DONA ORA
Pubblicazioni recenti - cardiovascular risk
-
Challenges in the Management of patients with systemic light chain (AL) amyloidosis during the COVID-19 pandemic.
Br J Haematol2020 Jun;():. doi: 10.1111/bjh.16898.
Kastritis Efstathios, Wechalekar Ashutosh, Schönland Stefan, Sanchorawala Vaishali, Merlini Giampaolo, Palladini Giovanni, Minnema Monique, Roussel Murielle, Jaccard Arnaud, Hegenbart Ute, Kumar Shaji, Cibeira Maria Teresa, Blade Joan, Dimopoulos Meletios A,
Abstract
The SARS-CoV-2-associated disease (COVID-19) is primarily manifested as a respiratory tract infection but may affect and cause complications from multiple organ systems (cardiovascular, gastrointestinal, kidneys, hematopoietic and immune systems) while no proven specific therapy exists. The challenges associated with COVID-19 are even greater for patients with light chain (AL) amyloidosis, a rare multisystemic disease affecting the heart, kidneys, liver, gastrointestinal and nervous system. Patients with AL amyloidosis may need to receive chemotherapy, which probably increases infection risk. Management of COVID-19 may be particularly challenging in patients with AL amyloidosis who often present with cardiac dysfunction, nephrotic syndrome, neuropathy, low blood pressure and gastrointestinal symptoms. In addition, AL patients may be more susceptible to toxicities of drugs used to manage COVID-19. Access to health care may be difficult or limited, diagnosis of AL amyloidosis may be delayed with detrimental consequences, treatment administration may need modification. Both patients and treating physicians need to adapt in a new reality.
This article is protected by copyright. All rights reserved.
Guarda su PubMed
-
Overweight or obesity and abdominal obesity and their association with cardiometabolic risk factors in Brazilian schoolchildren: A cross-sectional study.
Nutrition2020 Mar;78():110780. doi: S0899-9007(20)30063-0.
Teixeira Fabiana da Costa, Pereira Flįvia Erika Felix, Pereira Avany Fernandes, Ribeiro Beatriz Gonēalves,
Abstract
OBJECTIVES:
The aim of this study was to access the association between overweight or obesity and abdominal obesity (AO) and cardiometabolic risk factors (CRF) of schoolchildren.
METHODS:
We evaluated body weight (BW), height, body mass index (BMI), waist circumference (WC), fasting glycaemia (FG), blood pressure (BP), triacylglycerides (TGs), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in 501 students (6-10 y of age) from municipal schools in Macaé, Brazil. Statistical analyses were performed by ?, Fisher exact tests, and odds ratio (OR; 95% confidence interval [CI]).
RESULTS:
Children with overweight or obesity had higher TG, TC, and BP values than normal weight children (P < 0.05). The same trend was observed in children with AO versus those without AO. Among the schoolchildren, 58.5% had at least one CRF. Overweight or obese children had increased risk for high BP (OR, 3.98; 95% CI, 2.4-6.57), high TGs (OR, 2.81; 95% CI, 1.64-4.8), high TC (OR, 2.47; 95% CI, 1.53-4), high LDL-C (OR, 3.07; 95% CI, 1.09-8.6) and two or more CRFs (OR, 4.6; 95% CI, 2.89-7.3). Children with AO had increased risk for high BP (OR, 3.97; 95% CI, 2.18-7.22), high TGs (OR, 3.4; 95% CI, 1.79-6.49), high TC (OR, 2.57; 95% CI, 1.39-4.75), high LDL-C (OR, 3.7; 95% CI, 1.24-11.07), and two or more CRFs (OR, 3.25; 95% CI, 1.82-5.78). Schoolchildren with CRFs presented higher means of BW, BMI, WC, FG, TGs, TC, LDL-C, SBP, DBP, and lower HDL-C than children without CRFs.
CONCLUSION:
The relationship between increased body weight or AO and CRF, described in the present data, reinforces the importance of early prevention of excess weight in children.
Copyright © 2020 Elsevier Inc. All rights reserved.
Guarda su PubMed
-
Ambient fine particulate matter pollution and years of life lost from cardiovascular diseases in 48 large Chinese cities: Association, effect modification, and additional life gain.
Sci Total Environ2020 May;735():139413. doi: S0048-9697(20)32930-2.
Li Jie, Zhang Xiao, Yin Peng, Wang Limin, Zhou Maigeng,
Abstract
Existing evidence on the associations between fine particulate matter (PM) and years of life lost (YLL) from cardiovascular diseases (CVD) is limited and inconclusive, and the role of potential modifiers, especially those at city-level, is not fully understood. In this study, a time-series study was conducted in 48 large Chinese cities from 2013 to 2017. Generalized additive model coupled with random effects model were used to estimate national-average associations of PM with YLL. Effect modification by individual- and city-level characteristics obtained by linking with China Chronic Disease and Risk Factors Surveillance was explored. Moreover, additional life gain was evaluated under scenario where PM concentration would be reduced. For 10 ?g/m increase in PM concentration at lag01 day, the relative increment of YLL was 0.22% from CVD, 0.20% from ischemic heart disease, 0.26% from stroke, 0.23% from hemorrhagic stroke, and 0.31% from ischemic stroke. Some associations were stronger in elder and less educated people, warm season, as well as cities characterized by higher temperature and prevalence of binge drinking and excess red meat intake, or lower PM and prevalence of usual exercise. Additional life gain attributable to avoidable YLL from CVD was estimated to be 0.08 year if PM concentration could fall to the standard recommended by World Health Organization (25 ?g/m). This large epidemiological investigation demonstrated robust evidence of short-term associations between PM exposure and YLL from CVD. Potential modifiers should be considered to develop efficient intervention strategies. Implementation of more stringent standard is beneficial to alleviate YLL caused by PM.
Copyright © 2020 Elsevier B.V. All rights reserved.
Guarda su PubMed
-
Physical activity attenuated association of air pollution with estimated 10-year atherosclerotic cardiovascular disease risk in a large rural Chinese adult population: A cross-sectional study.
Environ Int2020 May;140():105819. doi: S0160-4120(20)31774-8.
Tu Runqi, Hou Jian, Liu Xiaotian, Li Ruiying, Dong Xiaokang, Pan Mingming, Mao Zhenxing, Huo Wenqian, Chen Gongbo, Guo Yuming, Li Shanshan, Wang Chongjian,
Abstract
BACKGROUND:
Although long-term exposure to air pollution and physical inactivity are linked to increased risk for atherosclerotic cardiovascular diseases (ASCVD), however, the interactive effect of air pollution and physical activity (PA) on high 10-year ASCVD risk is largely unknown.
METHODS:
A total of 31,162 individuals aged 35-74 years were derived from the Henan Rural Cohort Study, after individuals with personal histories of ASCVD or missing data on predictors of high 10-year ASCVD risk were excluded. Concentrations of air pollutants (nitrogen dioxide (NO), particulate matter with an aerodynamics diameters ? 1.0 µm (PM), ?2.5 µm (PM) or ?10 µm (PM)) of individuals were estimated using a spatiotemporal model based on satellites data. The metabolic equivalent (MET) of PA of each individual was evaluated using the formula: duration (hour/time) × frequency/week × MET coefficient of each type of activity. Logistic regression models were used to analyze associations between air pollutants, PA and high 10-year ASCVD risk. Interaction plots were used to describe interactive effects of air pollutants and PA on high 10-year ASCVD risk.
RESULTS:
Each 1 µg/m increase in PM, PM, PM and NO were related to a 4.4% (odds ratio (OR): 1.044, 95% confidence interval (CI): 1.034, 1.056), 9.1% (OR: 1.091, 95% CI: 1.079, 1.104), 4.6% (OR: 1.046, 95% CI: 1.040, 1.051) or 6.4% (OR: 1.064, 95% CI: 1.055, 1.072) increase in high 10-year ASCVD risk (all p < 0.001), respectively; each one unit-increase in PA MET (hour/day) value was related to a 1.8% (OR: 0.982, 95% CI: 0.980, 0.985) decrease in high 10-year ASCVD risk. Negative interactive effects of PA and PM, PM, PM and NO on high 10-year ASCVD risk were observed (all p < 0.001).
CONCLUSION:
Exposure to high levels of air pollutants were related to increase high 10-year ASCVD risk and these associations were attenuated by PA, implying that PA may be an effective method to the prevention of high 10-year ASCVD risk in highly polluted rural regions.
Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Guarda su PubMed
-
Estimated PCDD/F TEQ and total TEQ concentrations in the serum of 7-10 year old Finnish children.
Chemosphere2020 May;257():127137. doi: S0045-6535(20)31330-8.
Rantakokko Panu, Tuomisto Jouni T, Viluksela Matti, Tuomisto Jouko, Airaksinen Riikka, Raitakari Olli, Karvonen Anne M, Pekkanen Juha, Kiviranta Hannu,
Abstract
Polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) and polychlorinated biphenyls (PCBs) are persistent organic pollutants that have detrimental health effects. As people are exposed to them mainly through the diet, EU has set maximum food dioxin and PCBs levels. EFSA CONTAM Panel made new risk assessment in 2018 that lowered the tolerable weekly intake (TWI) from 14 pg-TEQ/kg bw/week to 2 pg-TEQ/kg bw/week. Critical effect was decreased semen count at the age of 18-19 years if serum total TEQ at the age of 9 years exceeded the No Observed Adverse Effect Level (NOAEL) of 7 pg/g lipid. However, it is largely unknown to what extent NOAEL is exceed in European boys currently. We thus measured PCBs from small volume of serum in 184 Finnish children 7-10 years of age. To estimate the TEQ levels of children from measured PCB levels, we used our existing human milk PCDD/F and PCB concentrations to create a hierarchical Bayesian regression model that was used to estimate TEQs from measured PCBs. For quality control (QC), three pooled blood samples from 18 to 20 year old males were measured for PCDD/Fs and PCBs, and estimated for TEQs. In QC samples measured and estimated TEQs agreed within 84%-106%. In our estimate for 7-10 year old children, PCDD/F TEQ exceeded NOAEL only in 0.5% and total TEQ in 2.7% of subjects. Risk management following the decreased TWI proposed by the CONTAM Panel should be carefully considered if total TEQ in children is already largely below the NOAEL.
Copyright © 2020 Elsevier Ltd. All rights reserved.
Guarda su PubMed
-
Usefulness of platelet-to-lymphocyte ratio as a marker of sarcopenia for critical limb threatening ischemia.
Ann Vasc Surg2020 May;():. doi: S0890-5096(20)30434-9.
Pizzimenti M, Charles A L, Riou M, Thaveau F, Chakfé N, Geny B, Lejay A,
Abstract
OBJECTIVE:
Sarcopenia is a factor of poor prognosis for patients with critical limb threatening ischemia (CLTI), but its diagnosis requires imaging measurements and is time consuming. We investigated whether preoperative platelet-to-lymphocyte ratio (PLR) could be an easy and rapid marker of sarcopenia.
METHODS:
Patients treated for CLTI between January 2019 and July 2019 were included in this single-center retrospective study. Sarcopenia was defined by a psoas muscle index (PMI) <5.5 cm/m in men, and <4.0 cm/m in women. PLR was calculated for all patients based on their systematic preoperative blood analysis. The diagnostic power of PLR was analyzed through a ROC curve. Early outcomes of sarcopenic patients in terms of 30-day mortality and 30-day morbidity were retrieved.
RESULTS:
64 patients were included in the study: 48 non-sarcopenic patients (mean PMI 7.34 cm/m; IQR: 6.58-8.01) and 16 sarcopenic patients (mean PMI 4.30 cm/m; IQR: 3.45-5.17). No difference was found between both groups regarding patient demographics, clinical characteristics, cardiovascular risk factors, comorbidities or revascularization modalities. PLR was significantly higher in the sarcopenic group (mean: 332.1; IQR 158.2-320.7) compared with the non-sarcopenic group (mean 204.6; IQR 133.8-265.6) (p=0.02). A PLR value ?292.5 was shown to be a diagnostic marker for sarcopenia based on the ROC curve (sensitivity 31.3%, specificity 91.7%). 30-day mortality was 12.5% in the sarcopenic group and 2.1% in the non-sarcopenic group (p=0.15); 30-day morbidity was 56.3% in the sarcopenic group and 10.4% in the non-sarcopenic group (p<0.001).
CONCLUSION:
PLR might help identifying a subgroup of CTLI patients associated with poor prognosis but does not seem appropriate to be used as a marker of sarcopenia given its low sensitivity.
Copyright © 2020 Elsevier Inc. All rights reserved.
Guarda su PubMed
-
A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: an observational cohort study.
J Infect2020 May;():. doi: S0163-4453(20)30314-5.
Galloway James B, Norton Sam, Barker Richard D, Brookes Andrew, Carey Ivana, Clarke Benjamin D, Jina Raeesa, Reid Carole, Russell Mark D, Sneep Ruth, Sugarman Leah, Williams Sarah, Yates Mark, Teo James, Shah Ajay M, Cantle Fleur,
Abstract
BACKGROUND:
The COVID-19 pandemic continues to escalate. There is urgent need to stratify patients. Understanding risk of deterioration will assist in admission and discharge decisions, and help selection for clinical studies to indicate where risk of therapy-related complications is justified.
METHODS:
An observational cohort of patients acutely admitted to two London hospitals with COVID-19 and positive SARS-CoV-2 swab results was assessed. Demographic details, clinical data, comorbidities, blood parameters and chest radiograph severity scores were collected from electronic health records. Endpoints assessed were critical care admission and death. A risk score was developed to predict outcomes.
FINDINGS:
Analyses included 1,157 patients. Older age, male sex, comorbidities, respiratory rate, oxygenation, radiographic severity, higher neutrophils, higher CRP and lower albumin at presentation predicted critical care admission and mortality. Non-white ethnicity predicted critical care admission but not death. Social deprivation was not predictive of outcome. A risk score was developed incorporating twelve characteristics: age>40, male, non-white ethnicity, oxygen saturations<93%, radiological severity score>3, neutrophil count>8.0 x10/L, CRP>40 mg/L, albumin<34 g/L, creatinine>100 µmol/L, diabetes mellitus, hypertension and chronic lung disease. Risk scores of 4 or higher corresponded to a 28-day cumulative incidence of critical care admission or death of 40.7% (95% CI: 37.1 to 44.4), versus 12.4% (95% CI: 8.2 to 16.7) for scores less than 4.
INTERPRETATION:
Our study identified predictors of critical care admission and death in people admitted to hospital with COVID-19. These predictors were incorporated into a risk score that will inform clinical care and stratify patients for clinical trials.
Copyright © 2020. Published by Elsevier Ltd.
Guarda su PubMed
-
Clinical Impact of Valvular Heart Disease in Elderly Patients Admitted for Acute Coronary Syndrome: Insights From the Elderly-ACS 2 Study.
Can J Cardiol2019 Nov;():. doi: S0828-282X(19)31439-4.
Crimi Gabriele, Montalto Claudio, Ferri Luca Angelo, Piatti Luigi, Bossi Irene, Morici Nuccia, Mandurino-Mirizzi Alessandro, Grosseto Daniele, Tortorella Giovanni, Savonitto Stefano, De Servi Stefano, ,
Abstract
BACKGROUND:
Elderly patients are under-represented in clinical trials and registries, and a gap of evidence exists for clinical decision making in the setting of acute coronary syndromes (ACS). We aimed to assess the prevalence and independent prognostic impact of valvular heart disease (VHD) diagnosed during the index hospitalization on clinical outcomes among elderly patients with ACS. Included VHDs were moderate-to-severe mitral regurgitation (MR), moderate-to-severe aortic stenosis (AS), or both combined.
METHODS:
We explored the Elderly-ACS 2 dataset, which includes patients older than 74 years of age diagnosed with ACS and managed invasively. The primary endpoint was a composite of all-cause death, myocardial infarction, disabling stroke, and rehospitalization for heart failure at 1 year; the secondary endpoint was death for cardiovascular causes. Patients were stratified into 4 groups: no VHD, moderate-to-severe MR, moderate-to-severe AS, and both moderate-to-severe MR and AS.
RESULTS:
Of the 1443 subjects enrolled, 190 (13.2%) had moderate-to-severe MR, 26 (1.8%) had moderate-to-severe AS, and 13 (0.9%) had both moderate-to-severe MR and AS. When compared with those with no VHD, patients with moderate-to-severe MR had hazard ratios (HRs) for the primary endpoint of 2.04 (95% confidence interval [CI], 1.36-3.07], those with moderate-to-severe AS had HRs of 3.10 (95% CI, 1.39-6.93), and those with both moderate-to-severe MR and AS had HRs of 4.00 (95% CI, 1.65-9.73] (all P < 0.01). Patients with moderate-to-severe MR also had increased risks of cardiovascular death (HR 3.17; 95% CI, 1.57-6.42; P < 0.01), whereas in those with moderate-to-severe AS or both moderate-to-severe MR and AS, a nonsignificant increased risk was observed.
CONCLUSIONS:
In a contemporary cohort of elderly patients admitted for ACS, VHD was found in 1 of 5 subjects and had an independent, consistent impact on prognosis.
Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
Guarda su PubMed
-
Red meat consumption and its association with hypertension and hyperlipidaemia among adult Maasai pastoralists of Ngorongoro Conservation Area, Tanzania.
PLoS One2020 ;15(6):e0233777. doi: 10.1371/journal.pone.0233777.
Diarz Ester J, Leyaro Beatrice J, Kivuyo Sokoine L, Ngowi Bernard J, Msuya Sia E, Mfinanga Sayoki G, Bonfoh Bassirou, Mahande Michael J,
Abstract
BACKGROUND:
Red meat is an important dietary source of protein and other essential nutrients. Its high intake has been associated with an increased risk of cardiovascular morbidity and mortality, including hypertension (HTN) and hyperlipidaemia (HLP). Despite being physically active, the Maasai at Ngorongoro Conservation Area (NCA) depend heavily on animals' products as their staple food with fewer intakes of vegetables or fruits due to restriction from carrying out agricultural activities within the NCA. This study aimed at determining the prevalence of HTN and HLP and their association with red meat consumption among adult Maasai of NCA.
METHODS:
A community-based cross-sectional study was conducted in October 2018 using multistage sampling technique. Eight hundred and ninety-four (894) participants enrolled from seven villages in three wards within NCA Data were collected using a modified WHO NCDs-STEPS tool. Anthropometric measurements, blood pressure (BP) measurements, and blood samples for glucose and cholesterol tests were obtained from the study participants. Crude and adjusted prevalence ratio (PR) for factors associated with HTN and HLP were estimated using Ordinal and Bayesian logistic regression models, respectively.
RESULTS:
The prevalence of HLP was 23.7 percent. The levels were higher among males than were among the females (29.0% vs. 20.1%, p = 0.002). The prevalence of HTN and pre-HTN (elevated BP) were 9.8 and 37.0 percent, respectively. Both HTN and elevated BP were higher among males than were among females (hypertensive [10.9% vs. 9.0%]; elevated BP [44.0% vs. 32.1%], p<0.001). The prevalence of HLP was significantly associated with level II (PR = 1.56, 95%CrI: 1.10-2.09) and level III (PR = 1.64, 95%CrI: 1.08-2.41) of red meat consumption as opposed to level I.
CONCLUSION:
The prevalence of hyperlipidaemia and elevated BP were high among NCA Maasai. We found a significant association between red meat consumption and hyperlipidaemia. Further follow-up studies are warranted to establish a temporal relationship between red meat consumption and both conditions.
Guarda su PubMed
-
Racial residential segregation, racial discrimination, and diabetes: The Coronary Artery Risk Development in Young Adults study.
Health Place2020 Mar;62():102286. doi: S1353-8292(19)30964-5.
Mayne Stephanie L, Loizzo Luigi, Bancks Michael P, Carnethon Mercedes R, Barber Sharrelle, Gordon-Larsen Penny, Carson April P, Schreiner Pamela J, Bantle Anne E, Whitaker Kara M, Kershaw Kiarri N,
Abstract
Although racial residential segregation and interpersonal racial discrimination are associated with cardiovascular disease, few studies have examined their link with diabetes risk or management. We used longitudinal data from 2,175 black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study to examine associations of racial residential segregation (G* statistic) and experiences of racial discrimination with diabetes incidence and management. Multivariable Cox models estimated associations for incident diabetes and GEE logistic regression estimated associations with diabetes management (meeting targets for HbA1c, systolic blood pressure, and LDL cholesterol). Neither segregation nor discrimination were associated with diabetes incidence or management.
Copyright © 2020. Published by Elsevier Ltd.
Guarda su PubMed
-
Resilience factors, race/ethnicity and sleep disturbance among diverse older females with hypertension.
J Affect Disord2020 Jun;271():255-261. doi: S0165-0327(19)32306-7.
Blanc Judite, Seixas Azizi, Donley Tiffany, Bubu Omonigho Michael, Williams Natasha, Jean-Louis Girardin,
Abstract
BACKGROUND:
This study examined the relationships between resilience and sleep disturbance in a diverse sample of older women with a history of hypertension and whether this relationship is moderated by individuals' race/ethnicity.
METHODS:
Sample includes 700 females from a community-based study in Brooklyn, New York with a mean age of 60.7 years (SD=6.52). Of the participants, 28.1% were born in the U.S.; 71% were African-descent, 17.4% were European and 11.6% were Hispanics descents. Data were gathered on demographics and sleep disturbance using the Comprehensive Assessment and Referral Evaluation (CARE) and the Stress Index Scale (SIS). Resilience Factors were assessed with both the Index of Self-Regulation of Emotion (ISE) and religious health beliefs. Chi-Square, Anova, Student t-tests, and multilinear regression analysis were conducted to explore associations between resilience factors and sleep disturbance. Associations between resilience factors and sleep disturbance were examined using stratified multilinear regression analysis in three models by race/ethnicity. Regression models was conducted examining the interaction between resilience factors and stress RESULTS: Resilience factor, ISE emerged as the strongest independent predictor of sleep disturbance [B(SE) = -0.368(0.008); p < .001] for African descents. ISE was not a significant predictor of sleep disturbance among Hispanic participants [B(SE) = -0.218(0.022);p = .052], however interaction effect analysis revealed that stress level moderates significantly the relationship between ISE, and their sleep disturbance [B(SE) = 0.243(0.001);p = .036].
CONCLUSIONS:
Results of our study suggest that resilience factors might be a more important protective factor for sleep disturbance among diverse older females.
Copyright © 2020 Elsevier B.V. All rights reserved.
Guarda su PubMed
-
Cardiovascular Risk of Isolated Systolic or Diastolic Hypertension in Young Adults.
Circulation2020 Jun;141(22):1778-1786. doi: 10.1161/CIRCULATIONAHA.119.044838.
Lee Hokyou, Yano Yuichiro, Cho So Mi Jemma, Park Jong Heon, Park Sungha, Lloyd-Jones Donald M, Kim Hyeon Chang,
Abstract
BACKGROUND:
Little is known regarding health outcomes associated with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), or systolic and diastolic hypertension (SDH) among young adults with stage 1 hypertension, defined using the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline.
METHODS:
From a nationwide health screening database, we included 6?424?090 participants, aged 20 to 39 years, who were not taking antihypertensive medication at the baseline examination in 2003 to 2007. Participants were categorized as having normal BP (untreated systolic BP [SBP] <120/diastolic BP [DBP] <80 mm?Hg; n=2?665?310); elevated BP (SBP 120-129/DBP <80 mm?Hg; n=705?344); stage 1 IDH (SBP <130/DBP 80-89 mm?Hg; n=1?271?505); stage 1 ISH (SBP 130-139/DBP <80 mm?Hg; n=255?588); stage 1 SDH (SBP 130-139/DBP 80-89 mm?Hg; n=711?503); and stage 2 hypertension (SBP ?140, DBP ?90 mm?Hg; n=814?840). The primary outcome was composite cardiovascular disease (CVD) events, including myocardial infarction, stroke, heart failure, and CVD-related death.
RESULTS:
The median age of the participants was 30 years and 60.9% were male. Over a median follow-up of 13.2 years, 44?070 new CVD events occurred. With normal BP as the reference, multivariable-adjusted hazard ratios (95% CIs) for CVD events were 1.14 (1.09-1.18) for elevated BP, 1.32 (1.28-1.36) for stage 1 IDH, 1.36 (1.29-1.43) for stage 1 ISH, 1.67 (1.61-1.72) for stage 1 SDH, and 2.40 (2.33-2.47) for stage 2 hypertension.
CONCLUSIONS:
Among young adults, stage 1 ISH, IDH, and SDH were all associated with higher CVD risks than normal BP. The CVD risks of stage 1 ISH and IDH were similar to each other but lower than the risk of stage 1 SDH. Categorizing young adults with stage 1 hypertension further into stage 1 ISH, IDH, and SDH may improve risk stratification for identifying high-risk individuals.
Guarda su PubMed
-
Occupational physical activity is associated with risk of atrial fibrillation in both men and women: a population-based cohort study.
Acta Cardiol2020 Jun;():1-6. doi: 10.1080/00015385.2020.1770978.
Drca Nikola, Wolk Alicja, Larsson Susanna C,
Abstract
Previous studies have found that excessive sport activities are associated with an increased risk of atrial fibrillation (AF). Whether occupational physical activity (OPA) increases the risk for AF is not well studied. We aimed to examine whether OPA influences the risk of AF. 80,922 men and women, free from AF, completed in 1997 a questionnaire about their OPA at that time (baseline), and also retrospectively in 1997 their OPA at the age of 30 and 50?years. Participants were categorised into three groups (low, medium and high) based on OPA load. Participants were followed-up in the Swedish National Patient Register for ascertainment of AF. Cox proportional hazards regression models were used to estimate relative risks (RR) with 95% confidence intervals (CI), adjusted for potential confounders. 11,614 cases of AF were diagnosed during follow-up time of up to 17?years. We observed an increased risk of AF in relation to increased load of OPA regardless of age. Compared with men who reported a low load of OPA, the multivariable RR (95% CI) for men with a high load was 1.10 (1.03-1.17) at 30?years, 1.11 (1.04-1.17) at 50?years and 1.19 (1.10-1.29) at baseline. The results for women were similar with multivariable RR of 1.16 (1.06-1.27) at 30?years, 1.14 (1.05-1.24) at 50?years and 1.11 (0.99-1.24) at baseline. These findings suggest that high load of OPA previous in life may play a role in increasing the risk for AF in both men and women.
Guarda su PubMed
-
Childhood Oral Infections Associate with Adulthood Metabolic Syndrome: A Longitudinal Cohort Study.
J Dent Res2020 Jun;():22034520929271. doi: 10.1177/0022034520929271.
Pussinen P J, Paju S, Viikari J, Salminen A, Taittonen L, Laitinen T, Burgner D, Kähönen M, Lehtimäki T, Hutri-Kähönen N, Raitakari O, Juonala M,
Abstract
Chronic oral infection/inflammation is cross-sectionally associated with metabolic syndrome (MetS) in adults, but there are few longitudinal studies and studies on childhood oral infections and adult MetS risk. We investigated whether childhood clinical parameters indicative of oral infection/inflammation were associated with adulthood MetS and its components. A total of 755 children aged 6, 9, and 12 y underwent a clinical oral examination in 1980 as part of the Cardiovascular Risk in Young Finns Study. Oral health measures included bleeding on probing (BOP), periodontal probing pocket depth, caries, fillings, and visible plaque. Metabolic parameters were determined at baseline and during follow-up. MetS was diagnosed ( = 588, 77.9%) in the adulthood at 21 y (in 2001), 27 y (in 2007), and 31 y (in 2011) after the oral assessment, when the participants were 27 to 43 y old. Regression analyses were adjusted for childhood age, sex, body mass index, and family income, as well as adulthood smoking and education level. In adulthood, MetS was diagnosed in 11.9% (2001), 18.7% (2007), and 20.7% (2011) of participants at the 3 follow-ups. Childhood caries and fillings were associated with increased risk of adult MetS (risk ratio [95% CI], 1.25 [0.90 to 2.45] and 1.27 [1.02 to 1.99]) and with increased systolic blood pressure (1.78 [1.01 to 4.26] and 2.48 [1.11 to 4.12]) and waist circumference (2.25 [1.02 to 4.99] and 1.56 [1.01 to 3.25]), whereas BOP and visible plaque were associated with plasma glucose (1.97 [1.08 to 3.60] and 1.88 [1.00 to 3.53]). Severity of BOP ( = 0.015) and caries ( = 0.005) and teeth with plaque ( = 0.027) were associated with number of MetS components. No such trends were seen with probing pocket depth. Childhood oral infection/inflammation was associated with adverse metabolic parameters and MetS in adulthood.
Guarda su PubMed
-
Mitral valve perforation during transcatheter aortic valve replacement.
Asian Cardiovasc Thorac Ann2020 Jun;():218492320930842. doi: 10.1177/0218492320930842.
Higa Shotaro, Nagano Takaaki, Yamashiro Satoshi, Iwabuchi Masashi,
Abstract
An 86-year-old female with severe aortic valve stenosis underwent transcatheter aortic valve replacement. A balloon-expandable valve was used, guided by a double-stiff guidewire that successfully straightened the aorta. During valve placement, the balloon shifted. After placement of the prosthetic valve, intraoperative transesophageal echocardiography revealed severe mitral regurgitation from the anterior mitral leaflet. Open conversion was performed immediately. A 5-mm hole was identified in the anterior leaflet, and direct closure was chosen for mitral valve repair. While transcatheter aortic valve replacement has gained popularity for patients with severe aortic stenosis and high operative risk, reports of mitral valve perforation are rare.
Guarda su PubMed
-
Physical activity is favorably associated with arterial stiffness in patients with obesity and elevated metabolic risk.
Int J Clin Pract2020 Jun;():e13563. doi: 10.1111/ijcp.13563.
Königstein Karsten, Infanger Denis, Klenk Christopher, Carrard Justin, Hinrichs Timo, Schmidt-Trucksäss Arno,
Abstract
OBJECTIVES:
Physical activity and cardiorespiratory fitness (CRF) are relevant modifiers of cardiovascular risk. Their independent effects on arterial stiffness have not been assessed in people with obesity. This study aimed to assess the independent effects of light (LPA) and moderate-to-vigorous (MVPA) physical activity and CRF on pulse wave velocity.
METHODS:
Brachial-ankle pulse wave velocity (baPWV) was measured cross-sectionally in 55 subjects (43.0±13.8 years; 66% women) with moderate cardiovascular risk. Body composition was assessed with bioelectrical impedance-analysis. Daily minutes of LPA and MVPA were measured by accelerometry and CRF (peak oxygen uptake (VO peak)) with spiroergometry. Independent effects of LPA, MVPA and VO peak on baPWV were analyzed in an age-, sex-, body fat mass- and blood pressure-adjusted ANOVA.
RESULTS:
Every 10min increase of daily MVPA was associated with a 2.8% (0.32m/s [-0.64 - 0.001m/s], P=0.05) reduction of baPWV, whereas LPA and VO peak had only little or no relevant effects on baPWV.
CONCLUSIONS:
Higher MVPA is associated with lower composite arterial stiffness independent of CRF and number of metabolic risk factors in patients with obesity and further metabolic risk factors. Thus, lifestyle interventions should aim for an increase of MVPA. BaPWV may improve monitoring of favorable effects of MVPA, even if an improvement of VO peak cannot be obtained.
This article is protected by copyright. All rights reserved.
Guarda su PubMed
-
Adapting STEMI care for the COVID-19 pandemic: The case for low-risk STEMI triage and early discharge.
Catheter Cardiovasc Interv2020 Jun;():. doi: 10.1002/ccd.28993.
Lopez John J, Ebinger Joseph E, Allen Sorcha, Yildiz Mehmet, Henry Timothy D,
Abstract
The coronavirus pandemic has resulted in the need for rapid assessment of resource utilization within our hospital systems. Specifically, the overwhelming need for intensive care unit (ICU) beds within epicenters of the pandemic has created a need for consideration as to how acute coronary syndrome cases, and specifically ST-elevation myocardial infarction (STEMI) patients, are managed postprocedure. While most patients in the United States continue to be managed in coronary care units after primary percutaneous coronary intervention, there is a robust literature regarding the ability to triage STEMI patients safely and efficiently with low-risk features to non-ICU beds. We review the various risk scores for STEMI triage and the data supporting their usage. In summary, these findings support an approach to low-risk STEMI triage that does not come at the expense of quality patient care or outcomes, where up to two-thirds of patients with STEMI may be able to be safely managed without ICU-level care.
© 2020 Wiley Periodicals, Inc.
Guarda su PubMed
-
Hypolipidemic and antioxidant activities of Trichosanthes kirilowii maxim seed oil and flavonoids in mice fed with a high-fat diet.
J Food Biochem2020 Jun;():e13272. doi: 10.1111/jfbc.13272.
Hou Zongkun, Zhu Liancai, Meng Run, Wang Bochu,
Abstract
Trichosanlhes kirilowii Maxim seed oil (TSO) is rich in conjugated linolenic acids, and the flavonoids (FLA) combined with n-3 fatty acids can effectively change the plasma antioxidant capacity. Hyperlipidemia and oxidative stress are one of the most important risk factors for cardiovascular disease. This study aims to evaluate the effect of the TSO, FLA, and TSO combined with FLA (TSOFLA) intake on hyperlipemia mice. TSO and TSOFLA administration resulted in a significant decline in serum levels of total cholesterol, triglycerides, and low density lipoprotein-cholesterol. TSOFLA improved the hepatic and serum antioxidant status as assessed by superoxide dismutase, glutathione peroxidase activities, and reduced the levels of lipid peroxidation. Hematoxylin-eosin staining of liver and aorta tissue has shown a marked reduction of the hyperlipidemia-induced lesions by gavage TSOFLA. Compared with TSO and FLA, TSOFLA has more significant hypolipidemic and antioxidant activities, which effects may be correlated to the synergy between TSO and FLA. PRACTICAL APPLICATIONS: Dyslipidemia is a common metabolic disorder, which is characterized by triglyceride levels increased, total cholesterol, and low-density lipoprotein cholesterol. Lipid-lowering treatment can reduce the expansion of coronary atherosclerosis, and particular the dietary lipids have important roles in controlling the concentrations of these risk factors. This is the first study evaluating the hypolipidemic and antioxidant activities effects of Trichosanlhes kirilowii Maxim seed oil (TSO), flavonoids (FLA), and TSO combined with FLA (TSOFLA) intake on hyperlipemia mice caused by a high-fat diet. The pharmacological effects of dietary TSOFLA are correlated to its high content of unsaturated fatty acids and flavonoids. This information can be of interest to the development of food supplements in the field of diseases associated with high-fat intakes such as cardiovascular diseases and adiposis.
© 2020 Wiley Periodicals LLC.
Guarda su PubMed
-
Association of Ischemic Stroke, Major Bleeding, and Other Adverse Events With Warfarin Use vs Non-vitamin K Antagonist Oral Anticoagulant Use in Patients With Atrial Fibrillation With a History of Intracranial Hemorrhage.
JAMA Netw Open2020 Jun;3(6):e206424. doi: 10.1001/jamanetworkopen.2020.6424.
Tsai Chuan-Tsai, Liao Jo-Nan, Chiang Chern-En, Lin Yenn-Jiang, Chang Shih-Lin, Lo Li-Wei, Hu Yu-Feng, Tuan Ta-Chuan, Chung Fa-Po, Chao Tze-Fan, Lip Gregory Y H, Chen Shih-Ann,
Abstract
Importance:
Current guidelines recommend the use of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF). Data regarding warfarin sodium use compared with NOAC use in patients with AF with a history of intracranial hemorrhage (ICH) are limited.
Objective:
To compare the clinical outcomes of warfarin use and NOAC use in patients with AF with a history of ICH using a nationwide cohort with AF.
Design, Setting, and Participants:
A nationwide cohort study from January 1, 2012, to December 31, 2016, was performed using data from the Taiwan National Health Insurance Research Database. The dates of analysis were July 1 to September 1, 2019. The study population comprised patients with AF with a history of ICH and a CHA2DS2-VASc score (congestive heart failure, hypertension, age ?75 years [doubled], diabetes, prior stroke/transient ischemic attack/thromboembolism [doubled], vascular disease [prior myocardial infarction, peripheral artery disease], age 65-74 years, sex category [female]) of at least 1 for men or at least 2 for women who had received warfarin or NOACs. The clinical outcomes were examined using Cox proportional hazards regression analyses among the study population before and after propensity score matching.
Exposures:
Oral anticoagulation with warfarin or NOACs.
Main Outcomes and Measures:
The clinical outcomes measured were all-cause mortality, ischemic stroke, ICH, major bleeding, and adverse events.
Results:
The study cohort included 4540 patients (mean [SD] age, 76.0 [10.5] years; 2653 men [58.4%]), with 1047 patients receiving warfarin (mean [SD] age, 75.1 [11.4] years; 571 men [54.5%]) and 3493 patients receiving NOACs (mean [SD] age, 76.3 [10.2] years; 2082 men [59.6%]). Compared with warfarin use, NOAC use was associated with statistically significantly lower risk of all-cause mortality (adjusted hazard ratio [aHR], 0.517; 95% CI, 0.457-0.585), ICH (aHR, 0.556; 95% CI, 0.389-0.796), and major bleeding (aHR, 0.645; 95% CI, 0.525-0.793), whereas the rate of ischemic stroke was similar in the 2 groups (aHR, 0.879; 95% CI, 0.678-1.141). These results were generally consistent after propensity score matching among 973 patients in each group.
Conclusions and Relevance:
Among patients with AF with prior ICH, NOAC use was associated with lower rates of ICH and major bleeding compared with warfarin use, whereas the rate of ischemic stroke was similar in the 2 groups. Among patients with AF with prior ICH, NOACs could be the preferred choice for stroke prevention.
Guarda su PubMed
-
Dabigatran and The Risk of Staphylococcus Aureus Bacteremia- A Nationwide Cohort Study.
Clin Infect Dis2020 Jun;():. doi: ciaa661.
Butt Jawad H, Fosbųl Emil L, Verhamme Peter, Gerds Thomas A, Iversen Kasper, Bundgaard Henning, Bruun Niels Eske, Larsen Anders R, Petersen Andreas, Andersen Paal S, Skov Robert L, Gislason Gunnar H, Torp-Pedersen Christian, Kųber Lars, Olesen Jonas B,
Abstract
BACKGROUND:
Treatment with dabigatran, an oral direct thrombin inhibitor, reduces the virulence of Staphylococcus aureus in in vitro and in vivo models. However, it remains to be determined whether dabigatran reduces the risk of S. aureus infections in humans. We investigated the incidence rate of Staphylococcus aureus bacteremia (SAB) in patients with atrial fibrillation treated with the direct thrombin inhibitor, dabigatran, compared with patients treated with the factor Xa-inhibitors, rivaroxaban, apixaban, and edoxaban.
METHODS:
In this observational cohort study, 112,537 patients with atrial fibrillation who initiated treatment with direct oral anticoagulants (August 2011-December 2017) were identified from Danish nationwide registries. The incidence rates of SAB in patients treated with dabigatran versus patients treated with the factor Xa-inhibitors were examined by multivariable Cox regression accounting for time-dynamic changes of exposure status during follow-up.
RESULTS:
A total of 112,537 patients were included. During a median follow-up of 2.0 years, 186 patients in the dabigatran group and 356 patients in the factor Xa-inhibitor group were admitted with SAB. The crude incidence rate of SAB was lower in the dabigatran group compared with the factor Xa-inhibitor group (22.8 [95%CI,19.7-26.3] and 33.8 [95%CI,30.5-37.6] events per 10.000 person-years, respectively). In adjusted analyses, dabigatran was associated with a significantly lower incidence rate of SAB compared with factor Xa-inhibitors (incidence rate ratio 0.76 [95%CI,0.63-0.93]).
CONCLUSIONS:
Treatment with dabigatran was associated with a significantly lower incidence rate of SAB compared with treatment with factor Xa-inhibitors.
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Guarda su PubMed
