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Pubblicazioni recenti - cardiovascular risk
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HDL cholesterol, triglycerides and characteristics of coronary atherosclerosis in patients with newly diagnosed significant coronary artery disease by CTCA.
Kardiol Pol2022 Dec;():. doi: 10.33963/KP.a2022.0279.
Oleksiak Anna, K?pka Cezary, K?pka Cezary, Ruci?ska Karolina, Ruci?ska Karolina, Marcinkiewicz Kamil, Marcinkiewicz Kamil, Demkow Marcin, Demkow Marcin, Kruk Mariusz, Kruk Mariusz,
Abstract
BACKGROUND:
Current European Society of Cardiology guidelines indicate specific target low-density lipoprotein cholesterol (LDL-C) levels for different cardiovascular risk categories in terms of prevention. However, the target for high-density lipoprotein cholesterol (HDL-C) and triglycerides have not been established.
AIM:
The study aim to investigate the associations betweenHDL-C,triglycerides andcoronary plaquescharacteristics.
METHODS:
This is a prospective single-center study with enrolled consecutive patients with newly diagnosed significant (?1stenosis ?50%) CAD on CTCA. Patients had lipids andCTCA analysis, including high-risk plaque (HRP) features: low-attenuation plaque (LAP), napkin-ring sign (NRS), positive remodeling (PR) and spotty calcium (SC), type of plaque (calcified, noncalcified, mixed), and their composition (calcified, fibrous, fibro-fatty, necrotic core).
RESULTS:
The study included 300 patients (191 men, 66 [8] years). 66% of them took lipid-lowering therapy. HRPwere found in 208 patients. There was no association between LDL-C, plaque composition and HRP presence. There was a negative correlation between HDL-Cand fibro-fatty and necrotic core plaque components (P = 0.0002, P = 0.0009). There was a positive correlation between triglycerides and necrotic core (P = 0.038). There were differences in HDL-C and triglycerides in patients with and without NRS (47 vs. 53 mg/dl, P = 0.0002 and 128 vs. 109 mg/dl, P = 0.02). In logistic regression, HDL-C (odds ratio [OR], 0.95;95% confidence interval [CI], 0.93-?0.98; P
CONCLUSION:
Lower HDL-C and higher triglycerides were associated with NRS presence and more necrotic core plaque component in coronary plaques in patients with newly diagnosed CAD.
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Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients With Congenital Heart Disease.
Circ Cardiovasc Imaging2022 Dec;():e014865. doi: 10.1161/CIRCIMAGING.122.014865.
Egbe Alexander C, Miranda William R, Anderson Jason H, Pellikka Patricia A, Connolly Heidi M,
Abstract
BACKGROUND:
Left ventricular global longitudinal strain (LVGLS) has been shown to improve risk stratification in patients with LV systolic dysfunction and subsequent recovery of LV ejection fraction (LVEF) in the acquired heart disease population. The purpose of this study was to assess the relationship between LVGLS and cardiovascular events (heart failure hospitalization, sustained ventricular tachycardia/appropriate shock, heart transplant, or cardiovascular death) and deterioration in LVEF (absolute decrease in LVEF ?10% to LVEF
METHODS:
Retrospective cohort study of congenital heart disease patients with previous diagnosis of LV systolic dysfunction (LVEF 18%) versus abnormal LVGLS (absolute LVGLS ?18%) groups.
RESULTS:
Of 193 patients with recovered LVEF, 86 (45%) had normalization of LVGLS at index echocardiogram. A higher absolute LVGLS and use of renin angiotensin aldosterone system antagonist was associated with a lower risk of cardiovascular events and subsequent deterioration in LVEF, while hypertension was associated with higher risk of cardiovascular events and deterioration in LVEF.
CONCLUSIONS:
These results suggest that patients with congenital heart disease with recovered LVEF remained at risk for adverse outcomes, and LVGLS can be used to identify patients at risk for adverse outcomes. Medical therapy for heart failure and treatment of hypertension may reduce the risk of adverse outcome, but these findings require empirical validation, hence the need for a clinical trial.
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Does osteoarthritis modify the association between NSAID use and risk of comorbidities and adverse events?
Osteoarthr Cartil Open2022 Jun;4(2):100253. doi: 100253.
Dell'Isola Andrea, Turkiewicz Aleksandra, Zhang Weiya, Kiadaliri Ali, Bierma-Zeinstra Sita, Runhaar Jos, Prieto-Alhambra Daniel, Englund Martin,
Abstract
OBJECTIVES:
To investigate the role of osteoarthritis (OA) in the incidence of musculoskeletal, metabolic, cardiovascular, digestive, neuro-psychological, kidney and other comorbidities/adverse events after (i) incident non-steroidal anti-inflammatory drug (NSAID) initiation and (ii) NSAID discontinuation.
METHODS:
We used register data for the population of Skåne, Sweden. For (i), we analysed the association between starting NSAIDs and the risk of incident outcome events in the 6 years following NSAID dispensation among people with prevalent OA vs no OA. For (ii) we studied the effect of discontinuing NSAIDs among people with and without OA up to 120 days. We used flexible parametric models to estimate adjusted differences in cumulative incidence with NSAIDs as time-varying exposure in the presence of non-proportional hazards.
RESULTS:
For (i) we included between 243,832 and 409,749 persons. In the whole cohort, over the 6 years of follow-up, NSAID initiation was associated with a 3% (metabolic) to 16% (musculoskeletal) higher cumulative incidence of outcomes compared to non-users. The difference between those initiating NSAIDs vs non-users was similar in those with and without OA for most outcomes, but in those with OA the increase was lower for neuro-psychological (95%CI: 3.7%-4.6% vs 7.1%-7.9%) and musculoskeletal comorbidities (12%-14.5% vs 16.2%-17.2%).In (ii), we found no interaction between OA and NSAID discontinuation. NSAID discontinuation was associated with decreased risks for most of the outcomes, from -1.3% for musculoskeletal to -0.4% for cardiovascular comorbidities.
CONCLUSIONS:
OA appears to have little influence on the increased risk of comorbidities observed after NSAID initiation or decrease after discontinuation.
© 2022 The Authors.
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Cost-Effectiveness of the CNIC-Polypill Strategy Compared With Separate Monocomponents in Secondary Prevention of Cardiovascular and Cerebrovascular Disease in Portugal: The MERCURY Study.
J Health Econ Outcomes Res2022 ;9(2):134-146. doi: 10.36469/001c.39768.
Aguiar Carlos, Araujo Francisco, Rubio-Mercade Gabriel, Carcedo David, Paz Silvia, Castellano Jose María, Fuster Valentín,
Abstract
Cardiovascular (CV) diseases remain a leading and costly cause of death globally. Patients with previous CV events are at high risk of recurrence. Secondary prevention therapies improve CV risk factor control and reduce disease costs. To assess the cost-effectiveness of a CV polypill strategy (CNIC-Polypill) compared with the loose combination of monocomponents to improve the control of CV risk factors in patients with previous coronary heart disease or stroke. A Markov model cost-utility analysis was developed using 4 health states, SMART risk equation, and 3-month cycles for year 1 and annual cycles thereafter, over a lifetime horizon from the perspective of the National Health System in Portugal (base case). The NEPTUNO study, Portuguese registries, mortality tables, official reports, and the literature were consulted to define effectiveness, epidemiological costs, and utility data. Outcomes were costs (estimated in 2020 euros) per life-year (LY) and quality-adjusted LY (QALY) gained. A 4% discount rate was applied. Alternative scenarios and one-way and probabilistic sensitivity analyses tested the consistency and robustness of results. The CNIC-Polypill strategy in secondary prevention provides more LY and QALY, at a higher cost, than monocomponents. The incremental cost-utility ratio is ?1557/QALY gained. Assuming a willingness-to-pay threshold of ?30?000/QALY gained, there is a 79.7% and a 44.4% probability of the CNIC-Polypill being cost-effective and cost-saving, respectively, compared with the loose combination of monocomponents. Results remain consistent in the alternative scenarios and robust in the sensitivity analyses. The model reflects increments in the number of years patients would live and in quality of life with the CNIC-Polypill. The clinical effectiveness of the CNIC-Polypill strategy initially demonstrated in the NEPTUNO study has been recently corroborated in the SECURE trial. The incremental cost of the CNIC-Polypill strategy emerges slightly above the comparator, but willingness-to-pay estimates and sensitivity analyses indicate that the CNIC-Polypill strategy is consistently cost-effective compared with monocomponents and remains within acceptable affordability margins. The CNIC-Polypill is a cost-effective secondary prevention strategy. In patients with histories of coronary heart disease or stroke, the CNIC-Polypill more effectively controls CV risk factors compared with monocomponents.
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Comparing Simvastatin Monotherapy V/S Simvastatin-Ezetimibe Combination Therapy for the Treatment of Hyperlipidemia: A Meta-Analysis and Review.
Cureus2022 Nov;14(11):e31007. doi: e31007.
Chauhan Dhruva, Memon Farzana, Patwardhan Vaibhav, Kotwani Priya, Shah Parth, Samala Venkata Vikramaditya,
Abstract
Longstanding hyperlipidemia can increase the risk of cardiovascular disease. Statins are currently the mainstay of treatment in hyperlipidemia. Combination therapy of statin with ezetimibe is only indicated for severe hypercholesterolemia and very high-risk atherosclerotic cardiovascular disease (ASCVD) population. There is a paucity of studies comparing statin monotherapy vs combination therapy with ezetimibe. This study aims to perform a meta-analysis of the existing literature and compare the effectiveness of statin monotherapy with statin-ezetimibe combination therapy in the management of hyperlipidemia. A systematic electronic search of the scientific literature was performed in PubMed, EMBASE, and Scopus. Only randomized controlled trials comparing simvastatin monotherapy vs simvastatin-ezetimibe combination therapy between the years 2000 and 2021 and published in English language were included. Fifteen studies were included in the final analysis. The main outcomes that were compared were a reduction in low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Our study showed that combination therapy led to a higher reduction of LDL-C (Mean difference: -20.22(-26.38, -14.07); P
Copyright © 2022, Chauhan et al.
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COVID-19, cardiac involvement and cardiac rehabilitation: Insights from a rehabilitation perspective - State of the Art.
Turk J Phys Med Rehabil2022 Sep;68(3):317-335. doi: 10.5606/tftrd.2022.11435.
Sonel Tur Birkan, Köseo?lu Belma Füsun, Kutay Ordu Gökkaya Nilüfer, Kurtai? Aytür Ye?im, Özyemi?ci Ta?k?ran Özden, Demirba? Kabayel Derya, Kesikta? Nur, T?k?z Canan, Özdemir Hande, Alemdaro?lu Ebru, Bilir Kaya Ba?ak, Genç Aysun, Tomruk Sütbeyaz Serap,
Abstract
Since the beginning of the pandemic, many novel coronavirus disease 2019 (COVID-19) patients have experienced multisystem involvement or become critically ill and treated in intensive care units, and even died. Among these systemic effects, cardiac involvement may have very important consequences for the patient's prognosis and later life. Patients with COVID-19 may develop cardiac complications such as heart failure, myocarditis, pericarditis, vasculitis, acute coronary syndrome, and cardiac arrhythmias or trigger an accompanying cardiac disease. The ratio of COVID-19 cardiac involvement ranges between 7 and 28% in hospitalized patients with worse outcomes, longer stay in the intensive care unit, and a higher risk of death. Furthermore, deconditioning due to immobility and muscle involvement can be seen in post-COVID-19 patients and significant physical, cognitive and psychosocial impairments may be observed in some cases. Considering that the definition of health is "a state of complete physical, mental and social well-being", individuals with heart involvement due to COVID-19 should be rehabilitated by evaluating all these aspects of the disease effect. In the light of the rehabilitation perspective and given the increasing number of patients with cardiac manifestations of COVID-19, in this review, we discuss the rehabilitation principles in this group of patients.
Copyright © 2022, Turkish Society of Physical Medicine and Rehabilitation.
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Clinical Characteristics and Prognosis Analysis of Bloodstream Infection Based on Propensity Matching.
Infect Drug Resist2022 ;15():6963-6974. doi: 10.2147/IDR.S387898.
Wang Jinghui, Zhang Jun, Wu Zhuang-Hao, Liu Lei, Ma Zijun, Lai Cheng-Cheng, Luo Yong-Gang,
Abstract
PURPOSE:
In view of the fact that bloodstream infection(BSI) is a great threat to human survival, early identification of the risk factors affecting prognosis will be of great benefit to the clinic.
PATIENTS AND METHODS:
A propensity score matching method was used to collect patients identified with BSI from 2016 to 2020 from a reputable hospital in China.
RESULTS:
A total of 398 patients were considered. According to the 28-day prognosis, they were divided into the survival group 150 (37.7%) and the death group 248 (62.3%), and the prognosis was analyzed. Subsequently, Propensity score matching was adjusted for variables with p-values
CONCLUSION:
The existence of drug resistance with only leads to Inappropriate empirical antibiotic therapy, ultimately, Inappropriate empirical antibiotic therapy was the direct predictor of mortality.
© 2022 Wang et al.
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Potential Roles of Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) in Nondiabetic Populations.
Cardiovasc Ther2022 ;2022():6820377. doi: 6820377.
Xu Dan, Nair Ankith, Sigston Charlie, Ho Chau, Li Jia, Yang Daya, Liao Xinxue, Chen Wei, Kuang Ming, Li Yanbing, Reid Christopher, Xiao Haipeng,
Abstract
Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have been observed in several large cardiovascular outcome trials to significantly reduce the incidence of major cardiovascular event (MACE) with type 2 diabetic patients. The clinical trials of GLP-1 RAs, including lixisenatide, exenatide, liraglutide, semaglutide, albiglutide, and dulaglutide, are associated with a significantly 14% lower risk of MACE in patients with T2DM and a history of CV disease, and with a nonsignificantly 6% lower risk in patients without history of CV disease. Some of the interpretation with GLP-1 RA trials suggested the possible role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in primary prevention of cardiovascular diseases in nondiabetic individual, echoed by a recent editorial redefining the role of GLP-1 RAs being beyond glycaemic control. The narrative review provides an in-depth insight into GLP-1 RA use guideline in different countries and regions of the world and examines the safety and concern of GLP-1 RA use. The narrative review draws the comparison of GLP-1 RA use between diabetic and nondiabetic individual in terms of cardiovascular and metabolic benefits and points out the direction of future clinical trials of GLP-1 RAs in nondiabetic individuals. The focus of the review is on GLP-1 RAs' preventive roles in nondiabetic individuals with cardiovascular disease, chronic kidney diseases, obesity, dyslipidaemia, hypertension, nonalcoholic fatty liver diseases, polycystic ovarian syndrome (PCOS), and perioperative complications of bariatric surgery, albeit in small studies and subset analysis of clinical trials of diabetic patients.
Copyright © 2022 Dan Xu et al.
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Prevalence, Incidence and Health Impacts of Sleep Disorders on Coronary Artery Disease Risk Factors: Results of a Community-Based Cohort Study (KERCADRS).
Iran J Psychiatry2022 Jul;17(3):247-256. doi: 10.18502/ijps.v17i3.9723.
Najafipour Hamid, Sabahi Abdolreza, Khoramipour Kayvan, Shojaei Shahrokhabad Mohadeseh, Banivaheb Ghodsyeh, Shadkam Mitra, Mirzazadeh Ali,
Abstract
Sleep disorders are associated with many health problems including anxiety, depression and coronary artery disease (CAD). This study investigated the prevalence, predictors and health impacts of insomnia and hypersomnia in southeastern Iran as well as the five-year incidence rate (IR) of these sleep disorders. The present study was a cross-sectional, single-stage, cluster sampling study examining nine CAD risk factors (KERCADR study phase two), including sleep disorders, carried out in Kerman on 9997 participants, 15 to 80 years old. Medical examination along with demographic, sleep status, Physical activity level (GPAQ), anxiety and depression status (Beck Inventories) were assessed and fasting blood sample was taken for blood glucose and lipids analysis. STATA v15 software was used for data analysis using survey data analysis package and a univariable survey logistic regression model. From 9997 participants, 59.4% were female. 45.3% of the participants were suffering from insomnia and hypersomnia, which was 15% more than the phase 1 prevalence (P married > widowed > divorced. While the IR of insomnia was higher in females, males had higher IR of hypersomnia. In addition, the IR of both sleep disorders was higher in participants with Low Physical Activity (LPA). The results showed high current prevalence and increasing trends of sleep disorders in the past five years. If left unaddressed, burden of CVDs in the community will demonstrate a significant increase in the future as a result of sleep disorders and other associated risk factors.
Copyright © 2022 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.
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Institutional analysis of intra- and post-operative tracheostomy management for risk reduction.
World J Otorhinolaryngol Head Neck Surg2022 Dec;8(4):370-377. doi: 10.1016/j.wjorl.2021.02.004.
Henry Laura E, Paul Ellen A, Atkins Joshua H, Martin Niels D, Chalian Ara A, Rassekh Christopher H,
Abstract
OBJECTIVES:
Determine variability in intra- and post-operative management of tracheostomies (trachs) at our institution as existing literature suggests that trachs are a frequent trigger for airway-related emergencies. Catalyze the development of an institution-wide protocols for trach care.
METHODS:
A 39-question online survey was sent to 55 providers who perform open and percutaneous trachs at three of the hospitals within our large, urban, academic medical center. These providers were identified by surveillance of the operating room schedules for 1 year.
RESULTS:
The survey was completed by 40 of the 53 eligible providers (75.5%). Response rate by question varied. Respondents included members of all departments that perform trachs at our institution (Otorhinolaryngology, Trauma Surgery, Thoracic Surgery, General Surgery, Cardiovascular Surgery and Interventional Pulmonology).While most responses demonstrated uniformity in practice, notable variations included the following: 80% of percutaneous trach providers stated that morbid obesity was not a contraindication to performing a trach outside of the operating room (?=?20) while 58% of open trach providers stated that morbid obesity was a contraindication; only 35% of open trach providers perform a Bjork flap (?=?350). The survey also identified significant variability in practice with regards to timing of trach suture removal.
DISCUSSION:
Lack of uniformity was identified in several practices related to intra- and post-operative tracheostomy care. Results did, however, trend toward consensus in many areas. The results are being used to establish a more consistent approach to tracheostomy management across our institution to ensure standardization of practice amidst the rapidly evolving practices of trach placement.
IMPLICATIONS FOR PRACTICE:
With ongoing evolution in the methods of trach placement and its management, the concepts put forth here will be a resource for health care providers at other institutions to consider intra-institutional analysis and establishment of practice standardization.
© 2022 The Authors. World Journal of Otorhinolaryngology - Head and Neck Surgery published by John Wiley & Sons Ltd on behalf of Chinese Medical Association.
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Prognostic factors in children with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation.
World J Pediatr Surg2022 ;5(1):e000271. doi: e000271.
Sun Mingwei, Zong Qing, Ye Li Fen, Fan Yong, Yang Lijun, Lin Ru,
Abstract
BACKGROUND:
Pediatric acute fulminant myocarditis (AFM) is a very dangerous disease that may lead to acute heart failure or even sudden death. Previous reports have identified some prognostic factors in adult AFM; however, there is no such research on children with AFM on venoarterial extracorporeal membrane oxygenation (VA-ECMO). This study aimed to find relevant prognostic factors for predicting adverse clinical outcomes.
METHODS:
A retrospective analysis was performed in an affiliated university children's hospital with consecutive patients receiving VA-ECMO for AFM from July 2010 to November 2020. These children were classified into a survivor group (n=33) and a non-survivor group (n=8). Patient demographics, clinical events, laboratory findings, and electrocardiographic and echocardiographic parameters were analyzed.
RESULTS:
Peak serum creatinine (SCr) and peak creatine kinase isoenzyme MB during ECMO had joint predictive value for in-hospital mortality (p=0.011, AUC=0.962). Based on multivariable logistic regression analysis, peak SCr level during ECMO support was an independent predictor of in-hospital mortality (OR=1.035, 95% CI 1.006 to 1.064, p=0.017, AUC=0.936, with optimal cut-off value of 78 ?mol/L).
CONCLUSION:
Tissue hypoperfusion and consequent end-organ damage ultimately hampered the outcomes. The need for left atrial decompression indicated a sicker patient on ECMO and introduced additional risk for complications. Earlier and more cautious deployment would likely be associated with decreased risk of complications and mortality.
© 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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Burnout Syndrome During COVID-19 Second Wave on ICU Caregivers.
J Crit Care Med (Targu Mures)2022 Oct;8(4):266-272. doi: 10.2478/jccm-2022-0026.
Caillet Anaëlle, Fillon Marina, Plou Margaux, Tisson Emmanuel, Vacheron Charles-Hervé, Allaouchiche Bernard,
Abstract
OBJECTIVE:
The main objective of this article is to evaluate the prevalence of burnout syndrome (BOS) among the Intensive Care Unit (ICU) healthcare workers.
METHODS:
The COVID-impact study is a study conducted in 6 French intensive care units. Five units admitting COVID patient and one that doesn't admit COVID patients. The survey was conducted between October 20th and November 20th, 2020, during the second wave in France. A total of 208 professionals responded (90% response rate). The Maslach Burnout Inventory scale, the Hospital Anxiety and Depression Scale and the Impact of Event Revisited Scale were used to study the psychological impact of the COVID-19 Every intensive care unit worker.
RESULTS:
The cohort includes 208 professionals, 52.4% are caregivers. Almost 20% of the respondents suffered from severe BOS. The professionals who are particularly affected by BOS are women, engaged people, nurses or reinforcement, not coming willingly to the intensive care unit and professionals with psychological disorders since COVID-19, those who are afraid of being infected, and people with anxiety, depression or post-traumatic stress disorder. Independent risk factors isolated were being engaged and being a reinforcement. Being a volunteer to come to work in ICU is protective. 19.7% of the team suffered from severe BOS during the COVID-19 pandemic in our ICU. The independent risk factors for BOS are: being engaged (OR = 3.61 (95% CI, 1.44; 9.09), don't working in ICU when it's not COVID-19 pandemic (reinforcement) (OR = 37.71 (95% CI, 3.13; 454.35), being a volunteer (OR = 0.10 (95% CI, 0.02; 0.46).
CONCLUSION:
Our study demonstrates the value of assessing burnout in health care teams. Prevention could be achieved by training personnel to form a health reserve in the event of a pandemic.
© 2022 Anaëlle Caillet, Marina Fillon, Margaux Plou, Emmanuel Tisson, Charles-Hervé Vacheron, Bernard Allaouchiche, published by Sciendo.
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Effects of L. (purslane) on the metabolic syndrome: A review.
Iran J Basic Med Sci2022 Nov;25(11):1275-1285. doi: 10.22038/IJBMS.2022.63264.13967.
Ebrahimian Zeinab, Razavi Bibi Marjan, Mousavi Shaegh Seyed Ali, Hosseinzadeh Hossein,
Abstract
Metabolic syndrome (MetS) is defined as a disorder with multiple abnormalities, including obesity, high blood pressure, dyslipidemia, and high blood glucose. MetS is the best-known risk factor for type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and obesity. With the globally increasing prevalence of MetS and its related abnormalities, attention to safe and effective prevention and treatment of this complex disorder has been increased. In particular, most treatments have been devoted to using natural agents that could provide more reliable and effective medicinal products with fewer side effects. L. (purslane) is an herb whose therapeutic properties could be found in some ancient medical books. Purslane has shown analgesic, antispasmodic, skeletal muscle relaxant, bronchodilator, antiasthmatic, anti-inflammatory, antiseptic, diuretic, antibacterial, antipyretic, and wound-healing properties. In addition, purslane's hypoglycemic and hypolipidemic properties have been reported in different studies. The positive effects of this plant include reducing stress oxidative and inflammation along with the atherogenic index, improving insulin level and glucose uptake, decreasing lipid profiles, and ameliorating weight gain. These activities could reduce MetS complications. This review aims to provide a comprehensive overview of various , animal, and human studies regarding the effect of on metabolic syndrome to better understand the underlying mechanisms of action for designing more effective treatments.
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Assessment of Patients' Views on Drug Benefits and Risks: An Interview Study with Cardiovascular Patients.
Int J Clin Pract2022 ;2022():6585271. doi: 6585271.
Wakob Ines, Wintsche Ina, Frisch Annett, Remane Yvonne, Laufs Ulrich, Bertsche Thilo, Schiek Susanne,
Abstract
Better and balanced information strategies supporting cardiovascular patients' adherence are required. Cardiovascular drugs have outstanding morbidity and mortality benefits. This can be counteracted by patients' perceptions of risks. Drug information should help the patient but not fuel unwarranted fears. We performed a cross-sectional survey of patients admitted to a cardiology ward. We evaluated (i) the patients' general benefit-risk estimation of their pharmacotherapy; (ii) views on benefits; (iii) views on risks; and (iv) information sources. Additionally, we assessed aspects of anxiety and depression with the Patient Health Questionnaire-4 (PHQ-4). (i) 67 patients (66%) rated expected drug benefits higher than potential risks. (ii) 72% of benefits motivated the patients to take their medication as prescribed. Patients more frequently mentioned surrogate markers as benefits than clinical benefits (
Copyright © 2022 Ines Wakob et al.
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Postprandial Metabolome Following a Low Glycaemic Index Meal-Challenge Test: A Narrative Review.
Malays J Med Sci2022 Oct;29(5):5-16. doi: 10.21315/mjms2022.29.5.2.
Lau Zhi Ch'ng, Mohd Yusof Barakatun Nisak, Abas Faridah, Abd Wahab Norasyikin, Wan Zukiman Wan Zul Haikal, Ismail Amin,
Abstract
The Identifying the dynamic metabolome of the individual in response to a particular stimulus using a metabolomic approach is an emerging research area. Measuring the postprandial metabolite response utilising a meal-challenge test (MCT) provides information beyond the fasting state, which is especially important since human beings spend most of their time in the postprandial state. This is pertinent as an excessive rise in postprandial glycaemia is common in individuals with type 2 diabetes mellitus (T2DM), which puts them at a high risk of developing cardiovascular disease (CVD). While a low glycaemic index (GI) meal improves postprandial glycaemia and insulin levels in MCT studies among individuals with T2DM, its effect on metabolite changes in the postprandial state is unclear. This review summarises the perturbation in postprandial metabolites following a low GI meal in comparison to that following a usual or high GI meal and maps the metabolites in their metabolic pathways. We undertook a literature review using electronic databases, with the Medical Subject Headings (MeSH) terms, to retrieve relevant studies based on specific criteria. A total of seven related studies were documented. For the majority of metabolites studied, it was identified that metabolic regulation following an MCT extends beyond the glucose pathway. Altered metabolic pathways after the consumption of a low GI meal include: i) essential amino acid metabolism by altering the levels of plasma phenylalanine, tyrosine, lysine, leucine, isoleucine and valine; ii) glycolysis and tricarboxylic acid (TCA) metabolism by altering citrate and alanine, and iii) gut microbiota metabolism by altering betaine and acetate. The altered metabolites regulated the pancreatic insulin secretion and related to other dietary factors beyond GI modifications. These metabolomics data need to be interpreted cautiously because the metabolic changes analysed might not be due to the beneficial effects of a low GI meal. Validation of the putative metabolomic biomarkers following a dietary intervention MCT is suggested because researchers need to fully understand the kinetics and metabolism of individuals metabolite before reaching a solid conclusion. Further research characterising the metabotype based on habitual dietary patterns is warranted.
© Penerbit Universiti Sains Malaysia, 2022.
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Time Under 90% Oxygen Saturation and Systemic Hypertension in Patients with Obstructive Sleep Apnea Syndrome.
Nat Sci Sleep2022 ;14():2123-2132. doi: 10.2147/NSS.S388238.
Wang Le, Wei Dong-Hui, Zhang Jing, Cao Jie,
Abstract
PURPOSE:
The diagnosis and severity of obstructive sleep apnea (OSA) are commonly based on the apnea hypopnea index (AHI). However, patients with similar severity AHIs may show widely varying comorbidities and risks for cardiovascular disease, which may be associated with different severities of nocturnal hypoxia. The percentage of cumulative time with oxygen saturation below 90% in total sleep time (T90) is receiving increasing attention in OSA research because it describes the duration and degree of hypoxia during the whole sleep. This study aimed to explore the distribution of T90 in OSA patients with similar severity and to evaluate the relationship between T90 and hypertension.
PATIENTS AND METHODS:
A total of 775 patients with OSA were enrolled in this study, all participants were divided into groups according to the T90 value: light hypoxia (T90?5%), mild hypoxia (T90 accounted for 5-10%), moderate hypoxia (T90 accounted for 10-25%), and severe hypoxia (T90>25%). Multivariate logistic regression analysis was performed to assess the association between T90 and hypertension.
RESULTS:
Of the patients with mild OSA, 94.33% had light hypoxia, and 88.64% of moderate OSA patients had light hypoxia. The proportions of light, mild, moderate, and severe hypoxia among patients with severe OSA were 28.60%, 17.69%, 21.40%, and 32.31%, respectively. After adjustment for potential confounders, the risk of hypertension in patients with severe OSA increased according to the severity categories of T90. The odds ratio for T90 accounting for 10-25% relative to T90?5% was 2.544 (95%confidence interval, 1.254-5.164; P=0.010) and as high as 2.692 (95%confidence interval, 1.403-5.166; P=0.003) in patients with T90>25%.
CONCLUSION:
OSA patients with similar degree of AHI may have different T90 values, especially in severe OSA. A higher T90 was independently associated with the risk of hypertension after adjustment for traditional risk factors in patients with severe OSA. Our findings highlight the potential role for T90 in predicting hypertension in patients severe OSA.
© 2022 Wang et al.
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Metformin: new applications for an old drug.
J Basic Clin Physiol Pharmacol2022 Dec;():. doi: 10.1515/jbcpp-2022-0252.
Naseri Amirreza, Sanaie Sarvin, Hamzehzadeh Sina, Seyedi-Sahebari Sepideh, Hosseini Mohammad-Salar, Gholipour-Khalili Elnaz, Rezazadeh-Gavgani Ehsan, Majidazar Reza, Seraji Parya, Daneshvar Sara, Rezazadeh-Gavgani Erfan,
Abstract
Metformin is a biguanide, evolved as one of the most widely used medicines. The applications of this component include but are not limited to reducing blood glucose, weight loss, and polycystic ovary syndrome. Studies about other probable indications have emerged, indicating that this agent can also be utilized for other purposes. In this review, applications of metformin are noticed based on the current evidence. Metformin commonly is used as an off-label drug in non-alcoholic fatty liver disease (NAFLD), but it worsens inflammation and should not be used for this purpose, according to the latest research. Metformin decreased the risk of death in patients with liver cirrhosis. It is an effective agent in the prevention and improvement of survival in patients suffering hepatocellular carcinoma. There is evidence of the beneficial effects of metformin in colorectal cancer, early-stage prostate cancer, breast cancer, urothelial cancer, blood cancer, melanoma, and bone cancer, suggesting metformin as a potent anti-tumor agent. Metformin shows neuroprotective effects and provides a potential therapeutic benefit for mild cognitive impairment and Alzheimer's disease (AD). It also has been shown to improve mental function and reduce the incidence of dementia. Another condition that metformin has been shown to slow the progression of is Duchenne muscular dystrophy. Regarding infectious diseases, tuberculosis (TB) and coronavirus disease (COVID-19) are among the conditions suggested to be affected by metformin. The beneficial effects of metformin in cardiovascular diseases were also reported in the literature. Concerning renal function, studies showed that daily oral administration of metformin could ameliorate kidney fibrosis and normalize kidney structure and function. This study reviewed the clinical and preclinical evidence about the possible benefits of metformin based on recent studies. Numerous questions like whether these probable indications of metformin can be observed in non-diabetics, need to be described by future basic experiments and clinical studies.
© 2022 Walter de Gruyter GmbH, Berlin/Boston.
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Normal norms of carotid vessel wall volume in Taiwanese adults as measured using three-dimensional ultrasound.
Acta Neurol Taiwan2023 Mar;32(1)():16-24.
Liao Chih-Chen, Chen Pei-Ya, Lin Shinn-Kuang,
Abstract
PURPOSE:
The three-dimensional (3D) measurement of vessel wall volume (VWV) and plaque volume is sensitive for predicting cardiovascular risk. We established the normal norms of carotid VWV.
METHODS:
We retrospectively enrolled 352 patients with normal findings of the carotid ultrasound studies. Two-dimensional carotid intima-media thickness (IMT) was measured online. Grayscale 3D images of both sides of the carotid arteries were analyzed offline for measurement of IMT (QIMT) and VWV.
RESULTS:
The median age of the enrollees was 59 years. The median carotid IMT, QIMT, and VWV was 0.61 mm, 0.72 mm, and 90 mm3, respectively. No differences in IMT and VWV were observed between men and women or between the right and left side. We stratified participants into four groups, namely young adults (?50 years), middle-aged adults (51-65 years), older adults (66-75 years), and senior adults (?75 years). All the values of measured variables increased with advancing age. The median VWV of each group was 84, 90, 100, and 112 mm3, respectively. The increment percentage from young to senior adults was similar in terms of IMT and VWV. Nevertheless, the difference in the value of VWV (28 mm3) was much larger than that in IMT (0.18 mm). All three measured variables exhibited a positive linear correlation with age.
CONCLUSION:
Both IMT and VWV have positive linear correlations with age. The application of QIMT measurements was limited by its inconsistent accuracy. VWV not only has a strong correlation with IMT but also enables observation of dynamic vessel wall changes, which is valuable for clinical observational studies.
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Absence of Effect of Emicizumab on D-Dimer Concentrations in Adult Patients with Severe Hemophilia A.
Clin Appl Thromb Hemost2022 ;28():10760296221143382. doi: 10.1177/10760296221143382.
Iarossi Michael, Lambert Catherine, Hermans Cedric,
Abstract
BACKGROUND:
The D-dimer (DD) assay is an essential biological test for the diagnosis and monitoring of thrombotic conditions. DD testing is usually not performed as part of the routine laboratory management of patients with hemophilia (PWH). There is an increasing concern about the risk of thrombotic complications in PWH, which is likely related to age, cardiovascular risk factors, invasive thrombogenic procedures, over-correction of Factor VIII (FVIII) or FIX, or administration of new therapeutic agents mimicking FVIII or rebalancing coagulation.
OBJECTIVE:
This retrospective study sought to assess the basal DD levels in PWH treated prophylactically with FVIII, and to evaluate potential changes after switching to emicizumab.
METHOD:
Patients over 18 years of age treated with emicizumab within a single center over the period 2017-2022 were included in the study.
RESULT:
DD levels were measured in 40 adult PWH (37 severe/ three moderate / two with FVIII inhibitor) with a median age of 46 years (range: 19-82; Q1-Q3: 30,25-56,5) before and at least 3 months after emicizumab initiation. No significant changes were revealed, with DD median values of 257 ng/mL (range: 250-2876; Q1-Q3: 250-493,5) before and 250 ng/mL (range: 50-6205; Q1-Q3: 250-380,25) after the switch (p??=??0.9).
CONCLUSION:
Most adult PWH on prophylaxis using FVIII display DD levels within the normal range, which remain unchanged after switching to emicizumab. In view of these reassuring results, monitoring of DDs at the start of emicizumab treatment does not appear necessary but could be considered when combined with other bypassing agents or high dose FVIII.
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Machine learning identifies prominent factors associated with cardiovascular disease: findings from two million adults in the Kashgar Prospective Cohort Study (KPCS).
Glob Health Res Policy2022 Dec;7(1):48. doi: 10.1186/s41256-022-00282-y.
Li Jia-Xin, Li Li, Zhong Xuemei, Fan Shu-Jun, Cen Tao, Wang Jianquan, He Chuanjiang, Zhang Zhoubin, Luo Ya-Na, Liu Xiao-Xuan, Hu Li-Xin, Zhang Yi-Dan, Qiu Hui-Ling, Dong Guang-Hui, Zou Xiao-Guang, Yang Bo-Yi,
Abstract
BACKGROUND:
Identifying factors associated with cardiovascular disease (CVD) is critical for its prevention, but this topic is scarcely investigated in Kashgar prefecture, Xinjiang, northwestern China. We thus explored the CVD epidemiology and identified prominent factors associated with CVD in this region.
METHODS:
A total of 1,887,710 adults at baseline (in 2017) of the Kashgar Prospective Cohort Study were included in the analysis. Sixteen candidate factors, including seven demographic factors, 4 lifestyle factors, and 5 clinical factors, were collected from a questionnaire and health examination records. CVD was defined according to International Clinical Diagnosis (ICD-10) codes. We first used logistic regression models to investigate the association between each of the candidate factors and CVD. Then, we employed 3 machine learning methods-Random Forest, Random Ferns, and Extreme Gradient Boosting-to rank and identify prominent factors associated with CVD. Stratification analyses by sex, ethnicity, education level, economic status, and residential setting were also performed to test the consistency of the ranking.
RESULTS:
The prevalence of CVD in Kashgar prefecture was 8.1%. All the 16 candidate factors were confirmed to be significantly associated with CVD (odds ratios ranged from 1.03 to 2.99, all p values?0.05) in logistic regression models. Further machine learning-based analysis suggested that age, occupation, hypertension, exercise frequency, and dietary pattern were the five most prominent factors associated with CVD. The ranking of relative importance for prominent factors in stratification analyses showed that the factor importance generally followed the same pattern as that in the overall sample.
CONCLUSIONS:
CVD is a major public health concern in Kashgar prefecture. Age, occupation, hypertension, exercise frequency, and dietary pattern might be the prominent factors associated with CVD in this region.In the future, these factors should be given priority in preventing CVD in future.
© 2022. The Author(s).
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