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Pubblicazioni recenti - cardiovascular risk
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Is There Really an Association of High Circulating Adiponectin Concentration and Mortality or Morbidity Risk in Stable Coronary Artery Disease?
Horm Metab Res2020 Aug;():. doi: 10.1055/a-1212-8759.
Mayer Otto, Seidlerová Jitka, Bruthans Jan, Gel?inský Julius, Rychecká Martina, Mate?ánková Markéta, Karnosová Petra, Wohlfahrt Peter, Cífková Renata, Filipovský Jan,
Abstract
Adiponectin has several beneficial properties, namely, on the level of glucose metabolism, but paradoxically, its high concentrations were associated with increased mortality. We aimed to clarify the impact of high serum adiponectin on mortality and morbidity in patients with stable coronary artery heart disease (CAD). A total of 973 patients after myocardial infarction and/or coronary revascularization were followed in a prospective cohort study. All-cause and cardiovascular (CV) death, non-fatal cardiovascular events, and hospitalizations for heart failure (HF) were registered as outcomes. High serum adiponectin levels (?8.58 ng/ml, i.?e., above median) were independently associated with increased risk of 5-year all-cause, CV mortality or HF [with HRR 1.57 (95% CI: 1.07-2.30), 1.74 (95% CI: 1.08-2.81) or 1.94 (95% CI: 1.20-3.12), respectively] when adjusted just for conventional risk factors. However, its significance disappeared if brain natriuretic peptide (BNP) was included in a regression model. In line with this, we observed strong collinearity of adiponectin and BNP. Additionally, major adverse cardiovascular event (i.?e., CV death, non-fatal myocardial infarction or stroke, coronary revascularization) incidence risk was not associated with high adiponectin. In conclusion, the observed inverse association between adiponectin concentrations and mortality risk seems to be attributable to concomitantly increased BNP, rather than high adiponectin being a causal factor.
© Georg Thieme Verlag KG Stuttgart · New York.
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Optimal antiplatelet therapy for prevention of gastrointestinal injury evaluated by ANKON magnetically controlled capsule endoscopy: Rationale and design of the OPT-PEACE trial.
Am Heart J2020 Jun;228():8-16. doi: S0002-8703(20)30184-8.
Li Yi, Wang Xiaozeng, Bao Dan, Liao Zhuan, Li Jing, Han Xiao, Wang Heyang, Xu Kai, Li Zhaoshen, Stone Gregg W, Han Yaling,
Abstract
BACKGROUND:
Gastrointestinal injury is a common complication in patients treated with antiplatelet agents after percutaneous coronary intervention (PCI). However, the effects of different antiplatelet regimens on the incidence and severity of gastrointestinal injury have not been well studied, principally due to the lack of a low-risk sensitive and accurate detection system.
TRIAL DESIGN:
OPT-PEACE is a multicenter, randomized, double-blind, placebo-controlled trial. Gastrointestinal injury will be evaluated with the ANKON magnetically controlled capsule endoscopy system (AMCE), a minimally invasive approach for detecting mucosal lesions in the stomach, duodenum and small intestine. Patients without AMCE-detected gastrointestinal erosions, ulceration or bleeding after drug-eluting stent implantation are enrolled and treated with open-label aspirin (100 mg/d) plus clopidogrel (75 mg/d) for 6 months. Thereafter, 480 event-free patients will undergo repeat AMCE and are randomly assigned in a 1:1:1 ratio to receive aspirin plus clopidogrel, aspirin plus placebo or clopidogrel plus placebo for an additional 6 months. A final AMCE is performed at 12 months. The primary endpoint is the incidence of gastric or intestinal mucosal lesions (erosions, ulceration, or bleeding) within 12 months after enrollment.
CONCLUSIONS:
OPT-PEACE is the first study to investigate the incidence and severity of gastrointestinal injury in patients receiving different antiplatelet therapy regimens after stent implantation. This trial will inform clinical decision-making for personalized antiplatelet therapy post-PCI.
Copyright © 2020. Published by Elsevier Inc.
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Serum magnesium and burden of atrial and ventricular arrhythmias: The Atherosclerosis Risk in Communities (ARIC) Study.
J Electrocardiol2020 Jul;62():20-25. doi: S0022-0736(20)30499-4.
Rooney Mary R, Lutsey Pamela L, Alonso Alvaro, Selvin Elizabeth, Pankow James S, Rudser Kyle D, Dudley Samuel C, Chen Lin Yee,
Abstract
INTRODUCTION:
Low serum magnesium (Mg) is associated with an increased incidence of atrial and ventricular arrhythmias. A richer phenotyping of arrhythmia indices, such as burden or frequency, may provide etiologic insights.
OBJECTIVES:
To evaluate cross-sectional associations of serum Mg with burden of atrial arrhythmias [atrial fibrillation (AF), premature atrial contractions (PAC), supraventricular tachycardia (SVT)], and ventricular arrhythmias [premature ventricular contractions (PVC), non-sustained ventricular tachycardia (NSVT)] over 2-weeks of ECG monitoring.
METHODS:
We included 2513 ARIC Study visit 6 (2016-2017) participants who wore the Zio XT Patch-a leadless, ambulatory ECG-monitor-for up to 2-weeks. Serum Mg was modeled categorically and continuously. AF burden was categorized as intermittent or continuous based on the percent of analyzable time spent in AF. Other arrhythmia burdens were defined by the average number of abnormal beats per day. Linear regression was used for continuous outcomes; logistic and multinomial regression were used for categorical outcomes.
RESULTS:
Participants were mean ± SD age 79 ± 5 years, 58% were women and 25% black. Mean serum Mg was 0.82 ± 0.08 mmol/L and 19% had hypomagnesemia (<0.75 mmol/L). Serum Mg was inversely associated with PVC burden and continuous AF. The AF association was no longer statistically significant with further adjustment for traditional lifestyle risk factors, only the association with PVC burden remained significant. There were no associations between serum Mg and other arrhythmias examined.
CONCLUSIONS:
In this community-based cohort of older adults, we found little evidence of independent cross-sectional associations between serum Mg and arrhythmia burden.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Predictive value of electrocardiographic left ventricular hypertrophy in the general population: A meta-analysis.
J Electrocardiol2020 Jul;62():14-19. doi: S0022-0736(20)30492-1.
You Zhigang, He Ting, Ding Ying, Yang Lu, Jiang Xinghua, Huang Lin,
Abstract
BACKGROUND:
Conflicting results have been reported on the predictive value of the electrocardiographic left ventricular hypertrophy (LVH) in the general population. This meta-analysis sought to compare the predictive value of different electrocardiographic criteria of LVH in the general population.
METHODS:
We comprehensively searched PubMed and Embase databases until May 9, 2020 to identify observational studies investigating the predictive value of different electrocardiographic criteria for LVH (Sokolow-Lyon voltage, Cornell voltage or Cornell product) in the general population. Outcome measures were major adverse cardiovascular events (MACEs), cardiovascular or all-cause mortality.
RESULTS:
Ten studies enrolling 58,400 individuals were included. Comparison with and without electrocardiographic LVH, the pooled risk ratio (RR) of MACEs was 1.62 (95% confidence interval [CI] 1.40-1.89) for the Sokolow-Lyon voltage criteria, 1.70 (95% CI 1.27-2.29) for the Cornell voltage criteria, and 1.56 (95% CI 1.17-2) for the Cornell product criteria. The pooled RR of all-cause mortality was 1.47 (95% CI 1.10-1.97) for the Sokolow-Lyon voltage criteria and 1.87 (95% CI 1.29-2.71) for the Cornell voltage criteria. Furthermore, the pooled RR of cardiovascular mortality was 1.38 (95% CI 1.19-1.60) for the Sokolow-Lyon criteria, 1.66 (95% CI 1.24-2.33) for the Cornell voltage criteria, and 1.82 (95% CI 0.65-5.09) for the Cornell product criteria.
CONCLUSIONS:
Different electrocardiographic criteria for evaluating LVH had a similar value in predicting MACEs among the general population. LVH detected by the Cornell voltage appeared to have a stronger predictive value in prediction of cardiovascular or all-cause mortality.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Left atrial mass: Relationship between gross anatomy and quantitative echocardiography.
Cardiovasc Pathol2020 Jul;():107265. doi: S1054-8807(20)30069-7.
Flink Laura, Parwani Purvi, Ursell Philip C, Bibby Dwight, Fang Qizhi, Schiller Nelson B,
Abstract
BACKGROUND:
Left atrial (LA) enlargement is associated with increased risk of adverse cardiovascular outcomes. Unlike the left ventricular mass, LA mass has not been described. We sought to define the anatomic mass of the LA using anatomic specimens from autopsy. We hypothesized that LA mass could be estimated by echocardiography.
METHODS AND RESULTS:
Using anatomic specimens of 22 subjects who died and underwent post mortem examination as well as echocardiogram, we defined normal LA mass by weighing anatomic specimens of those with normal LA volume on echocardiogram. Using 17 subjects with normal LA volume on echocardiogram, we found their LA mass on anatomic specimens to be 25.5±6.3 grams (14.4 ±3.2 g/m2). We developed an echocardiographic measure of LA mass and validated this measurement with paired LA anatomic specimens. We found the normal LA mass on echocardiogram to be 25.4± 6.3g (14.4±2.8g/m2) which correlated well with anatomic specimens (?=0.99; CI 0.6-1.4, p<0.0001; Pearson Correlation coefficient r=0.83). Furthermore, we defined the normal LA volume to mass ratio as 1.38±0.45.
CONCLUSIONS:
LA mass is an additional parameter with which may contribute to the study of LA morphology.
Copyright © 2020. Published by Elsevier Inc.
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Evaluation of Stress Cardiac Magnetic Resonance Imaging in Risk Reclassification of Patients With Suspected Coronary Artery Disease.
JAMA Cardiol2020 Jul;():. doi: 10.1001/jamacardio.2020.2834.
Antiochos Panagiotis, Ge Yin, Steel Kevin, Chen Yi-Yun, Bingham Scott, Abdullah Shuaib, Mikolich J Ronald, Arai Andrew E, Bandettini W Patricia, Patel Amit R, Farzaneh-Far Afshin, Heitner John F, Shenoy Chetan, Leung Steve W, Gonzalez Jorge A, Shah Dipan J, Raman Subha V, Ferrari Victor A, Schulz-Menger Jeanette, Stuber Matthias, Simonetti Orlando P, Murthy Venkatesh L, Kwong Raymond Y,
Abstract
Importance:
The role of stress cardiac magnetic resonance (CMR) imaging in clinical decision-making by reclassification of risk across American College of Cardiology/American Heart Association guideline-recommended categories has not been established.
Objective:
To examine the utility of stress CMR imaging for risk reclassification in patients without a history of coronary artery disease (CAD) who presented with suspected myocardial ischemia.
Design, Setting, and Participants:
A retrospective, multicenter cohort study with median follow-up of 5.4 years (interquartile range, 4.6-6.9) was conducted at 13 centers across 11 US states. Participants included 1698 consecutive patients aged 35 to 85 years with 2 or more coronary risk factors but no history of CAD who presented with suspected myocardial ischemia to undergo stress CMR imaging. The study was conducted from February 18, 2019, to March 1, 2020.
Main Outcomes and Measures:
Cardiovascular (CV) death and nonfatal myocardial infarction (MI). Major adverse CV events (MACE) including CV death, nonfatal MI, hospitalization for heart failure or unstable angina, and late, unplanned coronary artery bypass graft surgery.
Results:
Of the 1698 patients, 873 were men (51.4%); mean (SD) age was 62 (11) years, accounting for 67 CV death/nonfatal MIs and 190 MACE. Clinical models of pretest risk were constructed and patients were categorized using guideline-based categories of low (<1% per year), intermediate (1%-3% per year), and high (>3% year) risk. Stress CMR imaging provided risk reclassification across all baseline models. For CV death/nonfatal MI, adding stress CMR-assessed left ventricular ejection fraction, presence of ischemia, and late gadolinium enhancement to a model incorporating the validated CAD Consortium score, hypertension, smoking, and diabetes provided significant net reclassification improvement of 0.266 (95% CI, 0.091-0.441) and C statistic improvement of 0.086 (95% CI, 0.022-0.149). Stress CMR imaging reclassified 60.3% of patients in the intermediate pretest risk category (52.4% reclassified as low risk and 7.9% as high risk) with corresponding changes in the observed event rates of 0.6% per year for low posttest risk and 4.9% per year for high posttest risk. For MACE, stress CMR imaging further provided significant net reclassification improvement (0.361; 95% CI, 0.255-0.468) and C statistic improvement (0.092; 95% CI, 0.054-0.131), and reclassified 59.9% of patients in the intermediate pretest risk group (48.7% reclassified as low risk and 11.2% as high risk).
Conclusions and Relevance:
In this multicenter cohort of patients with no history of CAD presenting with suspected myocardial ischemia, stress CMR imaging reclassified patient risk across guideline-based risk categories, beyond clinical risk factors. The findings of this study support the value of stress CMR imaging for clinical decision-making, especially in patients at intermediate risk for CV death and nonfatal MI.
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Cardiovascular risk in persons at risk of developing rheumatoid arthritis.
PLoS One2020 ;15(8):e0237072. doi: 10.1371/journal.pone.0237072.
van Boheemen Laurette, van Beers-Tas Marian H, Kroese Johanna M, van de Stadt Lotte A, van Schaardenburg Dirkjan, Nurmohamed Michael T,
Abstract
BACKGROUND:
Rheumatoid arthritis (RA) is associated with an increased cardiovascular disease (CVD) risk which may start even before diagnosis. To explore this CVD risk prior to RA, we determined multiple risk factors and two 10-year clinical risk scores in a cohort of individuals at-risk of RA. We also analyzed associations with arthritis development and autoantibody status and compared a subset of at-risk individuals to an age and sex matched seronegative control group.
METHODS:
In a cohort of 555 consecutive arthralgia patients positive for rheumatoid factor (RF) and / or anti-citrullinated protein antibody (ACPA) we retrospectively identified patients with preclinical arthritis (i.e. those who developed arthritis), and non-arthritis patients (those without arthritis development during maximum 5 years follow up). Demographics, CVD risk factors and the 10-year cardiovascular risk according to the SCORE and QRISK3 system were determined at baseline.
RESULTS:
Preclinical arthritis patients (n = 188) had a higher heart rate (68 vs 63 bpm, p = 0.048) and lower cholesterol (5.2 mmol/l vs 5.5, p = 0.006), HDL (1.0 mmol/l vs 1.1, p0.003) and ApoB (0.85 g/l vs 0.91, p = 0.011) compared to non-arthritis patients (n = 367). Lipid levels were associated with ACPA status in both the preclinical arthritis and non-arthritis group. Ten-year CVD risk scores did not differ between preclinical arthritis and non-arthritis patients, in total, 7% (SCORE) and 8% (QRISK3) of seropositive arthralgia patients were classified as high risk. Seropositive at-risk patients (n = 71) had higher total cholesterol (5.4 vs 4.9, p<0.001), TC/HDL ratio (4.0 vs 3.0, p<0.001), triglycerides (1.4 vs 1.0, p = 0.001), ApoB (1.0 vs 0.9, p = 0.019) and 10-year risk scores (median SCORE 1.0 vs 0.0, p = 0.030 and median QRISK3 4.4 vs 3.1, p<0.001) compared to seronegative controls.
CONCLUSION:
Our results suggest that lipid changes commence prior to RA diagnosis and that ACPAs might play a role.
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The impact of diabetes, education and income on mortality and cardiovascular events in hypertensive patients: A cohort study from the Swedish Primary Care Cardiovascular Database (SPCCD).
PLoS One2020 ;15(8):e0237107. doi: 10.1371/journal.pone.0237107.
Andersson Tobias, Pikkemaat Miriam, Schiöler Linus, Hjerpe Per, Carlsson Axel C, Wändell Per, Manhem Karin, Kahan Thomas, Hasselström Jan, Bengtsson Boström Kristina,
Abstract
OBJECTIVE:
In this study we aimed to estimate the effect of diabetes, educational level and income on the risk of mortality and cardiovascular events in primary care patients with hypertension.
METHODS:
We followed 62,557 individuals with hypertension diagnosed 2001-2008, in the Swedish Primary Care Cardiovascular Database. Study outcomes were death, myocardial infarction, and ischemic stroke, assessed using national registers until 2012. Cox regression models were used to estimate adjusted hazard ratios of outcomes according to diabetes status, educational level, and income.
RESULTS:
During follow-up, 13,231 individuals died, 9981 were diagnosed with diabetes, 4431 with myocardial infarction, and 4433 with ischemic stroke. Hazard ratios (95% confidence intervals) for diabetes versus no diabetes: mortality 1.57 (1.50-1.65), myocardial infarction 1.24 (1.14-1.34), and ischemic stroke 1.17 (1.07-1.27). Hazard ratios for diabetes and ?9 years of school versus no diabetes and >12 years of school: mortality 1.56 (1.41-1.73), myocardial infarction 1.36 (1.17-1.59), and ischemic stroke 1.27 (1.08-1.50). Hazard ratios for diabetes and income in the lowest fifth group versus no diabetes and income in the highest fifth group: mortality 3.82 (3.36-4.34), myocardial infarction 2.00 (1.66-2.42), and ischemic stroke 1.91 (1.58-2.31).
CONCLUSIONS:
Diabetes combined with low income was associated with substantial excess risk of mortality, myocardial infarction and ischemic stroke among primary care patients with hypertension.
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Using machine learning algorithms to review computed tomography scans and assess risk for cardiovascular disease: Retrospective analysis from the National Lung Screening Trial (NLST).
PLoS One2020 ;15(8):e0236021. doi: 10.1371/journal.pone.0236021.
Stemmer Amos, Shadmi Ran, Bregman-Amitai Orna, Chettrit David, Blagev Denitza, Orlovsky Mila, Deutsch Lisa, Elnekave Eldad,
Abstract
BACKGROUND:
The National Lung Screening Trial (NLST) demonstrated that annual screening with low dose CT in high-risk population was associated with reduction in lung cancer mortality. Nonetheless, the leading cause of mortality in the study was from cardiovascular diseases.
PURPOSE:
To determine whether the used machine learning automatic algorithms assessing coronary calcium score (CCS), level of liver steatosis and emphysema percentage in the lungs are good predictors of cardiovascular disease (CVD) mortality and incidence when applied on low dose CT scans.
MATERIALS AND METHODS:
Three fully automated machine learning algorithms were used to assess CCS, level of liver steatosis and emphysema percentage in the lung. The algorithms were used on low-dose computed tomography scans acquired from 12,332 participants in NLST.
RESULTS:
In a multivariate analysis, association between the three algorithm scores and CVD mortality have shown an OR of 1.72 (p = 0.003), 2.62 (p < 0.0001) for CCS scores of 101-400 and above 400 respectively, and an OR of 1.12 (p = 0.044) for level of liver steatosis. Similar results were shown for the incidence of CVD, OR of 1.96 (p < 0.0001), 4.94 (p < 0.0001) for CCS scores of 101-400 and above 400 respectively. Also, emphysema percentage demonstrated an OR of 0.89 (p < 0.0001). Similar results are shown for univariate analyses of the algorithms.
CONCLUSION:
The three automated machine learning algorithms could help physicians to assess the incidence and risk of CVD mortality in this specific population. Application of these algorithms to existing LDCT scans can provide valuable health care information and assist in future research.
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Predictors of long-term renal function after kidney surgery for patients with preoperative chronic kidney disease.
Can Urol Assoc J2020 Jul;():. doi: 10.5489/cuaj.6485.
Silagy Andrew, Zabor Emily, Mano Roy, DiNatale Renzo, Marcon Julian, Kashani Mahyar, Blum Kyle, Reznik Eduard, Jaimes Edgar, Coleman Jonathan, Hakimi A Ari, Russo Paul,
Abstract
INTRODUCTION:
We evaluated the trajectory of estimated glomerular filtration rate (eGFR) after kidney surgery in patients with kidney cancer and chronic kidney disease (CKD).
METHODS:
We identified 1204 consecutive patients in our institutional database with preoperative CKD undergoing partial or radical nephrectomy from 1998-2016. Postoperative eGFR was tracked, with patients censored when receiving dialysis or kidney transplantation. A multivariable mixed-effects models assessed associations between preoperative baseline patient and tumor characteristics, and longitudinal eGFR. The Kaplan-Meier method and multivariable Cox regression were used to estimate overall survival, cancer-specific survival, and cumulative incidence of dialysis.
RESULTS:
Preoperatively, 892 (74.1%), 271 (22.5%), and 41 (3.4%) patients had CKD stage 3a, 3b, and 4/5, respectively. There were 55 patients dialyzed and 355 deaths (99 from kidney cancer). Median followup was 8.1 years, with 25 781 postoperative eGFR measurements. Factors associated with decreasing eGFR postoperatively included radical nephrectomy, male gender, older age, increased body mass index (BMI), and cardiovascular risk factors. We observed a significant interaction effect between time from surgery and preoperative CKD stage: the eGFR of stage 3a patients improved, while stage ?3b declined (p<0.001). The two- year and five-year cumulative incidence of dialysis was 1.8% (1.1-2.6%) and 3.1% (2.2-4.2%), respectively. The cumulative incidence of dialysis, with death as a competing event, significantly differed by preoperative CKD stage.
CONCLUSIONS:
Preoperative CKD stage ?3b is independently associated with a higher risk of declining renal function, dialysis, and mortality. With careful selection, patients with preoperative CKD withstand kidney surgery with low rates of dialysis.
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Plasma non-cholesterol sterols as markers of cholesterol synthesis and intestinal absorption: a critical review.
Curr Pharm Des2020 Jul;():. doi: 10.2174/1381612826666200730220230.
Quintão Eder Carlos Rocha,
Abstract
Plasma concentrations of phytosterols, and of non-cholesterol sterol precursors of cholesterol synthesis have been used as markers, respectively, of intestinal cholesterol absorption and synthesis in inherited and secondary dyslipidemias and in population-based investigations to evaluate the risk for cardiovascular disease. The method aims at replacing initial research tecniques such as use of stable isotopes associated with fecal steroid balance that are limited by high cost and tedious procedures. However, we show in this review that several results obtained with serum sterol measurements are contradictory. In this regard, the following points are discussed: 1) how phytosterols relate to atherosclerosis considering that defects in biliary output or in the transport of phytosterols from the intestinal mucosa back into the intestinal lumen provide increased content of phytosterols and other sterols in plasma and tissues not allowing to conclude that their presence in arteries and atheromas represents the etiology of atherosclerosis; 2) serum non cholesterol sterols as markers of cholesterol synthesis and absorption, such as cholestanol, present discrepant results rendering them often inadequate to identify cases of coronary artery disease as well as alterations in the whole body cholesterol metabolism; 3) such methods of measurement of cholesterol metabolism are confounded by factors like diabetes mellitus, body weight and other pathologies including considerable hereditary hyperlipidemias biological variabilities that influence the efficiency of synthesis and intestinal absorption of cholesterol.
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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A pilot study on secondary anemia in "frailty" patients treated with Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine: safety of treatment explored by HRV non-linear analysis as predictive factor of cardiovascular tolerability.
Eur Rev Med Pharmacol Sci2020 Jul;24(14):7776-7783. doi: 22280.
Marchitto N, Curcio A, Iannarelli N, Petrucci A, Romano A, Pironti M, Paparello P T, Raimondi G,
Abstract
OBJECTIVE:
Iron deficiency anemia (IDA) in patients with heart disease is correlated with decreased exercise capacity and poor health-related quality of life, and predicts worse cardiovascular outcomes, especially for elderly patients. IDA can worsen cardiac function that can be monitored with Heart Rate Variability (HRV) analysis, providing important information about cardiac health. In a recent study we explored the effect and the tolerability of the administration of Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel Forte®) in "frailty" patients with secondary anemia and low kidney failure, by analysing the HRV frequency domain. The aim of the present study is the further confirmation of the safety of the already evaluated intervention, by analysing non-linear domain of HRV.
PATIENTS AND METHODS:
In this pilot study we enrolled 52 "frailty" elderly patients, with a recent diagnosis of secondary anemia due to iron deficiency, with Class II New York Heart Association (NYHA) hypertensive heart disease, low kidney failure, and atherosclerosis. The patients were divided in 2 groups: Group A (N=23 patients) received oral administration of Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel Forte®) 2 tabs/day, containing 60 mg of Fe3+, for 24 days; Group B (N=29 patients) received intravenous administration of ferrous gluconate 63 mg/day added to saline solution, while they were hospitalized (15±5 days). We evaluated laboratory values of hemoglobin (Hb) and sideremia levels. Furthermore, we measured ECG signals before and after treatment, using non-linear analysis techniques.
RESULTS:
Both intravenous and oral treatments evaluated in this study, were effective and safe about the cardiovascular risk in "frailty" elderly patients, as resulted from non-linear HRV analysis. Efficacy results showed that hemoglobin and sideremia levels after treatments are significantly increased. The HRV non-linear analysis showed that all parameters evaluated, except for the SD1 values in the Group A, were not affected by treatments, confirming the absence of cardiovascular risk of the therapy.
CONCLUSIONS:
Non-linear HRV evaluation confirmed that oral administration of Ferric Sodium EDTA, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) did not impact the cardiovascular risk, without causing adverse events typically reported with other iron supplementation therapies, both oral and intravenous.
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The Predictive Value of Sarcopenia and Its Individual Criteria for Cardiovascular and All-Cause Mortality in Suburb-dwelling Older Chinese.
J Nutr Health Aging2020 ;24(7):765-771. doi: 10.1007/s12603-020-1390-8.
Han P, Chen X, Yu X, Zhang Y, Song P, Cai M, Liang L, Liang Z, Yang R, Jin F, Wang L, Guo Q,
Abstract
OBJECTIVES:
The aim of the present study is to investigate the associations between the Asian Working Group for Sarcopenia (AWGS) sarcopenic definition, and its individual criteria, and risk of cardiovascular disease (CVD) and all-cause mortality in the Chinese elderly.
METHODS:
Longitudinal analysis of 1,264 participants aged 60 years or older at baseline (2013-2014) living in suburban areas, China. Sarcopenia was defined according to the recommended algorithm of AWGS. Muscle mass was measured by a direct segmental multifrequency bioelectrical impedance analysis. Muscle strength was assessed by handgrip strength, and physical performance measured via usual walking speed.
RESULTS:
Cox proportional hazard models were used to assess the risk of CVD and all-cause mortality. After 40 months of follow-up, forty-eight deaths (4.2%) died in this cohort. The mortality rate with sarcopenia was 4.7% in men and 3.8% in women. After adjusting for potential confounders, the risk of all-cause death was 4.15 times higher in subjects with sarcopenia. Furthermore, low muscle mass (HR: 2.62, 95% CI 1.34-5.13) and low grip strength (HR: 5.79; 95% CI 2.28-14.71), but not walking speed, were found to be significantly associated with all-cause mortality. Risk of CVD mortality was significantly greater in sarcopenia. Low grip strength and low walking speed were associated with 11 times (HR: 11.03, 95% CI 1.58-77.02) and 13 times (HR: 13.02; 95% CI 1.18-143.78) higher risk of CVD mortality.
CONCLUSIONS:
Sarcopenia and components of sarcopenia were associated with greater CVD and all-cause mortality. Pertinent prevention or rehabilitation programs projects should look to promote healthy aging in different types of sarcopenia group.
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Association of cardio-metabolic risk factors with elevated basal heart rate in South African Asian Indians.
Minerva Endocrinol2020 Aug;():. doi: 10.23736/S0391-1977.20.03246-0.
Prakaschandra Rosaley, Prakesh Datshana,
Abstract
BACKGROUND:
The aim of this study was to determine the association of increasing basal heart rate (BHR) with cardio-metabolic risk in a community sample of Asian Indians from South Africa, due to lack of population-based data on the interaction between heart rate and cardiovascular factors.
METHODS:
Data drawn from 1349 randomly selected participants was collected using the WHO STEPS questionnaire. Anthropometry, blood pressure, physical examination and laboratory analyses of venous blood samples and definition of cardiometabolic derangements were performed according to established guidelines. BHR classified into three categories i.e. <60bpm; 60-89 bpm and ?90bpm. Stepwise backward regression models were constructed for determination of association between increasing BHR and cardiometabolic parameters. A ROC was constructed to determine the AUC and to determine their sensitivity and specificity for discriminating increasing BHR levels.
RESULTS:
In 379 men (mean age 42 ± 15 years; mean HR 79 ±13bpm) and 970 women (mean age 46 ± 12 years; mean HR 87±7.8bpm), with BHR significantly higher in women (p<0.0001). The distribution of HR was: <60 bpm (2.7%); HR 60-89 bmp (75.8%); HR ?90 bpm (20.1%). In the adjusted logistic regression model fasting plasma glucose (p=0.02; OR 95%CI=1.18[1.02;1.4]); age (p=0.01 OR95% CI= 0.97 [0.96,0.99]); systolic blood pressure (p<0.001 OR 95%CI= 0.95 [0.9,0.97]), and diastolic blood pressure (p=<0.001 OR 95%CI=1.1[1.06,1.1]) emerged as independently associated with increasing BHR. The highest AUC for discriminating increasing BHR was for mean diastolic blood pressure (AUC = 0.618; p<0.001), and fasting blood glucose (AUC = 0.595; p<0.0001).
CONCLUSIONS:
Increasing BHR was independently associated with derangements in fasting blood glucose and blood pressure.
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Effects of glucagon-like peptide-1 receptor agonists liraglutide and semaglutide on cardiovascular and renal outcomes across body mass index categories in type 2 diabetes: results of the LEADER and SUSTAIN 6 trials.
Diabetes Obes Metab2020 Aug;():. doi: 10.1111/dom.14160.
Verma Subodh, McGuire Darren K, Bain Stephen C, Bhatt Deepak L, Leiter Lawrence A, Mazer C David, Monk Fries Tea, Pratley Richard E, Rasmussen Søren, Vrazic Hrvoje, Zinman Bernard, Buse John B,
Abstract
Associations between body mass index (BMI) and the cardiovascular (CV) and kidney efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with type 2 diabetes (T2D) are uncertain; therefore, data analyzed separately from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial and the Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN 6) were examined. These international, randomized, placebo-controlled trials investigated liraglutide and semaglutide (both subcutaneous) in patients with T2D and at high risk of CV events. In post hoc analyses, patients were categorized by baseline BMI (<25?kg/m , ?25-<30?kg/m , ?30-<35?kg/m , ?35?kg/m ), and CV and kidney outcomes with GLP-1RA versus placebo analyzed. All baseline BMI data from LEADER (n = 9331) and SUSTAIN 6 (n = 3290) were included (91% and 92% of patients with overweight or obesity, respectively). In SUSTAIN 6, nominally significant heterogeneity of semaglutide efficacy by baseline BMI was observed for CV death/myocardial infarction/stroke (major adverse CV events [MACE], primary outcome of both; p =?0.02); otherwise, there was no statistical heterogeneity for either GLP-1RA versus placebo across BMI categories for key CV and kidney outcomes. The lack of statistical heterogeneity from these cardiorenal outcomes implies that liraglutide and semaglutide may be beneficial for many patients and is likely not to depend on their baseline BMI, but further study is needed. This article is protected by copyright. All rights reserved.
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Sodium-glucose cotransporter-2 (SGLT-2) inhibitors and major adverse limb events: a trial-level meta-analysis including 51,713 individuals.
Diabetes Obes Metab2020 Aug;():. doi: 10.1111/dom.14159.
Huang Chen-Yu, Lee Jen-Kuang,
Abstract
OBJECTIVE:
Previous meta-analysis results showed that the use of a sodium-glucose cotransporter-2 inhibitor (SGLT2i) is associated with an increased risk of lower extremity amputation. However, the effects of SGLT2i on specific lower extremity outcomes and whether outcome heterogeneity is based on key baseline characteristics remain unclear.
METHODS:
We performed a quantitative meta-analysis of randomized, placebo-controlled, cardiovascular outcome trials of SGLT2i in patients with type 2 diabetes. We searched the PubMed, Embase, and Cochrane databases for trials published up until June 30, 2020. The efficacy outcomes analyzed included amputations and were stratified by several subgroup variables, including age, duration of diabetes, glucose control, renal function, established peripheral artery disease, and diabetes microvascular complications. This review is registered before completing the analysis.
RESULTS:
Among 383 records identified, 6 studies assessing the following three SGLT2 inhibitors met our inclusion criteria: empagliflozin (EMPA-REG OUTCOME study), canagliflozin (CANVAS Program and CREDENCE study), dapagliflozin (DECLARE-TIMI 58 and DAPA-HF trials) and ertugliflozin (VERTIS CV study). Among a total of 51,713 participants, 858 required amputation operations. The event rates of amputation were 2.0 % (535/26,778) and 1.3% (323/24,927) in the SGLT2 inhibitors and control groups, respectively. The random effects model revealed that the SGLT2 inhibitors were not significantly associated with an increased risk of amputation with a substantial heterogeneity (pooled risk ratio [RR] 1.24, 95% confidence interval [CI] 0.96-1.60, I =?67.5%). This neutral effect of the SGLT2 inhibitors was also consistent across different levels of subgroups, including subgroups with or without established peripheral artery disease (PAD).
CONCLUSION:
SGLT-2 inhibitors are not associated with increased risks of amputation operations even among various high-risk subgroups, including patients with PAD. The amputation events primarily arise from critical limb ischemia and infection instead of acute limb ischemia. A multi-center study focused on major adverse limb events with a longer follow-up is needed to confirm these results and provide guidelines for clinical practice. This article is protected by copyright. All rights reserved.
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Associations between usual glycated haemoglobin A1c and Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus: A 10-year Diabetes cohort study.
Diabetes Obes Metab2020 Aug;():. doi: 10.1111/dom.14157.
Wan Eric Yuk Fai, Yu Esther Yee Tak, Chen Julie Yun, Wong Ian Chi Kei, Chan Esther Wai Yin, Lam Cindy Lo Kuen,
Abstract
AIMS:
The long-term effect of glycated haemoglobin A1c(HbA1c) level on cardiovascular disease(CVD) risks among patients with type 2 diabetes remains controversial. The aim of this study was to investigate their associations.
MATERIALS AND METHODS:
This retrospective cohort study conducted in Hong Kong selected patients aged 45-84?years old with type 2 diabetes mellitus and without CVD in primary care clinics within 2008-2010. The usual HbA1c measurement was calculated using a mixed effects model to minimize regression dilution bias. The association between usual HbA1c and CVD risk was assessed by Cox regression with adjustment of baseline covariates. Subgroup analyses by patient characteristics were also conducted.
RESULTS:
After a median follow-up period of 8.4years (1.4 million person-years), 174,028 patients with 34,074 CVD events were observed. Curvilinear association was found between the usual HbA1c and total CVD, stroke, heart failure and CVD mortality risk. No significant difference was found among patients with usual HbA1c<7% (53?mmol/mol). A positive linear association was found between usual HbA1c and the risks of outcomes when the HbA1c was 7% (53?mmol/mol) or above. The adjusted hazard ratios (HRs) for CVD risk per 1% increment in usual HbA1c>7%(53mmol/mol) was 21% (HR: 1.21; 95%C.I. (Confidence Interval): 1.18-1.23). Similar pattern was identified in patient's subgroups analysis, but the effect of usual HbA1c in younger patients were more prominent than the others.
CONCLUSIONS:
Increment in usual HbA1c level >7.0% (53mmol/mol) was associated with elevated CVD risk, but no difference was found in population with usual HbA1c<7.0% (53mmol/mol) irrespective of the patients' characteristics. For the CVD prevention, a strict adherence of HbA1c <7% (53?mmol/mol) should apply to patients with younger age. This article is protected by copyright. All rights reserved.
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Cardiometabolic Risk Factor Control in African American and White Caucasians initiating SGLT-2 Inhibitor: Real-world Study.
Diabetes Obes Metab2020 Aug;():. doi: 10.1111/dom.14164.
Montvida Olga, Verma Subodh, Shaw Jonathan E, Paul Sanjoy K,
Abstract
AIMS:
To explore cardiometabolic risk profiles, probability of sustainable control, and the effectiveness of treatment with SGLT-2i in African American (AA) and White Caucasian (WC).
MATERIALS AND METHODS:
Using nationally representative US electronic medical records, 72?690 WC and 10?004 AA adults diagnosed with type 2 diabetes initiating SGLT-2i during 2013-2018, continuing it ?6?months, and with follow-up ?12?months, were identified. HbA1c, body weight, SBP, and lipid changes at 6-month and sustainability of control over 18?months post SGLT-2i initiation were explored, separately in those with and without atherosclerotic cardiovascular disease (ASCVD).
RESULTS:
WC were older (58?years) with lower mean HbA1c (8.5%), compared to AA (54?years, HbA1c 9.0%). BMI distribution was similar, proportions of uncontrolled SBP /LDL-C /non-HDL-C/ Triglyceride were 24/ 42 /51 /62% in WC and 31/ 51 /49 / 32% in AA. At 6-month follow-up WC and AA had similar adjusted reduction in HbA1c (1.1%), SBP (8-10?mmHg), LDL-C (10-13?mg/dL) and body weight (1.1-1.4?kg). However, over 18?months follow-up, compared to WC, AA were significantly less likely to achieve a sustainable control in HbA1c (OR: 0.67; 95% CI: 0.63-0.72), body weight (OR: 0.81; 95% CI: 0.72-0.91), SBP (OR: 0.67; 95% CI: 0.61-0.74), LDL-C (OR: 0.77; 95% CI: 0.67-0.89). Triglyceride control was significantly better among AA. AA had significantly higher risk factor burden irrespective of ASCVD status.
CONCLUSIONS:
While effectiveness of SGLT-2i was similar among AA and WC irrespective of ASCVD status, AA continued to have worse cardiometabolic risk factor burden post SGLT-2i initiation. This article is protected by copyright. All rights reserved.
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Assessing the cost-effectiveness of SGLT2i in type 2 diabetes mellitus: a comprehensive economic evaluation using clinical trial and real-world evidence.
Diabetes Obes Metab2020 Aug;():. doi: 10.1111/dom.14162.
McEwan Phil, Bennett Hayley, Khunti Kamlesh, Wilding John, Edmonds Christopher, Thuresson Marcus, Wittbrodt Eric, Fenici Peter, Kosiborod Mikhail,
Abstract
AIMS:
The economic burden of diabetes is driven by the management of vascular complications. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated reductions in cardiovascular and renal complications, including hospitalisation for heart failure (HHF) and renal disease progression, in randomised clinical trials. The objective of this study was to evaluate the cost-effectiveness of the SGLT2i class versus standard of care in type 2 diabetes mellitus (T2DM), using evidence from both clinical trial and real-world studies.
METHODS:
An established T2DM model was adapted to use contemporary outcomes evidence from real-world studies and randomised controlled trial evaluations of SGLT2i and extrapolated over a lifetime for HHF, myocardial infarction, stroke, end-stage renal disease, and all-cause mortality. The economic analysis considered adults with T2DM, with and without established cardiovascular disease, and was conducted over a lifetime from the perspective of the healthcare payer in the UK, US, and China, discounted at country-specific rates.
RESULTS:
SGLT2i were consistently associated with increased treatment costs, reduced complication costs and gains in quality-adjusted life years driven by differences in projected life expectancy, cardiovascular and microvascular morbidity and weight loss. SGLT2i were estimated to be cost-saving or cost-effective at relevant thresholds for the overall population in the UK, US and China, with the cost-effectiveness being greatest in higher risk subgroups.
CONCLUSIONS:
The findings highlight the need to take into account cost savings from reducing common, morbid and preventable T2DM complications when considering the cost of diabetes medications. This article is protected by copyright. All rights reserved.
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Cardiovascular Outcomes Trials with Glucagon-like Peptide-1 Receptor Agonists: A Comparison of Study Designs, Populations, and Results.
Diabetes Obes Metab2020 Aug;():. doi: 10.1111/dom.14165.
Pantalone Kevin M, Munir Kashif, Hasenour Clinton M, Atisso Charles M, Varnado Oralee J, Maldonado Juan M, Konig Manige,
Abstract
Despite treatment advances leading to improved outcomes over the past two decades, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in people with diabetes. People with type 2 diabetes (T2D) have a 2- to 4-fold increased risk of CVD and CV death. Individuals with T2D have not seen the same improvements in CV morbidity and mortality as those without T2D. Given this, it is important to understand the CV impact of drugs used to treat T2D. In patients with T2D, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated a reduction in HbA1c and body weight regardless of their differences in chemical structure and pharmacokinetic parameters. Glycaemic efficacy, accompanied by the potential for weight reduction and a low risk for hypoglycaemia have moved GLP-1 RAs to the first treatment of choice following metformin monotherapy in the latest American Diabetes Association treatment guidelines. Additionally, all GLP-1 RAs have demonstrated CV safety and several have proven CV benefit. GLP-1 RAs have been evaluated in Cardiovascular Outcomes Trials (CVOTs) of varying sizes, designs, and patient populations with differing reported effects on CV outcomes. The purpose of this article is to review the completed GLP-1 RA CVOTs with special attention to how their design, size, patient populations, and conduct may influence interpretation of results. This article is protected by copyright. All rights reserved.
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