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Pubblicazioni recenti - cardiovascular disease
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Cost of primary care approaches for hypertension management and risk-based cardiovascular disease prevention in Bangladesh: a HEARTS costing tool application.
BMJ Open2022 Jun;12(6):e061467. doi: 10.1136/bmjopen-2022-061467.
Husain Muhammad Jami, Haider Mohammad Sabbir, Tarannum Renesa, Jubayer Shamim, Bhuiyan Mahfuzur Rahman, Kostova Deliana, Moran Andrew E, Choudhury Sohel Reza,
Abstract
OBJECTIVE:
To estimate the costs of scaling up the HEARTS pilot project for hypertension management and risk-based cardiovascular disease (CVD) prevention at the full population level in the four subdistricts (upazilas) in Bangladesh.
SETTINGS:
Two intervention scenarios in subdistrict health complexes: hypertension management only, and risk-based integrated hypertension, diabetes, and cholesterol management.
DESIGN:
Data obtained during July-August 2020 from subdistrict health complexes on the cost of medications, diagnostic materials, staff salaries and other programme components.
METHODS:
Programme costs were assessed using the HEARTS costing tool, an Excel-based instrument to collect, track and evaluate the incremental annual costs of implementing the HEARTS programme from the health system perspective.
PRIMARY AND SECONDARY OUTCOME MEASURES:
Programme cost, provider time.
RESULTS:
The total annual cost for the hypertension control programme was estimated at US$3.2?million, equivalent to US$2.8 per capita or US$8.9 per eligible patient. The largest cost share (US$1.35?million; 43%) was attributed to the cost of medications, followed by the cost of provider time to administer treatment (38%). The total annual cost of the risk-based integrated management programme was projected at US$14.4?million, entailing US$12.9 per capita or US$40.2 per eligible patient. The estimated annual costs per patient treated with medications for hypertension, diabetes and cholesterol were US$18, US$29 and US$37, respectively.
CONCLUSION:
Expanding the HEARTS hypertension management and CVD prevention programme to provide services to the entire eligible population in the catchment area may face constraints in physician capacity. A task-sharing model involving shifting of select tasks from doctors to nurses and local community health workers would be essential for the eventual scale-up of primary care services to prevent CVD in Bangladesh.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Examining anti-inflammatory therapies in the prevention of cardiovascular events: protocol for a systematic review and network meta-analysis of randomised controlled trials.
BMJ Open2022 Jun;12(6):e062702. doi: 10.1136/bmjopen-2022-062702.
Boczar Kevin Emery, Shin Sheojung, Bezzina Kathryn A, Geejo Aishwarya, Pearson Alexander Liam, Shahab Saba, Fehlmann Christophe A, Visintini Sarah, Beanlands Rob, Wells George A,
Abstract
INTRODUCTION:
Inflammation is emerging as an important risk factor for atherosclerotic cardiovascular disease and has been a recent target for many novel therapeutic agents. However, comparative evidence regarding efficacy of these anti-inflammatory treatment options is currently lacking.
METHODS AND ANALYSIS:
This systematic review will include randomised controlled trials evaluating the effect of anti-inflammatory agents on cardiovascular outcomes in patients with known cardiovascular disease. Studies will be retrieved from Medline, Embase, the Cochrane Central Register of Controlled Trials, as well as clinical trial registry websites, Europe PMC and conference abstract handsearching. No publication date or language restrictions will be imposed. Eligible interventions must have some component of anti-inflammatory agent. These include (but are not limited to): non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, prednisone, methotrexate, canakinumab, pexelizumab, anakinra, succinobucol, losmapimod, inclacumab, atreleuton, LP-PLA (darapladib) and sPLA (varespladib). The primary outcomes will include major adverse cardiac events (MACE), and each individual component of MACE (myocardial infarction, stroke and cardiovascular death). Key secondary outcomes will include unstable angina, heart failure, all-cause mortality, cardiac arrest and revascularisation. Screening, inclusion, data extraction and quality assessment will be performed independently by two reviewers. Network meta-analysis based on the random effects model will be conducted to compare treatment effects both directly and indirectly. The quality of the evidence will be assessed with appropriate tools including the Grading of Recommendations, Assessment, Development and Evaluation profiler or Confidence in Network Meta-Analysis tool.
ETHICS AND DISSEMINATION:
Ethics approval is not required for this systematic review. The findings will be disseminated through a peer-reviewed journal.
PROSPERO REGISTRATION NUMBER:
CRD42022303289.
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Swinging heart seen on single-photon emission computed tomography (SPECT).
BMJ Case Rep2022 Jun;15(6):. doi: e246487.
Mishra Shreya, Zoltowska Dominika, Zenni Martin, Sattiraju Srinivasan,
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HDAC1 Promotes Myocardial Fibrosis in Diabetic Cardiomyopathy by Inhibiting BMP-7 Transcription Through Histone Deacetylation.
Exp Clin Endocrinol Diabetes2022 Jun;():. doi: 10.1055/a-1780-8768.
Ouyang Chun, Huang Lei, Ye Xiaoqiang, Ren Mingming, Han Zhen,
Abstract
OBJECTIVE:
Diabetic cardiomyopathy (DCM) constitutes a primary cause of mortality in diabetic patients. Histone deacetylase (HDAC) inhibition can alleviate diabetes-associated myocardial injury. This study investigated the mechanism of HDAC1 on myocardial fibrosis (MF) in DCM.
METHODS:
A murine model of DCM was established by a high-fat diet and streptozotocin injection. The bodyweight, blood glucose, serum insulin, and cardiac function of mice were analyzed. Lentivirus-packaged sh-HDAC1 was injected into DCM mice and high glucose (HG)-induced cardiac fibroblasts (CFs). The pathological structure of the myocardium and the level of myocardial fibrosis were observed by histological staining. HDAC1 expression in mouse myocardial tissues and CFs was determined. Collagen I, collagen III, alpha-smooth muscle actin (?-SMA), and vimentin levels in CFs were detected, and CF proliferation was tested. HDAC activity and histone acetylation levels in tissues and cells were measured. Bone morphogenetic protein-7 (BMP-7) expression in myocardial tissues and CFs was determined. Functional rescue experiments were conducted to confirm the effects of histone acetylation and BMP-7 on myocardial fibrosis.
RESULTS:
DCM mice showed decreased bodyweight, elevated blood glucose and serum insulin, and cardiac dysfunction. Elevated HDAC1 and reduced BMP-7 expressions were detected in DCM mice and HG-induced CFs. HDAC1 repressed BMP-7 transcription through deacetylation. HDAC1 silencing alleviated MF, reduced CF proliferation and decreased collagen I, -III, ?-SMA, and vimentin levels. However, reducing histone acetylation level or BMP-7 downregulation reversed the effects of HDAC1 silencing on CF fibrosis.
CONCLUSION:
HDAC1 repressed BMP-7 transcription by enhancing histone deacetylation, thereby promoting MF and aggravating DCM.
Thieme. All rights reserved.
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Serial Left and Right Ventricular Strain Analysis in Patients Recovered from COVID-19.
J Am Soc Echocardiogr2022 Jun;():. doi: S0894-7317(22)00310-8.
Young Kathleen A, Krishna Hema, Jain Vaibhav, Hamza Izhan, Scott Christopher G, Pellikka Patricia A, Villarraga Hector R,
Abstract
BACKGROUND:
Strain analysis of transthoracic echocardiography (TTE) is a sensitive tool to detect myocardial dysfunction in those affected by COVID-19. Consideration of pre-existing cardiovascular disease is important in detecting changes related to COVID-19. We sought to assess serial TTE changes in patients recovered from COVID-19 compared to baseline, pre-COVID-19 exams, with a focus on left and right ventricular longitudinal strain.
METHODS:
In this retrospective review of serial TTEs in confirmed COVID-19 patients at Mayo Clinic sites, included patients had a TTE within 2 years prior to confirmed COVID-19 diagnosis and the first available outpatient TTE after diagnosis used as comparison. Patients with interval cardiac surgery, procedure, or device placement (n=9) were excluded. Biventricular strain was retrospectively performed on both echocardiograms.
RESULTS:
Of 259 individuals, age 60±16 years, 47% female, and 88% Caucasian, post-COVID-19 TTEs were performed a median of 55 days (IQR 37-92) following diagnosis. No clinically significant TTE changes were noted, though left ventricular ejection fraction (LVEF) was higher (58% vs 57%, p=0.049) and tricuspid annulus plane systolic excursion lower (20 vs 21mm, p=0.046) following COVID-19. Baseline LV global longitudinal strain (LV GLS) and right ventricular free wall strain (RV FWS) were normal (-19.6% and -25.8%, respectively) and similar following COVID-19 (-19.6% and -25.7%, p=0.07 and 0.77, respectively). In the 74 inpatients, no significant change from baseline was seen for LV GLS (-19.4% vs -19.1%, p=0.62), RV FWS (-25.5% vs -25.0%, p=0.69), or LVEF (57% vs 57%, p=0.71). A significant worsening in strain occurred in 27 patients, 16 (6.8%) of the 237 with LV GLS and 14 (6.0%) of the 235 with RV FWS. Ten (20%) patients reporting new symptoms following COVID-19 had worsened strain, compared to 5 (7%) with persistent/progressive symptoms and 11 (9%) with no new symptoms (p=0.04).
CONCLUSIONS:
While patients with new symptoms following COVID-19 were more likely to have a worsening in absolute strain values, no clinically significant change in TTE parameters was evident in most patients following COVID-19 regardless of symptom status.
Copyright © 2022. Published by Elsevier Inc.
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Abdominal aortic aneurysm in heart transplant recipients: new insights from a 30-year experience at a single center.
Ann Vasc Surg2022 Jun;():. doi: S0890-5096(22)00311-9.
Tchana-Sato Vincent, Koch Jean-Noël, Ancion Arnaud, Adelin Albert, Minga Lowampa Elie, Burelli Mara, Defraigne Jean-Olivier, Sakalihasan Natzi,
Abstract
OBJECTIVE:
The improvement in survival rates for heart transplant recipients (HTRs) has increased their risk of developing extracardiac diseases such as abdominal aortic aneurysms (AAAs). The purposes of this study were to evaluate the prevalence and to describe the clinical features and natural history of AAA in HTRs.
METHODS:
A retrospective review of all patients (375) who underwent heart transplantation (HT) at our center over a 32-year period (1983-2015) was carried out.
RESULTS:
We identified 20 patients (5.3%) with AAA. All but one patient were male (95%), and most of them (80%) had a history of ischemic heart disease (IHD) prior to transplantation. The mean age of the patients with AAA at transplant was 57.2±7.3 years (range: 42-62 years). Seven of the 20 patients with AAA already had an AAA (30 to 55 mm) prior to transplantation. The average aneurysm size at the time of diagnosis was 40.9±9.6 mm, and the average patient age at the time of diagnosis was 62.2±8.3 years. The mean linear expansion rate was 10.6±2.12 mm/y, and the exponential expansion rate was 0.220±0.040 year respectively. The median follow-up time was 5.4 years (range 0.1-27.4 years). The median survival was 143 months (95% confidence interval (CI) 65 to 180 months) for the 20 HTRs with AAA and 68.8 months (95% CI 46 to 88 months) for the other HTRs.
CONCLUSIONS:
The natural history of AAA in HTR is characterized by an increased expansion rate. Male HTR with end-stage IHD are particularly at risk and should be closely followed-up after HT.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Safety and Efficacy of Ultra Short-Duration Dual Antiplatelet Therapy After Percutaneous Coronary Interventions: A Meta analysis of Randomized Controlled Trials.
Curr Probl Cardiol2022 Jun;():101295. doi: S0146-2806(22)00192-X.
Abusnina Waiel, Baral Nischit, Seri Amith, Ben-Dor Itsik, Alkhouli Mohamad, Monteleone Peter, Haddad Elias, Goldsweig Andrew M, Paul Timir K,
Abstract
INTRODUCTION:
Dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention (PCI) to reduce stent thrombosis, but DAPT increases bleeding risks. The optimal duration of DAPT that provides the maximum protective ischemic effect along with the minimum bleeding risk is unclear. This is the first meta-analysis comparing outcomes for 1-month versus longer DAPT strategies following PCI.
METHODS:
We searched PubMed, Cochrane, and ClinicalTrials.gov databases (from inception to October 2021) for randomized controlled trials (RCTs) that compared 1-month duration versus > 1-month duration of DAPT following PCI. We used a random-effects model to calculate risk ratio (RR) with 95% confidence interval (CI). The co-primary outcomes for study selection were all-cause mortality, major bleeding, and stent thrombosis. Secondary outcomes included myocardial infarction (MI), cardiovascular mortality, ischemic stroke and target vessel revascularization.
RESULTS:
A total of five RCTs were included [n=29,355; 1-month DAPT(n=14,662) vs > 1-month DAPT (n=14,693)]. There was no statistically significant difference between the two groups in terms of all-cause mortality (RR 0.89; 95% CI 0.78-1.03; p?=?0.12) and stent thrombosis (RR 1.07; 95% CI 0.80-1.43; p?=?0.65). Similarly, there were no significant differences in MI, cardiovascular mortality, ischemic stroke, and target vessel revascularization. The rate of major bleeding was significantly lower in the group treated with DAPT for 1-month (RR 0.74; 95% CI 0.56-0.99, p?=?0.04).
CONCLUSION:
There is no difference in all-cause mortality, cardiovascular mortality, MI, stent thrombosis, ischemic stroke and target vessel revascularization with 1-month of DAPT following PCI with contemporary drug eluting stents compared to longer DAPT duration.
Copyright © 2022 Elsevier Ltd. All rights reserved.
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TRPP2 ion channels: The roles in various subcellular locations.
Biochimie2022 Jun;():. doi: S0300-9084(22)00172-9.
Tian Peng-Fei, Sun Meng-Meng, Hu Xian-Yu, Du Juan, He Wei,
Abstract
TRPP2 (PC2, PKD2 or Polycytin-2), encoded by PKD2 gene, belongs to the nonselective cation channel TRP family. Recently, the three-dimensional structure of TRPP2 was constructed. TRPP2 mainly functions in three subcellular compartments: endoplasmic reticulum, plasma membrane and primary cilia. TRPP2 can act as a calcium-activated intracellular calcium release channel on the endoplasmic reticulum. TRPP2 also interacts with other Ca release channels to regulate calcium release, like IP3R and RyR2. TRPP2 acts as an ion channel regulated by epidermal growth factor through activation of downstream factors in the plasma membrane. TRPP2 binding to TRPC1 in the plasma membrane or endoplasmic reticulum is associated with mechanosensitivity. In cilium, TRPP2 was found to combine with PKD1 and TRPV4 to form a complex related to mechanosensitivity. Because TRPP2 is involved in regulating intracellular ion concentration, TRPP2 mutations often lead to autosomal dominant polycystic kidney disease, which may also be associated with cardiovascular disease. In this paper, we review the molecular structure of TRPP2, the subcellular localization of TRPP2, the related functions and mechanisms of TRPP2 at different sites, and the diseases related to TRPP2.
Copyright © 2022. Published by Elsevier B.V.
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Assessment of drinking water safety in the Netherlands using nationwide exposure and mortality data.
Environ Int2022 Jun;166():107356. doi: S0160-4120(22)00283-5.
Houthuijs Danny, Breugelmans Oscar R P, Baken Kirsten A, Sjerps Rosa M A, Schipper Maarten, van der Aa Monique, van Wezel Annemarie P,
Abstract
BACKGROUND:
Although drinking water in the Netherlands is generally accepted as safe, public concern about health risks of long-term intake still exist.
OBJECTIVE:
The aim was to explore associations between drinking water quality for nitrate, water hardness, calcium and magnesium and causes-of-death as related to cardiovascular diseases amongst which coronary heart disease and colorectal cancer.
METHODS:
We used national administrative databases on cause-specific mortality, personal characteristics, residential history, social economic indicators, air quality and drinking water quality for parameters specified by the EU Drinking Water Directive. We put together a cohort of 6,998,623 persons who were at least 30 years old on January 1, 2008 and lived for at least five years on the same address. The average drinking water concentration over 2000-2010 at the production stations were used as exposure indicators. We applied age stratified Cox proportional hazards models.
RESULTS:
Magnesium was associated with a reduced risk for mortality due to coronary heart diseases: HR of 0.95 (95% CI: 0.90, 0.99) per 10 mg/L increase. For mortality due to cardiovascular diseases, a 100 mg/L increase in calcium was associated with a HR of 1.08 (95% CI: 1.03, 1.13) and an increase of 2.5 mmol/L of water hardness with a HR of 1.06 (95% CI: 1.01, 1.10). The results show an elevated risk for coronary heart disease mortality at calcium concentrations below 30 mg/L, but over the whole exposure range no exposure response relation was observed. For other combinations of drinking water quality parameters and cause-specific mortality studied, no statistical significant associations were identified.
CONCLUSION:
We identified in this explorative study a protective effect of magnesium for the risk of mortality to coronary heart disease. Also we found an increased risk of mortality due to cardiovascular disease associated with the concentration of calcium and the water hardness in drinking water.
Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Deletion of matrix metalloproteinase-12 compromises mechanical homeostasis and leads to an aged aortic phenotype in young mice.
J Biomech2022 Jun;141():111179. doi: S0021-9290(22)00222-6.
Spronck Bart, Ramachandra Abhay B, Moriyama Lauren, Toczek Jakub, Han Jinah, Sadeghi Mehran M, Humphrey Jay D,
Abstract
Mechanical homeostasis emerges following normal development of the arterial wall and requires thereafter a slow balanced degradation and deposition of extracellular matrix constituents within an unchanging mechanical state. Recent findings suggest that homeostasis is compromised in arterial aging, which contributes to the structural stiffening that is characteristic of aged central arteries. Matrix metalloproteinases (MMPs) have strong proteolytic activity and play fundamental roles in matrix turnover. Here, we use Mmp12 mice to examine effects of a potent metalloelastase, MMP-12, on the biomechanical phenotype of the thoracic and abdominal aorta in young and naturally aged mice. A key finding is that germline deletion of the gene (Mmp12) that encodes MMP-12 alters biomechanical properties from normal more in young adult than in older adult mice. Consequently, percent changes in biomechanical properties during aortic aging are greater in wild-type than in MMP-12 deficient mice, though with similar overall decreases in elastic energy storage and distensibility and increases in calculated pulse wave velocity. Reduced elastic energy storage compromises the ability of the aorta to augment antegrade and retrograde blood flow while an increased pulse wave velocity can adversely affect end organs, both conditions being characteristic of aortic aging in humans. In summary, MMP-12 is fundamental for establishing homeostatic values of biomechanical metrics in the aorta and its absence leads to a pre-aged aortic phenotype in young mice.
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Identifying peripheral arterial diseases or flow limitations of the lower limb: Important aspects for cardiovascular screening for referral in physiotherapy.
Musculoskelet Sci Pract2022 Jun;61():102611. doi: S2468-7812(22)00111-4.
Feller Daniel, Giudice Andrea, Faletra Agostino, Salomon Mattia, Galeno Erasmo, Rossettini Giacomo, Brindisino Fabrizio, Maselli Filippo, Hutting Nathan, Mourad Firas,
Abstract
Many conditions could potentially cause pain in the lower limbs. One of these is peripheral arterial disease (PAD). PAD is often a real challenge to be recognized for clinicians due to symptoms that commonly mimic musculoskeletal conditions. PAD is defined as a total or partial blockage of the vessels that supply blood from the heart to the periphery. Its prevalence is around 7 percent in subjects between 55 and 59, reaching almost 25% in individuals between 95 and 99 years old. The most dominant symptom of PAD is lower limb pain. Also, PAD can produce other symptoms such as discoloration, altered skin temperature, and, when arterial blood flow is insufficient to meet the metabolic demands of resting muscle or tissue, focal areas of ischemia. In our view, physical therapists should be capable of triaging for PAD in a direct access setting. Therefore, in this Professional Issue, we present the main characteristics of PAD and the physiotherapy role in its management. A supplementary step-by-step guide will provide further resources for testing PAD.
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Risk factors of clinically significant complications in transbronchial lung cryobiopsy: A prospective multi-center study.
Respir Med2022 Jun;200():106922. doi: S0954-6111(22)00187-1.
Mononen Minna, Saari Eeva, Hasala Hannele, Kettunen Hannu-Pekka, Suoranta Sanna, Nurmi Hanna, Randell Jukka, Laurikka Jari, Uibu Toomas, Koskela Heikki, Kaarteenaho Riitta, Purokivi Minna,
Abstract
BACKGROUND:
The use of a transbronchial lung cryobiopsy (TBLC) is increasing as a diagnostic method of interstitial lung diseases (ILD). This study aimed to evaluate risk factors associated with clinically significant complications of TBLC in ILD patients.
METHODS:
Patients referred to Kuopio or Tampere university hospitals, in Finland, for a suspected ILD were included. The TBLC was performed in an outpatient setting for 100 patients. Patients were mechanically ventilated in general anesthesia. Fluoroscopy guidance and prophylactic bronchial balloon were used. Complications, such as bleeding, pneumothorax, infections, and mortality were recorded. Moderate or serious bleeding, pneumothorax, or death ?90 days were defined as clinically significant complications. A multivariable model was created to assess clinically significant complications.
RESULTS:
The extent of traction bronchiectasis (Odds ratio [OR] 1.30, Confidence interval [CI] 1.03-1.65, p = 0.027) and young age (OR 7.96, CI 2.32-27.3, p = 0.001) were associated with the risk of clinically significant complications whereas the use of oral corticosteroids ?30 days before the TBLC (OR 3.65, CI 0.911-14.6, p = 0.068) did not quite reach statistical significance. A history of serious cough was associated with the risk of pneumothorax (OR 4.18, CI 1.10-16.0, p = 0.036). Procedure associated mortality ?90 days was 1%.
CONCLUSION:
The extent of traction bronchiectasis on HRCT and young age were associated with the risk of clinically significant complications whereas oral corticosteroid use did not quite reach statistical significance. A history of serious cough was associated with the risk of clinically significant pneumothorax.
Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Anti-hyperglycemic, anti-hyperlipidemic, and anti-inflammatory effect of the drug Guggulutiktaka ghrita on high-fat diet-induced obese rats.
J Ayurveda Integr Med2022 Jun;13(3):100583. doi: S0975-9476(22)00042-0.
Sheik Samreen M, Bakthavatchalam Pugazhandhi, Shenoy Revathi P, Hadapad Basavaraj S, Nayak M Deepak, Biswas Monalisa, Bolar Suryakanth Varashree,
Abstract
BACKGROUND:
Ayurveda is a holistic system of medicine and describes a vast array of herbs and herbal mixtures that are been demonstrated to possess efficacy in research investigations. Guggulutikthaka gritha (GTG) is one such drug evaluated for its role in skin and bone diseases.
OBJECTIVE:
In the current study, the hypoglycemic, hypolipidemic, and anti-inflammatory effect of the drug GTG was studied with the scope to treat dyslipidemia and thereby reduce the risk of cardiovascular disease.
MATERIALS AND METHOD:
The animals (Wistar rats) were fed a high-fat diet and dyslipidemia was induced. The control group was provided with a normal chow diet and had free access to water. The treatment with the drug GTG was given for 21 days after confirming dyslipidemia. The blood glucose was measured immediately using a glucometer. The serum was analyzed for lipid profile and Vascular Cell Adhesion Molecule - 1(VCAM 1) by ELISA method before and after treatment. The histopathology of the heart and liver was also performed.
RESULTS:
The abnormal change in lipid profile, blood glucose, and inflammatory marker along with the accumulation of intracellular fats in the arteries of the heart and liver confirmed dyslipidemia. A significant reduction in serum lipid profile (p
CONCLUSION:
The study provides scientific validation on the drug GTG being effective in hyperglycemia, hyperlipidemia, and inflammation in dyslipidemia.
Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.
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Omega-3 fatty acids, subclinical atherosclerosis, and cardiovascular events: Implications for primary prevention.
Atherosclerosis2022 Jun;353():11-19. doi: S0021-9150(22)01316-8.
Alfaddagh Abdulhamied, Kapoor Karan, Dardari Zeina A, Bhatt Deepak L, Budoff Matthew J, Nasir Khurram, Miller Michael, Welty Francine K, Miedema Michael D, Shapiro Michael D, Tsai Michael Y, Blumenthal Roger S, Blaha Michael J,
Abstract
BACKGROUND AND AIMS:
High-dose eicosapentaenoic acid (EPA) therapy was beneficial in high-risk patients without clinical cardiovascular disease (CVD). Whether higher plasma levels of EPA and docosahexaenoic acid (DHA) have similar benefits in those without subclinical CVD is unclear. We aim to evaluate the interplay between plasma omega-3 fatty acids and coronary artery calcium (CAC) in relation to CVD events.
METHODS:
We examined 6568 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with plasma EPA and DHA levels and CAC measured at baseline. The primary outcome was incident CVD events (myocardial infarction, angina, cardiac arrest, stroke, CVD death). Hazard ratios for the primary outcome were adjusted for potential confounder using Cox regression.
RESULTS:
Mean ± SD age was 62.1 ± 10.2 years and 52.9% were females. The median follow-up time was 15.6 years. Higher log(EPA) (adjusted hazard ratio, aHR = 0.83; 95% CI, 0.74-0.94) and log(DHA) (aHR = 0.79; 95% CI, 0.66-0.96) were independently associated with fewer CVD events. The difference in absolute CVD event rates between lowest vs. highest EPA tertile increased at higher CAC levels. The adjusted HR for highest vs. lowest EPA tertile within CAC = 0 was 1.02 (95% CI, 0.72-1.46), CAC = 1-99 was 0.71 (95% CI, 0.51-0.99), and CAC?100 was 0.67 (95% CI, 0.52-0.84). A similar association was seen in tertiles of DHA by CAC category.
CONCLUSIONS:
In an ethnically diverse population free of clinical CVD, higher plasma omega-3 fatty acid levels were associated with fewer long-term CVD events. The absolute decrease in CVD events with higher omega-3 fatty acid levels was more apparent at higher CAC scores.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Release of MMP-2 in the circulation of patients with acute coronary syndromes undergoing percutaneous coronary intervention: Role of platelets.
Thromb Res2022 Jun;216():84-89. doi: S0049-3848(22)00299-7.
Falcinelli Emanuela, De Paolis Marcella, Boschetti Enrico, Gresele Paolo,
Abstract
INTRODUCTION:
Matrix metalloproteinases (MMPs) of atherosclerotic tissue contribute to plaque rupture triggering acute coronary syndromes (ACS). Several MMPs, including MMP-2, are also contained in platelets and released upon activation. An increase in circulating levels of MMP-2 has been reported in patients undergoing percutaneous coronary interventions (PCI), but its time-course and origin remain unclear. Aims of our study were to assess the time-course of MMP-2 release in blood of stable and unstable coronary artery disease patients undergoing PCI and to unravel the possible contribution of platelets to its release.
METHODS:
Peripheral blood samples were drawn immediately before, 4 and 24 h after PCI from patients with ACS (NSTEMI or STEMI, n = 21) or with stable angina (SA, n = 21). Platelet-poor plasma and washed platelet lysates were prepared and stored for subsequent assay of MMP-2 and ?-thromboglobulin (?-TG), a platelet-specific protein released upon activation.
RESULTS:
Plasma MMP-2 and ?-TG increased significantly 4 h after PCI and returned to baseline at 24 h in ACS patients, while they did not change in SA patients. Platelet content of MMP-2 and ?-TG decreased significantly 4 h after PCI in patients with ACS, compatible with intravascular platelet activation and release, while they did not change in patients with SA.
CONCLUSIONS:
PCI triggers the release of MMP-2 in the circulation of ACS patients but not in that of patients with SA. Platelets activated by PCI contribute to the increase of plasma MMP-2 releasing their MMP-2 content. Given that previous mechanicistic studies have shown that MMP-2 may sustain platelet activation and unstabilize downstream-located plaques and in the long term favour restenosis and atherosclerosis progression, these data may encourage the search for therapeutic agents blocking MMP-2 release or activity in ACS.
Copyright © 2022 Elsevier Ltd. All rights reserved.
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Interleukin-35 ameliorates cardiovascular disease by suppressing inflammatory responses and regulating immune homeostasis.
Int Immunopharmacol2022 Jun;110():108938. doi: S1567-5769(22)00422-2.
Feng Jie, Wu Yanqing,
Abstract
The immune response is of great significance in the initiation and progression of a diversity of cardiovascular diseases involving pro-and anti-inflammatory cytokines. Interleukin-35 (IL-35), a cytokine of the interleukin-12 family, is a novel anti-inflammation and immunosuppressive cytokine, maintaining inflammatory suppression and regulating immune homeostasis. The role of IL-35 in cardiovascular diseases (CVDs) has aroused enthusiastic attention, a diversity of experimental or clinical evidence has indicated that IL-35 potentially has a pivot role in protecting against cardiovascular diseases, especially atherosclerosis and myocarditis. In this review, we initiate an overview of the relationship between Interleukin-35 and cardiovascular diseases, including atherosclerosis, acute coronary syndrome, pulmonary hypertension, abdominal aortic aneurysm, heart failure, myocardial ischemia-reperfusion, aortic dissection and myocarditis. Although the specific molecular mechanisms entailing the protective effects of IL-35 remain an unsolved issue, targeted therapies with IL-35 might provide a promising and effective solution to prevent and cure cardiovascular diseases.
Copyright © 2022 Elsevier B.V. All rights reserved.
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[Metabolic profile and concentration of ghrelin and obestatin in children and adolescents with obesity].
Rev Med Inst Mex Seguro Soc2022 May;60(3):268-274.
García-González Claudia Lizett, Romero-Velarde Enrique, Gurrola-Díaz Carmen Magdalena, Sánchez-Muñoz Martha Patricia, Soto-Luna Guadalupe Irma Catalina,
Abstract
Background:
It has been pointed out that ghrelin and obestatin could have an impact on the genesis of obesity, since they estimulate and inhibit apetite and, therefore, food consumption.
Objective:
To compare the metabolic profile, lipid profile and the concentrations of ghrelin and obestatin in children with normal weight or obesity.
Material and methods:
Cross-sectional design with 97 normal weight or obese children, 6 to 18 years of age, who did not present systemic diseases. The serum concentrations of glucose, insulin, total cholesterol, triglycerides, high (HDL), low (LDL) and very low density (VLDL) lipoproteins, aspartate aminotransferase (AST), alanine aminotransferase (ALT), ghrelin and obestatin were determined. Descriptive statistics were performed. Student's t test was used to compare groups, and correlation coefficients of ghrelin and obestatin values with biochemical and anthropometric variables. A p value of ? 0.05 was significant.
Results:
55 children with normal weight and 42 with obesity were included; mean age was 10.7 years. Triglycerides, LDL, VLDL, ALT and insulin were higher, and HDL lower in obese children (p
Conclusions:
The lower concentration of ghrelin in obese children may indicate a negative feedback to regulate energy consumption. Children and adolescents with obesity show metabolic and lipid profile alterations that place them at risk of early development of cardiovascular risk factors.
© 2022 Revista Medica del Instituto Mexicano del Seguro Social.
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A cross-sectional Survey Study on Homophobia among Medical, Nursing, Pharmacy, and Other Health Sciences Students.
J Homosex2022 Jun;():1-17. doi: 10.1080/00918369.2022.2087480.
Harmanci Seren Arzu Kader, E?kin Bacaksiz Feride, Çakir Hanife, Yilmaz Sevil, Sükut Özge, Turan Suzan, Maghsoudi Nurten,
Abstract
Since the lesbian, gay, bisexual, transgender, and intersex (LGBTI) community may be exposed to violence, discrimination, stigma, exclusion, and maltreatment due to their sexual orientation while accessing healthcare services, understanding, and improving the attitudes of future's health care professionals toward LGBTI individuals seem essential. This descriptive and cross-sectional study aimed to investigate the homophobia among medical, nursing, pharmacy, and healthcare sciences students and examine the related factors. The study included 2,531 students from medicine, nursing, pharmacy, and other health sciences (midwifery, nutrition and dietetics, physiotherapy, management of healthcare facilities) disciplines. Homophobia was measured with the Hudson and Ricketts Homophobia Scale. After getting ethical and institutional approvals, data were collected and analyzed using descriptive and inferential statistical tests. Medical students had the lowest homophobia score, and their mean score was significantly lower than other students. There was a significant difference between students' scores according to years of study, age, sex, acquaintance with LGBTI individuals, providing healthcare services to an LGBTI person, and opinions on providing care. Although homophobia scores of nursing, pharmacy, and other health sciences students were lower than the medical students', policies and expansive content regarding LGBTI should be in place in all health science educational institutes, including medical schools, to prevent students from holding homophobic and prejudicial attitudes against LGBTI individuals.
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Treatment of Multisystem Inflammatory Syndrome in Children: Understanding Differences in Results of Comparative Effectiveness Studies.
ACR Open Rheumatol2022 Jun;():. doi: 10.1002/acr2.11478.
Melgar Michael, Seaby Eleanor G, McArdle Andrew J, Young Cameron C, Campbell Angela P, Murray Nancy L, Patel Manish M, Levin Michael, Randolph Adrienne G, Son Mary Beth F, ,
Abstract
OBJECTIVE:
Two cohort studies in patients with multisystem inflammatory syndrome in children (MIS-C) demonstrated contrasting results regarding the benefit of initial immunomodulatory treatment with intravenous immunoglobulin (IVIG) alone versus IVIG and glucocorticoids. We sought to determine whether application of different MIS-C definitions and differing disease severity between cohorts underlay discrepant results.
METHODS:
The Overcoming COVID-19 Public Health Surveillance Registry (OC-19) included patients meeting the US Centers for Disease Control and Prevention (CDC) MIS-C definition, whereas the Best Available Treatment Study (BATS) applied the World Health Organization (WHO) definition. We applied the WHO definition to the OC-19 cohort and the CDC definition to the BATS cohort and determined the proportion that did not meet the alternate definition. We compared illness severity indicators between cohorts.
RESULTS:
Of 349 OC-19 patients, 9.5% did not meet the WHO definition. Of 350 BATS patients, 10.3% did not meet the CDC definition. Most organ system involvement was similar between the cohorts, but more OC-19 patients had WHO-defined cardiac involvement (87.1% vs 79.4%, P = 0.008). OC-19 patients were more often admitted to intensive care (61.0% vs 44.8%, P?0.001) and more often received vasopressors or inotropes (39.5% vs 22.9%, P?0.001) before immunomodulatory treatment.
CONCLUSION:
Greater illness severity and cardiovascular involvement in the OC-19 cohort compared with the BATS cohort, and not use of different MIS-C case definitions, may have contributed to differing study conclusions about optimal initial treatment for MIS-C. Disease severity should be considered in future MIS-C study designs and treatment recommendations to identify patients who would benefit from aggressive immunomodulatory treatment.
© 2022 The Authors. ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.
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Atezolizumab for Pretreated Non-Small Cell Lung Cancer with Idiopathic Interstitial Pneumonia: Final Analysis of Phase II AMBITIOUS Study.
Oncologist2022 Jun;():. doi: oyac118.
Ikeda Satoshi, Kato Terufumi, Kenmotsu Hirotsugu, Ogura Takashi, Sato Yuki, Hino Aoi, Harada Toshiyuki, Kubota Kaoru, Tokito Takaaki, Okamoto Isamu, Furuya Naoki, Yokoyama Toshihide, Hosokawa Shinobu, Iwasawa Tae, Kasajima Rika, Miyagi Yohei, Misumi Toshihiro, Okamoto Hiroaki,
Abstract
BACKGROUND:
Interstitial pneumonia (IP) is a poor prognostic comorbidity in patients with non-small cell lung cancer (NSCLC) and is also a risk factor for pneumonitis. The TORG1936/AMBITIOUS trial, the first known phase II study of atezolizumab in patients with NSCLC with comorbid IP, was terminated early because of the high incidence of severe pneumonitis.
METHODS:
This study included patients with idiopathic chronic fibrotic IP, with a predicted forced vital capacity (%FVC) of >70%, with or without honeycomb lung, who had previously been treated for NSCLC. The patients received atezolizumab every 3 weeks. The primary endpoint was the 1-year survival rate.
RESULTS:
A total of 17 patients were registered; the median %FVC was 85.4%, and 41.2% had honeycomb lungs. The 1-year survival rate was 53.3% (95% CI, 25.9-74.6). The median overall and progression-free survival times were 15.3 months (95% CI, 3.1-not reached) and 3.2 months (95% CI, 1.2-7.4), respectively. The incidence of pneumonitis was 29.4% for all grades, and 23.5% for grade ?3. Tumor mutational burden and any of the detected somatic mutations were not associated with efficacy or risk of pneumonitis.
CONCLUSION:
Atezolizumab may be one of the treatment options for patients with NSCLC with comorbid IP, despite the high risk of developing pneumonitis. This clinical trial was retrospectively registered in the Japan Registry of Clinical Trials on August 26, 2019, (registry number: jRCTs031190084, https://jrct.niph.go.jp/en-latest-detail/jRCTs031190084).
© The Author(s) 2022. Published by Oxford University Press.
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