DONA ORA
Pubblicazioni recenti - cardiovascular risk
-
PBMCs-Derived microRNA Signature as a Prethrombotic Status Discriminator in Stable Coronary Artery Disease.
Thromb Haemost2019 Nov;():. doi: 10.1055/s-0039-1700518.
Gao Jie, Liu Jia, Zhang Ying, Guan BaoYi, Qu Hua, Chai Hua, Wang WenTing, Ma XiaoJuan, Shi DaZhuo,
Abstract
Prethrombotic status (PTS) in patients with stable coronary artery disease (SCAD) increases the risk of coronary thrombosis. Accumulating evidences have indicated that micro-ribonucleic acids (miRNAs) may serve as promising biomarkers for SCAD patients with PTS. The present study aimed to identify the miRNA signature in SCAD patients with PTS and evaluated their diagnostic significance. In the screening phase, 32 differently expressed miRNAs (DEMs) in peripheral blood mononuclear cells (PBMCs) were detected in 35 SCAD patients compared with 5 healthy controls by microarray. MiRNA-gene network analysis was then performed, and 4 DEMs were selected for validation with reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR) test in an independent cohort comprising 79 SCAD patients and 19 healthy controls. Compared with healthy controls, RT-qPCR test verified the upregulations of miR-34a-5p, miR-432-5p, and miR-370-3p detected by microarray; while the upregulation of miR-495-3p measured by RT-qPCR was not consistent with its low expression detected by microarray. Only miR-34a-5p and miR-495-3p were significantly upregulated in the PTS group compared with the non-PTS group (?
Georg Thieme Verlag KG Stuttgart · New York.
Guarda su PubMed
-
Short-term e-cigarette vapour exposure causes vascular oxidative stress and dysfunction: evidence for a close connection to brain damage and a key role of the phagocytic NADPH oxidase (NOX-2).
Eur Heart J2019 Nov;():. doi: ehz772.
Kuntic Marin, Oelze Matthias, Steven Sebastian, Kröller-Schön Swenja, Stamm Paul, Kalinovic Sanela, Frenis Katie, Vujacic-Mirski Ksenija, Bayo Jimenez Maria Teresa, Kvandova Miroslava, Filippou Konstantina, Al Zuabi Ahmad, Brückl Vivienne, Hahad Omar, Daub Steffen, Varveri Franco, Gori Tommaso, Huesmann Regina, Hoffmann Thorsten, Schmidt Frank P, Keaney John F, Daiber Andreas, Münzel Thomas,
Abstract
AIMS:
Electronic (e)-cigarettes have been marketed as a 'healthy' alternative to traditional combustible cigarettes and as an effective method of smoking cessation. There are, however, a paucity of data to support these claims. In fact, e-cigarettes are implicated in endothelial dysfunction and oxidative stress in the vasculature and the lungs. The mechanisms underlying these side effects remain unclear. Here, we investigated the effects of e-cigarette vapour on vascular function in smokers and experimental animals to determine the underlying mechanisms.
METHODS AND RESULTS:
Acute e-cigarette smoking produced a marked impairment of endothelial function in chronic smokers determined by flow-mediated dilation. In mice, e-cigarette vapour without nicotine had more detrimental effects on endothelial function, markers of oxidative stress, inflammation, and lipid peroxidation than vapour containing nicotine. These effects of e-cigarette vapour were largely absent in mice lacking phagocytic NADPH oxidase (NOX-2) or upon treatment with the endothelin receptor blocker macitentan or the FOXO3 activator bepridil. We also established that the e-cigarette product acrolein, a reactive aldehyde, recapitulated many of the NOX-2-dependent effects of e-cigarette vapour using in vitro blood vessel incubation.
CONCLUSIONS:
E-cigarette vapour exposure increases vascular, cerebral, and pulmonary oxidative stress via a NOX-2-dependent mechanism. Our study identifies the toxic aldehyde acrolein as a key mediator of the observed adverse vascular consequences. Thus, e-cigarettes have the potential to induce marked adverse cardiovascular, pulmonary, and cerebrovascular consequences. Since e-cigarette use is increasing, particularly amongst youth, our data suggest that aggressive steps are warranted to limit their health risks.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
Guarda su PubMed
-
Associations between ?-blocker therapy and cardiovascular outcomes in patients with diabetes and established cardiovascular disease.
Am Heart J2019 Oct;218():92-99. doi: S0002-8703(19)30271-6.
Shavadia Jay S, Zheng Yinggan, Green Jennifer B, Armstrong Paul W, Westerhout Cynthia M, McGuire Darren K, Cornel Jan H, Holman Rury R, Peterson Eric D,
Abstract
BACKGROUND:
The effects of ?-blocker therapy in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (ASCVD) are unclear. We sought to evaluate associations between ?-blocker use in T2D with ASCVD and cardiovascular (CV) outcomes.
METHODS:
In patients with T2D and ASCVD enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), an inverse probability of treatment-weighted Cox proportional hazards model was used to examine the association between baseline ?-blocker therapy (at randomization) and the primary CV composite (defined as CV death, non-fatal myocardial infarction [MI], non-fatal stroke, or hospitalization for unstable angina), including in subgroups with prior MI and heart failure (HF); other outcomes evaluated included individual components of the primary composite, hospitalization for HF, and severe hypoglycemic events.
RESULTS:
Of the 14,671 patients randomized, 9322 (64%) were on a ?-blocker at baseline; these patients were more likely to have prior MI or HF. Over a median 3.0 (25th, 75th percentile: 2.2, 3.6) years, the risk of the primary CV composite was significantly higher with baseline ?-blocker use versus no ?-blocker use (4.5 vs. 3.4 events/100-patient years, adjusted hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.05-1.29); no significant interaction was noted for patients with versus without prior MI or HF. Baseline ?-blocker use was not associated with risks for severe hypoglycemic events (HR 1.14, 95% CI 0.88-1.48).
CONCLUSIONS:
In this observational analysis of T2D and ASCVD, baseline ?-blocker use was not associated with risks for severe hypoglycemia yet also was not associated with CV risk reduction over 3 years of follow-up, supporting a randomized examination of chronic ?-blocker therapy in this patient population. (TECOS ClinicalTrials.gov number, NCT00790205).
Copyright © 2019 Elsevier Inc. All rights reserved.
Guarda su PubMed
-
Applying contemporary antithrombotic therapy in the secondary prevention of chronic atherosclerotic cardiovascular disease.
Am Heart J2019 Oct;218():100-109. doi: S0002-8703(19)30235-2.
Welsh Robert C, Peterson Eric D, De Caterina Raffaele, Bode Christoph, Gersh Bernard, Eikelboom John W,
Abstract
For 4 decades, antithrombotic therapy with aspirin has been a cornerstone of secondary prevention for patients with chronic atherosclerotic cardiovascular disease (ASCVD). Unfortunately, despite the use of evidence-based therapies, patients with ASCVD continue to have recurrent major adverse cardiovascular events including death, myocardial infarction, and stroke-at a rate of approximately 2%-4% per year. To combat this continuing risk, several recent trials have evaluated the efficacy and safety of more intensive antithrombotic strategies through prolonged dual antiplatelet therapy (DAPT), combining a P2Y12 receptor antagonists and low-dose aspirin, or alternatively applying a dual pathway inhibition approach, combining low-dose non-vitamin K antagonist anticoagulant and low-dose aspirin. Both combination strategies have been shown to reduce recurrent ischemic events but at the cost of increased bleeding events. The clinical application of these antithrombotic strategies requires clinicians to assess and balance the risk of recurrent ischemic and bleeding events in an individual patient. Furthermore, clinicians may also need to adapt their antithrombotic strategies to achieve best patient outcomes, as ASCVD is a progressive disease and the risks of cardiovascular ischemic and bleeding events may shift over time. This state-of-the-art article reviews evidence from the trials and provides a practical approach to the application of DAPT and dual pathway antithrombotic therapy in the long-term management of patients with chronic ASCVD.
Copyright © 2019 Elsevier Inc. All rights reserved.
Guarda su PubMed
-
Spatial distribution of dengue in Honduras during 2016-2019 using a geographic information systems (GIS)-Dengue epidemic implications for public health and travel medicine.
Travel Med Infect Dis2019 Nov;():101517. doi: S1477-8939(19)30220-0.
Zambrano Lysien I, Rodriguez Edith, Espinoza-Salvado Iván Alfonso, Fuentes-Barahona Itzel Carolina, Lyra de Oliveira Tales, Luciano da Veiga Glaucia, Cláudio da Silva José, Valle-Reconco Jorge Alberto, Rodríguez-Morales Alfonso J,
Abstract
BACKGROUND:
After serious epidemics of chikungunya (CHIKV) and Zika (ZIKV) in the Americas, dengue (DENV) have reemerged in most countries. We analyzed the incidence, incidence rates, and evolution of DENV cases in Honduras from 2015 to 2018 and the ongoing 2019 epidemic.
METHODS:
Using epidemiological weeks (EW) surveillance data on the DENV in Honduras, we estimated incidence rates (cases/100,000 population), and developed maps at national, departmental, and municipal levels.
RESULTS:
From January 1, 2016 to July 21, 2019, a total of 109,557 cases of DENV were reported, 28,603 in 2019, with an incidence rate of 312.32 cases/100,000 population this year; 0.13% laboratory-confirmed. The highest peak was reached on the EW 28°, 2019 (5,299 cases; 57.89 cases/100,000 population). The department with the highest number of cases and incidence rate was Cortes (8,404 cases, 479.68 cases/100,000 population in 2019).
DISCUSSION:
The pattern and evolution of DENV epidemic in 2019 in Honduras has been similar to that which occurred for in 2015. As previously reported, this epidemic involved the north and central areas of the country predominantly, reaching municipality incidences there >1,000 cases/100,000 population (or 1%). Studies using geographical information systems linked with clinical disease characteristics are necessary to obtain accurate epidemiological data for public health systems. Such information is also useful for assessment of risk for travelers who visit specific areas in a destination country.
Copyright © 2019. Published by Elsevier Ltd.
Guarda su PubMed
-
Reducing Heart Failure Risk In People With Diabetes - the STOP HF Midlands Project.
J Card Fail2019 Nov;():. doi: S1071-9164(19)31473-3.
Gallagher J, James S, Watson C, Harkins V, Ledwidge M, McDonald K,
Guarda su PubMed
-
Ideal cardiovascular health and resting heart rate in the Multi-Ethnic Study of Atherosclerosis.
Prev Med2019 Nov;():105890. doi: S0091-7435(19)30370-6.
Osibogun Olatokunbo, Ogunmoroti Oluseye, Spatz Erica S, Fashanu Oluwaseun E, Michos Erin D,
Abstract
Elevated resting heart rate (RHR) is associated with an increased cardiovascular disease (CVD) risk, but little is known about its association with cardiovascular health (CVH), assessed by the Life's Simple 7 (LS7) metrics. We explored whether ideal CVH was associated with RHR in a cohort free from clinical CVD. We conducted cross-sectional analysis of baseline data (2000-2002) of 6457 Multi-Ethnic Study of Atherosclerosis participants in 2018. Each LS7 metric (smoking, physical activity, diet, body mass index, blood pressure, cholesterol and glucose) was scored 0-2. Total score ranged from 0 to 14. Scores of 0-8 indicate inadequate, 9-10 average, and 11-14 optimal CVH. RHR was categorized as <60, 60-69, 70-79 and ?80?bpm. We used multinomial logistic regression to determine associations between CVH score and RHR, adjusting for age, sex, race/ethnicity, education, income, health insurance, and atrioventricular nodal blockers. Mean age of participants (standard deviation) was 62 (10) years; 53% were women; 47% had inadequate CVH, 33% average, and 20% optimal. Favorable CVH was associated with lower odds of having higher RHR. Compared to RHR <60?bpm, participants with optimal CVH had adjusted odds ratio (95% CI) of 0.55 (0.46-0.64) for RHR of 60-69?bpm, 0.34 (0.28-0.43) for 70-79?bpm, and 0.14 (0.09-0.22) for ?80?bpm. A similar pattern was observed in stratified analysis by sex, race/ethnicity and age. Favorable CVH was less likely to be associated with elevated RHR irrespective of sex, race/ethnicity and age. More research is needed to explore the usefulness of promoting ideal CVH to reduce elevated RHR, a known risk factor for CVD.
Copyright © 2019. Published by Elsevier Inc.
Guarda su PubMed
-
The association of nativity/length of residence and cardiovascular disease risk factors in the United States.
Prev Med2019 Nov;():105893. doi: S0091-7435(19)30373-1.
Fryar Cheryl D, Fakhouri Tala H, Carroll Margaret D, Frenk Steven M, Ogden Cynthia L,
Abstract
Differences by nativity status for cardiovascular disease (CVD) risk factors have been previously reported. Recent research has focused on understanding how other acculturation factors, such as length of residence, affect health behaviors and outcomes. This study examines the association between CVD risk factors and nativity/length of US residence. Using cross-sectional data from 15,965 adults in the 2011-2016 National Health and Nutrition Examination Surveys (analyzed in 2018), prevalence ratios and predicted marginals from logistic regression models are used to estimate associations of CVD risk factors (i.e., hypertension, hypercholesterolemia, diabetes, overweight/obesity and smoking) with nativity/length of residence (<15?years, ?15?years) in the US. In sex-, age-, education- and race and Hispanic origin- adjusted analyses, a higher percentage of US (50 states and District of Columbia) born adults (86.4%) had ?1 CVD risk factor compared to non-US born residents in the US <15?years (80.1%) but not ?15?years (85.1%). Compared to US born counterparts, regardless of length of residence, hypertension overall and smoking among non-Hispanic white and Hispanic adults were lower among non-US born residents. Overweight/obesity overall and diabetes among Hispanic adults were lower among non-US born residents in the US <15?years. In contrast, non-US born non-Hispanic Asian residents in the US <15?years had higher prevalence of diabetes. Non-US born adults were less likely to have most CVD risk factors compared to US born adults regardless of length of residence, although, for smoking and diabetes this pattern differed by race and Hispanic origin.
Copyright © 2019. Published by Elsevier Inc.
Guarda su PubMed
-
Implications for REDUCE IT in clinical practice.
Prog Cardiovasc Dis2019 Nov;():. doi: S0033-0620(19)30137-9.
Bittner Vera,
Abstract
Statin therapy is effective in primary and secondary prevention, but substantial residual risk remains on statin treatment, especially among high risk and very high risk patients. Add-on therapy with ezetimibe and proprotein convertase subtilisin /kexin type 9 (PCSK9) inhibitors provides additional risk reduction through further reduction in low density lipoprotein cholesterol. Elevated triglycerides/triglyceride rich lipoproteins contribute to atherogenesis and to the residual risk on statin therapy. Addition of icosapent ethyl to statins has recently been shown to markedly lower risk of cardiovascular disease (CVD) events in patients with established atherosclerotic CVD (ASCVD) and high risk patients with type II diabetes mellitus. These data are discussed in the context of current guidelines and synthesized in a decision pathway to guide combination lipid-lowering therapy in patients at high ASCVD risk.
Copyright © 2019 Anesthesia History Association. Published by Elsevier Inc. All rights reserved.
Guarda su PubMed
-
Coronary artery calcium scoring for individualized cardiovascular risk estimation in important patient subpopulations after the 2019 AHA/ACC primary prevention guidelines.
Prog Cardiovasc Dis2019 Nov;():. doi: S0033-0620(19)30132-X.
Dzaye Omar, Dudum Ramzi, Reiter-Brennan Cara, Kianoush Sina, Tota-Maharaj Rajesh, Cainzos-Achirica Miguel, Blaha Michael J,
Abstract
The 2018 and 2019 American Heart Association and American College of Cardiology (AHA/ACC) guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend consideration of so-called "risk-enhancing factors" in borderline to intermediate risk individuals. These include high-risk race/ethnicity (e.g. South Asian origin), chronic kidney disease, a family history of premature ASCVD, the metabolic syndrome, chronic inflammatory disorders (e.g. rheumatoid arthritis [RA], psoriasis, or chronic human immunodeficiency virus [HIV]), and conditions specific to women, among others. Studies suggest, however, that risk may be highly heterogeneous within these subgroups. The AHA/ACC guidelines also recommend consideration of coronary artery calcium (CAC) scoring for further risk assessment in borderline to intermediate risk individuals in whom management is uncertain. Although the combination of risk enhancing factors and CAC burden (together with Pooled Cohort estimates) may lead to more accurate ASCVD risk assessment, few publications have closely examined the interplay between risk enhancing factors and CAC scoring for personalized risk estimation. Our aim is to review the relevant literature in this area. Although further research is clearly needed, CAC assessment seems a highly valuable option to inform individualized ASCVD risk management in these important, often highly heterogeneous patient subgroups.
Copyright © 2019. Published by Elsevier Inc.
Guarda su PubMed
-
Hepatic exosome-derived miR-130a-3p attenuates glucose tolerance via suppressing PHLPP2 gene in adipocyte.
Metabolism2019 Nov;():154006. doi: S0026-0495(19)30221-5.
Wu Jiahan, Dong Tao, Chen Ting, Sun Jiajie, Luo Junyi, He Jiajian, Wei Limin, Zeng Bin, Zhang Haojie, Li Weite, Liu Jie, Chen Xingping, Su Mei, Ni Yuechun, Jiang Qingyan, Zhang Yongliang, Xi Qianyun,
Abstract
OBJECTIVE:
Glucose and lipid metabolism disorder is a major risk factor for type II diabetes and cardiovascular diseases. Evidence has indicated that the interplay between the liver and adipose tissue is crucial in maintaining energy homeostasis. Recently, the interaction between two distant endocrine organs mainly focuses on the regulation of hormones and receptors. However, as a novel carrier in the inter-tissue communication, exosome plays a role in liver-fat crosstalk, but its effects on glucose and lipid metabolisms are still unclear. In this study, we sought to investigate the effects of hepatic exosome-derived miR-130a-3p in the regulation of glucose/lipid metabolism in adipose tissues.
MEASURE:
In vivo, we constructed generalized miR-130a-3p knockout (130KO) and overexpressed (130OE) mice. Wild type (WT), 130KO and 130OE mice (n?=?10) were assigned to a randomized controlled trial and were fed diets with either 10% (standard diet, SD) or 60% (high-fat diet, HFD) of total calories from fat (lard). Next, hepatic exosomes were extracted from WT-SD, 130KO-SD and 130OE-SD mice (WT-EXO, KO-EXO, OE-EXO), and 130KO mice were injected with 100?mg hepatic exosomes of different sources via tail-vein (once every 48?h) for 28?days, fed with HFD. In vitro, 3?T3-L1 cells were treated with miR-130a-3p mimics, inhibitor and hepatic exosomes. Growth performance and glucose and lipid metabolic profiles were examined.
RESULTS:
After feeding with HFD, the weights of 130KO mice were markedly higher than WT mice. Over-expression of miR-130a-3p in 130OE mice and intravenous injection of 130OE-EXO in 130KO mice contributed to a positive correlation with the recovery of insulin resistance. In addition, miR-130a-3p mimics and 130OE-EXO treatment of 3?T3-L1 cells exhibited decreasing generations of lipid droplets and increasing glucose uptake. Conversely, inhibition of miR-130a-3p in vitro and in vivo resulted in opposite phenotype changes. Furthermore, PHLPP2 was identified as a direct target of miR-130a-3p, and the hepatic exosome-derived miR-130a-3p could improve impaired glucose tolerance via suppressing PHLPP2 to activate AKT-AS160-GLUT4 signaling pathway in adipocytes.
CONCLUSIONS:
We demonstrated that hepatic exosome-derived miR-130a regulated energy metabolism in adipose tissues, and elucidated a new molecular mechanism that hepatic exosome-derived miR-130a-3p is a crucial participant in organismic energy homeostasis through mediating crosstalk between the liver and adipose tissues.
Copyright © 2019. Published by Elsevier Inc.
Guarda su PubMed
-
Risk Factors and Outcomes During a First Acute Myocardial Infarction in Breast Cancer Survivors Compared to Females without Breast Cancer: A Nationwide Cohort Study.
Am J Med2019 Nov;():. doi: S0002-9343(19)30960-X.
Yandrapalli Srikanth, Malik Aaqib H, Pemmasani Gayatri, Gupta Kanika, Harikrishnan Prakash, Nabors Christopher, Aronow Wilbert S, Cooper Howard A, Panza Julio A, Frishman William H, Jain Diwakar,
Abstract
PURPOSE:
The purpose of this research was to study the differences in epidemiology and outcomes of a first myocardial infarction in breast cancer survivors compared to the general female population in the United States.
METHODS:
We retrospectively analyzed the United States National Inpatient Sample years 2005-2015 to identify adult women with a first myocardial infarction. In this cohort, breast cancer survivors were identified. Outcomes evaluated were the differences in baseline demographics, comorbidities, and adjusted in-hospital mortality in women with and without breast cancer.
RESULTS:
Among 1,644,032 first myocardial infarction cases in adult women, there were 56,842 (3.5%) breast cancer survivors. Compared to women without breast cancer, breast cancer survivors were 6 years older (mean age 77 vs 71 years, p<0.001), had significantly higher prevalence of dyslipidemia and hypertension, and lower prevalence of obesity, diabetes mellitus, and smoking. Breast cancer survivors were more likely to have a non-ST segment elevation acute myocardial infarction and less likely to receive mechanical revascularization. In-hospital mortality was lower in breast cancer survivors (7.1%) compared to those without (7.9%, p<0.001), findings which persisted after risk adjustment (odds ratio 0.89, 95% CI 0.82-0.94).
CONCLUSIONS:
Breast cancer survivors had a first acute myocardial infarction at an older age and had small but favorable differences in cardiovascular disease risk factors and outcomes compared to women without breast cancer. The favorable impact of health education, preventative medical care, greater motivation for a healthier life-style, and participation in cancer survivorship programs on these seemingly paradoxical findings in breast cancer survivors should be further explored.
Copyright © 2019. Published by Elsevier Inc.
Guarda su PubMed
-
Risk Factors and Outcomes of Very Young Adults Who Experience Myocardial Infarction: The Partners YOUNG-MI Registry.
Am J Med2019 Nov;():. doi: S0002-9343(19)30962-3.
Yang Junjie, Biery David, Singh Avinainder, Divakaran Sanjay, DeFilippis Ersilia M, Wu Wanda Y, Klein Josh, Hainer Jon, Ramsis Mattheus, Natarajan Pradeep, Januzzi James L, Nasir Khurram, Bhatt Deepak L, Di Carli Marcelo F, Blankstein Ron,
Abstract
BACKGROUND:
Despite significant progress in primary prevention, the rate of myocardial infarction has not declined in young adults. We sought to compare the risk factor profiles and outcomes between individuals who experienced a first myocardial infarction at a very young (age ?40) and young (40< age ?50) age.
METHODS:
We evaluated all patients ?50 years of age admitted with a Type 1 myocardial infarction to two large academic hospitals from 2000 to 2016. Risk factors were determined by review of electronic medical records. The primary outcomes of interest were all-cause and cardiovascular mortality.
RESULTS:
Among 2097 consecutive young patients with myocardial infarction, 431 (20.5%) were ?40 years of age. When compared with their older counterparts, very young patients had similar risk profiles with the exception of greater substance abuse (17.9% vs. 9.3%, p<0.001) and less hypertension (37.9% vs. 50.9%, p<0.001). Spontaneous coronary artery dissection was more prevalent in very young patients (3.1% vs. 1.1%, p=0.003). Over a median follow-up of 11.2 years, very young myocardial infarction patients had a similar risk of all-cause and cardiovascular mortality.
CONCLUSIONS:
Despite being on average 10 years younger and having a lower prevalence of hypertension, very young myocardial infarction patients had similar one-year and long-term outcomes when compared to those aged 41 to 50 at the time of their index infarction. Our findings suggest the need for aggressive secondary prevention measures in very young patients who experience a myocardial infarction.
Copyright © 2019. Published by Elsevier Inc.
Guarda su PubMed
-
Long-term follow-up of epicardial pacing and left ventricular dysfunction in children with congenital heart block.
Ann Thorac Surg2019 Nov;():. doi: S0003-4975(19)31688-1.
Song Mi Kyoung, Kim Na Yeon, Bae Eun Jung, Kim Gi Beom, Kwak Jae Gun, Kim Woong Han, Lee Jeong Ryul,
Abstract
BACKGROUND:
Patients with congenital complete atrioventricular block often require lifelong pacemaker therapy which has a risk of left ventricular (LV) dysfunction. The aim of our study was to determine the long-term effects of epicardial pacing on LV function and dyssynchrony in children with congenital heart block.
METHODS:
We conducted a retrospective study at a single tertiary center in which 34 pediatric patients with isolated congenital complete heart block who underwent epicardial pacemaker implantation from 1987 to 2016 were enrolled.
RESULTS:
Their median age during pacemaker insertion was 2.5 years (range, 0-16.7 years) and the median follow-up duration was 12.3 years. The initial pacing sites were the right ventricle (RV) free wall for 10 patients, RV apex for 16, and LV apex for eight. LV dysfunction developed in seven patients, of whom four underwent lead relocation to the RV apex (n = 2) and cardiac resynchronization therapy upgrade (n = 2). RV free wall pacing had a significantly higher risk of LV dysfunction than either LV or RV apical pacing (Odds ratio 52.5; p = 0.003; 95% C.I. 3.9-700). All four patients who underwent lead repositioning showed improvement of LV function (median ejection fraction, 24% to 62.7%).
CONCLUSIONS:
Our study suggests that RV free wall pacing may be a significant risk factor for LV dysfunction. Pacemaker-induced LV dysfunction was improved via lead relocation to the RV apex or cardiac resynchronization therapy upgrade. Future studies with a bigger sample size and longer-term follow-up are required to confirm our results.
Copyright © 2019. Published by Elsevier Inc.
Guarda su PubMed
-
Repair of Complex Transposition of Great Arteries: Up to 30 Years of Follow-Up.
Ann Thorac Surg2019 Nov;():. doi: S0003-4975(19)31682-0.
Kari Fabian A, Bohnens Holger, Bierbach Benjamin, Bacha Emile A, Stiller Brigitte, Bauer Ulrike,
Abstract
BACKGROUND:
To characterize treatment of transposition of great arteries with ventricular septal defect and left ventricular outflow tract obstruction (TGA-VSD-LVOTO) in Germany, and to analyze late outcomes.
METHODS:
German National Quality Assurance for Congenital Heart Disease data were searched for TGA-VSD-LVOTO. A total of n=139 patients were treated at 15 institutions between 1968 and 2016 Risk factor analyses were performed for primary endpoints death and reoperation/reintervention.
RESULTS:
Follow-up was 88% complete, mean/median follow-up-times were 16±7/15 years (1-48 years), cumulative follow-up comprised 1739 patient-years. Atrial switches were performed in 15%, Rastelli in 48%, Nikaidoh in 9%, reparation a l'etage ventriculair (REV) in 8%, and arterial switch in 20%. Actuarial survival at 30 years was 86% (83-90%), with no difference between repairs. Freedom from primary reoperation was 17% (12-21%) at 30 years. Freedom from reoperation for LVOTO at 30 years was 74% (70-78%). Recurrent LVOTO was found in 9%, with risk factor diffuse subvalvular LVOTO (OR 9.8, p 0.04). Late freedom from first reoperations other than right-ventricle-to-pulmonary-artery-conduit was 60% (59-61%), with predictors multiple VSD (HR 6, p=0.03) and Rastelli (HR 12, p=0.03). Absolute reoperation rates were lowest for REV procedure (16% at a mean of 12 years).
CONCLUSIONS:
Long-term survival is good without detectable differences between operations. Since the early 2000s increasing use of Nikaidoh and REV-procedures was obvious, with REV performing particularly well. Surgery-specific and unspecific reoperations are most common after Rastelli.
Copyright © 2019. Published by Elsevier Inc.
Guarda su PubMed
-
Association of statin and its lipophilicity with cardiovascular events in patients receiving chronic dialysis.
Clin Pharmacol Ther2019 Nov;():. doi: 10.1002/cpt.1722.
Wang Shih-Wei, Li Lung-Chih, Su Chien-Hao, Yang Yao-Hsu, Hsu Tsuen-Wei, Hsu Chien-Ning,
Abstract
Lipophilicity of statins has been linked to extrahepatic cells penetration and inhibition of isoprenoid synthesis and coenzyme Q10 which may affect myocardial contraction. Whether statins lipophilicity affects the risk of cardiovascular disease development in patients under dialysis is unclear. This population-based study included 114,929 patients undergoing chronic dialysis, retrieved from the Registry for Catastrophic Illness Patients from the National Health Insurance Research Database in Taiwan from 2000 to 2013. Statins were initiated after dialysis and classified into hydrophilic and lipophilic by the duration of use. In total, 17,015 statin users and match controls were identified by using propensity score matching in 1:1 ratio. New statin use was associated with higher cardiovascular disease risk (adjusted hazard ratio (aHR): 1.2, 95% CI: 1.13-1.28) but lower all-cause mortality (aHR: 0.93, 95% CI: 0.89-0.96). Hydrophilic statins were significantly associated with lower risk of cardiovascular disease compared to lipophilic statins (aHR: 0.91, 95% CI: 0.85-0.97).
© 2019 The Authors Clinical Pharmacology & Therapeutics © 2019 American Society for Clinical Pharmacology and Therapeutics.
Guarda su PubMed
-
Effect of Bempedoic Acid vs Placebo Added to Maximally Tolerated Statins on Low-Density Lipoprotein Cholesterol in Patients at High Risk for Cardiovascular Disease: The CLEAR Wisdom Randomized Clinical Trial.
JAMA2019 11;322(18):1780-1788. doi: 10.1001/jama.2019.16585.
Goldberg Anne C, Leiter Lawrence A, Stroes Erik S G, Baum Seth J, Hanselman Jeffrey C, Bloedon LeAnne T, Lalwani Narendra D, Patel Pragna M, Zhao Xin, Duell P Barton,
Abstract
Importance:
Additional treatment options are needed for patients who do not achieve sufficient reduction in low-density lipoprotein cholesterol (LDL-C) level with available lipid-lowering therapies.
Objective:
To assess the efficacy of bempedoic acid vs placebo in patients at high cardiovascular risk receiving maximally tolerated lipid-lowering therapy.
Design, Setting, and Participants:
Phase 3, randomized, double-blind, placebo-controlled clinical trial conducted at 91 clinical sites in North America and Europe from November 2016 to September 2018, with a final date of follow-up of September 22, 2018. A total of 779 patients with atherosclerotic cardiovascular disease, heterozygous familial hypercholesterolemia, or both met randomization criteria, which included LDL-C level 70 mg/dL (1.8 mmol/L) or greater while receiving maximally tolerated lipid-lowering therapy.
Interventions:
Patients were randomized 2:1 to treatment with bempedoic acid (180 mg) (n?=?522) or placebo (n?=?257) once daily for 52 weeks.
Main Outcomes and Measures:
The primary end point was percent change from baseline in LDL-C level at week 12. Secondary measures included changes in levels of lipids, lipoproteins, and biomarkers.
Results:
Among 779 randomized patients (mean age, 64.3 years; 283 women [36.3%]), 740 (95.0%) completed the trial. At baseline, mean LDL-C level was 120.4 (SD, 37.9) mg/dL. Bempedoic acid lowered LDL-C levels significantly more than placebo at week 12 (-15.1% vs 2.4%, respectively; difference, -17.4% [95% CI, -21.0% to -13.9%]; P?
Conclusions and Relevance:
Among patients at high risk for cardiovascular disease receiving maximally tolerated statins, the addition of bempedoic acid compared with placebo resulted in a significant lowering of LDL-C level over 12 weeks. Further research is needed to assess the durability and clinical effect as well as long-term safety.
Trial Registration:
ClinicalTrials.gov Identifier: NCT02991118.
Guarda su PubMed
-
Variation in blood pressure and long-term risk of dementia: A population-based cohort study.
PLoS Med2019 Nov;16(11):e1002933. doi: 10.1371/journal.pmed.1002933.
Ma Yuan, Wolters Frank J, Chibnik Lori B, Licher Silvan, Ikram M Arfan, Hofman Albert, Ikram M Kamran,
Abstract
BACKGROUND:
Variation in blood pressure may relate to dementia risk via autonomic disturbance or hemodynamic mechanisms, but the long-term associations are unclear. We aimed to determine whether blood pressure variation over a period of years, considering both magnitude and direction, is associated with the risk of dementia.
METHODS AND FINDINGS:
In a prospective cohort study ongoing since 1989 in the Netherlands, 5,273 dementia-free participants (58.1% women; mean [SD] age, 67.6 [8.0] years) were included. As of 2016, 1,059 dementia cases occurred during a median follow-up of 14.6 years. Absolute variation in systolic blood pressure (SBP) was assessed as the absolute difference in SBP divided by the mean over two sequential visits every 4.2 (median) years, with the first quantile set as the reference level. The direction was the rise or fall in SBP, with the third quantile set as the reference level. We estimated the risk of dementia in relation to SBP variation measured at different time windows (i.e., at least 0, 5, 10, and 15 years) prior to dementia diagnosis, with adjustments for age, sex, education, apolipoprotein E (APOE) genotype, vascular risk factors, and history of cardiovascular disease. We repeated the above analysis for variation in diastolic blood pressure (DBP). A large SBP variation was associated with an increased dementia risk, which became more pronounced with longer intervals between the assessment of SBP variation and the diagnosis of dementia. The hazard ratio (HR) associated with large variation (the highest quintile) increased from 1.08 (95% confidence interval [CI] 0.88-1.34, P = 0.337) for risk within 5 years of SBP variation measurement to 3.13 (95% CI 2.05-4.77; P < 0.001) for risk after at least 15 years since the measurement of SBP variation. The increased long-term risk was associated with both large rises (HR for the highest quintile, 3.31 [95% CI 2.11-5.18], P < 0.001) and large falls in SBP (HR for the lowest quintile, 2.20 [95% CI 1.33-3.63], P = 0.002), whereas the higher short-term risk was only associated with large falls in SBP (HR, 1.21 [95% CI 1.00-1.48], P = 0.017). Similar findings were observed for variation in DBP. Despite our assessment of major confounders, potential residual confounding is possible, and the findings on blood pressure variability over periods of years may not be generalizable to variability over periods of days and other shorter periods.
CONCLUSIONS:
Results of this study showed that a large blood pressure variation over a period of years was associated with an increased long-term risk of dementia. The association between blood pressure variation and dementia appears most pronounced when this variation occurred long before the diagnosis. An elevated long-term risk of dementia was observed with both a large rise and fall in blood pressure.
Guarda su PubMed
-
Impact of chronic thrombocytopenia on in-hospital outcomes and healthcare resource utilization after transcatheter aortic valve replacement.
Catheter Cardiovasc Interv2019 Nov;():. doi: 10.1002/ccd.28519.
Fugar Setri, Behnamfar Omid, Okoh Alexis K, Alabre Alisha F, Salia Soziema, Kosinski Mark, Mahmood Ali, Jolly Neeraj, Doukky Rami, Kavinsky Clifford J,
Abstract
BACKGROUND:
There is little data on the impact of chronic thrombocytopenia (CTP) on outcomes after transcatheter aortic valve repair (TAVR). Most studies are from single centers and mostly focused on postprocedure thrombocytopenia.
OBJECTIVES:
This study sought to report on the impact of CTP (>1 year) on in-hospital outcomes and healthcare resource utilization after TAVR.
METHODS:
From the National Inpatient Sample (NIS) between 2012 and 2015, we identified patients with CTP who underwent TAVR. A 1:1 propensity-matched cohort was created to examine in-hospital outcomes in patients with and without CTP. The primary outcome was in-hospital mortality. Secondary outcomes included postprocedure complications, length of stay, total cost, and discharge disposition.
RESULTS:
A matched pair of 4,300 patients with and without CTP were identified. Patients with CTP had higher in-hospital mortality as compared to no CTP patients (6.0 vs. 3.3%, p-value .007), increased postprocedure hemorrhage, platelet and blood transfusion, vascular complications, postop sepsis, and acute kidney injury. With regards to resource utilization, CTP patients had a longer length of stay, higher total cost and were more likely to be discharged to a facility (34.1 vs. 27.6%) other than home (All, p-value <.001). Subanalysis, however, revealed this difference in resource utilization was seen when patients developed postprocedure complications.
CONCLUSION:
This study demonstrated higher risk of in-hospital mortality, perioperative complications, and healthcare resource utilization in patients with baseline CTP undergoing TAVR. Further studies are required to investigate ways to improve the management of these patients.
© 2019 Wiley Periodicals, Inc.
Guarda su PubMed
-
Lipid lowering and Alzheimer's disease risk: a Mendelian randomization study.
Ann Neurol2019 Nov;():. doi: 10.1002/ana.25642.
Williams Dylan M, Finan Chris, Schmidt Amand F, Burgess Stephen, Hingorani Aroon D,
Abstract
OBJECTIVE:
To examine whether genetic variation affecting the expression or function of lipid-lowering drug targets is associated with Alzheimer's disease (AD) risk, to evaluate the potential impact of long-term exposure to corresponding therapeutics.
METHODS:
We conducted Mendelian randomization analyses using variants in genes that encode the protein targets of several approved lipid-lowering drug classes: HMGCR (encoding the target for statins); PCSK9 (encoding the target for PCSK9 inhibitors e.g. evolocumab and alirocumab), NPC1L1 (encoding the target for ezetimibe); APOB (encoding the target of mipomersen). Variants were weighted by associations with low-density lipoprotein cholesterol (LDL-C) using data from lipid genetics consortia (N up to 295 826). We meta-analysed MR estimates for regional variants weighted by LDL-C on AD risk from two large samples (total N = 24718 cases, 56685 controls).
RESULTS:
Models for HMGCR, APOB and NPC1L1 did not suggest that the use of related lipid-lowering drug classes would affect AD risk. In contrast, exposure to PCSK9 inhibitors was predicted to increase AD risk in both of the AD samples (combined odds ratio per standard deviation lower LDL-C inducible by the drug target = 1.45; 95% confidence interval: 1.23, 1.69). This risk increase was opposite to, though more modest than, the degree of protection from coronary artery disease predicted by these same methods for PCSK9 inhibition.
INTERPRETATION:
We did not identify genetic support for the repurposing of statins, ezetimibe or mipomersen for AD prevention. Notwithstanding caveats to this genetic evidence, pharmacovigilance for AD risk among users of PCSK9 inhibitors may be warranted. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Guarda su PubMed
