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Pubblicazioni recenti - cardiovascular risk
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Carotid intima-media and epicardial adipose tissue thickness in adult patients with epilepsy taking anti-seizure medication and its long-term significance.
Epilepsy Behav2021 Nov;125():108432. doi: S1525-5050(21)00693-4.
Safarpour Lima Behnam, Mohamadzadeh Alireza, Dadras Morvarid, Mahdavi Ali, Mansouri Behnam, Farazdaghi Mohsen,
Abstract
OBJECTIVES:
We investigated epicardial adipose tissue thickness (EATT), carotid intima-media thickness (CIMT), and lipid profile in adult patients with epilepsy (PWE) taking anti-seizure medication(s) (ASM) and compared with those of the healthy population. We also investigated whether duration of follow-up and number of ASM(s) (mono- vs. polytherapy) affect these risk factors.
METHODS:
Twenty PWE older than 18?years of age were recruited at the outpatient epilepsy clinic and compared to twenty controls. Patients who were 18?years old and younger, those with cardiovascular risk factors, and patients with follow-up duration less than 2?years were excluded from the study.
RESULTS:
Epicardial adipose tissue thickness and CIMT were thicker compared to controls. While patients' low-density lipoprotein (LDL) levels were higher than controls, and high-density lipoprotein (HDL) levels were lower, the levels were in normal ranges. Those patients with duration of follow-up more than five years had thicker EATT. The 5-year LDL was in normal ranges while HDL was abnormally low. Number of ASM(s) was not associated with increased risks of atherosclerosis. Increased CIMT in patients taking ASM(s) was independent of their lipid profile.
CONCLUSION:
Anti-seizure medications contribute to accelerated atherosclerosis in people with epilepsy. Chronic use of ASMs may increase this chance. It is appropriate to use ASM(s) with lower chances of atherosclerosis in people with epilepsy and encourage them to change their lifestyle in order to modify cardiovascular risk factors. Meantime, it is reasonable to assess the risk of atherosclerosis periodically in these patients by noninvasive methods including lipid profile, CIMT, and EATT.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Access to Left Ventricular Assist Device: Travel Time Does Not Tell The Whole Story.
J Surg Res2021 Nov;271():52-58. doi: S0022-4804(21)00688-0.
Mehaffey J Hunter, Cullen J Michael, Hawkins Robert B, Fonner Clifford, Kern John, Speir Alan, Quader Mohammed, Ailawadi Gorav, Teman Nicholas, Yarboro Leora,
Abstract
BACKGROUND:
Negative health effects of traveling longer distances for surgical services have been reported. Given the high complexity of multidisciplinary care required for management of Left Ventricular Assist Device (LVAD) implantation, only 4 of 18 centers in our state perform these operations. Given the limited access we hypothesized increased travel time would adversely affect postoperative outcomes and 30-d mortality.
METHODS:
A statewide Society of Thoracic Surgeons database was queried to identify patients undergoing Heartmate II/III and HVAD implantation, and 725 patients were identified. Travel time was calculated by zip code. Patients were stratified into regional and distant groups by the upper quartile of travel time (1-h). Preoperative variables and outcomes were compared between the groups. Multivariate analysis was performed to evaluate the impact of travel time in risk-adjusted models of 30-d mortality.
RESULTS:
Median patient travel time to their LVAD center in our state is 32 min (mean 53 ± 65 min, 46 ± 71 miles). Patients in the distant group (n = 191) had lower median incomes, higher self-pay status, higher rates of medical comorbid disease. Despite these differences there was no difference between the groups in ICU and/or hospital length of stay, readmission, postoperative complications, or 30-d mortality. Multivariate regression demonstrated insurance status, age, and prior surgery predicted 30-d mortality, but not travel time.
CONCLUSIONS:
Despite only four centers in the state performing LVAD implantation, travel time was strongly associated with preoperative risk, and socioeconomic status but not postoperative outcomes or 30-d mortality. Therefore, increasing access should focus on insurance, and patient characteristics not travel time.
Copyright © 2021. Published by Elsevier Inc.
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Factors associated with the risk of cardiac death in children with hypertrophic cardiomyopathy: a systematic review and meta-analysis.
Heart Lung2021 Nov;52():26-36. doi: S0147-9563(21)00274-0.
Xia Kun, Sun Dongming, Wang Ruigeng, Zhang Yong,
Abstract
BACKGROUND:
Studies on risk factors of sudden cardiac death (CD) or CD in children with hypertrophic cardiomyopathy (HCM) are lacking.
OBJECTIVES:
To assess factors associated with the risk of sudden CD or CD in HCM children.
METHODS:
Pubmed, Embase, Cochrane Library, and Web of Science databases were searched.
RESULTS:
The results indicated that children with previous adverse cardiac events during childhood and with a history of syncope had an increased risk of sudden CD or CD. Non-sustained ventricular tachycardia (VT) in HCM children was associated with sudden CD or CD. Children with left ventricular hypertrophy (LVH) were at higher risk of sudden CD or CD. And left ventricular outflow tract (LVOT) obstruction was a potential risk factor for sudden CD in children with HCM (all P
CONCLUSION:
Optimal care and appropriate monitoring is necessary for HCM children with higher risk of sudden CD or CD.
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
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Effects of whole peanut within an energy-restricted diet on inflammatory and oxidative processes in obese women: a randomized controlled trial.
J Sci Food Agric2021 Nov;():. doi: 10.1002/jsfa.11692.
Fialho Cristiane Gonçalves de Oliveira, Boroni Moreira Ana Paula, Bressan Josefina, Alfenas Rita de Cássia Gonçalves, Mattes Richard, Costa Neuza Maria Brunoro,
Abstract
BACKGROUND:
Peanut consumption has little effect on body weight, despite its high energy density and is associated with reduced cardiovascular disease risk. Based on previous research, we hypothesized that the consumption of whole peanut would be associated with greater improvements in body composition, lipid profile, and biomarkers of inflammation and oxidative stress.
METHODOLOGY:
Twenty-four women with obesity (BMI?>?30?kg/m ), 33.1?±?8.7?years old, were assigned to 3 groups and consumed 56?g of whole peanut (WP), skinned peanut (SP), and no peanut (NP) and consumed energy-restricted diets (250?kcal/d less than their customary diet) for eight weeks.
RESULTS:
WP lost an average of 3.2?kg, while SP group lost 2.6?kg and the NP group 1.8?kg. However, only the groups that consumed peanuts showed a significant reduction in body mass index (BMI). WP group presented lower body weight, BMI, waist circumference, total lean mass, and total body fat than the SP group in the 8th week. There was a significant reduction in total cholesterol and LDL after four weeks of intervention, which was maintained in week-8 for the WP and SP groups. In addition, there was an improvement in platelets and plasma homocysteine with WP.
CONCLUSION:
Our results suggest that the regular intake of the whole peanut as part of an energy-restricted diet showed health benefits since it enhanced body weight loss, besides improving body composition and reducing cholesterol, platelets, and homocysteine concentrations. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Statins: a panacea to reduce mortality in patients undergoing liver transplantation for hepatocellular carcinoma?
Liver Transpl2021 Nov;():. doi: 10.1002/lt.26381.
Shawcross Debbie L, Suddle Abid,
Abstract
In Greek mythology Panacea was the goddess of universal remedy or health. In literary terms a panacea represents a solution to solve all ills and there are few drugs that can claim such an accolade. One drug class that has claimed to be a panacea in adults at increased risk of cardiovascular disease are statins. Since their FDA approval in the late 1980s, statins have revolutionised the management of hypercholesterolemia.
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Whipple's disease in renal transplant recipients: Management experience of 7 cases from Pakistan.
Transpl Infect Dis2021 Nov;():. doi: 10.1111/tid.13769.
Nasim Asma, Dodani Sunil Kumar, Badlani Sanjay, Babar Zaheer Udin, Shakil Shaheera, Mubarak Mohammad, Luck Nasir, Aziz Tahir,
Abstract
INTRODUCTION:
Whipple's disease (WD) is a rare multi-systemic disorder caused by actinomycetes, Tropheryma Whipplei (T. Whipplei). It presents with weight loss, arthralgia and diarrhea and may involve the heart, lung or central nervous system. The use of immunosuppressive medications or underlying immunodeficiency states are associated risk factors. Six cases in transplant recipients have so far been reported worldwide. We describe our experience of Whipple's disease in renal transplant recipients.
METHODS:
All renal transplant recipients who presented with diarrhea and were diagnosed with Whipple's disease on duodenal biopsy from 2016 till 2019 were included. Their data regarding duration since transplantation, immunosuppressive therapy, symptoms, treatment response and outcome was analyzed.
RESULTS:
Seven cases were diagnosed as Whipple's disease based on duodenal biopsy, with histological findings of Periodic acid Schiff positive granules in macrophages. All were male. The most common symptoms were chronic diarrhea and weight loss. Average time since transplantation was 4.8 years. All patients were on azathioprine and everolimus. Clinical relapse or adverse effects was seen in 5 of 7 patients treated with doxycycline and hydroxychloroquine which was discontinued. Trimethoprim/sulphamethoxazole for one year, with initial intravenous ceftriaxone in 2 patients, resulted in complete remission in all patients at a follow-up period averaging 1.5 years.
CONCLUSION:
Whipple's diseases in renal transplant recipients most commonly presents as an intestinal disorder. Treatment of one year with Trimethoprim/sulphamethoxazole has good response with complete remission at 1.5 years of follow up. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Ultrafiltration and cardiopulmonary bypass associated acute kidney injury: A systematic review and meta-analysis.
Clin Cardiol2021 Nov;():. doi: 10.1002/clc.23750.
Kandil Omneya A, Motawea Karam R, Darling Edward, Riley Jeffrey B, Shah Jaffer, Elashhat Mohamed Abdalla Mohamed, Searles Bruce, Aiash Hani,
Abstract
BACKGROUND:
Cardiopulmonary bypass is known to raise the risk of acute kidney injury (AKI). Previous studies have identified numerous risk factors of cardiopulmonary bypass including the possible impact of perioperative ultrafiltration. However, the association between ultrafiltration (UF) and AKI remains conflicting. Thus, we conducted a meta-analysis to further examine the relationship between UF and AKI.
HYPOTHESIS:
Ultrafiltration during cardiac surgery increases the risk of developping Acute kidney Injury.
METHODS:
We searched PubMed, Web of Science, EBSCO, and SCOPUS through July 2021. The RevMan (version 5.4) software was used to calculate the pooled risk ratios (RRs) and mean differences along with their associated confidence intervals (95% CI).
RESULTS:
We identified 12 studies with a total of 8005 patients. There was no statistically significant difference in the incidence of AKI between the group who underwent UF and the control group who did not (RR?=?0.90, 95% CI?=?0.64-1). Subgroup analysis on patients with previous renal insufficiency also yielded nonsignificant difference (RR?=?0.84, 95% CI?=?0.53 -1.33, p?=?.47). Subgroup analysis based on volume of ultrafiltrate removed (> or
CONCLUSION:
UF in cardiac surgery is not associated with increased AKI incidence and may be safely used even in baseline chronic injury patients.
© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
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Oxidized phospholipids and lipoprotein(a): An update.
Eur J Clin Invest2021 Nov;():e13710. doi: 10.1111/eci.13710.
Koutsogianni Amalia Despoina, Liberopoulos Evangelos, Tellis Konstantinos, Tselepis Alexandros D,
Abstract
Over the past few years, there has been an undiminished interest in lipoprotein(a) [Lp(a)] and oxidized phospholipids (OxPLs), mainly carried on this lipoprotein. Elevated Lp(a) has been established as an independent causal risk factor for cardiovascular disease. OxPLs play an important role in atherosclerosis. The main questions that remain to be answered, however, is to what extent OxPLs contribute to the atherogenicity of Lp(a), what effect hypolipidaemic medications may have on their levels and the potential clinical benefit of their reduction. This narrative review aimed to summarize currently available data on OxPLs and cardiovascular risk, as well as the effect of established and emerging hypolipidaemic medications on Lp(a)-OxPLs.
© 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.
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Roselle for hypertension in adults.
Cochrane Database Syst Rev2021 Nov;11():CD007894. doi: 10.1002/14651858.CD007894.pub3.
Pattanittum Porjai, Ngamjarus Chetta, Buttramee Fonthip, Somboonporn Charoonsak,
Abstract
BACKGROUND:
Hypertension is considered to be a serious health problem worldwide. Controlling and lowering blood pressure are of significant benefit to people with hypertension because hypertension is a risk factor for stroke, heart disease, and cardiovascular disease. Roselle, the tropical plant Hibiscus sabdariffa, also commonly called sour tea or red tea, has been used as both a thirst-quenching drink and for medicinal purposes.
OBJECTIVES:
To assess the effect of Roselle on blood pressure in people with primary hypertension.
SEARCH METHODS:
For this update, the Cochrane Hypertension Information Specialist searched the following databases and trials registers for randomised controlled trials (RCTs): the Cochrane Hypertension Specialised Register (to 6 August 2021), Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 7), MEDLINE Ovid (1946 to 5 August 2021), Embase Ovid (1974 to 5 August 2021), ProQuest Dissertations & Theses (to 6 August 2021), Web of Science Clarivate (to 7 August 2021), Food Science and Technology Abstracts Clarivate (to 7 August 2021), the WHO International Clinical Trials Registry Platform (to 6 August 2021), and the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (to 6 August 2021). We searched Google Scholar and OpenSIGLE. We also handsearched local and regional Chinese databases: CBM, CMCC, TCMLARS, CNKI, CMAC, and the Index to Chinese Periodical Literature (to 14 September 2020), as well as Thai databases (ThaiJO, CUIR, TDC, CMU e-Theses, TCTR) (to 3 October 2020). There were no language or publication date restrictions.
SELECTION CRITERIA:
We sought RCTs evaluating the use of any forms of Roselle with placebo or no treatment in adults with hypertension. Our primary outcome was change in trough and/or peak systolic and diastolic blood pressure (SBP, DBP). Secondary outcomes were withdrawals due to adverse effects, change in pulse pressure, and change in heart rate.
DATA COLLECTION AND ANALYSIS:
All search results were managed using Covidence and re-checked for the number of records, inclusion and exclusion of studies with Mendeley reference management software. We used standard methodological procedures expected by Cochrane. Two review authors worked independently in parallel for screening (titles and abstracts, and full reports), data extraction, risk of bias assessment, and assessment of the certainty of the evidence using the GRADE approach. Any disagreements were resolved by discussion or by consultation with the third review author if necessary. We presented mean difference (MD) of change in SBP and DBP with their corresponding 95% confidence interval (CI).
MAIN RESULTS:
For this update, only one RCT with a parallel-group design involving 60 participants with type 2 diabetes mellitus fulfilled the inclusion criteria. This study investigated the effect of Roselle extract capsules (total dose of 5600 mg) compared with placebo (lactose) at eight weeks. The study was at low risk of selection bias, performance bias, and detection bias. Conversely, it was at high risk of attrition bias, reporting bias, and other bias (baseline imbalance). We have very little confidence in the effect estimate of Roselle on change-from-baseline in both SBP and DBP between the two groups. The MD of change in SBP was 1.65, 95% CI -7.89 to 11.19 mmHg, 52 participants, very low-certainty evidence. The MD of change in DBP was 4.60, 95% CI -1.38 to 10.58 mmHg, 52 participants, very low-certainty evidence. Our secondary outcomes of withdrawals due to adverse effects, change in pulse pressure, and change in heart rate were not reported. Due to the limited available data, no secondary analyses were performed (subgroup and sensitivity analysis).
AUTHORS' CONCLUSIONS:
The evidence is currently insufficient to determine the effectiveness of Roselle compared to placebo for controlling or lowering blood pressure in people with hypertension. The certainty of evidence was very low due to methodological limitations, imprecision, and indirectness. There is a need for rigorous RCTs that address the review question.
Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Prognostic Accuracy of the Modified CHA2DS2-VASc Score in COVID-19 Patients Admitted to the Emergency Department Due to Clinical Worsening.
Acta Med Port2021 Nov;():. doi: 10.20344/amp.17016.
Valente Silva Beatriz, Plácido Rui, Jorge Cláudia, Mendonça Carlos, Urbano Maria Luísa, Rodrigues Tiago, Brito Joana, Alves da Silva Pedro, Rigueira Joana, Pinto Fausto J,
Abstract
INTRODUCTION:
Risk factors comprising the CHA2DS2VASc score are recognized as risk factors for venous thromboembolism and mortality in COVID-19 patients. A modified CHA2DS2VASc score (M-CHA2D2VASc), developed by changing gender criteria from female to male, has been proposed to predict in-hospital mortality in COVID-19 patients. The aim of this study was to evaluate the prognostic accuracy of M-CHA2D2VASc for adverse clinical outcomes and short-term mortality in COVID-19 patients admitted to the Emergency Department.
MATERIAL AND METHODS:
Retrospective study of patients admitted to the ED who underwent computed tomography pulmonary angiography due to suspected pulmonary embolism or clinical worsening. Patients were stratified into three M-CHA2DS2-VASc risk-categories: low (0 - 1 points), intermediate (2 - 3 points) and high-risk (? 4 points).
RESULTS:
We included 300 patients (median age 71 years, 59% male). The overall mortality was 27%. The M-CHA2DS2-VASc score was higher in non-survivors compared to survivors [4 (IQR:3 - 5) vs 2 (IQR: 1 - 4), respectively, p
DISCUSSION:
This is the first study to validate M-CHA2DS2-VASc score as a predictor of short-term mortality in patients admitted to the Emergency Department.
CONCLUSION:
The M-CHA2DS2-VASC score might be useful for prompt risk-stratification in COVID-19 patients during admission to the Emergency Department.
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Association between serum uric acid and carotid atherosclerosis in elderly postmenopausal women: A hospital-based study.
J Clin Lab Anal2021 Nov;():e24097. doi: 10.1002/jcla.24097.
Dong Xiao-Kang, Luo Dan, Chen Wen-Jing, Wang Rong-Rong, Yang Jie, Niu Miao-Miao,
Abstract
BACKGROUND:
Carotid atherosclerosis (CAS) is associated with increased cardiovascular risk and implicated in 20-30% of strokes.
METHODS:
504 patients were included in this study. The detailed medical history and the results of physical examination, carotid ultrasound examination, and routine laboratory tests were collected. Logistic regression analyses were conducted to analyze the relationship between the SUA and the presence of carotid plaques. And the relationship between SUA and the progression of CAS was analyzed by multiple linear regression. The effect of hormone replacement therapy (HRT) on CAS has also be evaluated.
RESULTS:
412 patients (81.7%) had carotid plaques of different sizes by carotid ultrasound examination. We found a positive association between the level of SUA and the probability of having carotid plaque by univariate logistic regression (OR: 2.01, 95% CI: 1.83-2.19, p = 0.003). At 2 years post-discharge, we found that 1 mg/dL increase in SUA levels was expected to 0.946% increase in plaque score and 0.026 cm increase in carotid intima-media thickness, separately. Moreover, patients treated by long-term HRT (?5 years) had a lower level of SUA and blood lipid and the less change of plaque score and carotid intima-media thickness than patients without HRT.
CONCLUSION:
The presence and progression of CAS had significantly positive associations with the level of SUA. And the HRT may have the ability to prevent the presence and progression of CAS. However, the safety and long-term outcome of HRT on CAS should be evaluated in further studies.
© 2021 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.
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Opioid use is associated with increased out-of-hospital cardiac arrest risk among 40,000-cases across two countries.
Br J Clin Pharmacol2021 Nov;():. doi: 10.1111/bcp.15157.
Eroglu Talip E, Barcella Carlo A, Blom Marieke T, Souverein Patrick C, Mohr Grimur H, Torp-Pedersen Christian, Folke Fredrik, Wissenberg Mads, de Boer Anthonius, Gislason Gunnar H, Tan Hanno L, ,
Abstract
AIM:
Opioid use has substantially increased in the last decade and is associated with overdose mortality, but also with increased mortality from cardiovascular causes. This finding may partly reflect an association between opioids and out-of-hospital cardiac arrest (OHCA). Therefore, we aimed to investigate OHCA-risk of opioids in the community.
METHODS:
We conducted two population-based case-control studies separately in the Netherlands (2009-2018) and Denmark (2001-2015). Cases were individuals who experienced OHCA of presumed cardiac cause. Each case was matched with up to five non-OHCA-controls according to age, sex and OHCA-date. Conditional logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI).
RESULTS:
We included 5,473 OHCA-cases matched with 21,866 non-OHCA-controls in the Netherlands, and 35,017 OHCA-cases matched with 175,085 non-OHCA-controls in Denmark. We found that use of opioids (the Netherlands: cases: 5.4%, controls: 1.8%; Denmark: cases: 11.9%, controls: 4.4%) was associated with increased OHCA-risk in both regions (the Netherlands: OR 2.1 [95%-CI 1.8-2.5]; Denmark: OR 1.8 [95%-CI 1.5-2.1]). The association was observed in both sexes, and in individuals with cardiovascular disease (the Netherlands: OR 1.8 [95%-CI 1.5-2.1]; Denmark: OR 1.6 [95%-CI 1.5-1.7]) or without (the Netherlands: OR 3.4 [95%-CI: 2.4-4.8], P-interaction
CONCLUSION:
Use of opioids is associated with increased OHCA-risk in both sexes, independently of concomitant cardiovascular disease. These findings should be considered when evaluating the harms and benefits of treatment with opioids.
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Pathophysiological metabolic changes associated with disease modify the proarrhythmic risk profile of drugs with potential to prolong repolarisation.
Br J Pharmacol2021 Nov;():. doi: 10.1111/bph.15757.
TeBay Clifford, McArthur Jeffrey R, Mangala Melissa, Kerr Nicholas, Heitmann Stewart, Perry Matthew D, Windley Monique J, Vandenberg Jamie I, Hill Adam P,
Abstract
BACKGROUND AND PURPOSE:
Hydroxychloroquine, chloroquine and azithromycin are three drugs that were proposed to treat COVID-19. While concern already existed around their proarrhythmic potential there is little data regarding how altered physiological states encountered in patients such as febrile state, electrolyte imbalances or acidosis might change their risk profiles.
EXPERIMENTAL APPROACH:
Potency of hERG block was measured using high-throughput electrophysiology in the presence of variable environmental factors. These potencies informed simulations to predict population risk profiles. Effects on cardiac repolarisation were verified in human induced pluripotent stem cell-derived cardiomyocytes from multiple individuals.
KEY RESULTS:
Chloroquine and hydroxychloroquine blocked hERG with IC of 1.47±0.07 ?M and 3.78±0.17 ?M respectively, indicating proarrhythmic risk at concentrations effective against SARS-CoV-2 in vitro. Hypokalaemia and hypermagnesemia increased potency of chloroquine and hydroxychloroquine, indicating increased proarrhythmic risk. Acidosis significantly reduced potency of all drugs, whereas increased temperature decreased potency of chloroquine and hydroxychloroquine against hERG but increased potency for azithromycin. In silico simulations demonstrated that proarrhythmic risk was increased by female sex, hypokalaemia and heart failure, and identified specific genetic backgrounds associated with emergence of arrhythmia.
CONCLUSION AND IMPLICATIONS:
Our study demonstrates how proarrhythmic risk can be exacerbated by metabolic changes and pre-existing disease. More broadly, the study acts as a blueprint for how high-throughput in vitro screening, combined with in silico simulations can help guide both preclinical screening and clinical management of patients in relation to drugs with potential to prolong repolarisation.
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Health Disparities of Cardiometabolic Disorders Among Filipino Americans: Implications for Health Equity and Community-Based Genetic Research.
J Racial Ethn Health Disparities2021 Nov;():. doi: 10.1007/s40615-021-01190-6.
Coronado Gerald, Chio-Lauri Jacqueline, Cruz Rosheanne Dela, Roman Youssef M,
Abstract
Health disparities are well-documented among different racial and ethnic minority groups in the United States. Filipino Americans (FAs) are the third-largest Asian-American group in the USA and are commonly grouped under the Asian categorization. FAs have a higher prevalence of cardiometabolic disorders than non-Hispanic Whites and other Asian subgroups with rates comparable to African Americans. Although no major epidemiological studies have ascertained the prevalence of cardiometabolic diseases in FAs, limited reports suggest that FAs have a higher prevalence of dyslipidemia, hypertension, diabetes, metabolic syndrome, hyperuricemia, and gout than non-FAs. A recent genetic study has shown that FAs could have the highest prevalence of a genetic polymorphism strongly associated with the development of gout and gout-related comorbidities. While developing cardiometabolic disorders is a heterogeneous and multifaceted process, the overall prevalence of certain cardiometabolic disorders parallel the prevalence of population-level risk factors, including genetics, dietary lifestyles, health beliefs, and social determinants of health. Therefore, assessment of the Filipino cuisine, health behaviors among Filipinos, socio-cultural factors, and acculturation to living in the USA are equally critical. Ascertaining the contribution of the biological causes to disease onset and the different psychosocial factors that could modulate disease risk or disease management are needed. Ultimately, a multilevel research approach is critical to assess the role of biological and non-biological risk factors of cardiometabolic disorders in FAs to inform culturally appropriate health promotion, disease prevention strategies, and a personalized approach to health.
© 2021. W. Montague Cobb-NMA Health Institute.
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The role of cardiovascular risk factors in maternal cardiovascular disease according to offspring birth characteristics in the HUNT study.
Sci Rep2021 Nov;11(1):22981. doi: 10.1038/s41598-021-99478-4.
Haug Eirin B, Markovitz Amanda R, Fraser Abigail, Dalen Håvard, Romundstad Pål R, Åsvold Bjørn O, Rich-Edwards Janet W, Horn Julie,
Abstract
A history of preterm or small (SGA) or large (LGA) for gestational age offspring is associated with smoking and unfavorable levels of BMI, blood pressure, glucose and lipids. Whether and to what extent the excess cardiovascular risk observed in women with these pregnancy complications is explained by conventional cardiovascular risk factors (CVRFs) is not known. We examined the association between a history of SGA, LGA or preterm birth and cardiovascular disease among 23,284 parous women and quantified the contribution of individual CVRFs to the excess cardiovascular risk using an inverse odds weighting approach. The hazard ratios (HR) between SGA and LGA offspring and CVD were 1.30 (95% confidence interval (CI) 1.15, 1.48) and 0.89 (95% CI 0.76, 1.03), respectively. Smoking explained 49% and blood pressure may have explained ?12% of the excess cardiovascular risk in women with SGA offspring. Women with preterm birth had a 24% increased risk of CVD (HR 1.24, 95% CI 1.06, 1.45), but we found no evidence for CVRFs explaining any of this excess cardiovascular risk. While smoking explains a substantial proportion of excess cardiovascular risk in women with SGA offspring and blood pressure may explain a small proportion in these women, we found no evidence that conventional CVRFs explain any of the excess cardiovascular risk in women with preterm birth.
© 2021. The Author(s).
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Comprehensive and long-term surveys of COVID-19 sequelae in Japan, an ambidirectional multicentre cohort study: study protocol.
BMJ Open Respir Res2021 Nov;8(1):. doi: e001015.
Nakagawara Kensuke, Namkoong Ho, Terai Hideki, Masaki Katsunori, Tanosaki Takae, Shimamoto Kyoko, Lee Ho, Tanaka Hiromu, Okamori Satoshi, Kabata Hiroki, Chubachi Shotaro, Ikemura Shinnosuke, Kamata Hirofumi, Yasuda Hiroyuki, Kawada Ichiro, Ishii Makoto, Ishibashi Yoshiki, Harada Sei, Fujita Takanori, Ito Daisuke, Bun Shogyoku, Tabuchi Hajime, Kanzaki Sho, Shimizu Eisuke, Fukuda Keitaro, Yamagami Jun, Kobayashi Keigo, Hirano Toshiyuki, Inoue Takashi, Kagyo Junko, Shiomi Tetsuya, Ohgino Keiko, Sayama Koichi, Otsuka Kengo, Miyao Naoki, Odani Toshio, Oyamada Yoshitaka, Masuzawa Keita, Nakayama Sohei, Suzuki Yusuke, Baba Rie, Nakachi Ichiro, Kuwahara Naota, Ishiguro Takashi, Mashimo Shuko, Minematsu Naoto, Ueda Soichiro, Manabe Tadashi, Funatsu Yohei, Koh Hidefumi, Yoshiyama Takashi, Saito Fumitake, Ishioka Kota, Takahashi Saeko, Nakamura Morio, Goto Ai, Harada Norihiro, Kusaka Yu, Nakano Yasushi, Nishio Kazumi, Tateno Hiroki, Edahiro Ryuya, Takeda Yoshito, Kumanogoh Atsushi, Kodama Nobuhiro, Okamoto Masaki, Umeda Akira, Hagimura Kazuto, Sato Toshiro, Miyazaki Naoki, Takemura Ryo, Sato Yasunori, Takebayashi Toru, Nakahara Jin, Mimura Masaru, Ogawa Kaoru, Shimmura Shigeto, Negishi Kazuno, Tsubota Kazuo, Amagai Masayuki, Goto Rei, Ibuka Yoko, Hasegawa Naoki, Kitagawa Yuko, Kanai Takanori, Fukunaga Koichi,
Abstract
INTRODUCTION:
The rapid spread of COVID-19 posed a global burden. Substantial number of people died of the disease in the acute phase of infection. In addition, a significant proportion of patients have been reported to suffer from post-acute phase symptoms, sequelae of COVID-19, which may negatively influence the quality of daily living and/or socioeconomic circumstances of the patients. However, no previous study has comprehensively and objectively assessed the quality of life of patients by using existing international scales. Further, evidence of socioeconomic consequences among patients with COVID-19 is scarce. To address the multidimensional issues from sequelae of COVID-19, evidence from comprehensive surveys beyond clinical perspectives is critical that investigates health, and social determinants of disease progression as well as socioeconomic consequences at a large scale.
METHODS AND ANALYSIS:
In this study, we plan to conduct a nationwide and comprehensive survey for the sequelae of COVID-19 in a total of 1000 patients diagnosed at 27 hospitals throughout Japan. This study will evaluate not only the health-related status of patients from clinical perspectives but also the Health-related Quality of Life (HRQoL) scores, socioeconomic status and consequences to discuss the sequelae of the disease and the related risk factors. The primary endpoint is the frequency of long-term complications of COVID-19 infection. The secondary endpoints are risk factors for progression to sequelae of COVID-19 infection. The study will provide robust and important evidence as a resource to tackle the issues from the sequelae of COVID-19 from the multi-dimensional perspectives.
ETHICS AND DISSEMINATION:
This trial was approved by the Keio University School of Medicine Ethics Committee (20200243, UMIN000042299). The results of this study will be reported at a society meeting or published in a peer-reviewed journal.
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Chronic thromboembolic pulmonary hypertension in patients with antiphospholipid syndrome: Risk factors and management.
J Heart Lung Transplant2021 Oct;():. doi: S1053-2498(21)02569-9.
Rosen Keren, Raanani Ehud, Kogan Alexander, Kenet Gili, Misgav Mudi, Lubetsky Aharon, Niznik Stanely, Schäfers Hans-Joachim, Segel Michael J, Agmon-Levin Nancy,
Abstract
BACKGROUND:
Antiphospholipid syndrome (APS) may cause chronic thromboembolic pulmonary hypertension (CTEPH). Current knowledge regarding prevalence and risk factors for CTEPH among APS patients is limited. We sought to determine clinical features and biomarkers that could identify APS subjects suffering from CTEPH, and describe the prevalence, course and treatment outcomes of patients with APS-CTEPH.
METHODS:
504 APS patients were treated in our center during 2008 to 2019. We studied clinical and laboratory features of 69 APS patients, comparing 19 patients diagnosed with CTEPH (APS-CTEPH) and treated accordingly, with 50 consecutive age and gender matched patients with no evidence of pulmonary hypertension (APS-No-CTEPH).
RESULTS:
CTEPH prevalence was 3.8% in our APS cohort and was linked with the following parameters: primary APS (p
CONCLUSIONS:
CTEPH is relatively common in APS. Primary APS, prior PE, recurrent VTE, thrombocytopenia and specific anti-phospholipid antibodies predict CTEPH in APS. Active assessment for CTEPH in APS patients should be considered, as PEA was found to be effective and relatively safe, especially if electively performed.
Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
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Tetramethylpyrazine alleviates diabetes-induced high platelet response and endothelial adhesion via inhibiting NLRP3 inflammasome activation.
Phytomedicine2021 Nov;():153860. doi: S0944-7113(21)00401-3.
Zhang Haowen, Chen Hanyu, Wu Xiang, Sun Tong, Fan Manlu, Tong Huaqin, Zhu Yejin, Yin Zhe, Sun Weixin, Zhang Chao, Zheng Xiao, Chen Xiaohu,
Abstract
BACKGROUND:
The inflammatory state of diabetes promotes high platelet response and endothelial adhesion, which are the main risk factors for cardiovascular events. Tetramethylpyrazine (TMP) is an amide alkaloid isolated from the traditional Chinese medicine Rhizoma Ligustici Chuanxiong, which has been widely used in the clinical treatment of ischemic cardiovascular disease.
PURPOSE:
This study aimed to investigate whether TMP could alleviate diabetes-induced high platelet response and endothelial adhesion and the underlying mechanisms.
METHODS:
Type 2 diabetes mellitus (T2DM) rat model was established by high-fat feeding combined with low dose of streptozotocin. Rats in the TMP treatment group were administered with TMP (100 or 200 mg/kg) for 21 days. Cultured human umbilical vein endothelial cells (HUVECs) were stimulated with glucose (5.5 mM) to induce endothelial activation. The NOD-like receptor protein 3 (NLRP3) over- and low-expressing cell models were established via transfection of NLRP3 lentivirus plasmid into HUVECs. INF39 (25 mg/kg), a chemical inhibitor of NLRP3 inflammasome, was used to explore the role of NLRP3 in T2DM associated high platelet response and endothelial adhesion.
RESULTS:
TMP effectively improved the prothrombotic phenotypes and inhibited the expression of vascular inflammatory factors and adhesion molecules in T2DM rats. TMP inhibited NLRP3 inflammasome and reduced the adhesion of HUVECs to platelets and monocytes in vitro. Over-expression of NLRP3 blocked the effect of TMP on HUVECs activation and adhesion, while TMP had no effect on NLRP3 low-expressing HUVECs. The NLRP3 inhibitor INF39 produced similar effects of TMP on diabetes-induced high platelet response, endothelial adhesion and vascular inflammation.
CONCLUSION:
TMP ameliorates diabetes-induced high platelet response and endothelial adhesion via inhibiting NLRP3 inflammasome activation in T2DM rats, which provide a new basis for the clinical prevention and treatment of diabetes-associated cardiovascular events.
Copyright © 2021 Elsevier GmbH. All rights reserved.
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[Retinal vascular network: Changes with aging and systemic vascular disease (cardiac and cerebral)].
J Fr Ophtalmol2021 Nov;():. doi: S0181-5512(21)00521-0.
Arnould L, Guenancia C, Binquet C, Delcourt C, Chiquet C, Daien V, Cottin Y, Bron A M, Acar N, Creuzot-Garcher C,
Abstract
For over 10 years, the description of the retinal microvascular network has benefited from the development of new imaging techniques. Automated retinal image analysis software, as well as OCT angiography (OCT-A), are able to highlight subtle, early changes in the retinal vascular network thanks to a large amount of microvascular quantitative data. The challenge of current research is to demonstrate the association between these microvascular changes, the systemic vascular aging process, and cerebrovascular and cardiovascular disease. Indeed, a pathophysiological continuum exists between retinal microvascular changes and systemic vascular diseases. In the Montrachet study, we found that a suboptimal retinal vascular network, as identified by the Singapore I Vessel Assessment (SIVA) software, was significantly associated with treated diabetes and an increased risk of cardiovascular mortality. In addition, we supplemented our research on the retinal vascular network with the use of OCT-A. In the EYE-MI study, we showed the potential role of quantitative characterization of the retinal microvascular network by OCT-A in order to assess the cardiovascular risk profile of patients with a history of myocardial infarction. A high AHA (American Heart Association) risk score was associated with low retinal vascular density independently of hemodynamic changes. Thus, a better understanding of the association between the retinal microvasculature and macrovascular disease might make its use conceivable for early identification of at-risk patients and to suggest a personalized program of preventative care. The retinal vascular network could therefore represent an indicator of systemic vascular disease as well as an interesting predictive biomarker for vascular events.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
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Seasonal influenza vaccination is associated with reduced risk of death among Medicare beneficiaries.
Vaccine2021 Nov;():. doi: S0264-410X(21)01461-4.
Buchman Timothy G, Simpson Steven Q, Sciarretta Kimberly L, Finne Kristen P, Sowers Nicole, Collier Michael, Chavan Saurabh, Do Rose, Lin Cheng, Oke Ibijoke, Rhodes Kiersten E, Santhosh Aathira, Sandhu Alexander T, Chu Steve, Patel Sandeep A, Disbrow Gary L, Bright Rick A, MaCurdy Thomas E, Kelman Jeffrey A,
Abstract
BACKGROUND:
Influenza causes substantial mortality, especially among older persons. Influenza vaccines are rarely more than 50% effective and rarely reach more than half of the US Medicare population, which is primarily an aged population. We wished to estimate the association between vaccination and mortality reduction.
METHOD:
We used the US Center for Medicare and Medicaid Services (CMS) DataLink Project to determine vaccination status and timing during the 2017-2018 influenza season for more than 26 million Medicare enrollees. Patient-level demographic, health, co-morbidity, hospitalization, vaccination, and healthcare utilization claims data were supplied as covariates to general linear models in order to isolate and estimate the association between participation in the vaccination program and relative risk of death.
FINDINGS:
The 2017-2018 seasonal influenza vaccine reduced (Relative Risk Ratio [RRR] 0.936 [95% CI = 0.918-0.954]) the risk of all-cause death among beneficiaries following a hospitalization for sepsis and moreover the risk of death without a prior hospitalization during the 2.5-month outcome window (RRR 0.870 [95% CI = 0.853-0.887]). We estimate the number needed to vaccinate (NNV) to prevent a death in the ten-week outcome window is between 1,515 beneficiaries (95% CI = 1,351-1,754; derived from the average treatment effect of augmented inverse probability weighting) and 1,960 beneficiaries (95% CI = 1,695-2,381; derived from the average marginal effect of logistic regression). Among beneficiaries requiring hospitalization, the greatest death risk reduction accrued to those 85 + years of age who were hospitalized with sepsis, RRR 0.92 [95% CI = 0.89-0.95]. No apparent benefit was realized by beneficiaries who required custodial (nursing home) care.
INTERPRETATION:
Seasonal influenza immunization is associated with relative reduction of death risk among non-institutionalized Medicare beneficiaries.
FUNDING:
All authors are full-time or contractual employees of the United States Federal Government, Department of Health and Human Services, the funding agency.
Published by Elsevier Ltd.
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