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Pubblicazioni recenti - cardiovascular risk
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High miR-133a levels in the circulation anticipates presentation of clinical events in familial hypercholesterolemia patients.
Cardiovasc Res2020 Feb;():. doi: cvaa039.
Escate Rafael, Padró Teresa, Suades Rosa, Camino Sandra, Muñiz Ovidio, Diaz-Diaz Jose Luis, Sionis Alessandro, Mata Pedro, Badimon Lina,
Abstract
AIMS:
Presentation of acute events in patients with atherosclerosis remains unpredictable even after controlling for classical risk factors. MicroRNAs (miRNAs) measured in liquid biopsies could be good candidate biomarkers to improve risk prediction. Here, we hypothesized that miRNAs could predict atherosclerotic plaque progression and clinical event presentation in familial hypercholesterolemia (FH) patients.
METHODS AND RESULTS:
Circulating miRNAs (plasma, exosomes, microvesicles) were investigated by TaqMan Array and RT-qPCR assays. Patients with genetic diagnosis of FH and healthy relatives from the SAFEHEART cohort were included. A differential signature of 10 miRNA was obtained by comparing two extreme phenotypes consisting of FH-patients suffering a cardiovascular event (CVE) within a 8-year follow-up period (FH-CVE, N=42) and non-FH hypercholesterolemic relatives from the same cohort, matched for age and treatment, without CVE during the same period (nFH-nCVE, N=30). The validation studies included two independent groups of patients with FH-background (Discovery-Group, N=89, Validation-Group N=196), developing a future CVE (FH-CVE) or not (FH-nCVE) within the same time period of follow-up. Of the 10 miRNAs initially selected, miR-133a was significantly higher in FH-CVE than in FH-nCVE patients. ROC-analysis confirmed miR-133a as the best microRNA for predicting CVE in FH-patients (0.76±0.054; P<0.001). Furthermore, Kaplan-Meier and COX-analysis showed that high plasma miR-133a levels associated to the higher risk of presenting a CVE within the next 8 years (HR: 3.89 [95%CI: 1.88-8.07], P<0.001). In silico analysis of curate biological interactions related miR-133a with target genes involved in regulation of the cell-membrane lipid-receptor LRP6 and inflammatory cytokines (CXCL8, IL6, TNF). These predictions were experimentally proven in human macrophages and endothelial cells transfected with agomiR-133a.
CONCLUSION:
Elevated levels of miR-133a in the circulation anticipate those FH-patients that are going to present a clinical CVE within the next 2 years (average). Mechanistically, miR-133a is directly related with lipid- and inflammatory-signalling in key cells for atherosclerosis progression.
TRANSLATIONAL PERSPECTIVE:
The present study in patients with familial hypercholesterolemia shows that epigenetic markers can allow the identification of those patients that are going to present an acute clinical event within the next two years (average). There are currently few prognostic biomarkers able to identify subjects at risk of developing major acute cardiovascular events. Here, by using a non-targeted approach of miRNA-discovery, we show for first time that plasma levels of miR-133a have prognostic value to predict incident cardiovascular events in patients with familial hypercholesterolemia treated as per guidelines. Future studies with larger independent cohorts are needed to validate the prognostic value of miR-133a in the general population.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions please email: journals.permissions@oup.com.
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A telephone reminder to enhance adherence to interventions in cardiovascular randomized trials: A protocol for a study within a trial (SWAT).
J Evid Based Med2020 Feb;():. doi: 10.1111/jebm.12375.
Bensaaud Abdelsalam, Gibson Irene, Jones Jennifer, Flaherty Gerard, Sultan Sherif, Tawfick Wael, Jordan Fionnuala,
Abstract
The impact of reduced adherence in randomized clinical trials is well documented in the literature. Nonadherence can negatively affect the trial sample size and estimation of the treatment effect. This protocol aims to evaluate the effects of a telephone call reminder on the adherence rates of participants to interventions in a cardiovascular randomized trial. This is a study within a trial (SWAT). The host trial is evaluating the effectiveness of a multidisciplinary 16-wk cardiovascular disease prevention program on risk factor profile among patients with carotid artery stenosis. Simultaneously, this SWAT will evaluate the effectiveness of telephone call reminders on the participants' adherence to the host trial intervention. The primary outcome is adherence to the protocol of the host trial. Secondary outcomes are level of adherence, number of dropouts, and time to drop out from the host trial.
© 2020 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.
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Extending the Role of Cardiac Magnetic Resonance in Sarcoidosis Risk Stratification: Editorial for "Regional Myocardial Remodeling Characteristics Correlates With Cardiac Events in Sarcoidosis".
J Magn Reson Imaging -
Growth hormone therapy in adults with growth hormone deficiency: a critical assessment of the literature.
Pituitary2020 Feb;():. doi: 10.1007/s11102-020-01031-5.
He Xin, Barkan Ariel L,
Abstract
PURPOSE:
Growth hormone (GH) therapy has been studied as treatment for clinical manifestations of adult-onset growth hormone deficiency (AO-GHD), including cardiovascular risk, bone health, and quality of life. Patients with AO-GHD typically also have significant history of pituitary pathology and hypopituitarism, which raises the question of what proportion of their clinical presentation can be attributed to GHD alone. Currently, much of the existing data for GH therapy in AO-GHD come from uncontrolled retrospective studies and observational protocols. These considerations require careful reassessment of the role of GH as a therapeutic agent in adult patients with hypopituitarism.
METHODS:
We contrast results from placebo-controlled trials with those from uncontrolled and retrospective studies for GH replacement in patients with hypopituitarism. We also examine the evidence for the manifestations of AO-GHD being attributed to GHD alone, as well as the data on adults with congenital, life-long untreated isolated GHD.
RESULTS:
The evidence for increased morbidity and mortality in hypopituitary patients with GHD, and for the benefits of GH therapy, are conflicting. There remains the possibility that the described clinical manifestations of AO-GHD may not be due to GHD alone, but may also be related to underlying pituitary pathology, treatment history and suboptimal hormone replacement.
CONCLUSIONS:
In the setting of inconsistent data on the benefits of GH therapy, treatment of AO-GHD remains an individualized decision. There is a need for more randomized, placebo-controlled studies to evaluate the long-term outcomes of GH therapy in adults with hypopituitarism.
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Subclinical hypothyroidism is associated with albuminuria in Japanese nondiabetic subjects.
Endocrine2020 Feb;():. doi: 10.1007/s12020-020-02220-9.
Toda Akiko, Hara Shigeko, Tsuji Hiroshi, Arase Yasuji,
Abstract
PURPOSE:
Thyroid dysfunction is a risk factor of cardiovascular disease (CVD), and albuminuria is a predictor of CVD. For preventing the CVD, it is essential to clarify from which stage of thyroid dysfunction the risk of CVD starts developing. We thus investigated the association between subclinical thyroid dysfunction and albuminuria, focusing on a nondiabetic general population.
METHODS:
We analyzed the data of 17,221 nondiabetic subjects who underwent annual health checkups by multivariate logistic regression analyses.
RESULTS:
Compared with the subjects with euthyroidism, those with subclinical hypothyroidism presented a higher prevalence of albuminuria. By a multivariate logistic regression analysis, subclinical hypothyroidism showed a significant and independent association with the high prevalence of albuminuria compared with euthyroidism (OR 1.64, 95% CI 1.21-2.21, p?=?0.001). In accord with this result, the analysis in which the lowest quartile of thyroid stimulating hormone (TSH) concentration (<0.96?µIU/mL) was used as a reference revealed that the highest quartile (>2.07?µIU/mL) had a significant and independent association with the prevalence of albuminuria (OR 1.23, 95% CI 1.01-1.51, p?=?0.04). One microliter unit per milliliter increase of the serum concentration of TSH also had a significant and independent association with the prevalence of albuminuria (OR 1.07, 95% CI 1.02-1.12, p?=?0.006). The association between subclinical hyperthyroidism and the prevalence of albuminuria was not significant.
CONCLUSION:
Our data indicated that subclinical hypothyroidism was significantly and independently associated with the high prevalence of albuminuria.
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Effects of vitamin D supplementation on cardiometabolic outcomes in children and adolescents: a systematic review and meta-analysis of randomized controlled trials.
Eur J Nutr2020 Feb;():. doi: 10.1007/s00394-019-02150-x.
Hauger Hanne, Laursen Rikke Pilmann, Ritz Christian, Mølgaard Christian, Lind Mads Vendelbo, Damsgaard Camilla Trab,
Abstract
PURPOSE:
In observational studies, higher S-25-hydroxyvitamin D [S-25(OH)D] has been associated with a more favorable cardiometabolic profile in childhood, but results may be confounded. We examined effects of vitamin D supplementation on cardiometabolic outcomes in children and adolescents.
METHODS:
We systematically searched relevant databases for randomized controlled trials (RCTs) examining effects of vitamin D supplementation compared to placebo or a lower dose of vitamin D on blood glucose, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), glycated hemoglobin, cholesterol [total, high-density, and low-density lipoprotein (LDL-C)], triglycerides, or blood pressure. We conducted random-effects meta-analyses of weighted mean differences in all participants and in subgroups of overweight/obese versus normal weight participants with or without baseline S-25(OH)D?
RESULTS:
Fourteen RCTs with a total of 1088 participants aged 4-19 years were included. In the meta-analysis, vitamin D supplementation increased S-25(OH)D by 27 nmol/L [95% CI 16; 37] (P?
CONCLUSIONS:
These results do not support the use of vitamin D supplementation for improving cardiometabolic health in childhood. Indicated beneficial effects on insulin resistance in those with obesity could be investigated further, while unfavorable effects on LDL-C may be a concern.
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Cardiorespiratory Fitness Is Associated With Better Cardiometabolic Health and Lower PTSD Severity in Post-9/11 Veterans.
Mil Med2020 Feb;():. doi: usaa005.
Whitworth James W, Hayes Scott M, Andrews Ryan J, Fonda Jennifer R, Beck Brigitta M, Hanlon Lilly B, Fortier Catherine B, Milberg William P, McGlinchey Regina E,
Abstract
INTRODUCTION:
Post-traumatic stress disorder (PTSD) is associated with an increased risk of cardiovascular and metabolic diseases and physical inactivity. Cardiorespiratory fitness (CRF), which is modifiable by physical activity, is a strong independent predictor of cardiometabolic health. However, the relationship between CRF and cardiometabolic health in veterans with PTSD is unknown. Thus, this study aimed to explore the cross-sectional relationships among CRF, indices of cardiometabolic health (ie, HbA1c, blood lipids, blood pressure, waist-hip ratio, and body mass index), and PTSD severity in veterans with PTSD.
MATERIALS AND METHODS:
This study was approved by the local Institutional Review Board. All participants were informed of the study risks and provided consent prior to participation. Participants (n = 13) completed a cardiopulmonary exercise test, a fasting blood draw, and the Clinician Administered PTSD Scale. Correlations between CRF and cardiometabolic health were examined with Spearman's rank correlations, and differences in PTSD symptom severity were explored as a function of CRF (ie, low-to-moderate vs. high CRF), using multiple linear regression.
RESULTS:
Peak oxygen uptake ($\dot{\mathrm{V}}$O2peak) was correlated with high-density lipoproteins rho = 0.60, P = 0.04 and diastolic blood pressure rho = -0.56, P = 0.05. Ventilatory threshold was correlated with HbA1c rho = -0.61, P = 0.03 and diastolic blood pressure rho = -0.56, P = 0.05. Higher CRF was associated with lower total PTSD severity standardized ? = -0.84, P = 0.01, adjusted R2 = 0.47, total Cluster C symptoms (avoidance/numbing) ? = -0.71, P = 0.02, adjusted R2 = 0.49, and total Cluster D symptoms (hyperarousal) ? = -0.89, P = 0.01, adjusted R2 = 0.41, while adjusting for age and smoking status.
CONCLUSIONS:
These preliminary findings suggest that CRF and by proxy physical activity may be important factors in understanding the increased risk of cardiovascular and metabolic disease associated with PTSD.
Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by US Government employees and is in the public domain in the US.
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Glycolysis/gluconeogenesis- and tricarboxylic acid cycle-related metabolites, Mediterranean diet, and type 2 diabetes.
Am J Clin Nutr2020 Feb;():. doi: nqaa016.
Guasch-Ferré Marta, Santos José L, Martínez-González Miguel A, Clish Clary B, Razquin Cristina, Wang Dong, Liang Liming, Li Jun, Dennis Courtney, Corella Dolores, Muñoz-Bravo Carlos, Romaguera Dora, Estruch Ramón, Santos-Lozano José Manuel, Castañer Olga, Alonso-Gómez Angel, Serra-Majem Luis, Ros Emilio, Canudas Sílvia, Asensio Eva M, Fitó Montserrat, Pierce Kerry, Martínez J Alfredo, Salas-Salvadó Jordi, Toledo Estefanía, Hu Frank B, Ruiz-Canela Miguel,
Abstract
BACKGROUND:
Glycolysis/gluconeogenesis and tricarboxylic acid (TCA) cycle metabolites have been associated with type 2 diabetes (T2D). However, the associations of these metabolites with T2D incidence and the potential effect of dietary interventions remain unclear.
OBJECTIVES:
We aimed to evaluate the association of baseline and 1-y changes in glycolysis/gluconeogenesis and TCA cycle metabolites with insulin resistance and T2D incidence, and the potential modifying effect of Mediterranean diet (MedDiet) interventions.
METHODS:
We included 251 incident T2D cases and 638 noncases in a nested case-cohort study within the PREDIMED Study during median follow-up of 3.8 y. Participants were allocated to MedDiet + extra-virgin olive oil, MedDiet + nuts, or control diet. Plasma metabolites were measured using a targeted approach by LC-tandem MS. We tested the associations of baseline and 1-y changes in glycolysis/gluconeogenesis and TCA cycle metabolites with subsequent T2D risk using weighted Cox regression models and adjusting for potential confounders. We designed a weighted score combining all these metabolites and applying the leave-one-out cross-validation approach.
RESULTS:
Baseline circulating concentrations of hexose monophosphate, pyruvate, lactate, alanine, glycerol-3 phosphate, and isocitrate were significantly associated with higher T2D risk (17-44% higher risk for each 1-SD increment). The weighted score including all metabolites was associated with a 30% (95% CI: 1.12, 1.51) higher relative risk of T2D for each 1-SD increment. Baseline lactate and alanine were associated with baseline and 1-y changes of homeostasis model assessment of insulin resistance. One-year increases in most metabolites and in the weighted score were associated with higher relative risk of T2D after 1 y of follow-up. Lower risks were observed in the MedDiet groups than in the control group although no significant interactions were found after adjusting for multiple comparisons.
CONCLUSIONS:
We identified a panel of glycolysis/gluconeogenesis-related metabolites that was significantly associated with T2D risk in a Mediterranean population at high cardiovascular disease risk. A MedDiet could counteract the detrimental effects of these metabolites.This trial was registered at controlled-trials.com as ISRCTN35739639.
Copyright © The Author(s) 2020.
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Arterial Stiffness in Hypertension and Function of Large Arteries.
Am J Hypertens2020 Feb;():. doi: hpz193.
Zhang Yi, Lacolley Patrick, Protogerou Athanase D, Safar Michel E,
Abstract
BACKGROUND:
Arterial stiffness-typically assessed from non-invasive measurement of pulse wave velocity along a straight portion of the vascular tree between the right common carotid and femoral arteries-is a reliable predictor of cardiovascular risk in patients with essential hypertension.
METHODS:
We reviewed how carotid-femoral pulse wave velocity increases with age and is significantly higher in hypertension (than in age- and gender-matched individuals without hypertension), particularly when hypertension is associated with diabetes mellitus.
RESULTS:
From the elastic aorta to the muscular peripheral arteries of young healthy individuals, there is a gradual but significant increase in stiffness, with a specific gradient. This moderates the transmission of pulsatile pressure towards the periphery, thus protecting the microcirculatory network. The heterogeneity of stiffness between the elastic and muscular arteries causes the gradient to disappear or be inversed with aging, particularly in long-standing hypertension.
CONCLUSIONS:
In hypertension therefore, pulsatile pressure transmission to the microcirculation is augmented, increasing the potential risk of damage to the brain, the heart, and the kidney. Furthermore, elevated pulse pressure exacerbates end-stage renal disease, particularly in older hypertensive individuals. With increasing age, the elastin content of vessel walls declines throughout the arterial network, and arterial stiffening increases further due to the presence of rigid wall material such as collagen, but also fibronectin, proteoglycans, and vascular calcification. Certain genes, mainly related to angiotensin and/or aldosterone, affect this aging process and contribute to the extent of arterial stiffness, which can independently affect both forward and reflected pressure waves.
© American Journal of Hypertension, Ltd 2020. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Oral health complications after a heart transplant: a review.
Br Dent J2020 Feb;228(3):177-182. doi: 10.1038/s41415-020-1244-0.
Gruter M O, Brand H S,
Abstract
Background Heart transplants have become a successful treatment for some cardiovascular diseases. To prevent rejection of the transplanted heart, patients have to take immunosuppressive medication.Aims The aims of this study were to identify and review oral health complications after heart transplantation.Methods The electronic database PubMed was searched for relevant articles. The search yielded 332 papers, of which 24 matched the criteria for this review.Results Gingival hyperplasia was observed in 8.3-67% of the patients. Heart transplant patients who received professional periodontal treatment starting six months after transplantation showed significantly better scores on the Gingival Index (GI) and gingival hyperplasia. In comparison to a control group, heart transplant patients did not differ significantly in the DMF(T) index. The incidence of fungal infection in patients receiving a heart transplant varied between 10% and 25%. Heart transplant patients had a 4.3 times higher chance of developing oral cancer.Conclusion Patients who underwent a heart transplant and subsequently used immunosuppressive medicines appear to have a higher risk of gingival hyperplasia, periodontal conditions, the presence of Candida species and oral malignancies, in comparison to healthy individuals. The association between heart transplants and dental caries was unclear. It is recommended that heart transplant patients receive frequent oral examination and professional dental cleaning.
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Benefit of lifestyle-based T2DM prevention is influenced by prediabetes phenotype.
Nat Rev Endocrinol2020 Feb;():. doi: 10.1038/s41574-019-0316-1.
Campbell Matthew D, Sathish Thirunavukkarasu, Zimmet Paul Z, Thankappan Kavumpurathu R, Oldenburg Brian, Owens David R, Shaw Jonathan E, Tapp Robyn J,
Abstract
The prevention of type 2 diabetes mellitus (T2DM) is a target priority for the WHO and the United Nations and is a key priority in the 2018 Berlin Declaration, which is a global call for early actions related to T2DM. Health-care policies advocate that individuals at high risk of developing T2DM undertake lifestyle modification, irrespective of whether the prediabetes phenotype is defined by hyperglycaemia in the postprandial state (impaired glucose tolerance) and/or fasting state (impaired fasting glucose) or by intermediate HbA levels. However, current evidence indicates that diabetes prevention programmes based on lifestyle change have not been successful in preventing T2DM in individuals with isolated impaired fasting glucose. We propose that further research is needed to identify effective lifestyle interventions for individuals with isolated impaired fasting glucose. Furthermore, we call for the identification of innovative approaches that better identify people with impaired glucose tolerance, who benefit from the currently available lifestyle-based diabetes prevention programmes.
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Gut microbial taxa as potential predictive biomarkers for acute coronary syndrome and post-STEMI cardiovascular events.
Sci Rep2020 Feb;10(1):2639. doi: 10.1038/s41598-020-59235-5.
Gao Jing, Yan Kun-Tao, Wang Ji-Xiang, Dou Jing, Wang Jie, Ren Min, Ma Jing, Zhang Xu, Liu Yin,
Abstract
Plasma trimethylamine N-oxide (TMAO) is associated with coronary atherosclerotic plaque and cardiovascular disease risk, but associations between gut microbes in acute coronary syndrome (ACS) and post-ST-segment elevation myocardial infarction (post-STEMI) events are unknown. We investigated associations between gut microbial taxa and systemic TMAO levels and the possible TMAO contribution to incident post-STEMI cardiovascular events.
PATIENTS AND METHODS:
A total of 60 patients, including 30 with unstable angina pectoris (UAP), 30 post-STEMI and 30 healthy controls, were enrolled from June to November 2017. Metagenomic sequencing was performed and TMAO and IL-6 were detected.
RESULTS:
Minimal discriminators of gut microbial taxa (top 40) distinguished ACS patients from controls. Serum TMAO levels were positively associated with increased abundance of Aerococcaceae, Ruminococcaceae_UCG.005, Ruminococcaceae_UCC.014 and X. Eubacterium_fissicatena, and decreased abundance of Lachnospiraceae_FCS020 (P?
CONCLUSIONS:
ACS and incident post-STEMI MACE may be associated with the gut bacteria choline metabolite TMAO. The specific gut microbial taxa identified in association with serum TMAO levels may be potential predictive biomarkers for accurate diagnosis of ACS onset.
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Prevalence of Congenital Heart Disease Amongst Schoolchildren in Southwest China.
Indian Pediatr2020 Feb;57(2):138-141.
Han Shen, Wei Chuan-Yu, Hou Zong-Liu, Li Ya-Xiong, Ding Yun-Chuan, Guang Xue-Feng, Huang Dong, Na Zhu-Hui, Chen Wen-Min, Jian G Li-Hong,
Abstract
OBJECTIVE:
To investigate the prevalence and risk factors of congenital heart disease in Yunnan, China which has diverse ethnic groups.
METHODS:
This cross-sectional study enrolled 244,023 children from 2010 to 2015. To diagnose CHD, a conventional physical examination was used to screen suspicious cases, which were further confirmed by echocardiography.
RESULTS:
A total of 1695 children were diagnosed with CHD. The estimated prevalence was 6.94%. Atrial septal defects were the most common cardiac abnormalities. A higher prevalence of CHD was observed with preterm birth, low birth weight, maternal age ?35 years, and high-altitude regions. The prevalence also showed differences between diverse ethnic groups.
CONCLUSIONS:
The prevalence of CHD in China may have ethnic differences.
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Liver tissue microbiome in NAFLD: next step in understanding the gut-liver axis?
Gut2020 Feb;():. doi: gutjnl-2019-320490.
Tilg Herbert, Burcelin Remy, Tremaroli Valentina,
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Heritability of 596 lipid species and genetic correlation with cardiovascular traits in the Busselton Family Heart Study.
J Lipid Res2020 Feb;():. doi: jlr.RA119000594.
Cadby Gemma, Melton Phillip E, McCarthy Nina S, Giles Corey, Mellett Natalie A, Huynh Kevin, Hung Joseph, Beilby John, Dubé Marie-Pierre, Watts Gerald F, Blangero John, Meikle Peter J, Moses Eric K,
Abstract
INTRODUCTION:
Cardiovascular disease (CVD) is the leading cause of death worldwide, and genetic investigations into the human lipidome may provide insight into CVD risk. The aim of this study was to estimate the heritability of circulating lipid species and their genetic correlation with CVD traits. Methods: Targeted lipidomic profiling was performed on 4492 participants from the Busselton Family Heart Study to quantify the major fatty acids of 596 lipid species from 33 classes. We estimated narrow-sense heritabilities of lipid species/classes, and their genetic correlations with eight CVD traits - body mass index, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, triglycerides, total cholesterol, waist-hip-ratio, systolic blood pressure, and diastolic blood pressure. Results: We report heritabilities and genetic correlations of new lipid species/sub-classes, including acylcarnitine, ubiquinone, sulfatide, and oxidized cholesteryl esters. Over 99% of lipid species were significantly heritable (h2:0.06-0.50) and all lipid classes were significantly heritable (h:0.14-0.50). The monohexosylceramide and acylcarnitine classes had the highest median heritabilities (h=0.43). The largest genetic correlation was between clinical triglycerides and total diacylglycerol (r=0.88). We observed novel positive genetic correlations between clinical triglycerides and phosphatidylglycerol species (r: 0.64-0.82), and HDL-C and alkenylphosphatidylcholine species (r:0.45-0.74). Overall, 51% of the 4768 lipid species-CVD trait genetic correlations were statistically significant after correction for multiple comparisons.
CONCLUSION:
This is the largest lipidomic study to address the heritability of lipids, and their genetic correlation with CVD traits. Future work includes identifying putative causal genetic variants for lipid species and CVD using genome-wide single nucleotide polymorphism and whole genome sequencing data.
Published under license by The American Society for Biochemistry and Molecular Biology, Inc.
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Coronary arterial abnormalities in hypoplastic left heart syndrome: Pathologic characteristics of archived specimens.
Semin Thorac Cardiovasc Surg2020 Feb;():. doi: S1043-0679(20)30020-4.
Stephens Elizabeth H, Gupta Dipankar, Bleiweis Mark, Backer Carl L, Anderson Robert H, Spicer Diane E,
Abstract
Palliation of patients with hypoplastic left heart syndrome remains challenging. Although coronary ischemia can be catastrophic, the prevalence and pathologies of anomalies of the coronary arteries remains unknown. We reviewed 119 specimens with the features of hypoplastic left heart syndrome, focusing our attention on the aortic root and the coronary arteries. We found 36 (30%) specimens with the combination of mitral and aortic atresia, 26 (22%) with mitral and aortic stenosis, and 57 (48%) with mitral stenosis combined with aortic atresia. In 29 specimens (24%), the coronary arteries were not located in the center of any sinuses, while in 24 specimens (21%) at least one coronary artery was located very proximal to a raphe or commissure, with potential for obstruction. The specimens with combined stenosis were more likely to have eccentric positions of the coronary arteries (11 specimens, 42%), compared to the 3 specimens with combined atresia (9%, p=0.009). The specimens with combined stenosis were also more likely to have positioning at risk for obstruction (9 specimens, 35%), compared to those with combined atresia (3 specimens, 9%, p=0.05). Coronary arterial fistulous communications were found in 11 specimens (9%), significantly more frequently in specimens with mitral stenosis and aortic atresia (9 specimens, 16%, p=0.041). The origins of the coronary arteries in patients with hypoplastic left heart syndrome place them at potential risk for ischemia, with fistulous communications being a particular risk in those with mitral stenosis combined with aortic atresia.
Copyright © 2020. Published by Elsevier Inc.
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Hypertension in Adults With Intellectual Disability: Prevalence and Risk Factors.
Am J Prev Med2020 Feb;():. doi: S0749-3797(20)30036-2.
Schroeder Elizabeth C, DuBois Lindsay, Sadowsky Molly, Hilgenkamp Thessa I M,
Abstract
INTRODUCTION:
Individuals with intellectual disability have a high prevalence of obesity and low physical activity levels, which are risk factors for hypertension. This study estimated the prevalence of hypertension in a global data set of adults with intellectual disability participating in Special Olympics and investigated the role of physical activity and obesity in hypertension risk.
METHODS:
A total of 33,122 individuals aged ?18 years with intellectual disability who participated in Special Olympic events from 2014 to 2018 had their brachial blood pressure, BMI, and self-reported physical activity assessed. Hypertension was classified using 2017 American College of Cardiology/American Heart Association guidelines (systolic blood pressure?130 mmHg and diastolic blood pressure?80 mmHg). Data were analyzed in 2019.
RESULTS:
Participants were aged 31 (SD=11) years, 64% male, and had a resting blood pressure of 121 (SD=16)/76 (SD=12) mmHg. The population was 48% (95% CI=47.5%, 48.6%) hypertensive. Male participants had a higher prevalence of hypertension (50.7%, 95% CI=50.1%, 51.4%) than female participants (43.1%, 95% CI=42.2%, 44.0%), with prevalence increasing with age. Odds of hypertension increased when performing no or insufficient physical activity and with increasing obesity (p<0.01), tripling (OR=3.06, 3.66) for all individuals who performed no physical activity except for those of normal weight (OR=1.72), and doubling (OR=2.13-3.87) for individuals who were obese or morbidly obese across all physical activity levels.
CONCLUSIONS:
This study is the first to determine population-based prevalence rates of hypertension in individuals with intellectual disability. It highlights the similarity in prevalence to the general population. The results emphasize the importance of population-wide screening, increasing physical activity, and reducing obesity in decreasing cardiovascular risk in this population.
Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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Thrombin/PAR-1 activation induces endothelial damages via NLRP1 inflammasome in gestational diabetes.
Biochem Pharmacol2020 Feb;():113849. doi: S0006-2952(20)30070-8.
Liu Yue, Tang Zhuang-Zhuang, Zhang Yu-Meng, Kong Li, Xiao Wei-Fen, Ma Teng-Fei, Liu Yao-Wu,
Abstract
Gestational diabetes mellitus (GDM) is associated with an increased risk of progressing to type 2 DM and cardiovascular disease; however, the pathogenesis is still poorly understood. This study was to investigate roles of thrombin and its receptor protease-activated receptor 1 (PAR-1) and NLRP1 inflammasome in endothelial injury in GDM condition. Umbilical cord and plasma of GDM patients and high glucose (HG) cultured human umbilical vein endothelial cells (HUVECs) were used to examine the pathological changes of these pathways. Meanwhile, ameliorative effects and potential mechanisms of a natural product sarsasapogenin (Sar) were investigated in HUVECs. Thrombin/PAR-1 pathway, advanced glycation endproducts (AGEs) and their receptor (RAGE) axis, and the nucleotide-binding domain and leucine-rich repeat containing protein 1 (NLRP1) inflammasome were activated in GDM condition and HG-cultured HUVECs, accompanied by endothelial injury (decreased cell viability and increased lactate dehydrogenase release). Nevertheless, thrombin inhibition or PAR-1 antagonism caused decreases in AGEs formation and RAGE expression in HG-cultured HUVECs, while AGEs inhibition or RAGE antagonism declined PAR-1 expression not thrombin activity. Furthermore, thrombin inhibition or PAR-1 antagonism restrained NLRP1 inflammasome activation in HG-cultured HUVECs; meanwhile, NLRP1 expression and interleukin 18 levels were remarkably reduced in HG-cultured HUVECs after PAR-1 knockdown. Interestingly, Sar co-treatment could suppress thrombin/PAR-1 pathway, NLRP1 inflammasome, and AGEs/RAGE axis. Together, endothelial damages in GDM were likely due to enhanced interaction between AGEs/RAGE axis and thrombin/PAR-1 pathway, followed by NLRP1 inflammasome activation. Moreover, Sar may act as a protective agent against endothelial injury in chronic HG condition.
Copyright © 2020. Published by Elsevier Inc.
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Physical activity trends and metabolic health outcomes in people living with HIV in the US, 2008-2015.
Prog Cardiovasc Dis2020 Feb;():. doi: S0033-0620(20)30035-9.
Willig Amanda L, Webel Allison R, Westfall Andrew O, Levitan Emily B, Crane Heidi M, Buford Thomas W, Burkholder Greer A, Willig James H, Blashill Aaron J, Moore Richard D, Mathews W Christopher, Zinski Anne, Muhammad Josh, Geng Elvin H, Napravnik Sonia, Eron Joseph J, Rodriguez Benigno, Bamman Marcas M, Overton E Turner,
Abstract
Despite its potential to improve metabolic health outcomes, longitudinal physical activity (PA) patterns and their association with cardiometabolic disease among people living with HIV (PLWH) have not been well characterized. We investigated this relationship among PLWH in the Centers for AIDS Research Network of Integrated Clinical Systems with at least one PA self-report between 2008 and 2015. The 4-item Lipid Research Clinics PA instrument was used to categorize habitual PA levels as: Very Low, Low, Moderate, or High. We analyzed demographic differences in PA patterns. Multivariable generalized estimating equation regression models were fit to assess longitudinal associations of PA with blood pressure, lipid, and glucose levels. Logistic regression modeling was used to assess the odds of being diagnosed with obesity, cardiovascular disease (CVD), cerebrovascular disease, hypertension, diabetes, or multimorbidity. A total of 40,462 unique PA assessments were provided by 11,719 participants. Only 13% of PLWH reported High PA, while 68% reported Very Low/Low PA at baseline and did not increase PA levels during the study period. Compared to those reporting High PA, participants with Very Low PA had almost 2-fold increased risk for CVD. Very Low PA was also associated with several risk factors associated with CVD, most notably elevated triglycerides (odds ratio 25.4), obesity (odds ratio 1.9), hypertension (odds ratio 1.4), and diabetes (odds ratio 2.3; all p?
Copyright © 2020. Published by Elsevier Inc.
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Albumin-globulin ratio and mortality in patients on peritoneal dialysis: a retrospective study.
BMC Nephrol2020 Feb;21(1):51. doi: 10.1186/s12882-020-1707-1.
Peng Fenfen, Sun Lingzhi, Chen Ting, Zhu Yan, Zhou Weidong, Li Peilin, Chen Yihua, Zhuang Yiyi, Huang Qianyin, Long Haibo,
Abstract
BACKGROUND:
Albumin-globulin ratio (AGR), a variable based on serum albumin and non-albumin proteins, has been demonstrated as a predictor of mortality in patients with malignant neoplasm. The aim of this study was to evaluate the prognostic value of AGR on peritoneal dialysis (PD) patients.
METHODS:
We retrospectively analyzed 602 incident PD patients from January 1st, 2008, to December 31st, 2017, at our center and followed them until December 31st, 2018. Kaplan-Meier curves and multivariate Cox regression models were applied to analyze the association between AGR and all-cause of mortality and cardiovascular mortality.
RESULTS:
The median follow-up time was 32.17 (interquartile range?=?32.80) months. During follow-up, 131 (21.8%) patients died, including 57 patients (43.5%) who died due to cardiovascular diseases. Kaplan-Meier curves showed that patients with AGR?>?1.26 had better rates of survival than those with AGR???1.25 (p?
CONCLUSIONS:
Patients with a low AGR level had an increased all-cause and cardiovascular mortality. AGR may be a useful index in identifying patients on PD at risk for CVD and all-cause of mortality.
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