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Pubblicazioni recenti - cardiovascular disease
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Epigenetic studies and pediatric research.
Pediatr Res2019 Nov;():. doi: 10.1038/s41390-019-0644-9.
Bellanti Joseph A,
Abstract
The 2020 Annual Review Issue, "Preventing Disease in the 21st Century" was selected by the Editors-in-Chief of Pediatric Research to include a variety of disease entities that confront health-care practitioners entrusted to the care of infants and children. In keeping with this mandate, this article reviews the subject of epigenetics, which impacts pediatric research from bench to bedside. Epigenetic mechanisms exert their effects through the interaction of environment, various susceptibility genes, and immunologic development and include: (1) DNA methylation; (2) posttranslational modifications of histone proteins through acetylation and methylation, and (3) RNA-mediated gene silencing by microRNA (miRNA) regulation. The effects of epigenetics during fetal life and early periods of development are first reviewed together with clinical applications of cardiovascular and metabolic disorders in later life. The relationships of epigenetics to the allergic and autoimmune diseases and cancer are next reviewed. A specific focus of the article is directed to the recent recognition that many of these disorders are driven by aberrant immune responses in which immunoregulatory events are often poorly functioning and where through interventive epigenetic measures prevention may be possible by alterations in programming of DNA during fetal and early periods as well as in later life.
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Reporting sample size calculations for randomized controlled trials published in nursing journals: A cross-sectional study.
Int J Nurs Stud2019 Oct;102():103450. doi: S0020-7489(19)30257-3.
Tam Wilson, Lo Kenneth, Woo Brigitte,
Abstract
BACKGROUND:
Prior sample size calculation is essential to ensure that a randomized controlled trial (RCT) has enough power to detect any statistical differences between two groups while not over-recruiting participants. However, the compliance among RCTs published in nursing field is unknown.
OBJECTIVE:
To describe the reporting of sample size methodology and parameters used in RCTs published in nursing journals.
DESIGN:
A cross-sectional database search of all RCTs published in nursing journals was conducted.
SETTING:
116 journals in the category of nursing.
PARTICIPANTS:
Not applicable.
METHODS:
A database search was conducted to identify all RCTs published in nursing journals from January 2016 to December 2016. Two-arm RCTs were reviewed to see if sample size estimation was mentioned in the text and if the parameters were sufficient for the estimation. For RCTs with effect size, sample sizes were recomputed and compared with the reported size.
RESULTS:
Two hundred and twenty-three RCTs were included in this study, and 143 (64.1%) studies mentioned how they obtained their sample sizes. Among these 143 studies, 132 (92.3%), 133 (93.0%), 33 (23.1%), and 84 (58.7%) specified their levels of significance (?), powers, tails of the test, and effect size related information, respectively. Only 22 (15.4%) provided all the necessary parameters to compute their sample sizes. Out of the 84 RCTs with effect size information, 49 (58.3%) had a relative difference of less than 25%.
DISCUSSION:
Around 36% of the RCTs published in nursing journals did not report how they reached their sample sizes. For those that had reported, only 15% provided all the necessary parameters to re-compute their sizes. It is concluded that the methodology and parameters used for sample size determination are inadequately reported in RCTs published in nursing journals.
Copyright © 2019. Published by Elsevier Ltd.
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Effects of road traffic noise on the prevalence of cardiovascular diseases: The case of Thessaloniki, Greece.
Sci Total Environ2019 Nov;703():134477. doi: S0048-9697(19)34468-7.
Begou Paraskevi, Kassomenos Pavlos, Kelessis Apostolos,
Abstract
Road traffic noise is a growing challenge for human health in the last decades. World Health Organization (WHO) summarized the scientific evidence on side effects of noise on public health and wellbeing since 1999 in its publication "Guidelines for community noise". The WHO's documentation was completed in 2009 with the Night Noise Guidelines for Europe and in 2011 with the Burden of disease from environmental noise highlighting the negative effects of environmental noise on health. In this paper, we studied and presented the overall noise levels and the exposure of the population in the city of Thessaloniki, Greece. The estimation of the exposure to road traffic noise was based on the census data for a 15-year time period (e.g. 2000-2015). The quantification of the environmental burden of cardiovascular diseases, due to urban traffic noise, is calculated in terms of DALYs. The calculation is based on the morbidity and mortality data from the hypertensive, ischemic heart, and cerebrovascular diseases of the total population. Our analysis proved that the road traffic noise in Thessaloniki causes almost 2000 DALYs lost in the total population each year. Also, the exposure to road traffic noise was estimated by three measuring points, two of them located in the urban Thessaloniki (a high traffic highway and a residential area) and the third one situated in one urban background area in the urban outskirts of Thessaloniki. The noise levels were measured for a 24-h period during a 3?year time period for every measuring point. The imposed WHO noise levels were exceeded in both high traffic highway and residential areas for almost the whole time of the measurement period.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Exposure to air pollution and risk of hospitalization for cardiovascular diseases amongst Vietnamese adults: Case-crossover study.
Sci Total Environ2019 Nov;703():134637. doi: S0048-9697(19)34628-5.
Nhung Nguyen Thi Trang, Schindler Christian, Chau Ngo Quy, Hanh Phan Thi, Hoang Le Tu, Dien Tran Minh, Thanh Nguyen Thi Nhat, Künzli Nino,
Abstract
BACKGROUND:
Associations between hospital admissions and ambient air pollutants in the Vietnamese population have been reported in previous studies. However, most studies were conducted in Hanoi or Hochiminh city. We used hospital records of seven hospitals in Northern Vietnam to investigate short-term associations between ambient air pollutants and hospital admissions due to cardiovascular conditions.
METHODS:
We used 135'101 hospital records of residents (age ?15) living in three provinces (Hanoi, Quang Ninh, and Phu Tho) and daily ambient air pollutant concentrations to estimate percentage changes and 95% confidence intervals for hospital admissions due to seven cardiovascular conditions per interquartile range (IQR) increases in daily ambient air pollutants. We used a time-stratified case-crossover analysis adjusting for meteorological factors, indicators of holidays and influenza epidemics. We also investigated modification of effects by age groups (<65 and ?65), seasons (cold and hot) and hospital levels (national and province level).
RESULTS:
Particulate matter concentrations were positively associated with daily hospital admissions due to most cardiovascular conditions. For example, an increment in the two-day average (lag1-2) level of PM by one IQR (34.4?µg/m) was associated with a 6.3% (95%CI: 3.0%-9.8%) increase in the daily count of admissions for ischemic heart disease in Hanoi and with 23.2% (95%CI: 11.1%-36.5%) for cardiac failure in Quang Ninh. Moreover, hospitalisations for stroke in Hanoi and cardiac failure in Phu Tho showed strong positive associations with SO. The findings also show that estimates varied by age groups, seasons and hospital levels.
CONCLUSION:
Ambient air pollutants were associated with daily cardiovascular admissions in Northern Vietnam. The findings underline the important role of ambient air pollutants as a trigger of cardiovascular conditions.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Depression in the house: The effects of household air pollution from solid fuel use among the middle-aged and older population in China.
Sci Total Environ2019 Nov;703():134706. doi: S0048-9697(19)34697-2.
Liu Yan, Chen Xi, Yan Zhijun,
Abstract
BACKGROUND:
Although the adverse health effects of ambient air pollution are well documented, evidence on the depression effects of household air pollution (HAP) are scarce.
OBJECTIVES:
We investigated the effects of HAP exposure from the use of solid fuel on depression using a nationally representative dataset of middle-aged and older population in China.
METHODS:
By employing the propensity score matching method, we first matched the type of household fuel based on background information, including demographic characteristics, lifestyles, health status, and household economic levels. Based on the matched data, we conducted OLS and logistic regressions with cluster standard error at community level to examine the effects of household solid fuel use on depression and adjusted for potential confounders. Heterogeneous effects for vulnerable population were also considered.
RESULTS:
We found a significantly higher Center for Epidemiologic Studies Depression Scale (CES-D) score and depression risk among current household solid fuel users. After matching and adjusting for potential confounders, current solid fuel users had a higher CES-D score of 0.59 (95% confidence interval [CI]: 0.31, 0.89) than clean fuel users. The OR of depression risk were 1.26 (95% CI: 1.14, 1.41). Solid fuel users had the highest CES-D scores (??=?0.99, 95% CI: 0.62, 1.36) and depression risk (OR?=?1.49, 95% CI: 1.30, 1.73) for over five years. These associations were generally higher in females, participants aged 65?years and older, with a BMI???25, with low education, with low household economic levels, and those suffer from chronic diseases, including diabetes, chronic lung diseases, and cardiovascular diseases.
CONCLUSIONS:
Exposure to HAP from solid fuel combustion was linked with strong depression outcomes. Findings suggested a need to strengthen public health efforts, such as controlling the social, health, and economic costs of depression by taking the physical environment, including HAP exposure, into account.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Anti-inflammatory cytokines IL-35 and IL-10 block atherogenic lysophosphatidylcholine-induced, mitochondrial ROS-mediated innate immune activation, but spare innate immune memory signature in endothelial cells.
Redox Biol2019 Nov;28():101373. doi: S2213-2317(19)31187-5.
Li Xinyuan, Fang Pu, Sun Yu, Shao Ying, Yang William Y, Jiang Xiaohua, Wang Hong, Yang Xiaofeng,
Abstract
It has been shown that anti-inflammatory cytokines interleukin-35 (IL-35) and IL-10 could inhibit acute endothelial cell (EC) activation, however, it remains unknown if and by what pathways IL-35 and IL-10 could block atherogenic lipid lysophosphatidylcholine (LPC)-induced sustained EC activation; and if mitochondrial reactive oxygen species (mtROS) can differentiate mediation of EC activation from trained immunity (innate immune memory). Using RNA sequencing analyses, biochemical assays, as well as database mining approaches, we compared the effects of IL-35 and IL-10 in LPC-treated human aortic ECs (HAECs). Principal component analysis revealed that both IL-35 and IL-10 could similarly and partially reverse global transcriptome changes induced by LPC. Gene set enrichment analyses showed that while IL-35 and IL-10 could both block acute EC activation, characterized by upregulation of cytokines/chemokines and adhesion molecules, IL-35 is more potent than IL-10 in suppressing innate immune signatures upregulated by LPC. Surprisingly, LPC did not induce the expression of trained tolerance itaconate pathway enzymes but induced trained immunity enzyme expressions; and neither IL-35 nor IL-10 was found to affect LPC-induced trained immunity gene signatures. Mechanistically, IL-35 and IL-10 could suppress mtROS, which partially mediate LPC-induced EC activation and innate immune response. Therefore, anti-inflammatory cytokines could reverse mtROS-mediated acute and innate immune trans-differentiation responses in HAECs, but it could spare metabolic reprogramming and trained immunity signatures, which may not fully depend on mtROS. Our characterizations of anti-inflammatory cytokines in blocking mtROS-mediated acute and prolonged EC activation, and sparing trained immunity are significant for designing novel strategies for treating cardiovascular diseases, other inflammatory diseases, and cancers.
Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.
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Race and sex-based disparities associated with carotid endarterectomy in the Atherosclerosis Risk in Communities (ARIC) study.
Atherosclerosis2019 Nov;292():10-16. doi: S0021-9150(19)31547-3.
Hicks Caitlin W, Daya Natalie R, Black James H, Matsushita Kunihiro, Selvin Elizabeth,
Abstract
BACKGROUND AND AIMS:
The indications for carotid endarterectomy (CEA) are well established. The aim of the current study was to investigate sex and race-based disparities in the incidence of CEA after adjusting for carotid artery stenosis risk factors.
METHODS:
We conducted a prospective cohort analysis of 14,492 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study without prevalent stroke at baseline (1987-1989). We used Kaplan-Meier curves and Cox proportional hazards models adjusting for sociodemographic, cardiovascular, and disease severity risk factors to quantify the associations of sex and race with incident CEA.
RESULTS:
CEA was performed in 330 of 14,492 ARIC participants during a median of 27 years of follow-up [incidence rate 1.00 (95% CI 0.90-1.12) per 1000 persons-years]. The crude incidence of CEA varied significantly by sex [female vs. male: HR 0.60 (95% CI 0.48-0.74)] and race [black vs. white: HR 0.65 (95% CI 0.49-0.86)]. Adjustment for sociodemographic and cardiovascular risk factors, carotid intima-media thickness, and symptomatic status attenuated the association of sex with CEA [females vs. males HR 0.96 (0.76-1.22)], but black participants had a lower risk of incident CEA after adjustment [HR 0.68 (95% CI 0.49-0.95)].
CONCLUSIONS:
We found significant variation in the incidence of CEA procedures based on race that was independent of traditional risk factors and carotid IMT. Whether this disparity is a reflection of differences in disease presentation or access to care deserves investigation.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Adiponectin, a unique adipocyte-derived factor beyond hormones.
Atherosclerosis2019 Nov;292():1-9. doi: S0021-9150(19)31551-5.
Maeda Norikazu, Funahashi Tohru, Matsuzawa Yuji, Shimomura Iichiro,
Abstract
Visceral fat accumulation has a marked impact on atherosclerotic cardiovascular diseases and metabolic syndrome clustering diabetes, dyslipidemia, and hypertension. Adiponectin, an adipocyte-derived circulating protein, is a representative adipocytokine and uniquely possesses two major properties: 1) its circulating concentration is approximately 3-6 orders of magnitude greater than ordinary hormones and cytokines; 2) its concentration inversely correlates with body fat mass despite its adipocyte-specific production. Low serum levels of adiponectin correlate with cardiometabolic diseases. Extensive experimental evidence has demonstrated that adiponectin possesses multiple properties, such as anti-atherosclerotic, anti-diabetic, and anti-inflammatory activities. It has been shown to play a central role against the development of metabolic syndrome and its complications. However, even approximately 25 years after its discovery, the properties of adiponectin, including how and why it exerts multiple beneficial effects on various tissues and/or organs, remain unclear. Furthermore, the mechanisms responsible for the very high circulating concentrations of adiponectin in the bloodstream have not been elucidated. Several adiponectin-binding partners, such as AdipoR1/2, have been identified, but do not fully explain the multi-functional and beneficial properties of adiponectin. Recent advances in adiponectin research may resolve these issues. Adiponectin binds to and covers cell surfaces with T-cadherin, a unique glycosylphosphatidylinositol (GPI)-anchored cadherin. The adiponectin/T-cadherin complex enhances exosomal production and release, excreting cell-toxic products from cells, particularly in the vasculature. In this review, we discuss adiponectin and the role of the adiponectin/T-cadherin system in the maintenance of whole body homeostasis and cardiovascular protection.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Rapeseed oil fortified with micronutrients improves cognitive alterations associated with metabolic syndrome.
Brain Behav Immun2019 Nov;():. doi: S0889-1591(19)30463-5.
Fourrier Célia, Kropp Camille, Aubert Agnčs, Sauvant Julie, Vaysse Carole, Chardigny Jean-Michel, Layé Sophie, Joffre Corinne, Castanon Nathalie,
Abstract
Metabolic syndrome represents a major risk factor for severe comorbidities such as cardiovascular diseases or diabetes. It is also associated with an increased prevalence of emotional and cognitive alterations that in turn aggravate the disease and related outcomes. Identifying therapeutic strategies able to improve those alterations is therefore a major socioeconomical and public health challenge. We previously reported that both hippocampal inflammatory processes and neuronal plasticity contribute to the development of emotional and cognitive alterations in db/db mice, an experimental model of metabolic syndrome that displays most of the classical features of the syndrome. In that context, nutritional interventions with known impact on those neurobiological processes appear as a promising alternative to limit the development of neurobiological comorbidities of metabolic syndrome. We therefore tested here whether n-3 polyunsaturated fatty acids (n-3 PUFAs) associated with a cocktail of antioxidants can protect against the development of behavioral alterations that accompany the metabolic syndrome. Thus, this study aimed: 1) to evaluate if a diet supplemented with the plant-derived n-3 PUFA ?-linolenic acid (ALA) and antioxidants (provided by n-3 PUFAs-rich rapeseed oil fortified with a mix of naturally constituting antioxidant micronutrients, including coenzyme Q10, tocopherol, and the phenolic compound canolol) improved behavioral alterations in db/db mice, and 2) to decipher the biological mechanisms underlying this behavioral effect. Although the supplemented diet did not improve anxiety-like behavior and inflammatory abnormalities, it reversed hippocampus-dependent spatial memory deficits displayed by db/db mice in a water maze task. It concomitantly changed subunit composition of glutamatergic AMPA and NMDA receptors in the hippocampus that has been shown to modulate synaptic function related to spatial memory. These data suggest that changes in local neuronal plasticity may underlie cognitive improvements in db/db mice fed the supplemented diet. The current findings might therefore provide valuable data for introducing new nutritional strategies for the treatment of behavioral complications associated with MetS.
Copyright © 2019. Published by Elsevier Inc.
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Does a physically active lifestyle attenuate the association between alcohol consumption and mortality risk? Findings from the UK biobank.
Prev Med2019 Nov;():105901. doi: S0091-7435(19)30381-0.
Powell Lauren, Feng Yingyu, Duncan Mitch J, Hamer Mark, Stamatakis Emmanuel,
Abstract
Alcohol consumption is common across Western culture, despite its associations with adverse health outcomes, including cancer and cardiovascular disease (CVD). Physical activity (PA) has beneficial effects on many alcohol related outcomes, with data suggesting PA may offset the association between alcohol consumption and mortality. This study examined the joint associations of PA and alcohol on all-cause, CVD and cancer mortality. Participants were recruited between 2006 and 2010 in the United Kingdom. Alcohol consumption was categorised based on current UK guidelines (14?units/week). PA was categorised based on the Metabolic Task Equivalent of PA as low, moderate and high. Data were analysed using Cox proportional-hazard models. The final analysis, conducted in 2019, included 297,988 adults aged ?40. Over an average follow-up of 6.9?years, 6079 deaths were recorded, including 1219 CVD deaths and 3112 cancer deaths. We observed greater point estimates for risk of all-cause mortality among low PA individuals who consumed alcohol at the same level as active individuals. For example, low PA participants who reported alcohol consumption ?double guidelines had a greater HR (1.55, 95% CI 1.25, 1.93) than active individuals (moderate PA HR 1.21, 95% CI 0.95, 1.54; high PA HR 1.21, 95% CI 1.00, 1.46). Considering CVD, we observed a similar trend with lower point estimates of risk of mortality among active individuals. We found some evidence that PA modified the associations of alcohol and all-cause and CVD mortality in this large population sample of British adults.
Copyright © 2018. Published by Elsevier Inc.
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Analysis of dynamic texture and spatial spectral descriptors of dynamic contrast-enhanced brain magnetic resonance images for studying small vessel disease.
Magn Reson Imaging2019 Nov;():. doi: S0730-725X(19)30496-5.
Bernal Jose, Valdés-Hernández Maria Del C, Escudero Javier, Viksne Linda, Heye Anna K, Armitage Paul A, Makin Stephen, Touyz Rhian M, Wardlaw Joanna M,
Abstract
Cerebral small vessel disease (SVD) comprises various pathological processes affecting small brain vessels and damaging white and grey matter. In this paper, we propose a framework comprising region of interest sampling, dynamic spectral and texture description, functional principal component analysis, and statistical analysis to study exogenous contrast agent distribution over time in various brain regions in patients with recent mild stroke and SVD features.We compared our results against current semi-quantitative surrogates of dysfunction such as signal enhancement area and slope. Biological sex, stroke lesion type and overall burden of white matter hyperintensities (WMH) were significant predictors of intensity, spectral, and texture features extracted from the ventricular region (p-value < 0.05), explaining between a fifth and a fourth of the data variance (0.20 ?Adj.R ? 0.25). We observed that spectral feature reflected more the dysfunction compared to other descriptors since the overall WMH burden explained consistently the power spectra variability in blood vessels, cerebrospinal fluid, deep grey matter and white matter. Our preliminary results show the potential of the framework for the analysis of dynamic contrast-enhanced brain magnetic resonance imaging acquisitions in SVD since significant variation in our metrics was related to the burden of SVD features. Therefore, our proposal may increase sensitivity to detect subtle features of small vessel dysfunction. A public version of the code will be released on our research website.
Copyright © 2019. Published by Elsevier Inc.
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Macrophage Polarization in Atherosclerosis.
Clin Chim Acta2019 Nov;():. doi: S0009-8981(19)32098-4.
Yang Sai, Yuan Hou-Qin, Hao Ya-Meng, Ren Zhong, Qu Shun-Lin, Liu Lu-Shan, Wei Dang-Heng, Tang Zhi-Han, Zhang Ji-Feng, Jiang Zhi-Sheng,
Abstract
Atherosclerosis is a chronic inflammatory response that increases the risk of cardiovascular diseases. An in-depth study of the pathogenesis of atherosclerosis is critical for the treatment of atherosclerotic cardiovascular disease. The development of atherosclerosis involves many cells, such as endothelial cells, vascular smooth muscle cells, macrophages, and others. The considerable effects of macrophages in atherosclerosis are inextricably linked to macrophage polarization and the resulting phenotype. Moreover, the significant impact of macrophages on atherosclerosis depend not only on the function of the different macrophage phenotypes but also on the relative ratio of different phenotypes in the plaque. Research on atherosclerosis therapy indicates that the reduced plaque size and enhanced stability are partly due to modulating macrophage polarization. Therefore, regulating macrophage polarization and changing the proportion of macrophage phenotypes in plaques is a new therapeutic approach for atherosclerosis. This review provides a new perspective for atherosclerosis therapy by summarizing the relationship between macrophage polarization and atherosclerosis, as well as treatment targeting macrophage polarization.
Copyright © 2019. Published by Elsevier B.V.
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Effect of (m)VD-hemopressin against A?1-42-induced oxidative stress and apoptosis in mouse hippocampal neurons.
Peptides2019 Nov;():170185. doi: S0196-9781(19)30163-9.
Zhang Ruisan, Zheng Yongcai, Hu Fengrui, Meng Xin, Lv Bosen, Lao Kejing, Gao Xingchun, Zhang Xiaohua, Gou Xingchun,
Abstract
Alzheimer's disease (AD) is a serious neurodegenerative disease. Senile plaques (SPs) composed of amyloid-? (A?) are typical features of AD. A? plays a key role in the disease and has the ability to induce other pathological characteristics of AD, including oxidative stress injury. (m)VD-hemopressin (VD), a peptide derived from mouse brain extracts, can bind cannabinoid 1 receptor (CB1R) as an agonist. Our previous report indicated that VD reverses memory impairment induced by A?1-42 in mice. This study aimed to clarify the mechanism by which VD protects hippocampal neurons against A?1-42-induced impairment. Our results showed that VD inhibited oxidative stress injury induced by A?1-42, as demonstrated by the VD-induced reversal of the upregulation of reactive oxygen species (ROS) and the intracellular lipid peroxidation product malondialdehyde (MDA) and the downregulation of the activities of the antioxidative enzymes catalase (CAT) and glutathione peroxidase (GSH-PX) in mouse hippocampal neurons. We also found that VD restored the decrease in cell growth and viability induced by A?1-42 and reversed A?1-42-induced apoptosis mediated by the apoptosis-associated proteins Bcl-2 and Bax. However, cotreatment with AM251 (an antagonist of CB1R) blocked the effects of VD. In brief, this study suggested that through CB1R, VD reversed the impairment of cell growth and viability, oxidative stress injury and apoptosis induced by A?1-42. Therefore, VD may be a promising agent for the treatment of diseases that involve oxidative stress injury and apoptosis induced by A?1-42, such as AD.
Copyright © 2019. Published by Elsevier Inc.
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Percutaneous gallbladder drainage as a bridge to concomitant coronary artery bypass grafting and laparoscopic cholecystectomy.
J Card Surg2019 Nov;():. doi: 10.1111/jocs.14340.
Fu Xian-Ming, Zhao Yuan, Li Jian-Ming, Zhang Xia, Zhou Xin-Min, Liao Xiao-Bo,
Abstract
A 74-year-old woman with left main and three-vessel coronary artery disease was scheduled for off-pump coronary artery bypass grafting and developed acute severe cholecystitis preoperatively. Percutaneous gallbladder drainage was placed to achieve gallbladder decompression and infection control. Two weeks later, CABG and laparoscopic cholecystectomy were successfully performed at the same time.
© 2019 Wiley Periodicals, Inc.
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Comparisons of exacerbations and mortality among regular inhaled therapies for patients with stable chronic obstructive pulmonary disease: Systematic review and Bayesian network meta-analysis.
PLoS Med2019 Nov;16(11):e1002958. doi: 10.1371/journal.pmed.1002958.
Lee Hyun Woo, Park Jimyung, Jo Junwoo, Jang Eun Jin, Lee Chang-Hoon,
Abstract
BACKGROUND:
Although exacerbation and mortality are the most important clinical outcomes of stable chronic obstructive pulmonary disease (COPD), the drug classes that are the most efficacious in reducing exacerbation and mortality among all possible inhaled drugs have not been determined.
METHODS AND FINDINGS:
We performed a systematic review (SR) and Bayesian network meta-analysis (NMA). We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the European Union Clinical Trials Register, and the official websites of pharmaceutical companies (from inception to July 9, 2019). The eligibility criteria were as follows: (1) parallel-design randomized controlled trials (RCTs); (2) adults with stable COPD; (3) comparisons among long-acting muscarinic antagonists (LAMAs), long-acting beta-agonists (LABAs), inhaled corticosteroids (ICSs), combined treatment (ICS/LAMA/LABA, LAMA/LABA, or ICS/LABA), or a placebo; and (4) study duration ? 12 weeks. This study was prospectively registered in International Prospective Register of Systematic Reviews (PROSPERO; CRD42017069087). In total, 219 trials involving 228,710 patients were included. Compared with placebo, all drug classes significantly reduced the total exacerbations and moderate to severe exacerbations. ICS/LAMA/LABA was the most efficacious treatment for reducing the exacerbation risk (odds ratio [OR] = 0.57; 95% credible interval [CrI] 0.50-0.64; posterior probability of OR > 1 [P(OR > 1)] < 0.001). In addition, in contrast to the other drug classes, ICS/LAMA/LABA and ICS/LABA were associated with a significantly higher probability of reducing mortality than placebo (OR = 0.74, 95% CrI 0.59-0.93, P[OR > 1] = 0.004; and OR = 0.86, 95% CrI 0.76-0.98, P[OR > 1] = 0.015, respectively). The results minimally changed, even in various sensitivity and covariate-adjusted meta-regression analyses. ICS/LAMA/LABA tended to lower the risk of cardiovascular mortality but did not show significant results. ICS/LAMA/LABA increased the probability of pneumonia (OR for triple therapy = 1.56; 95% CrI 1.19-2.03; P[OR > 1] = 1.000). The main limitation is that there were few RCTs including only less symptomatic patients or patients at a low risk.
CONCLUSIONS:
These findings suggest that triple therapy can potentially be the best option for stable COPD patients in terms of reducing exacerbation and all-cause mortality.
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Area-level Socioeconomic Environment and Cardiorespiratory Fitness in Youth.
Med Sci Sports Exerc2019 Dec;51(12):2474-2481. doi: 10.1249/MSS.0000000000002066.
Clennin Morgan N, Dowda Marsha, Sui Xuemei, Pate Russell R,
Abstract
INTRODUCTION:
Cardiorespiratory fitness is one of the most important markers of cardiometabolic health and is a strong predictor of cardiovascular disease and all-cause mortality across the lifespan. However, little is known regarding the relationship of area-level socioeconomic environment on cardiorespiratory fitness during childhood and adolescence.
PURPOSE:
To examine the relationship between area-level socioeconomic environment and cardiorespiratory fitness in a diverse sample of school-age youth; and to determine the extent to which grade level, sex, race/ethnicity, and student poverty status moderate this relationship.
METHODS:
South Carolina FitnessGram data for school year 2015 to 2016 were obtained for 44,078 youth. Cardiorespiratory fitness was determined using Progressive Aerobic Cardiovascular Endurance Run or 1-mile run/walk test. Area-level socioeconomic environment was expressed as a composite index score at the census tract level using data from the American Community Survey. Multilevel logistic regression analyses were conducted, controlling for individual-level characteristics and nesting within schools and districts. Interaction terms were then introduced to the model to examine their effect of multiple sociodemographic moderators.
RESULTS:
Approximately half of the sample had inadequate cardiorespiratory fitness for health. The odds of achieving the Healthy Fitness Zone for cardiorespiratory fitness decreased by approximately 25% to 34% with increasing deprivation of the area-level socioeconomic environment, after controlling for covariates. The association between area-level socioeconomic environment and cardiorespiratory fitness also varied significantly by sex, grade level, and race/ethnicity subgroups.
CONCLUSIONS:
Cardiorespiratory fitness was positively associated with area-level socioeconomic environment; however, the relationship varied by demographic characteristics. These results highlight the importance of examining the influence of area-level socioeconomic environment on health across the life span. Additional research is needed to explore how area-level socioeconomic environment may impact evidence-based efforts to improve youth cardiorespiratory fitness levels.
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Research Progress of Mechanisms and Drug Therapy For Atherosclerosis on Toll-Like Receptor Pathway.
J Cardiovasc Pharmacol2019 Nov;74(5):379-388. doi: 10.1097/FJC.0000000000000738.
Yin Qi-Yang, Zhao Bo, Qiu Yan-Ying, Fei Yu-Xiang, Hu Ya-Hui, Li Yun-Man,
Abstract
Recent reports have established atherosclerosis (AS) as a major factor in the pathogenetic process of cardiovascular diseases such as ischemic stroke and coronary heart disease. Although the possible pathogenesis of AS remains to be elucidated, a large number of investigations strongly suggest that the inhibition of toll-like receptors (TLRs) alleviates the severity of AS to some extent by suppressing vascular inflammation and the formation of atherosclerotic plaques. As pattern recognition receptors, TLRs occupy a vital position in innate immunity, mediating various signaling pathways in infective and sterile inflammation. This review summarizes the available data on the research progress of AS and the latest antiatherosclerotic drugs associated with TLR pathway.
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Assessment of cardiac risk in chronic asymptomatic alcoholics using blood pressure and electrocardiogram, and the relation with duration of drinking.
J Basic Clin Physiol Pharmacol2019 Nov;():. doi: 10.1515/jbcpp-2019-0205.
Iyer Shruti, Omprakash Abirami,
Abstract
Background The Global Status Report 2017 reveals that 11% of Indians indulge in binge drinking. Chronic alcohol intake may lead to cardiac problems and hypertension. The aim of this study was to evaluate cardiovascular risk among asymptomatic chronic alcoholics. Methods A total of 80 asymptomatic chronic alcoholics of South Indian origin, from the psychiatry ward of Sri Ramachandra Institute of Higher Education and Research, India were diagnosed with alcohol dependence syndrome(ADS). Group I includes alcoholics for 10 years or less and group II includes alcoholics for more than 10 years. Alcohol consumption was measured using the DSM IV criteria. Blood pressure (BP) and electrocardiographic (ECG) data were measured on admission and 2 weeks later. The paired t-test compared a significant outcome of the two sets of data at p ? 0.05 level of significance. Results Forty percent of the patients were found to be hypertensive and only 2.5% were found to be pre-hypertensive on admission. The mean age of the hypertensives was 46.9 and nonhypertensives was 42.1 The difference in the BP evaluated after 2 weeks was staggering - systolic BP had a mean fall of 6.1 mm Hg (p < 0.001) and diastolic BP 2.25 mm Hg (p = 0.001). The electrocardiogram results showed significant changes like left ventricular hypertrophy, abnormal T waves, and QT prolongation. Conclusions Chronic alcoholism is a major criterion for heart abnormalities such as elevated BP and left ventricular enlargement, and our study supports this as we see that alcohol consumption for more than 10 years shows significant deterioration. Further clinical observations and long-term prospective studies are needed to confirm these observations.
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Explaining income-related inequalities in cardiovascular risk factors in Tunisian adults during the last decade: comparison of sensitivity analysis of logistic regression and Wagstaff decomposition analysis.
Int J Equity Health2019 Nov;18(1):177. doi: 10.1186/s12939-019-1047-6.
Saidi Olfa, Zoghlami Nada, Bennett Kathleen E, Mosquera Paola Andrea, Malouche Dhafer, Capewell Simon, Romdhane Habiba Ben, O'Flaherty Martin,
Abstract
BACKGROUND:
It is important to quantify inequality, explain the contribution of underlying social determinants and to provide evidence to guide health policy. The aim of the study is to explain the income-related inequalities in cardiovascular risk factors in the last decade among Tunisian adults aged between 35 and 70?years old.
METHODS:
We performed the analysis by applying two approaches and compared the results provided by the two methods. The methods were global sensitivity analysis (GSA) using logistic regression models and the Wagstaff decomposition analysis.
RESULTS:
Results provided by the two methods found a higher risk of cardiovascular diseases and diabetes in those with high socio-economic status in 2005. Similar results were observed in 2016. In 2016, the GSA showed that education level occupied the first place on the explanatory list of factors explaining 36.1% of the adult social inequality in high cardiovascular risk, followed by the area of residence (26.2%) and income (15.1%). Based on the Wagstaff decomposition analysis, the area of residence occupied the first place and explained 40.3% followed by income and education level explaining 19.2 and 14.0% respectively. Thus, both methods found similar factors explaining inequalities (income, educational level and regional conditions) but with different rankings of importance.
CONCLUSIONS:
The present study showed substantial income-related inequalities in cardiovascular risk factors and diabetes in Tunisia and provided explanations for this. Results based on two different methods similarly showed that structural disparities on income, educational level and regional conditions should be addressed in order to reduce inequalities.
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Electrical Stimulation in the Treatment of Lymphedema and Associated Skin Ulcers.
Lymphat Res Biol2019 Nov;():. doi: 10.1089/lrb.2019.0052.
Baglivo Mirko, Martelli Francesco, Paolacci Stefano, Manara Elena, Michelini Sandro, Bertelli Matteo,
Abstract
Lymphedema is a disorder in which lymph accumulates in the interstitial spaces due to poor lymphatic flow resulting from hypoplasia or aplasia of the lymphatic vessels, or to morpho-functional alterations that impair lymphatic flow. Lymphedema is a debilitating condition associated initially with inflammation that then degenerates into hardening of affected tissues and the formation of ulcers on the skin of affected limbs. No definitive treatment is available. The only therapy for lymphedema consists of physiotherapy, surgery, and compression to reduce impairment, which only treats the symptoms, not the causes. A possible new therapy that could reinforce the treatment of lymphedema progression and complications is electrical stimulation (ES). Many studies underline the effects of electric currents on the different cell mechanisms associated with disease. In this review, we summarize the effects of ES on the molecular and cellular processes involved in the pathophysiology of lymphedema, highlighting their therapeutic potential for edema reduction, ulcer repair, and restoration of lymphatic flow and . ES exerts its effect on the main stages that characterize lymphedema, from its onset to ulcer formation. There are few evidences on lymphatic models and more molecular studies are needed to understand the mechanism of action of this application in the treatment of lymphedema.
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