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Pubblicazioni recenti - cardiovascular disease
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[What's new in CKD-MBD?]
Dtsch Med Wochenschr2020 Aug;145(16):1170-1173. doi: 10.1055/a-1173-5147.
Brandenburg Vincent,
Abstract
CKD-MBD (chronic kidney disease - mineral and bone disorder) describes a complex syndrome of renal osteodystrophy, mineral disturbances and cardiovascular disease in patients with chronic kidney disease. The present articles intends to provide an up-to-date summary of recent clinically important developments in the field of CKD-MBD. The article touches specifically phosphate management, secondary hyperparathyroidism, vitamin D, arteriosclerosis, renal bone disease, and SGLT2-inhibitors. The summary also comments on which grade of evidence novel aspects and innovative developments in CKD-BMD are based. The author concludes that nephrologists should strive after more high-quality, large-scale randomized-controlled interventional trials in order to optimize the evidence behind CKD-MBD therapy.
© Georg Thieme Verlag KG Stuttgart · New York.
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[COVID-19 and the impact of cardiovascular comorbidities].
Dtsch Med Wochenschr2020 Aug;145(16):1157-1160. doi: 10.1055/a-1158-5996.
Seoudy Hatim, Frey Norbert,
Abstract
Since its outbreak, coronavirus disease 2019 (COVID-19) has rapidly resulted in a global pandemic. Underlying cardiovascular disease (CVD) is associated with severe COVID-19 infection and adverse clinical outcomes. While COVID-19 predominantly causes respiratory symptoms, a substantial number of patients eventually develop an acute cardiovascular syndrome associated with an excessive risk of mortality. While the exact mechanisms remain uncertain, angiotensin-converting enzyme 2 plays a pivotal role as a link between COVID-19 and the cardiovascular system. As there is no evidence that inhibition of the renin-angiotensin-aldosterone-system is harmful in COVID-19, therapy should be continued as indicated in hypertension or heart failure patients. As multiple drugs are being investigated in ongoing clinical trials, potential cardiotoxicity remains an important issue. In times of rigorous public health measures such as social distancing, efforts should be undertaken to ensure timely treatment of acute CVD and continuation of guideline-directed treatment in order to avoid an increase in morbidity and mortality. In addition to its acute complications, COVID-19 is likely to be associated with long-term cardiovascular damage. Consequently, for a subgroup of patients a long-term management strategy is needed.
© Georg Thieme Verlag KG Stuttgart · New York.
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Genetic Variants in One-Carbon Metabolism Pathway Predict Survival Outcomes of Early-Stage Non-Small Cell Lung Cancer.
Oncology2020 Aug;():1-8. doi: 10.1159/000509658.
Do Sook Kyung, Choi Sun Ha, Lee Shin Yup, Choi Jin Eun, Kang Hyo-Gyoung, Hong Mi Jeong, Kim Ji Hyun, Baek Sun Ah, Lee Jang Hyuck, Lee Won Kee, Do Young Woo, Lee Eung Bae, Shin Kyung Min, Jeong Ji Yun, Lee Yong Hoon, Seo Hyewon, Yoo Seung Soo, Lee Jaehee, Cha Seung Ick, Kim Chang Ho, Seok Yangki, Cho Sukki, Jheon Sanghoon, Park Jae Yong,
Abstract
BACKGROUND:
This study was conducted to investigate the association between genetic variants in one-carbon metabolism and survival outcomes of surgically resected non-small cell lung cancer (NSCLC).
METHODS:
We genotyped 41 potentially functional variants of 19 key genes in the one-carbon metabolism pathway among 750 NSCLC patients who underwent curative surgery. The association between genetic variants and overall survival (OS)/disease-free survival (DFS) were analyzed.
RESULTS:
Among the 41 single-nucleotide polymorphisms (SNPs) analyzed, 4 SNPs (MTHFD1L rs6919680T>G and rs3849794T>C, MTR rs2853523C>A, and MTHFR rs4846049G>T) were significantly associated with survival outcomes. MTHFD1L rs6919680T>G and MTR rs2853523C>A were significantly associated with better OS (adjusted hazard ratio [aHR] = 0.73, 95% confidence interval [CI] = 0.54-0.99, p = 0.04) and worse OS (aHR = 2.14, 95% CI = 1.13-4.07, p = 0.02), respectively. MTHFD1L rs3849794T>C and MTHFR rs4846049G>T were significantly associated with worse DFS (aHR = 1.41, 95% CI = 1.08-1.83, p = 0.01; and aHR = 1.97, 95% CI = 1.10-3.53, p = 0.02, respectively). When the patients were divided according to histology, the associations were significant only in squamous cell carcinoma (SCC), but not in adenocarcinoma (AC). In SCC, MTHFD1L rs6919680T>G and MTR rs2853523C>A were significantly associated with better OS (aHR = 0.64, 95% CI = 0.41-1.00, p = 0.05) and worse OS (aHR = 2.77, 95% CI = 1.11-6.91, p = 0.03), respectively, and MTHFD1L rs3849794T>C and MTHFR rs4846049G>T were significantly associated with worse DFS (aHR = 1.73, 95% CI = 1.17-2.56, p = 0.01; and aHR = 2.78, 95% CI = 1.12-6.88, p = 0.03, respectively).
CONCLUSIONS:
Our results suggest that the genetic variants in the one-carbon metabolism pathway could be used as biomarkers for predicting the clinical outcomes of patients with early-stage NSCLC.
© 2020 S. Karger AG, Basel.
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A case report: An aortobifemoral bypass implant found during cadaver dissection promotes inquiry-based learning.
Int J Surg Case Rep2020 Jul;74():53-57. doi: S2210-2612(20)30577-0.
Gotham Zachary P, Tanilli Rachel S, Wirfel Olivia M, Dalvi Prasad S,
Abstract
INTRODUCTION:
An unusual vascular implant found during routine cadaver dissection influenced instructors and students to learn more about the underlying disease and the surgical technique used to treat this disorder triggering an inquiry-based learning.
PRESENTATION OF CASE:
This report describes a case of peripheral arterial disease (PAD) with an aortobifemoral arterial bypass implant that was never found before in any of the previously dissected cadavers at Gannon University.
DISCUSSION:
PAD develops due to impaired blood flow to the lower extremities that causes numbness, weakness, and lower leg pain. The treatments can aim to improve the long-term cardiovascular outcomes. If therapeutic medications do not improve outcomes of PAD, revascularization by endovascular repair or aortofemoral bypass grafting is considered.
CONCLUSION:
We would like to note that accidental discoveries of pathologies or surgical procedures during routine cadaveric dissections present a unique possibility for inquiry-based learning among future healthcare providers.
Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Low birth weight and abnormal pre-pregnancy body mass index were at higher risk for hypertensive disorders of pregnancy.
Pregnancy Hypertens2020 Aug;22():119-125. doi: S2210-7789(20)30105-7.
Wagata Maiko, Ishikuro Mami, Obara Taku, Nagai Masato, Mizuno Satoshi, Nakaya Naoki, Nakamura Tomohiro, Hirata Takumi, Tsuchiya Naho, Metoki Hirohito, Ogishima Soichi, Hozawa Atsushi, Kinoshita Kengo, Kure Shigeo, Yaegashi Nobuo, Yamamoto Masayuki, Kuriyama Shinichi, Sugawara Junichi,
Abstract
Low birth weight is known to be associated with hypertension, cardiovascular disease and hypertensive disorders of pregnancy (HDP); however, this association might vary by race/ethnicity. This study aimed to clarify the association between women's own birth weight and their subsequent risk for HDP in a Japanese population, in combination with pre-pregnancy body mass index (BMI). We conducted a cohort study as part of the Tohoku Medical Megabank Birth and Three-Generation Cohort Study in Miyagi, Japan. Our study's population included 4810 women. A multivariate logistic regression analysis was performed to calculate the adjusted odds ratio (aOR) and the 95% confidence interval (CI) of the women's own birth weight for HDP, in the combination categories of birth weight and pre-pregnancy BMI. As a result, the group with a low birth weight of <2500 g had a significant association with HDP (the aOR, 1.50; 95% CI, 1.02-2.21). In the subtype analysis, the odds ratio for only preeclampsia was significantly increased in the low birth weight group (aOR, 3.37; 95% CI, 1.84-6.16). In the group with a low birth weight, the prevalence of HDP was higher in both the underweight and overweight groups. In conclusion, there was a significant association between low birth weight and subsequent HDP in Japanese women. Furthermore, a significant association with HDP was found for women born with a low birth weight who were underweight or overweight as adults. Maintaining a normal weight may be effective for preventing HDP even if a woman was born small.
Copyright © 2020. Published by Elsevier B.V.
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Trimethylamine N-Oxide levels are associated with NASH in obese subjects with type 2 diabetes.
Diabetes Metab2020 Aug;():. doi: S1262-3636(20)30102-6.
León-Mimila Paola, Villamil-Ramírez Hugo, Li Xinmin S, Shih Diana M, Hui Simon T, Ocampo-Medina Elvira, López-Contreras Blanca, Morán-Ramos Sofía, Olivares-Arevalo Marisol, Grandini-Rosales Paula, Macías-Kauffer Luis, González-González Israel, Hernández-Pando Rogelio, Gómez-Pérez Francisco, Campos-Pérez Francisco, Aguilar-Salinas Carlos, Larrieta-Carrasco Elena, Villarreal-Molina Teresa, Wang Zeneng, Lusis Aldons J, Hazen Stanley L, Huertas-Vazquez Adriana, Canizales-Quinteros Samuel,
Abstract
AIMS:
Trimethylamine N-oxide (TMAO), choline and betaine serum levels have been associated with metabolic diseases including type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD). These associations could be mediated by insulin resistance. However, the relationships among these metabolites, insulin resistance and NAFLD have not been thoroughly investigated. Moreover, it has recently been suggested that TMAO could play a role in NAFLD by altering bile acid metabolism. We examined the association between circulating TMAO, choline and betaine levels and NAFLD in obese subjects.
METHODS:
Serum TMAO, choline, betaine and bile acid levels were measured in 357 Mexican obese patients with different grades of NAFLD as determined by liver histology. Associations of NAFLD with TMAO, choline and betaine levels were tested. Moreover, association of TMAO levels with non-alcoholic steatohepatitis (NASH) was tested separately in patients with and without T2D.
RESULTS:
TMAO and choline levels were significantly associated with NAFLD histologic features and NASH risk. While increased serum TMAO levels were significantly associated with NASH in patients with T2D, in non-T2D subjects this association lost significance after adjusting for sex, BMI and insulin resistance. Moreover, circulating secondary bile acids were associated both with increased TMAO levels and NASH.
CONCLUSIONS:
In obese patients, circulating TMAO levels were associated with NASH mainly in the presence of T2D. Functional studies are required to evaluate the role of insulin resistance and T2D in this association, both highly prevalent in NASH patients.
Copyright © 2020. Published by Elsevier Masson SAS.
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National Trends and Cost Burden of Surgically Treated Gunshot Wounds in the US.
J Am Coll Surg2020 Jul;():. doi: S1072-7515(20)30545-7.
Dobaria Vishal, Aguayo Esteban, Sanaiha Yas, Tran Zachary, Hadaya Joseph, Sareh Sohail, Cho Nam Yong, Benharash Peyman,
Abstract
INTRODUCTION:
Gun violence remains a major burden on the US healthcare system with annual costs exceeding $170 billion. Literature regarding the national trends in costs and survival of gun violence victims requiring operative interventions is lacking.
STUDY DESIGN:
All adults admitted with a diagnosis of gunshot wound (GSW) requiring operative intervention(s) were identified using the 2005-16 National Inpatient Sample (NIS). The International Classification of Diseases Injury Severity score (ICISS), a validated prediction tool, was used to quantify the extent of traumatic injuries. Survey-weighted methodology was employed to provide national estimates. Hospitalizations exceeding the 66 percentile of annual costs were considered as high cost tertile (HCT). Multivariable logistic regressions with stepwise forward selection were used to identify factors associated with mortality and HCT.
RESULTS:
Over the study period, 262,098 admissions met inclusion criteria with a significant increase in annual frequency and decrease in ICISS scores. A decline in mortality (8.6% to 7.6%, P-trend=0.03) was accompanied by increasing mean costs ($25,900 to $33,000, NP- trend<0.001). After adjusting for patient and hospital characteristics, head and neck (adjusted odds ratio (AOR): 31.2; 95% CI: 11.0-88.4, P<0.001), vascular operations (AOR: 24.5; 95% CI:19.2-31.1, P<0.001), and gastrointestinal (AOR: 27.8; 95% CI:17.2-44.8, P<0.001), were independently associated with HCT designation compared to patients who did not undergo these operations.
CONCLUSION:
Over the past decade, the increase in gun violence and severity has resulted in higher costs. Operations involving selected surgical treatments incurred higher in-hospital costs. Given the profound economic and social impact of surgically treated GSWs, policy and public health efforts to reduce gun violence are imperative.
Copyright © 2020. Published by Elsevier Inc.
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Trends in Place of Death for Individuals with Deaths Attributed to Advanced Chronic or End-Stage Kidney Disease in the United States.
J Pain Symptom Manage2020 Aug;():. doi: S0885-3924(20)30654-0.
Cross Sarah H, Lakin Joshua R, Mendu Mallika, Mandel Ernest I, Warraich Haider J,
Abstract
CONTEXT:
An important aspect of end-of-life care, place of death is understudied in advanced chronic (CKD) and end-stage kidney disease (ESKD).
OBJECTIVE:
We sought to examine trends and factors associated with where advanced CKD/ESKD patients die.
METHODS:
We conducted a retrospective cross-sectional study using mortality data from 2003 to 2017 for deaths attributed primarily to advanced CKD/ESKD in the United States.
RESULTS:
Between 2003-2017, 222,247 deaths were attributed to advanced CKD/ESKD. From 2003-2017, deaths occurring in hospitals declined from 56.0% (n=5,356) to 35.6% (n= 7,764), while increases occurred in deaths at home (13.5% (n=1,292) to 24.3% (n=5,306)), nursing facilities (18.6% (n=1,776) to 19.3% (n=4,221)) and hospice facilities (0.3% (n=29) to 13.4% (n=2,917)). Non-white race was associated with increased odds of hospital death [Black (OR=1.59; 95%CI= 1.55, 1.62); Native American (OR=1.47; 95%CI= 1.32, 1.63); Asian (OR=1.43; 95%CI= 1.32, 1.55] and reduced odds of nursing facility [Black (OR=.622; 95%CI= .600, .645); Native American (OR=.638; 95%CI= .572, .712); Asian (OR=.574; 95%CI= .533, .619] or hospice facility death [Black (OR=.843; 95%CI= .773, .918); Native American (OR=.380; 95%CI= .289, .500); Asian (OR=.609; 95%CI= .502, .739]. Older age was associated with reduced odds of hospital death [ ?85 (OR=.334; 95%CI= .312, .358)] and increased odds of home [ ?85 (OR=1.55; 95%CI= 1.43, 1.68)], nursing facility [ ?85 (OR=3.09; 95%CI= 2.76, 3.45)] or hospice facility death [ ?85 (OR=1.60; 95%CI= 1.49, 1.72)].
CONCLUSIONS:
Hospitals remain the most common place of death from advanced CKD/ESKD, however the proportion of home, nursing facility, and hospice facility deaths have increased.
Copyright © 2020. Published by Elsevier Inc.
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Disrupted Endothelial Cell Heterogeneity and Network Organization Impair Vascular Function in Prediabetic Obesity.
Metabolism2020 Aug;():154340. doi: S0026-0495(20)30204-3.
Wilson Calum, Zhang Xun, Lee Matthew D, MacDonald Margaret, Heathcote Helen R, Alorfi Nasser M N, Buckley Charlotte, Dolan Sharron, McCarron John G,
Abstract
BACKGROUND:
Obesity is a major risk factor for diabetes and cardiovascular diseases such as hypertension, heart failure, and stroke. Impaired endothelial function occurs in the earliest stages of obesity and underlies vascular alterations that give rise to cardiovascular disease. However, the mechanisms that link weight gain to endothelial dysfunction are ill-defined. Increasing evidence suggests that endothelial cells are not a population of uniform cells but are highly heterogeneous and are organized as a communicating multicellular network that controls vascular function.
PURPOSE:
To investigate the hypothesis that disrupted endothelial heterogeneity and network-level organization contribute to impaired vascular reactivity in obesity.
METHODS AND RESULTS:
To study obesity-related vascular function without complications associated with diabetes, a state of prediabetic obesity was induced in rats. Small artery diameter recordings confirmed nitric-oxide mediated vasodilator responses were dependent on increases in endothelial calcium levels and were impaired in obese animals. Single-photon imaging revealed a linear relationship between blood vessel relaxation and population-wide calcium responses. Obesity did not alter the slope of this relationship, but impaired calcium responses in the endothelial cell network. The network comprised structural and functional components. The structural architecture, a hexagonal lattice network of connected cells, was unchanged in obesity. The functional network contained sub-populations of clustered specialized agonist-sensing cells from which signals were communicated through the network. In obesity there were fewer but larger clusters of sensory cells and communication path lengths between clusters increased. Communication between neighboring cells was unaltered in obesity. Altered network organization resulted in impaired, population-level calcium signaling and deficient endothelial control of vascular tone.
CONCLUSIONS:
The distribution of cells in the endothelial network is critical in determining overall vascular response. Altered cell heterogeneity and arrangement in obesity decreases endothelial function and provides a novel framework for understanding compromised endothelial function in cardiovascular disease.
Copyright © 2020 The Author. Published by Elsevier Inc. All rights reserved.
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Nicotine and the nicotinic cholinergic system in COVID-19.
FEBS J2020 Aug;():. doi: 10.1111/febs.15521.
Tizabi Yousef, Getachew Bruk, Copeland Robert L, Aschner Michael,
Abstract
There is an urgent need to address the devastating pandemic, COVID-19, caused by SARS-CoV-2. The efforts to understand the details of this disease in hope of providing effective treatments is commendable. It is clear now that the virus can cause far more damage in patients with co-morbid conditions - particularly in those with respiratory, cardiovascular or immune-compromised system - than in patients without such co-morbidities. Drug use can further exacerbate the condition. In this regard, the ill effects of smoking are amply documented, and no doubt can be a confounding factor in COVID-19 progression. Although conflicting hypotheses on the potential role of nicotine in COVID-19 pathology have recently been offered, we believe that nicotine itself, through its interaction with the nicotinic cholinergic system, as well as ACE2, may not only be of use in a variety of neuropsychiatric and neurodegenerative diseases, but may also be of potential use in COVID-19. Thus, on one hand, while we strongly support smoking cessation as a means of harm reduction associated with COVID-19, on the other hand, we support a potential therapeutic role for nicotine, nicotinic agonists or positive allosteric modulators of nicotinic cholinergic receptors in COVID-19, owing to their varied effects including mood regulation, anti-inflammatory as well as purported interference with SARS-CoV-2 entry and/or replication.
This article is protected by copyright. All rights reserved.
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Correlates of self-rated health in people with diabetic peripheral neuropathy: a longitudinal study.
Diabet Med2020 Aug;():. doi: 10.1111/dme.14383.
Hoogendoorn C J, Gonzalez J S, Schechter C B, Flattau A, Reeves N D, Boulton A J M, Vileikyte L,
Abstract
AIM:
Self-rated health, a measure of self-reported general health, is a robust predictor of morbidity and mortality in various populations, including persons with diabetes. This study examines correlates of self-rated health in adults with diabetic peripheral neuropathy (DPN).
METHODS:
Participants recruited from the UK and USA (n = 295; mean (± sd) age: 61.5 ± 10.7 years; 69% male; 71% type 2 diabetes) rated their health at baseline and 18 months. DPN severity was assessed using the neuropathy disability score and the vibration perception threshold. Validated self-report measures assessed neuroticism, DPN-symptoms of pain, unsteadiness and reduced sensation in feet, DPN-related limitations in daily activities, DPN-specific emotional distress and symptoms of depression.
RESULTS:
In the fully adjusted baseline model, younger age, presence of cardiovascular disease and higher depression symptom scores showed likely clinically meaningful independent associations with worse health ratings. Being at the UK study site and presence of nephropathy indicated potentially meaningful independent associations with lower baseline health ratings. These predictors were largely consistent in their association with health ratings at 18 months.
CONCLUSION:
Results identify independent correlates of health ratings among adults with DPN. Future research should investigate the clinical implications of associations and examine changes in these variables over time and potential effects on changes in health perceptions. If these associations reflect causal pathways, our results may guide interventions to target issues that are likely to have an impact on subjectively experienced health as an important patient-reported outcome in DPN care.
This article is protected by copyright. All rights reserved.
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Defining heart disease risk for death in COVID-19 infection.
QJM2020 Aug;():. doi: hcaa246.
Li Jialing, Guo Tao, Dong Dandan, Zhang Xinxin, Chen Xi, Feng Yujia, Wei Baozhu, Zhang Wei, Zhao Min, Wan Jing,
Abstract
BACKGROUND:
Cardiovascular disease (CVD) was in common in Coronavirus Disease 2019 (COVID-19) patients and associated with unfavorable outcomes. We aimed to compare the clinical observations and outcomes of SARS-CoV-2-infected patients with or without CVD.
METHODS:
Patients with laboratory-confirmed SARS-CoV-2 infection were clinically evaluated at Wuhan Seventh People's Hospital, Wuhan, China, from January 23 to March 14, 2020. Demographic data, laboratory findings, comorbidities, treatments and outcomes were collected and analyzed in COVID-19 patients with and without CVD.
RESULTS:
Among 596 patients with COVID-19, 215 (36.1%) of them with CVD. Compared with patients without CVD, these patients were significantly older (66 years vs 52 years) and had higher proportion of men (52.5% vs 43.8%). Complications in the course of disease were more common in patients with CVD, included acute respiratory distress syndrome (22.8% vs 8.1%), malignant arrhythmias (3.7% vs 1.0%) including ventricular tachycardia/ventricular fibrillation, acute coagulopathy(7.9% vs 1.8%), and acute kidney injury(11.6% vs 3.4%). The rate of glucocorticoid therapy (36.7% vs 25.5%), Vitamin C (23.3% vs 11.8%), mechanical ventilation (21.9% vs 7.6%), intensive care unit admission (12.6% vs 3.7%) and mortality (16.7% vs 4.7%) were higher in patients with CVD (both p?
CONCLUSIONS:
CVD are independent risk factors for COVID-19 patients. COVID-19 patients with CVD were more severe and had higher mortality rate, early intervention and vigilance should be taken.
© The Author(s) 2020. Published by Oxford University Press on behalf of the Association of Physicians.
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Comparing the Effects of Docosahexaenoic and Eicosapentaenoic Acids on Inflammation Markers Using Pairwise and Network Meta-Analyses of Randomized Controlled Trials.
Adv Nutr2020 Aug;():. doi: nmaa086.
Vors Cécile, Allaire Janie, Mejia Sonia Blanco, Khan Tauseef A, Sievenpiper John L, Lamarche Benoît,
Abstract
Recent data from randomized clinical trials (RCTs) suggest that DHA may have stronger anti-inflammatory effects than EPA. This body of evidence has not yet been quantitatively reviewed. The aim of this study was to compare the effect of DHA and EPA on several markers of systemic inflammation by pairwise and network meta-analyses of RCTs. MEDLINE, EMBASE, and The Cochrane Library were searched through to September 2019. We included RCTs of ?7 d on adults regardless of health status that directly compared the effects of DHA with EPA and RCTs of indirect comparisons, in which the effects of DHA or EPA were compared individually to a control fatty acid. Differences in circulating concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-?) and adiponectin were the primary outcome measures. Data were pooled by pairwise and network meta-analysis and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic) in the pairwise meta-analysis. Inconsistency and transitivity were evaluated in the network meta-analysis. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Eligibility criteria were met by 5 RCTs (N = 411) for the pairwise meta-analysis and 20 RCTs (N = 1231) for the network meta-analysis. In the pairwise meta-analysis, DHA and EPA had similar effects on plasma CRP [MDDHA versus EPA = 0.14 mg/L (95% CI: -0.57, 0.85); I2 = 61%], IL-6 [MDDHA versus EPA = 0.10 pg/mL (-0.15, 0.34); I2 = 40%], and TNF-? [MDDHA versus EPA = -0.10 pg/mL (-0.37, 0.18); I2 = 40%]. In the network meta-analysis, the effects of DHA and EPA on plasma CRP [MDDHA versus EPA = -0.33 mg/L (-0.75, 0.10)], IL-6 [MDDHA versus EPA = 0.09 pg/mL (-0.12, 0.30)], and TNF-? [MDDHA versus EPA = -0.02 pg/mL (-0.25, 0.20)] were also similar. DHA and EPA had similar effects on plasma adiponectin in the network meta-analysis. Results from pairwise and network meta-analyses suggest that supplementation with either DHA or EPA does not differentially modify systemic markers of subclinical inflammation.
Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.
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Characterising the application of the "progressive overload" principle of exercise training within cardiac rehabilitation: A United Kingdom-based community programme.
PLoS One2020 ;15(8):e0237197. doi: 10.1371/journal.pone.0237197.
Khushhal Alaa, Nichols Simon, Carroll Sean, Abt Grant, Ingle Lee,
Abstract
BACKGROUND:
Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies.
DESIGN:
Observational study.
METHODS:
We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated.
RESULTS:
Thirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg?m-2] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF10 = 0.61), sRPE (BF10 = 1.1), and change in estimated METs (BF10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed extreme evidence for changes in CV training duration (BF10 = 2.438e+26), TRIMP (BF10 = 71436), and sRPE-TL (BF10 = 779570).
CONCLUSION:
The key exercise training principle of progressive overload was only partially applied. Increases observed in exercise dose were due to increases in the duration of CV training, rather than combined with increases in exercise intensity [%HRR-CV and sRPE]. Accordingly, allied health professionals must ensure that exercise intensity is more consistently progressed to optimise the exercise stimulus and improvements in CRF and patient outcomes.
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Identi?cation and treatment of obstructive sleep apnea by a primary care team with a subset focus on chronic pain management.
PLoS One2020 ;15(8):e0237359. doi: 10.1371/journal.pone.0237359.
Whittington Kathleen, Simpson Leigh, Clay Michael, Tierney Joanna, Harris Dixie,
Abstract
BACKGROUND:
Patients diagnosed with obstructive sleep apnea (OSA), who also consume prescription opioids, have a greater likelihood of morbidity and mortality. This study evaluated whether a primary care team, focused on chronic pain care management, could use a validated questionnaire (STOP-Bang) and motivational follow-up, to increase identification and treatment of OSA.
METHODS:
This study was a retrospective, dual arm, pre/post controlled study. Participants of this study included the complete chronic pain management sub group treated by this primary care team. Participants were ? 18 years old and prescribed daily opioids for treatment of chronic pain. All participants had a multifaceted, individualized, educational meeting that included completing a STOP-Bang questionnaire. Participants who received a score ? three were advised to follow up with their primary care physician. Participants were seen quarterly throughout the study.
RESULTS:
The primary outcome of this study was that 65% of participants with likely OSA were using CPAP for a minimum of 12 months (range of 12-25 months, 18-month average) post-intervention vs. 37% CPAP-use in the control group (12 months of observation), both groups were chronic opioid users with OSA. This was a 28% relative improvement (p = 0.0034). A secondary outcome was that 8.9% of non-prior CPAP users obtained CPAP post- intervention; a 56.7% pre-post improvement (p = 0.0064, x2 = 10.08 with 1 degree of freedom). Also, participants who were likely to have OSA (STOP-Bang score ? 3 or had a positive polysomnography (AHI >5 with comorbidities)) compared to those unlikely to have OSA (STOP-Bang score <3 or had a negative polysomnography (AHI <5)) in this study were more likely to be male, have a higher BMI, have hypertension, have cardiovascular disease and/or have diabetes (all types).
CONCLUSION:
Team based care management for participants taking prescription opioids, where STOP-Bang questionnaires were completed, were associated with an increase in the identification and treatment of OSA.
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Psoriatic disease and body composition: A systematic review and narrative synthesis.
PLoS One2020 ;15(8):e0237598. doi: 10.1371/journal.pone.0237598.
Blake Tim, Gullick Nicola J, Hutchinson Charles E, Barber Thomas M,
Abstract
BACKGROUND:
Obesity is a leading comorbidity in psoriatic disease, including both psoriasis (PsO) and psoriatic arthritis (PsA), and is associated with adverse metabolic and cardiovascular (CV) outcomes. Anthropometric parameters, such as weight, body mass index (BMI) and waist-to-hip ratio, have been extensively reported in psoriatic disease. However, the associations of body composition and fat distribution with psoriasis have not yet been fully defined.
OBJECTIVES:
To identify whether patients with psoriatic disease, including psoriatic arthritis, have altered body composition compared with the general population, and to review existing modalities for the assessment of body composition.
METHODS:
Electronic searches of the literature were conducted in PubMed, Medline (Ovid®), Embase (Ovid®), Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. Titles and abstracts were reviewed by two authors independently against a set of prespecified inclusion/exclusion criteria. The research question was answered with a systematic literature review and results were summarized narratively.
RESULTS:
Twenty-five full text articles met the inclusion criteria and were included in the final narrative analysis. The studies were of heterogeneous design and used a range of objective measures to assess body composition, including simple anthropometric measures, bioimpedance analysis (BIA), dual energy X-ray absorptiometry (DXA) and computed tomography (CT). Few studies met all the quality assessment criteria. Clinical heterogeneity prevented meta-analysis.
CONCLUSIONS:
Patients with psoriatic disease reveal defined body composition changes that are independent of obesity and the customary metabolic syndrome, including higher overall body fat, visceral fat and sarcopenia. These findings emphasize that patients with psoriatic disease should be screened for abnormal adipose effects beyond their weight and body mass index (BMI). Our findings show that the last decade has seen an exciting expansion of research interest in the development and validation of new modalities for the assessment of body composition. There is no consensus on the optimal assessment method of body composition for this diverse group; hence there is a need for validation of existing modalities and standardization of assessment tools.
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Integrated analysis of DNA methylation profile of HLA-G gene and imaging in coronary heart disease: Pilot study.
PLoS One2020 ;15(8):e0236951. doi: 10.1371/journal.pone.0236951.
Schiano Concetta, Benincasa Giuditta, Infante Teresa, Franzese Monica, Castaldo Rossana, Fiorito Carmela, Mansueto Gelsomina, Grimaldi Vincenzo, Della Valle Giovanni, Fatone Gerardo, Soricelli Andrea, Nicoletti Giovanni Francesco, Ruocco Antonio, Mauro Ciro, Salvatore Marco, Napoli Claudio,
Abstract
AIMS:
Immune endothelial inflammation, underlying coronary heart disease (CHD) related phenotypes, could provide new insight into the pathobiology of the disease. We investigated DNA methylation level of the unique CpG island of HLA-G gene in CHD patients and evaluated the correlation with cardiac computed tomography angiography (CCTA) features.
METHODS:
Thirty-two patients that underwent CCTA for suspected CHD were enrolled for this study. Obstructive CHD group included fourteen patients, in which there was a stenosis greater than or equal to 50% in one or more of the major coronary arteries detected; whereas subjects with Calcium (Ca) Score = 0, uninjured coronaries and with no obstructive CHD (no critical stenosis, NCS) were considered as control subjects (n = 18). For both groups, DNA methylation profile of the whole 5'UTR-CpG island of HLA-G was measured. The plasma soluble HLA-G (sHLA-G) levels were detected in all subjects by specific ELISA assay. Statistical analysis was performed using R software.
RESULTS:
For the first time, our study reported that 1) a significant hypomethylation characterized three specific fragments (B, C and F) of the 5'UTR-CpG island (p = 0.05) of HLA-G gene in CHD patients compared to control group; 2) the hypomethylation level of one specific fragment of 161bp (+616/+777) positively correlated with coronary Ca score, a relevant parameter of CCTA (p<0.05) between two groups evaluated and was predictive for disease severity.
CONCLUSIONS:
Reduced levels of circulating HLA-G molecules could derive from epigenetic marks. Epigenetics phenomena induce hypomethylation of specific regions into 5'UTR-CpG island of HLA-G gene in CHD patients with obstructive non critical stenosis vs coronary stenosis individuals.
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The predictive role of circulating telomerase and vitamin D for long-term survival in patients undergoing coronary artery bypass grafting surgery (CABG).
PLoS One2020 ;15(8):e0237477. doi: 10.1371/journal.pone.0237477.
Zarei Mahtab, Najafi Mahdi, Movahedi Elnaz, Javanbakht Mohamad Hassan, Choi Yun-Hee, Yaseri Mehdi, Shirvani Arash, Sellke Frank W, Stranges Saverio,
Abstract
BACKGROUNDS:
Cardiovascular disease (CVD) is the leading cause of mortality all over the globe. Inflammation is believed to play a pivotal role in the pathophysiology of CVD. While there are studies on the interrelationship of telomerase and vitamin D and their involvement in CVD, their independent contributions to long-term outcomes in patients with CVD are not well-defined. This study aimed to investigate the association of both telomerase and vitamin D concentrations with 10-year survival among candidates of coronary artery bypass grafting (CABG) surgery.
METHODS:
Participants were 404 patients from Tehran Heart Center-Coronary Outcome Measurement (THC-COM) cohort who were recruited from CABG surgery candidates in 2006. In addition to demographic and clinical data including risk factors for coronary artery disease, laboratory parameters such as markers of inflammation as well as baseline serum 25-hydroxy vitamin D [25(OH)D] and telomerase concentrations were measured. Cardiac function indexes alongside outcome measures such as mortality and survival days were recorded for every patient up to 10 years after CABG. Cox-proportional hazard model was used to study the association between all-cause mortality and research parameters.
RESULTS:
The mean serum telomerase enzyme level was 24.92 ±21.4 nmol/L and the mean serum 25(OH)D was 27.27±10.3 ng/mL. 10-year mortality was reported in 64 (15.8%) patients. 25(OH)D was categorized into three groups (<20, 20-30, and >30) and the cut-point for telomerase was set at 25.0 nmol/L. In Cox regression analysis, higher levels of telomerase (>25 nmol/L) were significantly associated with longer survival (p = 0.041), whereas 25(OH)D concentrations were not associated with survival time. Further analysis showed that telomerase concentrations significantly predicted survival only in the presence of insufficient levels of 25(OH)D (20-30 ng/mL) (p = 0.037).
CONCLUSIONS:
Telomerase can be regarded as a potential predictor of long-term outcomes in patients who underwent CABG. However, the association of telomerase with the mortality may be modified by vitamin D concentrations.
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Levels of and determinants for physical activity and physical inactivity in a group of healthy elderly people in Germany: Baseline results of the MOVING-study.
PLoS One2020 ;15(8):e0237495. doi: 10.1371/journal.pone.0237495.
Kleinke Fabian, Penndorf Peter, Ulbricht Sabina, Dörr Marcus, Hoffmann Wolfgang, van den Berg Neeltje,
Abstract
BACKGROUND:
Low levels of physical activity (PA) and high levels of physical inactivity (PI) are associated with higher mortality and cardiovascular diseases. Higher age is associated with a decrease of PA, only 2.4-29% of ?60 year-olds achieve the PA times recommended by WHO. The aim of this study was to identify levels of and determinants for moderate PA, overall PA and PI in a sample of individuals aged ?65 years.
METHODS:
We analyzed baseline data from an intervention-study aiming to increase PA and decrease PI by automatically generated feedback letters to objectively measured PA and PI. Recruitment was multimodal including re-contacting participants of previous studies and advertisements in regional public buses and newspapers. At baseline, participants wore an accelerometer over a period of 7 consecutive days. PA was categorized using cut-points suggested by Freedsoon 1998 in light, moderate and vigorous physical intensity as well as physical inactivity. Potential determinants (self-efficacy, education) were measured by questionnaires or in a physical examination (BMI). Multiple linear regression models were fitted to identify determinants for PA and PI.
RESULTS:
N = 199 persons (mean age 71.0 years (SD 4.9), 59.3% female) participated in the study. The weekly amount of overall PA for men was on average 1,821 minutes (SD 479.1), for women on average 1,929 minutes (SD 448.8). 79.7% of the women and 72.8% of the men achieved the WHO recommendation of 30 minutes moderate PA/day at baseline. The time of PI during the observation time period of 7 days was on average 4,057 minutes in men and 3,973 minutes in women. In males, age was found to be a significant negative determinant for overall PA (p = 0.002) and for moderate PA (p<0.001). Higher education was positively associated with higher levels of overall PA (p = 0.013) and moderate PA (p = 0.06) in men. BMI was a significant negative determinant for overall PA both in men (p = 0.039) and women (p = 0.032) as well as for moderate PA for women (p = 0.009). Only in women, not in men, self-efficacy was to be a significant positive determinant for overall PA (p = 0.020) as well as negatively associated with PI (p = 0.006).
DISCUSSION:
The participants of our study showed high levels of PA. This is likely due to selection bias in this convenience sample. However, also levels of PI are very high and those correspond with average levels in the German population. The determinants for higher PA and lower PI differed between males and females. Thus, strategies for improving PA and decrease PI are likely different with respect to sex and should take individual factors (e.g. age, BMI) into account.
TRIAL REGISTRATION NUMBER:
DRKS00010410 Date: 17 May 2017.
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Time-series cardiovascular risk factors and receipt of screening for breast, cervical, and colon cancer: The Guideline Advantage.
PLoS One2020 ;15(8):e0236836. doi: 10.1371/journal.pone.0236836.
Guo Aixia, Drake Bettina F, Khan Yosef M, Langabeer Ii James R, Foraker Randi E,
Abstract
BACKGROUND:
Cancer is the second leading cause of death in the United States. Cancer screenings can detect precancerous cells and allow for earlier diagnosis and treatment. Our purpose was to better understand risk factors for cancer screenings and assess the effect of cancer screenings on changes of Cardiovascular health (CVH) measures before and after cancer screenings among patients.
METHODS:
We used The Guideline Advantage (TGA)-American Heart Association ambulatory quality clinical data registry of electronic health record data (n = 362,533 patients) to investigate associations between time-series CVH measures and receipt of breast, cervical, and colon cancer screenings. Long short-term memory (LSTM) neural networks was employed to predict receipt of cancer screenings. We also compared the distributions of CVH factors between patients who received cancer screenings and those who did not. Finally, we examined and quantified changes in CVH measures among the screened and non-screened groups.
RESULTS:
Model performance was evaluated by the area under the receiver operator curve (AUROC): the average AUROC of 10 curves was 0.63 for breast, 0.70 for cervical, and 0.61 for colon cancer screening. Distribution comparison found that screened patients had a higher prevalence of poor CVH categories. CVH submetrics were improved for patients after cancer screenings.
CONCLUSION:
Deep learning algorithm could be used to investigate the associations between time-series CVH measures and cancer screenings in an ambulatory population. Patients with more adverse CVH profiles tend to be screened for cancers, and cancer screening may also prompt favorable changes in CVH. Cancer screenings may increase patient CVH health, thus potentially decreasing burden of disease and costs for the health system (e.g., cardiovascular diseases and cancers).
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