patients with stable coronary artery disease, heart rate ≥70 bpm (sinus rhythm), and stable background β-blocker therapy. Patients received ivabradine 7.5 mg BID or matched placebo for two 3-week periods with a crossover design and evaluation by aplanation tonometry. Treatment with ivabradine was associated with a significant reduction in resting heart rate after 3 weeks versus no change with placebo (-15.8±7.7 versus +0.3±5.8 bpm; P=0.0010). There was no relevant between-group difference in change in central aortic systolic blood pressure (-4.0±9.6 versus +2.4±12.0 mm Hg; P=0.13) or augmentation index (-0.8±10.0% versus +0.3±7.6%; P=0.87). Treatment with ivabradine was associated with a modest increase in left ventricular ejection time (+18.5±17.8 versus +2.8±19.3 ms; P=0.074) and a prolongation of diastolic perfusion time (+215.6±105.3 versus -3.0±55.8 ms with placebo; P=0.0005). Consequently, ivabradine induced a pronounced increase in Buckberg index, an index of myocardial viability (+39.3±27.6% versus -2.5±13.5% with placebo; P=0.0015). In conclusion, heart rate reduction with ivabradine does not increase central aortic blood pressure and is associated with a marked prolongation of diastolic perfusion time and an improvement in myocardial perfusion index. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrialsregister.eu. Unique identifier: 2011-004779-35.
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Affiliation(s)
- Jean-Guillaume Dillinger
- From the Service de Cardiologie, Hôpital Lariboisière, Paris, France (J.-G.D., P.H., D.L., S.M.S.); Adipose Vascular Research Unit, Adelaide and Meath Hospital, Dublin, Ireland (V.M.); Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy (C.V.); Institut de Recherches Internationales Servier, Cardiovascular Therapeutic Innovation Pole, Suresnes, France (G.A.); and Physiologie Clinique, Explorations Fonctionnelles, Institut des Vaisseaux et du Sang, Hôpital Lariboisière, Paris, France (B.I.L.); Inserm U970, PARRC HEGP, Paris, France (B.I.L.)
| | - Vincent Maher
- From the Service de Cardiologie, Hôpital Lariboisière, Paris, France (J.-G.D., P.H., D.L., S.M.S.); Adipose Vascular Research Unit, Adelaide and Meath Hospital, Dublin, Ireland (V.M.); Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy (C.V.); Institut de Recherches Internationales Servier, Cardiovascular Therapeutic Innovation Pole, Suresnes, France (G.A.); and Physiologie Clinique, Explorations Fonctionnelles, Institut des Vaisseaux et du Sang, Hôpital Lariboisière, Paris, France (B.I.L.); Inserm U970, PARRC HEGP, Paris, France (B.I.L.)
| | - Cristiana Vitale
- From the Service de Cardiologie, Hôpital Lariboisière, Paris, France (J.-G.D., P.H., D.L., S.M.S.); Adipose Vascular Research Unit, Adelaide and Meath Hospital, Dublin, Ireland (V.M.); Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy (C.V.); Institut de Recherches Internationales Servier, Cardiovascular Therapeutic Innovation Pole, Suresnes, France (G.A.); and Physiologie Clinique, Explorations Fonctionnelles, Institut des Vaisseaux et du Sang, Hôpital Lariboisière, Paris, France (B.I.L.); Inserm U970, PARRC HEGP, Paris, France (B.I.L.)
| | - Patrick Henry
- From the Service de Cardiologie, Hôpital Lariboisière, Paris, France (J.-G.D., P.H., D.L., S.M.S.); Adipose Vascular Research Unit, Adelaide and Meath Hospital, Dublin, Ireland (V.M.); Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy (C.V.); Institut de Recherches Internationales Servier, Cardiovascular Therapeutic Innovation Pole, Suresnes, France (G.A.); and Physiologie Clinique, Explorations Fonctionnelles, Institut des Vaisseaux et du Sang, Hôpital Lariboisière, Paris, France (B.I.L.); Inserm U970, PARRC HEGP, Paris, France (B.I.L.)
| | - Damien Logeart
- From the Service de Cardiologie, Hôpital Lariboisière, Paris, France (J.-G.D., P.H., D.L., S.M.S.); Adipose Vascular Research Unit, Adelaide and Meath Hospital, Dublin, Ireland (V.M.); Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy (C.V.); Institut de Recherches Internationales Servier, Cardiovascular Therapeutic Innovation Pole, Suresnes, France (G.A.); and Physiologie Clinique, Explorations Fonctionnelles, Institut des Vaisseaux et du Sang, Hôpital Lariboisière, Paris, France (B.I.L.); Inserm U970, PARRC HEGP, Paris, France (B.I.L.)
| | - Stephane Manzo Silberman
- From the Service de Cardiologie, Hôpital Lariboisière, Paris, France (J.-G.D., P.H., D.L., S.M.S.); Adipose Vascular Research Unit, Adelaide and Meath Hospital, Dublin, Ireland (V.M.); Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy (C.V.); Institut de Recherches Internationales Servier, Cardiovascular Therapeutic Innovation Pole, Suresnes, France (G.A.); and Physiologie Clinique, Explorations Fonctionnelles, Institut des Vaisseaux et du Sang, Hôpital Lariboisière, Paris, France (B.I.L.); Inserm U970, PARRC HEGP, Paris, France (B.I.L.)
| | - Guillaume Allée
- From the Service de Cardiologie, Hôpital Lariboisière, Paris, France (J.-G.D., P.H., D.L., S.M.S.); Adipose Vascular Research Unit, Adelaide and Meath Hospital, Dublin, Ireland (V.M.); Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy (C.V.); Institut de Recherches Internationales Servier, Cardiovascular Therapeutic Innovation Pole, Suresnes, France (G.A.); and Physiologie Clinique, Explorations Fonctionnelles, Institut des Vaisseaux et du Sang, Hôpital Lariboisière, Paris, France (B.I.L.); Inserm U970, PARRC HEGP, Paris, France (B.I.L.)
| | - Bernard I Levy
- From the Service de Cardiologie, Hôpital Lariboisière, Paris, France (J.-G.D., P.H., D.L., S.M.S.); Adipose Vascular Research Unit, Adelaide and Meath Hospital, Dublin, Ireland (V.M.); Department of Medical Science, IRCCS San Raffaele Pisana, Rome, Italy (C.V.); Institut de Recherches Internationales Servier, Cardiovascular Therapeutic Innovation Pole, Suresnes, France (G.A.); and Physiologie Clinique, Explorations Fonctionnelles, Institut des Vaisseaux et du Sang, Hôpital Lariboisière, Paris, France (B.I.L.); Inserm U970, PARRC HEGP, Paris, France (B.I.L.).
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Murphy TM, Waterhouse DF, Maher V, O'Hanlon R. CMR detection of membraneous ventricular septal aneurysm causing ventricular tachycardia. Diagn Interv Imaging 2015; 96:963-4. [PMID: 25920688 DOI: 10.1016/j.diii.2014.12.009] [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: 05/30/2014] [Revised: 12/21/2014] [Accepted: 12/22/2014] [Indexed: 11/27/2022]
Affiliation(s)
- T M Murphy
- Blackrock Clinic, Center for Cardiovascular Magnetic Resonance, Rock Road, Dublin, Ireland.
| | - D F Waterhouse
- Blackrock Clinic, Center for Cardiovascular Magnetic Resonance, Rock Road, Dublin, Ireland
| | - V Maher
- Blackrock Clinic, Center for Cardiovascular Magnetic Resonance, Rock Road, Dublin, Ireland
| | - R O'Hanlon
- Blackrock Clinic, Center for Cardiovascular Magnetic Resonance, Rock Road, Dublin, Ireland
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Crowley RK, Broderick D, O'Shea T, Boran G, Maher V, Crowther S, Gibney J, Conlon KC, Sherlock M. Spironolactone interference in the immunoassay of androstenedione in a patient with a cortisol secreting adrenal adenoma. Clin Endocrinol (Oxf) 2014; 81:629-30. [PMID: 24612380 DOI: 10.1111/cen.12372] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mac Ananey O, Maher V. P4.28 GLYCAEMIC HOMEOSTASIS, ARTERIAL STIFFNESS AND DIASTOLIC FUNCTION IN HEALTHY SUBJECTS. Artery Res 2013. [DOI: 10.1016/j.artres.2013.10.146] [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: 10/26/2022] Open
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Mac Ananey O, Mc Loughlin B, Abuzaid I, Leonard A, Gaffney P, Boran G, Maher V. P3.09 STIFFER ARTERIES IN “HEALTHY” SUBJECTS WITH COMPONENTS OF THE METABOLIC SYNDROME. Artery Res 2013. [DOI: 10.1016/j.artres.2013.10.097] [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: 10/26/2022] Open
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O'Kane MJ, Menown IB, Graham I, Maher V, Tomkin G, Nicholls P, Graham C. The detection of heterozygous familial hypercholesterolemia in Ireland. Adv Ther 2012; 29:456-63. [PMID: 22610724 DOI: 10.1007/s12325-012-0021-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Indexed: 12/01/2022]
Abstract
Heterozygous familial hypercholesterolemia (HeFH) is an autosomal dominant condition with a population prevalence of 1 in 500, and is associated with significant cardiovascular morbidity and mortality. It may be caused by mutations in the low-density lipoprotein (LDL) receptor, apolipoprotein B100 (Apo B100), or proprotein convertase subtilisin/kexin type 9 (PCSK9) genes, with over 1,000 causative mutations described. Statin therapy in HeFH is considered effective and safe. Audit data suggest that approximately 80% of the putative HeFH population remains unidentified and, therefore, there is a need to develop a strategy for the identification of affected individuals so that early lipid-lowering treatment may be offered. There is good evidence showing the effectiveness and acceptability of HeFH screening programs in Europe. The authors describe a protocol for an all island approach to HeFH detection in the Republic of Ireland/Northern Ireland. Index cases will be identified by opportunistic screening using the Simon Broome, or Make Early Diagnosis to Prevent Early Death (MedPed) and World Health Organization (WHO) criteria. Patients identified as "definite," "probable," or "possible" HeFH criteria will be offered genetic testing. The authors expect causative mutations to be identified in approximately 80% of patients with "definite" HeFH but in only approximately 20% of patients with "possible" HeFH. Cascade screening will be undertaken in first-degree relatives of the index case using genetic testing (where a causative mutation has been identified), or otherwise using LDL cholesterol concentration. The establishment of a HeFH screening program on an all-island basis will require: expansion of the existing molecular genetics diagnostic services, the establishment of a cohort of nurses/genetic counselors, a HeFH database to support cascade testing, the development of a network of lipid clinics (in a primary or secondary care setting), and an educational initiative to raise awareness of HeFH among healthcare professionals and the general population.
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Affiliation(s)
- Maurice J O'Kane
- Clinical Chemistry Laboratory, Altnagelvin Hospital, Londonderry, Northern Ireland.
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Mac Ananey O, Mellotte G, Maher L, Dunne M, Maher A, Maher V. P1.05 SEDENTARY LIFESTYLE IS ASSOCIATED WITH INDICES OF ARTERIAL STIFFNESS, DIASTOLIC DYSFUNCTION AND OBESITY. Artery Res 2012. [DOI: 10.1016/j.artres.2012.09.042] [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: 10/27/2022] Open
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Desmond A, Stanton A, Maher V, Crean P, Feely J, Sullivan P. A survey of patients' attitudes to clinical research. Ir Med J 2011; 104:117-119. [PMID: 21675095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Every year hundreds of patients voluntarily participate in clinical trials across Ireland. However, little research has been done as to how patients find the experience. This survey was conducted in an attempt to ascertain clinical trial participants' views on their experience of participating in a clinical trial and to see and how clinical trial participation can be improved. One hundred and sixty-six clinical trial participants who had recently completed a global phase IV cardiovascular endpoint clinical trial were sent a 3-page questionnaire. Ninety-one (91%) respondents found the experience of participating in a clinical trial a good one with 85 (84.16%) respondents saying they would recommend participating in a clinical trial to a friend or relative and eighty-five (87.63%) respondents feeling they received better healthcare because they had participated in a clinical trial.
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Affiliation(s)
- A Desmond
- Boehringer Ingelheim Ireland Ltd, Sandyford Business Estate, Dublin 18.
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Maher V, Markham C, OHalloran A, O’Dowd M, Carey M, Brown A, McInerney D. P6.12 BRACHIAL ARTERY REACTIVITY IS DIRECTLY PROPORTIONAL TO BASAL BRACHIAL ARTERY TONE: POSSIBLE CONFOUNDER IN MEASURING ENDOTHELIAL FUNCTION. Artery Res 2009. [DOI: 10.1016/j.artres.2009.10.079] [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: 11/30/2022] Open
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Abstract
BACKGROUND Lipid measurements are essential in cardiovascular disease management in primary care. However, utilizing hospital laboratories may result in excess patient travel, sample loss and repeat clinic visits. Point of care (POC) lipid measurement would overcome these difficulties but has not been validated in an Irish setting. AIM To compare POC lipid profile measurements using a cholestech LDX analyser with a hospital reference laboratory (Lab). METHOD One-hundred subjects (30 men, 70 women) participated. Finger prick and venous samples were analysed directly by Cholestech LDX and the Lab. RESULTS A broad range of lipid values were measured. Absolute differences between POC and Lab measurements were insignificant except for a small over-estimation by the POC method of triglyceride 0.25 mmol/l (95% CI 0.17 to 0.24), and an underestimation of HDLc - 0.11 mmol/l (95% CI - 0.143 to -0.078). There were significant correlations between POC and Lab. levels; total cholesterol r=0.92, triglyceride r=0.93, HDLc r=0.92 and LDLc r=0.86 (all p< 0.0001). CONCLUSION These results validate the use of the Cholestech LDX analyser for point of care lipid measurements in clinical practice, provided well trained operators are supported by a hospital laboratory delivering quality assurance support.
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Affiliation(s)
- M Carey
- Depts of Cardiology and Chemical Pathology, The Adelaide and Meath Hospital incorporating The National Children's Hospital, Dublin, Ireland
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Ingram S, Maher V, Bennett K, Gormley J. The effect of cardiopulmonary resuscitation training on psychological variables of cardiac rehabilitation patients. Resuscitation 2006; 71:89-96. [PMID: 16945466 DOI: 10.1016/j.resuscitation.2006.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 02/08/2006] [Accepted: 02/14/2006] [Indexed: 11/30/2022]
Abstract
As a component of cardiac rehabilitation (CR), cardiopulmonary resuscitation (CPR) training is widely recommended. These recommendations advocate the importance of offering CPR training to cardiac patients' families. Prior research examining the effect of CPR training on the cardiac patients spouse or family member, suggests that receiving CPR training within a supportive environment such as cardiac rehabilitation causes no adverse psychological effects in the family members. Patients are often excluded from CPR training due to fears of the possible physiological consequences. Conversely, there may be negative psychological consequences for patients who are excluded from CPR training. Although cardiac patients are at high risk of cardiac arrest themselves this should not preclude them from having the ability to help another. The aim of this study was to assess the impact on anxiety, depression and perception of control (POC) of CPR training for the cardiac patients as an integral part of an 8-week phase III Cardiac Rehabilitation Programme. Fifty-eight patients and 54 family members or partners attending an 8-week CR programme were offered optional CPR training during the final week of the programme. Forty-nine patient subjects were evaluated at four time points, using the hospital anxiety and depression scale and the control attitudes scale. Seventy-five percent (n = 37) of patients participated in the CPR training. Teaching CPR to cardiac patients did not affect anxiety levels adversely. There was an overall significant decrease in anxiety scores for both patient groups over time (p = 0.0071). Both patient groups showed an average moderate level of POC at baseline but the POC level in those who did the CPR training continued to increase slightly throughout the study period. If the patient agreed to undertake CPR training approximately 61% of their relatives or partners also undertook the training, but when the patient did not avail of the CPR training only 20% of their relatives or partners participated. Cardiac patients would appear to have a desire to learn CPR. It is recommended that cardiac patients be involved in CPR training as it poses them no adverse psychological consequences and may improve their perception of control. Inclusion of the patients in the CPR training may help increase the participation in CPR training by cardiac patients' families.
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Affiliation(s)
- Shirley Ingram
- Cardiac Rehabilitation Department, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
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Maher V, Sinfuego J, Chao P, Parekh J. Primary prevention of coronary heart disease. What has WOSCOPS told us and what questions remain? West Of Scotland Coronary Prevention Study. Drugs 1997; 54:1-8. [PMID: 9211076 DOI: 10.2165/00003495-199754010-00001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 02/04/2023]
Abstract
Coronary heart disease remains the major cause of death and morbidity in developed countries. As a consequence, its prevention constitutes a significant public health challenge. In recent times, our understanding of this disease process has expanded and many of the factors that influence its expression have been elucidated. In addition, a number of trials of diet and lipid-lowering drugs have been performed in an effort to tackle this problem. These studies demonstrate that when lipid levels are favourably altered, cardiovascular events are reduced without adverse effect. The rate at which event outcomes diverge between treated and untreated patients depends on the degree of atherosclerosis manifestation prior to treatment and the aggressiveness of the lipid altering strategy. Nonetheless, to date, the residual risk of cardiovascular events is still unacceptably high despite even the most potent lipid-lowering treatments used in these trials. In order to minimise the risk of future events, earlier intervention and a greater change in LDL and HDL cholesterol levels are needed in conjunction with other risk factor modifications.
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Affiliation(s)
- V Maher
- University of Washington Medical Center, Seattle, USA.
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Owens D, Maher V, Collins P, Johnson A, Tomkin G. Cellular cholesterol regulation--a defect in the type 2 (non-insulin-dependent) diabetic patient in poor metabolic control. Diabetologia 1990; 33:93-9. [PMID: 2328848 DOI: 10.1007/bf00401046] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study investigates the relationship between Type 2 (non-insulin-dependent) diabetes mellitus and hypercholesterolaemia with regard to delivery of cholesterol to cells and regulation of endogenous cholesterol synthesis. The ability of LDL, from hypercholesterolaemic and Type 2 diabetic patients, to suppress cellular cholesterologenesis and to enhance mitogen-stimulated lymphocyte proliferation was compared. Cholesterol synthesis was estimated by measuring [14C]-acetate incorporation into cholesterol and lymphocyte proliferation was assessed by [3H]-thymidine incorporation into mitogen-stimulated normal lymphocytes. The results indicate that LDL from both Type 2 diabetic patients in poor metabolic control and hypercholesterolaemic patients was significantly less effective (p less than 0.001) than LDL from non-diabetic normocholesterolaemic subjects in suppressing cholesterol synthesis in lymphocytes. LDL from all hypercholesterolaemic patients enhanced lymphocyte proliferation to a greater extent than LDL from normocholesterolaemic subjects and this effect was significantly increased using LDL from Type 2 diabetic, hypercholesterolaemic patients. Both suppression of [14C]-acetate incorporation and enhancement of [3H]-thymidine uptake could be related to an increased esterified/free cholesterol ratio in the LDL particle. The fact that cholesterol synthesis and cell proliferation were markedly altered by the above changes in LDL composition suggests a mechanism for cellular cholesterol accumulation in the Type 2 diabetic patient, even in the absence of elevated serum cholesterol levels.
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Affiliation(s)
- D Owens
- Department of Biochemistry, Royal College of Surgeons, Ireland
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Thompson G, Maher V, Pappu A, Illingworth D. Use of plasma mevalonate to monitor HMG CoA reductase inhibition. Atherosclerosis 1989. [DOI: 10.1016/0021-9150(89)90051-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Collagen synthesis in rat osteosarcoma cell line 17/2 (ROS 17/2) was assessed by measuring the incorporation of [3H]proline into collagenase-digestible protein and the formation of [3H]hydroxyproline. PTH and 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] inhibited collagen synthesis in ROS 17/2 cells in a time- and dose-dependent manner. PTH reduced collagen synthesis after a 3-h incubation, whereas the effect of 1,25-(OH)2D3 was somewhat slower. Maximal and half-maximal inhibition of collagen synthesis occurred at approximately 1 and 0.1 nM of each hormone, respectively. At confluency, ROS 17/2 cells synthesized 96% type I and 4% type III collagen. PTH reduced the synthesis of type I, but not type III, collagen. PTH and 1,25-(OH)2D3 also reduced procollagen mRNA levels, as determined by a dot blot hybridization assay. Thus, ROS 17/2 cells are a convenient model system for studying the hormonal regulation of collagen metabolism and gene expression in a cloned cell line with the osteoblastic phenotype.
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Radović M, Todorović P, Radojicić C, Maher V, Ruzić R, Durić D, Ivanović I, Zunić G, Taseski J, Mijusković Z. [Chemical changes in CPD-blood]. VOJNOSANIT PREGL 1984; 41:244-50. [PMID: 6506549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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