13351
|
Subramanian U, Schmittdiel JA, Gavin N, Traylor A, Uratsu CS, Selby JV, Mangione CM. The association of patient age with cardiovascular disease risk factor treatment and control in diabetes. J Gen Intern Med 2009; 24:1049-52. [PMID: 19603239 PMCID: PMC2726890 DOI: 10.1007/s11606-009-1059-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 04/30/2009] [Accepted: 06/22/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND While inadequate treatment intensification may contribute to sub-optimal CVD risk factor control in older patients with diabetes, the relationship between patient age and treatment intensification is largely unexplored. OBJECTIVE To examine differences in treatment intensification and control for blood pressure (BP), lipids and A1c in older vs. younger adults with diabetes. METHODS A total of 161,697 Kaiser Permanente Northern California adult diabetes patients were stratified by age (<50, 50-64, 65-74 and 75-85) and assessed for control of A1c (<8%), LDL-c (<100 mg/dl) and SBP (<140 mmHg). Probit models assessed the marginal effects of patient age on treatment intensification and control for all three CVD risk factors. RESULTS Patients aged 50-64 and 65-74 were significantly more likely to receive treatment intensification for elevated SBP than patients under 50 (74% and 76% vs. 71%) and significantly less likely to receive treatment intensification for elevated A1c (73% and 72% vs. 76%), with no differences noted for LDL-c treatment. Older patients had significantly worse SBP control, but better control of A1c and LDL-c. CONCLUSIONS Both treatment intensification rates and control of BP, A1c and LDL cholesterol control varied somewhat by age, suggesting room for further improvement in treatment intensification and control.
Collapse
|
13352
|
Kerrigan SW, Cox D. The thrombotic potential of oral pathogens. J Oral Microbiol 2009; 1. [PMID: 21523210 PMCID: PMC3077004 DOI: 10.3402/jom.v1i0.1999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 07/26/2009] [Accepted: 07/30/2009] [Indexed: 11/14/2022] Open
Abstract
In recent times the concept of infectious agents playing a role in cardiovascular disease has attracted much attention. Chronic oral disease such as periodontitis, provides a plausible route for entry of bacteria to the circulation. Upon entry to the circulation, the oral bacteria interact with platelets. It has been proposed that their ability to induce platelet aggregation and support platelet adhesion is a critical step in the pathogenesis of the infection process. Many published studies have demonstrated multiple mechanisms through which oral bacteria are able to bind to and activate platelets. This paper will review the various mechanisms oral bacteria use to interact with platelets.
Collapse
|
13353
|
Tourlouki E, Matalas AL, Panagiotakos DB. Dietary habits and cardiovascular disease risk in middle-aged and elderly populations: a review of evidence. Clin Interv Aging 2009; 4:319-30. [PMID: 19696896 PMCID: PMC2722871 DOI: 10.2147/cia.s5697] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The proportion of elderly is increasing worldwide. This trend is paralleled by an increase in chronic diseases, such as cardiovascular disease. A limited number of studies have investigated the effect of diet on cardiometabolic risk factors (such as hypertension, hypercholesterolemia, diabetes, obesity) in older populations, despite the fact that diet plays a significant role in elderly health. In this review, a summary of studies that have evaluated the effect of dietary habits on cardiovascular disease risk in elderly populations is presented. Methods A search was made in available databases (PubMed and Scopus) looking for results from observational studies and clinical trials that assessed dietary habits on cardiovascular disease risk in elderly populations (>65 years old). Studies during the last decade were retrieved and summarized. Results All eight of the reviewed observational studies and all three reviewed clinical trials performed in elderly populations reported an inverse association between healthy dietary patterns with cardiovascular disease risk and its predisposing markers. Conclusion Dietary intervention strategies should be implemented in older adults, in order to prevent cardiovascular disease morbidity and mortality, and improve quality of life.
Collapse
|
13354
|
Hoffmann B, Moebus S, Dragano N, Stang A, Möhlenkamp S, Schmermund A, Memmesheimer M, Bröcker-Preuss M, Mann K, Erbel R, Jöckel KH. Chronic residential exposure to particulate matter air pollution and systemic inflammatory markers. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:1302-8. [PMID: 19672412 PMCID: PMC2721876 DOI: 10.1289/ehp.0800362] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 05/11/2009] [Indexed: 05/19/2023]
Abstract
BACKGROUND Long-term exposure to urban air pollution may accelerate atherogenesis, but mechanisms are still unclear. The induction of a low-grade systemic inflammatory state is a plausible mechanistic pathway. OBJECTIVES We analyzed the association of residential long-term exposure to particulate matter (PM) and high traffic with systemic inflammatory markers. METHODS We used baseline data from the German Heinz Nixdorf Recall Study, a population-based, prospective cohort study of 4,814 participants that started in 2000. Fine PM [aerodynamic diameter <or= 2.5 microm (PM(2.5))] exposure based on a small-scale dispersion and chemistry transport model was assigned to each home address. We calculated distances between residences and major roads. Long-term exposure to air pollution (annual PM(2.5) and distance to high traffic) and concentration of inflammatory markers [high-sensitivity C-reactive protein (hs-CRP) and fibrinogen] on the day of the baseline visit were analyzed with sex-stratified multiple linear regression, controlling for individual-level risk factors. RESULTS In the adjusted analysis, a cross-sectional exposure difference of 3.91 microg/m(3) in PM(2.5) (interdecile range) was associated with increases in hs-CRP of 23.9% [95% confidence interval (CI), 4.1 to 47.4%] and fibrinogen of 3.9% (95% CI, 0.3 to 7.7%) in men, whereas we found no association in women. Chronic traffic exposure was not associated with inflammatory markers. Short-term exposures to air pollutants and temperature did not influence the results markedly. CONCLUSIONS Our study indicates that long-term residential exposure to high levels of PM(2.5) is associated with systemic inflammatory markers in men. This might provide a link between air pollution and coronary atherosclerosis.
Collapse
|
13355
|
Bremner JD, Cheema FA, Ashraf A, Afzal N, Fani N, Reed L, Musselman DL, Ritchie JC, Faber T, Votaw JR, Nemeroff CB, Vaccarino V. Effects of a cognitive stress challenge on myocardial perfusion and plasma cortisol in coronary heart disease patients with depression. Stress Health 2009; 25:267-278. [PMID: 34113216 PMCID: PMC8189292 DOI: 10.1002/smi.1246] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although it is well established that coronary heart disease (CHD) patients with depression exhibit increased mortality compared with equally ill cardiac patients without depression, the mechanisms mediating this effect remain obscure. Depression is characterized by vulnerability to stress and heightened stress responsiveness, and stress can theoretically act through several biological pathways to contribute to excess mortality from CHD. Mechanisms connecting stress, depression and cardiovascular mortality have not been previously explored in detail. The purpose of this study was to assess the effects of stress and depression on myocardial perfusion and plasma cortisol concentrations in CHD patients. Patients with CHD with and without depression (n = 28) underwent single photon emission computed tomography imaging of myocardial perfusion at rest and during a stressful cognitive challenge. Severity of ischaemia was measured by summing perfusion defect scores across myocardial segments and subtracting out rest from stress scores. Plasma cortisol concentrations were measured at baseline and in response to the stressful challenge. There were no differences in stress-induced myocardial ischaemia or plasma cortisol response to stress between CHD patients with and without depression. Depressed CHD patients with a history of psychological trauma (n = 5) had an increase in stress-induced ischaemia scores [7; standard deviation (SD) = 5] compared with CHD patients with depression without a history of psychological trauma (2 SD = 2) and CHD patients without depression or psychological trauma (1; SD = 2) (F = 8.51; degree of freedom = 2,23; p = 0.007). Eighty per cent of CHD/depression trauma-exposed subjects had stress-induced ischaemia as opposed to 38 per cent of CHD/depression subjects without trauma exposure and 23 per cent of subjects with CHD without depression or trauma. Self-reported nervousness during the cognitive stressor was correlated with stress-induced ischaemia. These preliminary findings suggest that depression with a history of prior exposure to traumatic stress is associated with increased risk for stress-induced cardiovascular ischaemia.
Collapse
|
13356
|
Vaziri ND, Moradi H, Pahl MV, Fogelman AM, Navab M. In vitro stimulation of HDL anti-inflammatory activity and inhibition of LDL pro-inflammatory activity in the plasma of patients with end-stage renal disease by an apoA-1 mimetic peptide. Kidney Int 2009; 76:437-44. [PMID: 19471321 PMCID: PMC3280585 DOI: 10.1038/ki.2009.177] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Features of end-stage renal disease such as oxidative stress, inflammation, hypertension, and dyslipidemia are associated with accelerated atherosclerosis and increased risk of death from cardiovascular disease. By inhibiting the formation and increasing the disposal of oxidized lipids, HDL exerts potent antioxidant and anti-inflammatory actions. Given that apolipoproteinA-1 can limit atherosclerosis, we hypothesized that an apolipoproteinA-1 mimetic peptide, 4F, may reduce the proinflammatory properties of LDL and enhance the anti-inflammatory properties of HDL in uremic plasma. To test this, plasma from each of 12 stable hemodialysis patients and age-matched control subjects was incubated with 4F or vehicle. The isolated HDL and LDL fractions were added to cultured human aortic endothelial cells to quantify monocyte chemotactic activity, thus measuring their pro- or anti-inflammatory index. The LDL from the hemodialysis patients was more pro-inflammatory and their HDL was less anti-inflammatory than those of the control subjects. Pre-incubation of the plasma from the hemodialysis patients with 4F decreased LDL pro-inflammatory activity and enhanced HDL anti-inflammatory activity. Whether 4F or other apolipoproteinA-1 mimetic peptides will have any therapeutic benefit in end-stage renal disease will have to be examined directly in clinical studies.
Collapse
|
13357
|
Davis KA, Crow JA, Chambers HW, Meek EC, Chambers JE. Racial differences in paraoxonase-1 (PON1): a factor in the health of southerners? ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:1226-31. [PMID: 19672401 PMCID: PMC2721865 DOI: 10.1289/ehp.0900569] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 03/11/2009] [Indexed: 05/25/2023]
Abstract
BACKGROUND The southern United States (excluding Florida) has the highest age-adjusted rate of cardiovascular disease (CVD) in the country, with African Americans having a higher prevalence of CVD than Caucasians. Paraoxonase-1 (PON1), an enzyme associated with high-density lipoprotein particles, participates both in the hydrolysis of oxidized lipids (thus protecting against atherosclerosis) and in the hydrolysis of organophosphates. Higher paraoxonase activity has been associated with lower risk of atherosclerosis. OBJECTIVES In this study we characterized the distribution of the functional PON1(Q192R) polymorphisms (PON status as assessed by diazoxonase to paraoxonase ratios) and the PON1 activity levels in 200 adult males and females of both races (50 in each race/sex class) from the southern United States from commercially obtained blood bank serum samples. METHODS We used spectrophotometric methods with serum to determine PON1 status, arylesterase activities (phenyl acetate hydrolysis), and levels of cotinine and C-reactive protein (CRP). RESULTS African Americans had higher paraoxonase activities but lower diazoxonase activities than did Caucasians, consistent with African Americans having a lower proportion of the functional genotype QQ (QQ 15%, QR 34%, RR 44%, 7% indeterminate), than did Caucasians (QQ 60%, QR 31%, RR 7%, 2% indeterminate). Cotinine levels indicated that all samples came from non-smokers and that CRP levels were higher in African Americans than in Caucasians and higher in females than in males. CRP levels showed no association with paraoxonase activities. CONCLUSIONS These data present initial observations for use in characterizing the poorer cardiovascular health status of the population in the southern United States and more specifically southern African Americans.
Collapse
|
13358
|
Cardi M, Munk N, Zanjani F, Kruger T, Schaie KW, Willis SL. Health behavior risk factors across age as predictors of cardiovascular disease diagnosis. J Aging Health 2009; 21:759-75. [PMID: 19516045 PMCID: PMC2856461 DOI: 10.1177/0898264309333312] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The current study examines the prevalence of health risk behaviors and their cumulative effects on cardiovascular disease (CVD) among a sample of adults. Age cohort is also examined to determine the role of age in predicting CVD and risky health behaviors. METHOD Medical records of a sample of adults from the Seattle Longitudinal Study categorized into one of four age-group cohorts were examined. Data regarding participants' health risk behaviors were examined individually and cumulatively for predicting later CVD diagnosis. RESULTS The prevalence of CVD increases with age, obesity, and risky medical checkups. Female risky sleepers are more likely to receive a CVD diagnosis than men who report risky sleep patterns (p < .05). DISCUSSION A high risk of CVD appears to exist for adults across the life span, and several risky health behaviors also seem to place individuals more at risk for being diagnosed with CVD.
Collapse
|
13359
|
Sheridan SL, Behrend L, Vu MB, Meier A, Griffith JM, Pignone MP. Individuals' responses to global CHD risk: a focus group study. PATIENT EDUCATION AND COUNSELING 2009; 76:233-239. [PMID: 19286342 PMCID: PMC2713789 DOI: 10.1016/j.pec.2009.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 01/14/2009] [Accepted: 01/25/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To explore how individuals respond to global coronary heart disease (CHD) risk and use it in combination with treatment information to make decisions to initiate and maintain risk reducing strategies. METHODS We conducted four focus groups of individuals at risk for CHD (n=29), purposively sampling individuals with each of several risk factors. Two reviewers coded verbatim transcripts and arbitrated differences, using ATLAS.ti 5.2 to facilitate analysis. RESULTS Participants generally regarded the concept of global CHD risk as useful and motivating, although had questions about its precision and comprehensiveness. They identified several additional influential factors in decision-making (e.g. achievable risk, the quickness and self-evidence of results) and generally preferred lifestyle changes to medications (although most would accept medications under certain circumstances). They also noted the importance of participating in decision-making. CONCLUSION Our results underscore the motivating potential of global CHD risk and the importance of patient participation in decision-making. PRACTICE IMPLICATIONS Global CHD risk is a useful adjunct to CHD prevention and can be presented in ways, and with information, that might improve CHD outcomes.
Collapse
|
13360
|
Popova S, Patra J, Rehm J. Avoidable portion of tobacco-attributable acute care hospital days and its cost due to implementation of different intervention strategies in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:2179-92. [PMID: 19742154 PMCID: PMC2738881 DOI: 10.3390/ijerph6082179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Accepted: 07/30/2009] [Indexed: 11/25/2022]
Abstract
The impact of four effective population-based interventions, focusing on individual behavioural change and aimed at reducing tobacco-attributable morbidity, was assessed by modeling with respect to effects on reducing prevalence rates of cigarette smoking, population-attributable fractions, reductions of disease-specific morbidity and its cost for Canada. Results revealed that an implementation of a combination of four tobacco policy interventions would result in a savings of 33,307 acute care hospital days, which translates to a cost savings of about $37 million per year in Canada. Assuming 40% coverage rate for all individually based interventions, the two most effective interventions, in terms of avoidable burden due to morbidity, would be nicotine replacement therapy and physicians' advice, followed by individual behavioural counselling and increasing taxes by 10%. Although a sizable reduction in the number of hospital days and accumulated costs could be achieved, overall these interventions would reduce less than 3% of all tobacco-attributable costs in Canada.
Collapse
|
13361
|
Hange D, Lissner L, Bengtsson C, Sundh V, Björkelund C. Perceived nervousness and moodiness associated with increased CVD but not cancer morbidity in pre- and postmenopausal women. Observations from the Population Study of Women in Gothenburg, Sweden. Int J Gen Med 2009; 2:39-45. [PMID: 20360885 PMCID: PMC2840577 DOI: 10.2147/ijgm.s4894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 32-year prospective observational study was initiated in 1968, including 1462 women aged 60, 54, 50, 46, and 38, representative of the female population in these age groups. Measures included self-reported nervous symptoms and moodiness at baseline, menopausal status, risk factors as smoking, s-cholesterol, s-triglycerides, body mass index (BMI), waist–hip ratio (WHR), blood pressure, and socioeconomic status (SES). The prevalence of nervousness and moodiness was investigated as well as if these reported symptoms could predict mortality and morbidity within 32 years in pre-and postmenopausal women. Women who reported at least two of the symptoms suffered from an increased risk of 32-year mortality, independent of all background variables described above (hazard ratio [HR] = 1.28, confidence interval [CI] 1.03–1.58). Women with only one of the nervous symptoms already had an increased risk of suffering from cardiovascular disease (CVD) also after multivariable adjustment (HR = 1.29, CI 1.09–1.52) a risk that also remained significant when analyzing CVD risk in the group of premenopausal women (HR = 1.28, CI 1.02–1.62). There was no significantly increased risk among pre-or postmenopausal women with perceived nervousness/moodiness of developing cancer during the 32-year follow-up. There seems to be an association between nervousness/ moodiness and premature mortality and morbidity in CVD, especially when present already in the premenopausal state in women.
Collapse
|
13362
|
Jafar TH, Qadri Z, Hashmi S. Prevalence of microalbuminuria and associated electrocardiographic abnormalities in an Indo-Asian population. Nephrol Dial Transplant 2009; 24:2111-6. [PMID: 19225011 PMCID: PMC2698093 DOI: 10.1093/ndt/gfp042] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 01/20/2009] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Microalbuminuria (MA) is a known predictor of cardiovascular disease (CVD) in European origin populations, but such data are lacking in native Indo-Asian populations, where CVD risks are high. Major electrocardiographic (ECG) changes are predictive of cardiovascular mortality. We determined the association of MA with major ECG changes in the general population of Pakistan. METHODS A total of 3143 subjects aged >or=40 years from 12 randomly selected communities in Karachi participated. MA was defined as the urine albumin to creatinine (ACR) ratio of < 300 mg/g creatinine and >or=17 mg/g in men and >or=25 mg/g in women from a single-spot morning urine sample. Major changes on ECG were coded in duplicate using Minnesota classification. RESULTS The mean age of subjects was 51.5 (10.7) years. The median (25-75 percentile) ACR was 4.2 (2.9-7.9) mg/g in men and 6.0 (3.9-10.8) mg/g in women (P < 0.001). The overall prevalence (95% CI) of MA was 12.3% (11.1-13.5%), and 20.3% in those with major ECG changes. In a multivariable model, major ECG changes (OR, 95% CI) (1.50, 1.10-2.00), diabetes (3.57, 2.93-4.35), hypertension (2.30, 1.85-2.86), female sex (0.61, 0.53-0.69), age (1.09, 1.05-1.13, for each 5-year increase) and eGFR (0.80, 0.78-0.81, for each 10 mg/g increase) were independently associated with MA. The presence of MA increased the prevalence of major ECG changes from 21 to 31% in those with hypertension (44.9%), 15 to 28% among those with diabetes (21.4%), 14 to 26% among those with overweight or obesity (68.4%) and 14 to 26% among current users of tobacco (38.7%) (P < 0.001) each. CONCLUSIONS The strong association between MA and major ECG changes underscores the importance of screening Indo-Asian subjects for MA for unmasking underlying CVD, especially those with hypertension, diabetes, obesity, and tobacco users.
Collapse
|
13363
|
Aschbacher K, Roepke SK, von Känel R, Mills PJ, Mausbach BT, Patterson TL, Dimsdale JE, Ziegler MG, Ancoli-Israel S, Grant I. Persistent versus transient depressive symptoms in relation to platelet hyperactivation: a longitudinal analysis of dementia caregivers. J Affect Disord 2009; 116:80-7. [PMID: 19131112 PMCID: PMC2772124 DOI: 10.1016/j.jad.2008.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 11/10/2008] [Accepted: 11/10/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depressive symptoms and caregiving stress may contribute to cardiovascular disease (CVD) via chronic platelet activation; however, it remains unclear whether this elevated activation constitutes a trait or state marker. The primary objective was to investigate whether persistent depressive symptoms would relate to elevated platelet activation in response to acute psychological stress over a three-year period. METHODS Depressive symptoms (Brief Symptom Inventory) were assessed among 99 spousal dementia caregivers (52-88 years). Platelet P-selectin expression was assessed in vivo using flow cytometry at three time-points over the course of an acute stress test: baseline, post-stress, and after 14 min of recovery. Two competing structural analytic models of depressive symptoms and platelet hyperactivity with three yearly assessments were compared. RESULTS Although depressive symptoms were generally in the subclinical range, their persistent elevation was associated with heightened platelet reactivity and recovery at all three-years while the change in depressive symptoms from the previous year did not predict platelet activity. LIMITATIONS These results focus on caregivers providing consistent home care, while future studies may extend these results by modeling major caregiving stressors. CONCLUSIONS Enduring aspects of negative affect, even among those not suffering from clinical depression are related to hemostatic changes, in this case platelet reactivity, which might be one mechanism for previously reported increase in CVD risk among elderly Alzheimer caregivers.
Collapse
|
13364
|
Miller MA, Kandala NB, Kivimaki M, Kumari M, Brunner EJ, Lowe GDO, Marmot MG, Cappuccio FP. Gender differences in the cross-sectional relationships between sleep duration and markers of inflammation: Whitehall II study. Sleep 2009; 32:857-864. [PMID: 19639748 PMCID: PMC2706900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To examine the relationships between sleep and inflammatory markers because these may be important in the development of cardiovascular disease. METHODS AND RESULTS The relationship between self-reported sleep duration and interleukin-6 (IL-6) (n = 4642) and high-sensitivity C-reactive protein (hs-CRP) (n = 4677) was examined in individuals from the Whitehall II study. Following multiple adjustments, there were no overall linear or nonlinear trends between sleep duration and IL-6. However, in women but not men (interaction P < 0.05), levels of IL-6 tended to be lower in individuals who slept 8 hours (11% [95% confidence interval 4 to 17]) as compared to 7 hours. With hs-CRP, in the adjusted model, there was no association between hs-CRP and sleep duration in men. However, there was a significant nonlinear association in women, the level of hs-CRP being significantly higher in women short sleepers (5 hours or less) after multiple adjustments (P = 0.04) (interaction P < 0.05). CONCLUSIONS No significant variation in inflammatory markers with sleep duration was observed in men. By contrast, both IL-6 and hs-CRP levels varied with sleep duration in women. The observed pattern of variation was different according to the inflammatory marker observed. Further longitudinal studies are required to fully investigate possible temporal relationships between short sleep and markers of inflammation.
Collapse
|
13365
|
Abstract
A large body of epidemiologic evidence has demonstrated that the combination of a Western diet and lifestyle is primarily responsible for the increased metabolic disease risk, such as obesity, type 2 diabetes mellitus (T2DM), and metabolic syndrome, noted in society today. Thus finding optimal intervention strategies to combat these growing epidemics is imperative. Despite some controversy, a growing body of literature indicates that one aspect of diet that likely affects phenotypic outcomes and metabolic disease risk is the glycemic load (GL). This brief review will provide an overview of the GL concept, discuss epidemiologic work investigating relationships between both GL and metabolic risk factors, as well as intervention studies that have assessed the impact of GL on phenotypic outcomes related to T2DM and cardiovascular disease. Overall, a low dietary GL may be protective against metabolic disease and should be considered as a healthful dietary component.
Collapse
|
13366
|
Ng SP, Conklin DJ, Bhatnagar A, Bolanowski DD, Lyon J, Zelikoff JT. Prenatal exposure to cigarette smoke induces diet- and sex-dependent dyslipidemia and weight gain in adult murine offspring. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:1042-1048. [PMID: 19654910 PMCID: PMC2717127 DOI: 10.1289/ehp.0800193] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 03/20/2009] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) affects 71 million American adults and remains the leading cause of death in the United States and Europe. Despite studies that suggest that the development of CVD may be linked to intrauterine growth or early events in childhood, little direct experimental evidence supports the notion. OBJECTIVE We investigated whether exposure to cigarette smoke in utero alters the risk of developing CVD later in life. METHODS We exposed B(6)C(3)F(1) mice (via whole-body inhalation) to either filtered air or mainstream cigarette smoke (MCS, at a particle concentration of 15 mg/m(3)) from gestational day 4 to parturition. Adult offspring were fed a normal chow diet or switched to a high-fat diet 2 weeks before sacrifice. We measured dam and offspring body weight, plasma lipid parameters, lipoprotein subclass particle numbers and sizes, and total antioxidant capacities. RESULTS Adult female mice prenatally exposed to MCS demonstrated significantly higher body weight and levels of plasma high-density lipoprotein (HDL) and low-density lipoprotein than did their air-exposed counterparts. When fed a high-fat diet for 2 weeks, males, but not females, exposed prenatally to MCS gained substantially more weight and exhibited dramatic alterations in total cholesterol and HDL levels compared with their air-exposed counterparts. CONCLUSIONS These data provide, for the first time, direct experimental evidence supporting the notion that prenatal exposure to cigarette smoke affects offspring weight gain and induces a lipid profile that could alter the offspring's risk of developing CVD later in life.
Collapse
|
13367
|
Fish, mercury, selenium and cardiovascular risk: current evidence and unanswered questions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:1894-916. [PMID: 19578467 PMCID: PMC2705224 DOI: 10.3390/ijerph6061894] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 06/04/2009] [Indexed: 12/13/2022]
Abstract
Controversy has arisen among the public and in the media regarding the health effects of fish intake in adults. Substantial evidence indicates that fish consumption reduces coronary heart disease mortality, the leading cause of death in developed and most developing nations. Conversely, concerns have grown regarding potential effects of exposure to mercury found in some fish. Seafood species are also rich in selenium, an essential trace element that may protect against both cardiovascular disease and toxic effects of mercury. Such protective effects would have direct implications for recommendations regarding optimal selenium intake and for assessing the potential impact of mercury exposure from fish intake in different populations. Because fish consumption appears to have important health benefits in adults, elucidating the relationships between fish intake, mercury and selenium exposure, and health risk is of considerable scientific and public health relevance. The evidence for health effects of fish consumption in adults is reviewed, focusing on the strength and consistency of evidence and relative magnitudes of effects of omega-3 fatty acids, mercury, and selenium. Given the preponderance of evidence, the focus is on cardiovascular effects, but other potential health effects, as well as potential effects of polychlorinated biphenyls and dioxins in fish, are also briefly reviewed. The relevant current unanswered questions and directions of further research are summarized.
Collapse
|
13368
|
Rudež G, Janssen NA, Kilinc E, Leebeek FW, Gerlofs-Nijland ME, Spronk HM, Cate HT, Cassee FR, de Maat MP. Effects of ambient air pollution on hemostasis and inflammation. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:995-1001. [PMID: 19590696 PMCID: PMC2702419 DOI: 10.1289/ehp.0800437] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/22/2009] [Indexed: 05/20/2023]
Abstract
BACKGROUND Air pollution has consistently been associated with increased morbidity and mortality due to respiratory and cardiovascular disease. Underlying biological mechanisms are not entirely clear, and hemostasis and inflammation are suggested to be involved. OBJECTIVES Our aim was to study the association of the variation in local concentrations of airborne particulate matter (PM) with aerodynamic diameter < 10 mum, carbon monoxide, nitrogen monoxide, nitrogen dioxide, and ozone with platelet aggregation, thrombin generation, fibrinogen, and C-reactive protein (CRP) levels in healthy individuals. METHODS From 40 healthy volunteers, we collected 13 consecutive blood samples within a 1-year period and measured light-transmittance platelet aggregometry, thrombin generation, fibrinogen, and CRP. We performed regression analysis using generalized additive models to study the association between the hemostatic and inflammatory variables, and local environmental concentrations of air pollutants for time lags within 24 hr before blood sampling or 24-96 hr before blood sampling. RESULTS In general, air pollutants were associated with platelet aggregation [average, +8% per interquartile range (IQR), p < 0.01] and thrombin generation (average, +1% per IQR, p < 0.05). Platelet aggregation was not affected by in vitro incubation of plasma with PM. We observed no relationship between any of the air pollutants and fibrinogen or CRP levels. CONCLUSIONS Air pollution increased platelet aggregation as well as coagulation activity but had no clear effect on systemic inflammation. These prothrombotic effects may partly explain the relationship between air pollution and the risk of ischemic cardiovascular disease.
Collapse
|
13369
|
Ganschow PS, Jacobs EA, Mackinnon J, Charney P. Update in women's health. J Gen Intern Med 2009; 24:765-70. [PMID: 19259751 PMCID: PMC2686759 DOI: 10.1007/s11606-009-0917-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 12/19/2008] [Accepted: 12/29/2008] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The aim of this clinical update is to summarize articles and guidelines published in the last year with the potential to change current clinical practice as it relates to women's health. METHODS We used two independent search strategies to identify articles relevant to women's health published between March 1, 2007 and February 29, 2008. First, we reviewed the Cochrane Database of Systematic Reviews and journal indices from the ACP Journal Club, Annals of Internal Medicine, Archives of Internal Medicine, British Medical Journal, Circulation, Diabetes, JAMA, JGIM, Journal of Women's Health, Lancet, NEJM, Obstetrics and Gynecology, and Women's Health Journal Watch. Second, we performed a MEDLINE search using the medical subject heading term "sex factors." The authors, who all have clinical and/or research experience in the area of women's health, reviewed all article titles, abstracts, and, when indicated, full publications. We excluded articles related to obstetrical aspects of women's health focusing on those relevant to general internists. We had two acceptance criteria, scientific rigor and potential to impact women's health. We also identified new and/or updated women's health guidelines released during the same time period. RESULTS We identified over 250 publications with potential relevance to women's health. Forty-six articles were selected for presentation as part of the Clinical Update, and nine were selected for a more detailed discussion in this paper. Evidence-based women's health guidelines are listed in Table 1. Table 1 Important Women's Health Guidelines in 2007-2008: New or Updated Topic Issuing organization Updated recommendations and comments Mammography screening in women 40-4917 ACP Individualized risk assessment and informed decision making should be used to guide decisions about mammography screening in this age group. To aid in the risk assessment, a discussion of the risk factors, which if present in a woman in her 40s increases her risk to above that of an average 50-year-old woman, is provided in the guidelines. In addition, available risk prediction models, such as the NIH Web site calculator (http://www.cancer.gov/bcrisktool/) can also be used to estimate quantitative breast cancer risk. This model was updated in 2008 with race-specific data for calculating risk in African-American women.18 The harms and benefits of mammography should be discussed and incorporated along with a woman's preferences and breast cancer risk profile into the decision on when to begin screening. If a woman decides to forgo mammography, the decision should be readdressed every 1 to 2 years. STD screening guidelines19 USPSTF and CDC Routine screening for this infection is now recommended for ALL sexually active women age 24 and under, based on the recent high prevalence estimates for chlamydia It is not recommended for women (pregnant or nonpregnant) age 25 and older, unless they are at increased risk for infection. STD treatment guidelines20 CDC Flouroquinolones are NO longer recommended for treatment of N. gonorrhea, due to increasing resistance (as high as 15% of isolates in 2006). For uncomplicated infections, treatment of gonorrhea should be initiated with ceftriaxone 125 mg IM or cefixime 400 mg PO and co-treatment for chlamydia infection (unless ruled out with testing). Recent estimates demonstrate that almost 50% of persons with gonorrhea have concomitant chlamydia infection21. STD = sexually transmitted disease, NIH = National Institutes of Health, ACP = American College of Physicians, USPSTF = United States Prevention Services Task Force, CDC = Centers for Disease Control.
Collapse
|
13370
|
Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag 2009; 5:427-48. [PMID: 19707253 PMCID: PMC2701485 DOI: 10.2147/tcrm.s3025] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Indexed: 12/13/2022] Open
Abstract
Increased longevity and population aging will increase the number of men with late onset hypogonadism. It is a common condition, but often underdiagnosed and undertreated. The indication of testosterone-replacement therapy (TRT) treatment requires the presence of low testosterone level, and symptoms and signs of hypogonadism. Although controversy remains regarding indications for testosterone supplementation in aging men due to lack of large-scale, long-term studies assessing the benefits and risks of testosterone-replacement therapy in men, reports indicate that TRT may produce a wide range of benefits for men with hypogonadism that include improvement in libido and sexual function, bone density, muscle mass, body composition, mood, erythropoiesis, cognition, quality of life and cardiovascular disease. Perhaps the most controversial area is the issue of risk, especially possible stimulation of prostate cancer by testosterone, even though no evidence to support this risk exists. Other possible risks include worsening symptoms of benign prostatic hypertrophy, liver toxicity, hyperviscosity, erythrocytosis, worsening untreated sleep apnea or severe heart failure. Despite this controversy, testosterone supplementation in the United States has increased substantially over the past several years. The physician should discuss with the patient the potential benefits and risks of TRT. The purpose of this review is to discuss what is known and not known regarding the benefits and risks of TRT.
Collapse
|
13371
|
Peng RD, Bell ML, Geyh AS, McDermott A, Zeger SL, Samet JM, Dominici F. Emergency admissions for cardiovascular and respiratory diseases and the chemical composition of fine particle air pollution. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:957-63. [PMID: 19590690 PMCID: PMC2702413 DOI: 10.1289/ehp.0800185] [Citation(s) in RCA: 324] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 02/10/2009] [Indexed: 05/17/2023]
Abstract
BACKGROUND Population-based studies have estimated health risks of short-term exposure to fine particles using mass of PM(2.5) (particulate matter <or= 2.5 microm in aerodynamic diameter) as the indicator. Evidence regarding the toxicity of the chemical components of the PM(2.5) mixture is limited. OBJECTIVE In this study we investigated the association between hospital admission for cardiovascular disease (CVD) and respiratory disease and the chemical components of PM(2.5) in the United States. METHODS We used a national database comprising daily data for 2000-2006 on emergency hospital admissions for cardiovascular and respiratory outcomes, ambient levels of major PM(2.5) chemical components [sulfate, nitrate, silicon, elemental carbon (EC), organic carbon matter (OCM), and sodium and ammonium ions], and weather. Using Bayesian hierarchical statistical models, we estimated the associations between daily levels of PM(2.5) components and risk of hospital admissions in 119 U.S. urban communities for 12 million Medicare enrollees (>or= 65 years of age). RESULTS In multiple-pollutant models that adjust for the levels of other pollutants, an interquartile range (IQR) increase in EC was associated with a 0.80% [95% posterior interval (PI), 0.34-1.27%] increase in risk of same-day cardiovascular admissions, and an IQR increase in OCM was associated with a 1.01% (95% PI, 0.04-1.98%) increase in risk of respiratory admissions on the same day. Other components were not associated with cardiovascular or respiratory hospital admissions in multiple-pollutant models. CONCLUSIONS Ambient levels of EC and OCM, which are generated primarily from vehicle emissions, diesel, and wood burning, were associated with the largest risks of emergency hospitalization across the major chemical constituents of PM(2.5).
Collapse
|
13372
|
Tsai EJ, Kass DA. Cyclic GMP signaling in cardiovascular pathophysiology and therapeutics. Pharmacol Ther 2009; 122:216-38. [PMID: 19306895 PMCID: PMC2709600 DOI: 10.1016/j.pharmthera.2009.02.009] [Citation(s) in RCA: 298] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 02/19/2009] [Indexed: 02/07/2023]
Abstract
Cyclic guanosine 3',5'-monophosphate (cGMP) mediates a wide spectrum of physiologic processes in multiple cell types within the cardiovascular system. Dysfunctional signaling at any step of the cascade - cGMP synthesis, effector activation, or catabolism - have been implicated in numerous cardiovascular diseases, ranging from hypertension to atherosclerosis to cardiac hypertrophy and heart failure. In this review, we outline each step of the cGMP signaling cascade and discuss its regulation and physiologic effects within the cardiovascular system. In addition, we illustrate how cGMP signaling becomes dysregulated in specific cardiovascular disease states. The ubiquitous role cGMP plays in cardiac physiology and pathophysiology presents great opportunities for pharmacologic modulation of the cGMP signal in the treatment of cardiovascular diseases. We detail the various therapeutic interventional strategies that have been developed or are in development, summarizing relevant preclinical and clinical studies.
Collapse
|
13373
|
Knoell DL, Johnston JS, Bao S, Kelley KA. A genotyping exercise for pharmacogenetics in pharmacy practice. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2009; 73:43. [PMID: 19564986 PMCID: PMC2703267 DOI: 10.5688/aj730343] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 08/13/2008] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To develop a genotype exercise to improve pharmacy students' comprehension of pharmacogenetic principles that apply to patient care. DESIGN Deoxyribonucleic acid (DNA) was collected during class from 10 student volunteers and subjected to genotype analysis. The results were presented to the class and discussed in the context of a patient genetic counseling session. Students completed a survey instrument regarding their attitudes toward this learning experience. ASSESSMENT Students indicated that the exercise engaged them with the course content and would positively influence their ability to apply pharmacogenetic principles to patient care. CONCLUSION An applied genotype exercise enhanced learning of pharmacogenetic principles. Based on these findings, conducting a genotype exercise in a large classroom setting is feasible in terms of time and expense, and meaningful in terms of student satisfaction.
Collapse
|
13374
|
Williams P, Wu J, Cohn S, Koletar S, McCutchan J, Murphy R, Currier J. Improvement in lipid profiles over 6 years of follow-up in adults with AIDS and immune reconstitution. HIV Med 2009; 10:290-301. [PMID: 19220493 PMCID: PMC2778216 DOI: 10.1111/j.1468-1293.2008.00685.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate long-term changes in lipids and to assess other coronary heart disease (CHD) risk factors in highly experienced AIDS patients with immune reconstitution, and to examine their association with antiretroviral therapy (ART). METHODS We evaluated 433 AIDS patients with prior severe immunosuppression and ART-based immune reconstitution, followed in a multicentre prospective observational study between 2000 and 2006. We estimated the prevalence at entry of hypercholesterolaemia and metabolic syndrome, and 10-year CHD risks. Trends in total cholesterol (TC), triglycerides (TG) and high-density lipoprotein (HDL) cholesterol were evaluated over time, and use of specific ART drugs at each study visit was assessed using mixed effect models, adjusting for CHD risk factors and use of lipid-lowering agents. RESULTS At entry to observational follow-up, 28% of the 433 subjects had hypercholesterolaemia and 15% had a predicted 10-year CHD risk above 20%. Average TC and fasting TG levels declined over the follow-up period (median=5.8 years), and these declines were associated with increased use of physician-prescribed lipid-lowering agents and changes in ART regimens. After adjustment for CHD risk factors, TC and TG levels were significantly higher for those on ritonavir-boosted protease inhibitors and those on nonnucleoside reverse transcriptase inhibitors (NNRTIs), particularly efavirenz, than for other patients. CONCLUSIONS Abnormalities in serum lipids were common at baseline but became less so over time, and this improvement was associated with increased use of lipid-lowering agents and selection of ART agents with less deleterious effects on lipids.
Collapse
|
13375
|
Campbell NRC, Leiter LA, Larochelle P, Tobe S, Chockalingam A, Ward R, Morris D, Tsuyuki R. Hypertension in diabetes: a call to action. Can J Cardiol 2009; 25:299-302. [PMID: 19417860 PMCID: PMC2707170 DOI: 10.1016/s0828-282x(09)70493-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 03/19/2009] [Indexed: 01/11/2023] Open
Abstract
The Canadian Hypertension Education Program, Blood Pressure Canada, Canadian Hypertension Society, Heart and Stroke Foundation of Canada, Canadian Diabetes Association, College of Family Physicians of Canada, Canadian Pharmacists Association and the Canadian Council of Cardiovascular Nurses call on Canadian health care professionals to redouble efforts to help patients achieve treatment targets (blood pressure less than 130 mmHg systolic and less than 80 mmHg diastolic) in people with diabetes. Treatment of high blood pressure in people with diabetes results in large reductions in death and disability within a short period of time and needs to be a therapeutic priority. Achieving blood pressure targets requires sustained lifestyle modification, and three or more drugs including a diuretic are often required. Antihypertensive treatment in people with diabetes is one of the few medical treatments estimated to reduce overall health costs. The cost of treatment is less than the cost of complications prevented. Blood pressure needs to be assessed at all visits and home blood pressure assessment is encouraged. Management strategies need to include assessment and management of cardiovascular risks including smoking, unhealthy eating, physical inactivity, abdominal obesity, dyslipidemia as well as dysglycemia. The risks and benefits of acetylsalicylic acid in primary prevention of cardiovascular disease are uncertain in people with hypertension and diabetes. Intensive individualized lifestyle modification is recommended to prevent and treat hypertension, dyslipidemia, dysglycemia and other vascular risks in people with diabetes.
Collapse
|
13376
|
Zhang ZM, Whitsel EA, Quibrera PM, Smith RL, Liao D, Anderson GL, Prineas RJ. Ambient fine particulate matter exposure and myocardial ischemia in the Environmental Epidemiology of Arrhythmogenesis in the Women's Health Initiative (EEAWHI) study. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:751-6. [PMID: 19479017 PMCID: PMC2685837 DOI: 10.1289/ehp.0800046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 01/23/2009] [Indexed: 05/02/2023]
Abstract
BACKGROUND Ambient particulate matter (PM) air pollution is associated with coronary heart disease, but the pathways underlying the association remain to be elucidated. METHODS We studied the association between PM and ischemia among 57,908 Women's Health Initiative clinical trial participants from 1999-2003. We used the Minnesota Code criteria to identify ST-segment and T-wave abnormalities, and estimated T amplitude (microvolt) from resting, standard 12-lead electrocardiogram (ECG). We used U.S. Environmental Protection Agency's monitor data to estimate concentrations of PM < 2.5 microm (PM(2.5)) at geocoded participant addresses over 6 days before the ECGs (lag0 through lag5). We excluded 2,379 women with ECG QRS duration > or = 120 msec. RESULTS Overall, 6% of the remaining 55,529 women (52-90 years of age; 83% non-Hispanic white) had ST abnormalities and 16% had T abnormalities. Lead-specific T amplitude was normally distributed (range of means from -14 to 349 microV). PM(2.5) (mean +/- SD) averaged over lag(0-2) was 14 +/- 7 microg/m(3). In logistic and linear regression models adjusted for demographic, clinical, temporal, and climatic factors, a 10-microg/m(3) increase in lag(0-2) PM(2.5) was associated with a 4% [95% confidence interval (CI), -3%, to 10%] increase in the odds of ST abnormality and a 5% (95% CI, 0% to 9%) increase in the odds of T abnormality. We observed corresponding decreases in T amplitude in all exam sites and leads except lead V1, reaching a minimum of -2 microV (95% CI, -5 to 0 microV) in lead V3. CONCLUSIONS Short-term PM(2.5) exposure is associated with ECG evidence of myocardial ischemia among postmenopausal women. The principal manifestations include subclinical but potentially arrhythmogenic ST-T abnormalities and decreases in T amplitude.
Collapse
|
13377
|
Zhang WL, Lopez-Garcia E, Li TY, Hu FB, van Dam RM. Coffee consumption and risk of cardiovascular events and all-cause mortality among women with type 2 diabetes. Diabetologia 2009; 52:810-7. [PMID: 19266179 PMCID: PMC2666099 DOI: 10.1007/s00125-009-1311-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 02/09/2009] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS Coffee has been linked to both beneficial and harmful health effects, but data on its relationship with cardiovascular disease and mortality in patients with type 2 diabetes are sparse. METHODS This was a prospective cohort study including 7,170 women with diagnosed type 2 diabetes but free of cardiovascular disease or cancer at baseline. Coffee consumption was assessed in 1980 and then every 2-4 years using validated questionnaires. A total of 658 incident cardiovascular events (434 coronary heart disease and 224 stroke) and 734 deaths from all causes were documented between 1980 and 2004. RESULTS After adjustment for age, smoking and other cardiovascular risk factors, the relative risks were 0.76 (95% CI 0.50-1.14) for cardiovascular diseases (p trend = 0.09) and 0.80 (95% CI 0.55-1.14) for all-cause mortality (p trend = 0.05) for the consumption of >or=4 cups/day of caffeinated coffee compared with non-drinkers. Similarly, multivariable RRs were 0.96 (95% CI 0.66-1.38) for cardiovascular diseases (p trend = 0.84) and 0.76 (95% CI 0.54-1.07) for all-cause mortality (p trend = 0.08) for the consumption of >or=2 cups/day of decaffeinated coffee compared with non-drinkers. Higher decaffeinated coffee consumption was associated with lower concentrations of HbA(1c) (6.2% for >or=2 cups/day versus 6.7% for <1 cup/month; p trend = 0.02). CONCLUSIONS These data provide evidence that habitual coffee consumption is not associated with increased risk of cardiovascular diseases or premature mortality among diabetic women.
Collapse
|
13378
|
Stanek KM, Gunstad J, Paul RH, Poppas A, Jefferson AL, Sweet LH, Hoth KF, Haley AP, Forman DE, Cohen RA. Longitudinal cognitive performance in older adults with cardiovascular disease: evidence for improvement in heart failure. J Cardiovasc Nurs 2009; 24:192-7. [PMID: 19390336 PMCID: PMC2700621 DOI: 10.1097/jcn.0b013e31819b54de] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and particularly heart failure (HF) have been associated with cognitive impairment in cross-sectional studies, but it is unclear how cognitive impairment progresses over time in older adults with these conditions. OBJECTIVE The aim of this study was to prospectively examine cognitive function in patients with HF versus other forms of CVD. METHOD Seventy-five older adults (aged 53-84 years) with CVD underwent Doppler echocardiogram to evaluate cardiac status and 2 administrations of the Dementia Rating Scale (DRS), a test of global cognitive functioning, 12 months apart. RESULTS Although DRS performance did not statistically differ between groups at either administration, a significant between-group difference in the rate of cognitive change emerged (lambda = 0.87; F = 10.50; P = .002; omega 2 = 0.11). Follow-up analyses revealed that patients with HF improved significantly on global DRS performance, whereas patients with other forms of CVD remained stable. More specifically, patients with HF showed improvement on subscales of attention, initiation/perseveration, and conceptualization. Exploratory analyses indicated that higher diastolic blood pressure at baseline was associated with improved DRS performance in patients with HF (r = 0.38; P = .02). CONCLUSIONS Patients with HF exhibited modest cognitive improvements during 12 months, particularly in attention and executive functioning. Higher diastolic blood pressure at baseline was associated with improvement. These results suggest that cognitive impairment in patients with HF may be modifiable and that improved blood pressure control may be an important contributor to improved function. Further prospective studies are needed to replicate results and determine underlying mechanisms.
Collapse
|
13379
|
Abstract
OBJECTIVE To examine whether depressive symptoms are differentially associated with visceral adipose tissue (VAT), which is more metabolically active and confers greater cardiovascular risk than subcutaneous fat (SAT). Prior research has shown an association between depression and central adiposity. Mechanisms underlying the association between depression and increased cardiovascular risk remain poorly understood. Central adiposity is one potential pathway. METHODS We investigated the cross-sectional association between depressive symptoms, assessed by the Center for Epidemiological Studies Depression Scale (CES-D), and VAT and SAT, assessed by computed tomography, in a sample of 409 middle-aged women (44.7% African-Americans, 55.3% Whites; mean age = 50.4 years) participating in the Chicago site of the Study of Women's Health Across the Nation (SWAN). RESULTS With adjustments for age, race, total percent fat, and sex hormone binding globulin (SHBG), each 1-point higher score on the CES-D was associated with 1.03-cm(2) greater VAT (p < .001). Women with a CES-D score of >or=16, indicative of clinically relevant depressive symptomatology, had 24.5% more VAT than women with lower CES-D scores (p < .001). Further adjustment for Framingham Risk Score and physical activity did not alter the findings, and associations did not vary by race. Associations were strongest in obese and overweight women. Depressive symptoms were unrelated to SAT. CONCLUSIONS Increased visceral fat may be one pathway by which depression contributes to excess risk for cardiovascular disease and diabetes. Further research is needed to examine whether depressive symptoms influence accumulation of VAT over time.
Collapse
|
13380
|
Frishman WH, Henderson LS, Lukas MA. Controlled-release carvedilol in the management of systemic hypertension and myocardial dysfunction. Vasc Health Risk Manag 2009; 4:1387-400. [PMID: 19337551 PMCID: PMC2663448 DOI: 10.2147/vhrm.s3148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cardiovascular disease is the leading cause of death worldwide. Within the treatment armamentarium, beta-blockers have demonstrated efficacy across the spectrum of cardiovascular disease--from modification of a risk factor (ie, hypertension) to treatment after an acute event (ie, myocardial infarction). Recently, the use of beta-blockers as a first-line therapy in hypertension has been called into question. Moreover, beta-blockers as a class are saddled with a misperception of having poor tolerability. However, vasodilatory beta-blockers such as carvedilol have a different hemodynamic action that provides the benefits of beta-blockade with the addition of vasodilation resulting from alpha 1-adrenergic receptor blockade. Vasodilation reduces total peripheral resistance, which may produce an overall positive effect on tolerability. Recently, a new, controlled-release carvedilol formulation has been developed that provides the clinical efficacy of carvedilol but is indicated for once-daily dosing. This review presents an overview of the clinical and pharmacologic carvedilol controlled-release data.
Collapse
|
13381
|
Barnett AH. Redefining the role of thiazolidinediones in the management of type 2 diabetes. Vasc Health Risk Manag 2009; 5:141-51. [PMID: 19436665 PMCID: PMC2672454 DOI: 10.2147/vhrm.s4664] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There is a need to evaluate oral glucose-lowering agents not only for their value in achieving glycemic control but also for their impact on cardiac risk factor modification. This article reviews the evidence base for the two thiazolinediones currently available, pioglitazone and rosiglitazone. These drugs exert their effects through actions affecting metabolic control, lipid profiles, and the vascular wall. They have been shown to be as efficacious in establishing glycemic control, in both monotherapy and combination therapy regimens, as more traditional oral agents, and may be able to sustain that control in the long term. Both thiazolidinediones have demonstrated favorable effects on markers of cardiovascular disease. Evidence from the large PROactive outcomes study suggests that pioglitazone may exert protective effects in patients with type 2 diabetes and macrovascular disease. Thiazolidinediones are generally well tolerated but they can cause weight gain, induce fluid retention, and may contribute to bone loss in postmenopausal women. The place of thiazolidinediones in the management of type 2 diabetes is well established. The potential for additional benefits in reducing macrovascular risk encourages further long-term study of these agents.
Collapse
|
13382
|
De Lorenzo F, Boffito M, Collot-Teixeira S, Gazzard B, McGregor JL, Shotliff K, Xiao H. Prevention of atherosclerosis in patients living with HIV. Vasc Health Risk Manag 2009; 5:287-300. [PMID: 19436663 PMCID: PMC2672452 DOI: 10.2147/vhrm.s5206] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED INVESTIGATIONAL PRODUCT: Rosuvastatin (Crestor; Astra Zeneca). ACTIVE INGREDIENTS Rosuvastatin (5 mg). STUDY TITLE Prevention of Atherosclerosis in Patients Living with HIV. PHASE OF STUDY Phase III. AIMS PRIMARY AIM: To assess whether rosuvastatin therapy could slow the progression of the carotid intima-media thickness (C-IMT; as measured by the change in the mean IMT of the near and far walls of the distal common carotid arteries) over 2 years in HIV-infected patients (HIV-IP). SECONDARY AIMS To assess whether rosuvastatin therapy could reduce highly sensitive C reactive protein (hs-CRP) inflammatory marker that is increased in HIV-IP.To assess the effect of rosuvastatin therapy on serum lipid levels (total cholesterol [TC], low-density lipoprotein [LDL] cholesterol, high-density lipoprotein [HDL] cholesterol and triglycerides [TG]) and apolipoproteins (APO A1, APO B and APO B/A1).To assess the safety of rosuvastatin in HIV-IP through the evaluation of clinical laboratory analyses (liver function tests and creatine kinase) and adverse events (AEs). STUDY DESIGN Two-year randomized, double-blind, placebo-controlled, parallel group study. PLANNED SAMPLE SIZE 320 HIV-IP. SUMMARY OF ELIGIBILITY CRITERIA HIV-IP who are aged between 30 and 60 years, with a CD4 count. greater than 200 cells/mm(3). Patients must be stable on combination antiretroviral therapy (cART) for at least 12 months and have a 10-year CVD risk of less than 20% (using the Framingham risk score). NUMBER OF STUDY CENTERS One. DURATION OF TREATMENT Two years (5 mg rosuvastatin or placebo once daily). DOSE AND ROUTE OF ADMINISTRATION Oral rosuvastatin (5 mg) once daily. The incidence of cardiovascular disease (CVD) in HIV-IP is at least three times higher than in the general population and further increases each year with combination anti-retroviral therapy (cART). The carotid atherosclerosis progression rate is 10 times higher in HIV-IP than in uninfected individuals. The aim of this study is to assess whether therapy with 5 mg rosuvastatin could: 1) Slow the progression in the mean IMT of the distal common carotid arteries over two years in HIV-IP.2) Change the concentration in the inflammatory marker--hs-CRP, which is increased in HIV-IP.3) Change the concentrations of TC, LDL cholesterol, HDL cholesterol, TG, apolipoproteins (APO) B, APO A1 and APO B/A1.4) Be administered safely in the study population. Pharmacological intervention with rosuvastatin will be evaluated in a double-blind, placebo-controlled, randomized clinical trial in HIV-IP treated with cART not matching the published selection criteria for lipid-lowering therapy. For the first time, this study will investigate anti-inflammatory and anti-atherogenic effects of a pharmacological lipid-lowering agent in HIV-IP that may lead to the reduction of CVD.
Collapse
|
13383
|
Shah SH, Hauser ER, Bain JR, Muehlbauer MJ, Haynes C, Stevens RD, Wenner BR, Dowdy ZE, Granger CB, Ginsburg GS, Newgard CB, Kraus WE. High heritability of metabolomic profiles in families burdened with premature cardiovascular disease. Mol Syst Biol 2009; 5:258. [PMID: 19357637 PMCID: PMC2683717 DOI: 10.1038/msb.2009.11] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 01/23/2009] [Indexed: 01/06/2023] Open
Abstract
Integration of genetic and metabolic profiling holds promise for providing insight into human disease. Coronary artery disease (CAD) is strongly heritable, but the heritability of metabolomic profiles has not been evaluated in humans. We performed quantitative mass spectrometry-based metabolic profiling in 117 individuals within eight multiplex families from the GENECARD study of premature CAD. Heritabilities were calculated using variance components. We found high heritabilities for amino acids (arginine, ornithine, alanine, proline, leucine/isoleucine, valine, glutamate/glutamine, phenylalanine and glycine; h(2)=0.33-0.80, P=0.005-1.9 x 10(-16)), free fatty acids (arachidonic, palmitic, linoleic; h(2)=0.48-0.59, P=0.002-0.00005) and acylcarnitines (h(2)=0.23-0.79, P=0.05-0.0000002). Principal components analysis was used to identify metabolite clusters. Reflecting individual metabolites, several components were heritable, including components comprised of ketones, beta-hydroxybutyrate and C2-acylcarnitine (h(2)=0.61); short- and medium-chain acylcarnitines (h(2)=0.39); amino acids (h(2)=0.44); long-chain acylcarnitines (h(2)=0.39) and branched-chain amino acids (h(2)=0.27). We report a novel finding of high heritabilities of metabolites in premature CAD, establishing a possible genetic basis for these profiles. These results have implications for understanding CAD pathophysiology and genetics.
Collapse
|
13384
|
Leal J, Gray AM, Clarke PM. Development of life-expectancy tables for people with type 2 diabetes. Eur Heart J 2009; 30:834-9. [PMID: 19109355 PMCID: PMC2663724 DOI: 10.1093/eurheartj/ehn567] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 11/24/2008] [Accepted: 11/27/2008] [Indexed: 01/28/2023] Open
Abstract
AIMS To develop tables that report the life expectancy associated with levels of major modifiable risk factors for patients with type 2 diabetes. METHODS AND RESULTS A set of tables reporting life-expectancy stratified by age-sex groups for combinations of modifiable risk was constructed based on predictions from the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model. This model is based on a system of parametric proportional hazards risk equations for estimating mortality and vascular complications of diabetes that have been estimated from 3642 patients from the UKPDS. The tables show substantial potential gains in life expectancy within every age group from modifying major risk factors. The estimated life expectancy of men at age of 55 years with type 2 diabetes, 5 years after diagnosis, varies between 13.2 years for a patient who smokes, has systolic blood pressure of 180 mmHg, a total:HDL cholesterol ratio of 8, and HbA(1c) of 10%, and 21.1 years for a non-smoker with SBP of 120 mmHg, total/HDL ratio of 4, and HbA(1c) of 6%. CONCLUSION Life expectancy tables provide a potentially useful tool of conveying prognostic information to people with type 2 diabetes and suggest substantial scope for increasing longevity by improving modifiable risk factors.
Collapse
|
13385
|
Bajpeyi S, Tanner CJ, Slentz CA, Duscha BD, McCartney JS, Hickner RC, Kraus WE, Houmard JA. Effect of exercise intensity and volume on persistence of insulin sensitivity during training cessation. J Appl Physiol (1985) 2009; 106:1079-85. [PMID: 19196913 PMCID: PMC2698641 DOI: 10.1152/japplphysiol.91262.2008] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 01/29/2009] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to determine whether exercise prescriptions differing in volume or intensity also differ in their ability to retain insulin sensitivity during an ensuing period of training cessation. Sedentary, overweight/obese subjects were assigned to one of three 8-mo exercise programs: 1) low volume/moderate intensity [equivalent of approximately 12 miles/wk, 1,200 kcal/wk at 40-55% peak O(2) consumption (Vo(2peak)), 200 min exercise/wk], 2) low volume/vigorous intensity ( approximately 12 miles/wk, 1,200 kcal/wk at 65-80% Vo(2peak), 125 min/wk), and 3) high volume/vigorous intensity ( approximately 20 miles/wk, 2,000 kcal/wk at 65-80% Vo(2peak), 200 min/wk). Insulin sensitivity (intravenous glucose tolerance test, S(I)) was measured when subjects were sedentary and at 16-24 h and 15 days after the final training bout. S(I) increased with training compared with the sedentary condition (P < or = 0.05) at 16-24 h with all of the exercise prescriptions. S(I) decreased to sedentary, pretraining values after 15 days of training cessation in the low-volume/vigorous-intensity group. In contrast, at 15 days S(I) was significantly elevated compared with sedentary (P < or = 0.05) in the prescriptions utilizing 200 min/wk (low volume/moderate intensity, high volume/vigorous intensity). In the high-volume/vigorous-intensity group, indexes of muscle mitochondrial density followed a pattern paralleling insulin action by being elevated at 15 days compared with pretraining; this trend was not evident in the low-volume/moderate-intensity group. These findings suggest that in overweight/obese subjects a relatively chronic persistence of enhanced insulin action may be obtained with endurance-oriented exercise training; this persistence, however, is dependent on the characteristics of the exercise training performed.
Collapse
|
13386
|
Gatto NM, Henderson VW, St. John JA, McCleary C, Detrano R, Hodis HN, Mack WJ. Subclinical atherosclerosis is weakly associated with lower cognitive function in healthy hyperhomocysteinemic adults without clinical cardiovascular disease. Int J Geriatr Psychiatry 2009; 24:390-9. [PMID: 18836986 PMCID: PMC2661006 DOI: 10.1002/gps.2134] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Atherosclerosis is the most common pathologic process underlying cardiovascular disease (CVD). It is not well known whether subclinical atherosclerosis is an independent risk factor for lower cognitive function among individuals without clinically evident CVD. METHODS We examined cross-sectional associations between subclinical atherosclerosis and cognitive function in a community-based sample of otherwise healthy adults with plasma homocysteine >or=8.5 micromol/L enrolled in the BVAIT study (n = 504, mean age 61 years). Carotid artery intima-media thickness (CIMT), coronary artery calcium (CAC) and abdominal aortic calcium (AAC) were used to measure subclinical atherosclerosis. Cognitive function was assessed with a battery of neuropsychological tests. A principal components analysis was used to extract five uncorrelated cognitive factors from scores on individual tests, and a measure of global cognition was derived. Multivariable linear regression was used to examine the association between subclinical atherosclerosis and cognitive function, adjusting for other correlates of cognition. RESULTS Increasing thickness of CIMT was associated with significantly lower scores on the verbal learning factor (beta = -0.07 per 0.1 mm increase CIMT [SE(beta) = 0.03], p = 0.01). CAC and AAC were not individually associated with any of the cognitive factors. CONCLUSIONS This study provides evidence that increasing CIMT is weakly associated with lower verbal learning abilities but not global cognition in a population of otherwise healthy middle-to-older aged adults with elevated plasma homocysteine levels but without clinically evident CVD. The association between CIMT and poor verbal learning may pertain particularly to men.
Collapse
|
13387
|
Rousset X, Vaisman B, Amar M, Sethi AA, Remaley AT. Lecithin: cholesterol acyltransferase--from biochemistry to role in cardiovascular disease. Curr Opin Endocrinol Diabetes Obes 2009; 16:163-71. [PMID: 19306528 PMCID: PMC2910390 DOI: 10.1097/med.0b013e328329233b] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW We discuss the latest findings on the biochemistry of lecithin : cholesterol acyltransferase (LCAT), the effect of LCAT on atherosclerosis, clinical features of LCAT deficiency, and the impact of LCAT on cardiovascular disease from human studies. RECENT FINDINGS Although there has been much recent progress in the biochemistry of LCAT and its effect on high-density lipoprotein metabolism, its role in the pathogenesis of atherosclerosis is still not fully understood. Studies from various animal models have revealed a complex interaction between LCAT and atherosclerosis that may be modified by diet and by other proteins that modify lipoproteins. Furthermore, the ability of LCAT to lower apoB appears to be the best way to predict its effect on atherosclerosis in animal models. Recent studies on patients with LCAT deficiency have shown a modest but significant increase in incidence of cardiovascular disease consistent with a beneficial effect of LCAT on atherosclerosis. The role of LCAT in the general population, however, has not revealed a consistent association with cardiovascular disease. SUMMARY Recent research findings from animal and human studies have revealed a potential beneficial role of LCAT in reducing atherosclerosis but additional studies are necessary to better establish the linkage between LCAT and cardiovascular disease.
Collapse
|
13388
|
Abstract
PURPOSE OF REVIEW To address the progress of the investigation on dysfunctional high-density lipoprotein (HDL). RECENT FINDINGS HDL is generally considered to be an independent protective factor against cardiovascular disease. However, emerging evidence indicates that HDL can be modified under certain circumstances and lose its protective effect or even become atherogenic. The underlying mechanisms responsible for generating the dysfunctional HDL and the chemical and structural changes of HDL remain largely unknown. Recent studies focus on the role of myeloperoxidase in generating oxidants as participants in rendering HDL dysfunctional in vivo. Myeloperoxidase modifies HDL in humans by oxidation of specific amino acid residues in apolipoprotein A-I, which impairs cholesterol efflux through ATP-binding cassette transporter A1 and contributes to atherogenesis. SUMMARY HDL may not always be atheroprotective and can be atherogenic paradoxically under certain conditions. The mechanisms responsible for generating the dysfunctional HDL remain largely unknown. Recent data suggest that myeloperoxidase-associated modification of HDL may be one of the mechanisms. Further studies are needed to investigate the in-vivo mechanisms of HDL modification and identify therapeutic approaches aiming at controlling HDL modification.
Collapse
|
13389
|
Cheung N, Rogers S, Mosley TH, Klein R, Couper D, Wong TY. Vital exhaustion and retinal microvascular changes in cardiovascular disease: atherosclerosis risk in communities study. Psychosom Med 2009; 71:308-12. [PMID: 19073748 PMCID: PMC2987558 DOI: 10.1097/psy.0b013e318190f009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine if vital exhaustion, a measure of negative emotion, is associated with microvascular changes in the retina. Negative psychological factors, such as depression, have been implicated in the development of cardiovascular disease. Whether this link is mediated by macrovascular or microvascular disease is unknown. METHODS We performed a population-based, cross-sectional study of 10,364 White and African Americans aged 48 to 73 years. Vital exhaustion scores were determined from the Maastricht questionnaire and categorized into quartiles. Retinopathy signs and retinal vascular caliber were graded from retinal photographs following standardized protocols. RESULTS After adjusting for age, gender, race, study center, education, smoking, blood pressure, diabetes, and other risk factors, higher vital exhaustion scores (highest versus lowest quartiles) were associated modestly with the presence of retinopathy (odds ratio [OR] = 1.27; 95% Confidence Interval [CI] = 1.01-1.59), particularly retinal hemorrhages (OR = 1.71; 95% CI = 1.20-2.44), and with generalized retinal venular widening (OR = 1.19; 95% CI = 1.03-1.38). Analyzing vital exhaustion as a continuous variable did not change the pattern of the associations. CONCLUSIONS Middle-aged people with vital exhaustion may be more likely to have retinopathy signs that have been identified as risk predictors of cardiovascular events. Further research is needed to explore the possible adverse effects of negative emotion on the microcirculation.
Collapse
|
13390
|
Szeto CC, Li PKT. The use of vitamin D analogues in chronic kidney diseases: possible mechanisms beyond bone and mineral metabolism. NDT Plus 2009; 2:205-12. [PMID: 25983993 PMCID: PMC4421197 DOI: 10.1093/ndtplus/sfp034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 03/03/2009] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease (CKD) is a common and costly medical condition, and currently available therapeutic options remain unsatisfactory. Vitamin D analogues are widely used for the bone and mineral disorder associated with CKD. However, accumulating evidence suggests that vitamin D analogues may have actions other than their effects on bone and mineral metabolism. In this article, we review the following aspects on the use of vitamin D analogues for the treatment of CKD: (1) epidemiological studies showing that patients with late-stage CKD have better survival than untreated patients; (2) animal studies showing that vitamin D analogues may retard the progression of CKD; (3) human studies on the anti-proteinuric and possibly renal protecting effects of vitamin D analogues in CKD and (4) the potential mechanisms of its therapeutic benefit. Nonetheless, definitive proof of the clinical benefits by randomized control trial would be necessary before one could advocate the routine use of vitamin D analogues for the treatment of CKD patients.
Collapse
|
13391
|
Hruska KA, Mathew S, Lund RJ, Memon I, Saab G. The pathogenesis of vascular calcification in the chronic kidney disease mineral bone disorder: the links between bone and the vasculature. Semin Nephrol 2009; 29:156-65. [PMID: 19371806 PMCID: PMC2758096 DOI: 10.1016/j.semnephrol.2009.01.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Considerable scientific progress in the pathogenesis of vascular calcification that has accrued in recent years is reviewed in this article. Factors regulating mesenchymal cell differentiation and their role in the neointimal calcification of atherosclerosis and the vascular media calcification observed in chronic kidney disease and diabetes are discussed, as is the role of bone regulatory proteins in bone mineralization and vascular calcification. This includes recent studies related to fetuin-A, and the discovery of a new circulating hormone involved in regulating phosphate homeostasis and sensing skeletal hydroxyapatite precipitation. Finally, the relationship between skeletal mineralization and vascular mineralization is discussed in terms of their links, especially through serum phosphate concentrations.
Collapse
|
13392
|
Frisard MI, Rood JC, Fang X, Su J, Welsh DA, Jazwinski SM, Ravussin E. Metabolic syndrome and risk factors for cardiovascular disease: are nonagenarians protected? AGE (DORDRECHT, NETHERLANDS) 2009; 31:67-75. [PMID: 19234770 PMCID: PMC2645995 DOI: 10.1007/s11357-008-9082-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 12/09/2008] [Indexed: 05/27/2023]
Abstract
This study assessed cardiovascular disease risk factors in three groups of human subjects aged 20-34 [young, 20 male (M)/33 female (F)], 60-74 (aged, 29M/29F), and > 90 years (nonagenarian, 47M/50F). Components of the metabolic syndrome, cardiovascular disease, and markers of inflammation and oxidative stress were assessed. Nonagenarians weighed less than the two other groups (P < 0.001); however, there was no difference in percent fat among the three groups. Aged individuals had the highest prevalence of the metabolic syndrome (P < 0.001) according to the Adult Treatment Panel III classification. Both fibrinogen and homocysteine concentrations were significantly higher in the nonagenarians compared to younger groups. However, there were no significant differences between groups in fasting insulin, high sensitive C-reactive protein, and plasminogen activator inhibitor 1 concentrations. There were also no relationships between inflammation/ oxidative stress and the metabolic syndrome or cardiovascular disease although nonagenarians appear to be protected from oxidative damage to DNA.
Collapse
|
13393
|
Schulz R, Beach SR, Hebert RS, Martire LM, Monin JK, Tompkins CA, Albert SM. Spousal suffering and partner's depression and cardiovascular disease: the Cardiovascular Health Study. Am J Geriatr Psychiatry 2009; 17:246-54. [PMID: 19454851 PMCID: PMC2697395 DOI: 10.1097/jgp.0b013e318198775b] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the effects of suffering in a spouse on prevalent and incident psychiatric (depression) and physical morbidity (cardiovascular disease [CVD]) in their partner, controlling for known risk factors for depression and CVD. DESIGN Descriptive longitudinal study. PARTICIPANTS A total of 1,330 older married couples enrolled in the Cardiovascular Health Study, a large epidemiologic study of the elderly. MEASUREMENTS Predictor variables were physical, psychological, and existential/spiritual indicators of suffering. Primary outcomes were prevalent and incident depression and CVD. RESULTS Controlling for known risk factors for depression, the authors found a dose-response relationship between suffering in a spouse and concurrent depression in their partner as well as a relationship between suffering and the partner's future risk for depression. With respect to CVD, and controlling for subclinical CVD at baseline, husbands whose wives reported high levels of suffering also had higher rates of prevalent CVD, but there were no significant associations between wives suffering and husbands incident CVD. There were no associations between husbands' suffering and wives' prevalent or incident CVD. CONCLUSION Exposure to spousal suffering is an independent and unique source of distress in married couples that contributes to psychiatric and physical morbidity. More attention should be paid to the interpersonal effects of suffering in married couples and to its role in contributing to morbidity.
Collapse
|
13394
|
Joshi R, Galan BD, Chalmers J, Perkovic V, Patel A. Routine blood pressure lowering and intensive glucose control in patients with Type 2 diabetes: the ADVANCE trial. Expert Rev Endocrinol Metab 2009; 4:111-118. [PMID: 30780861 DOI: 10.1586/17446651.4.2.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial investigated the effects of routine blood pressure lowering and intensive blood glucose control on major vascular events in people with Type 2 diabetes. In this factorial randomized study, 11,140 individuals with Type 2 diabetes were randomly assigned to a fixed combination of perindopril and indapamide or matching placebo, and to intensive glucose control with the use of modified-release gliclazide plus other drugs required to achieve a hemoglobin A1c of 6.5% of less, or standard guideline-based glucose control. The primary outcomes were composites of major macrovascular and major microvascular events (major vascular events), analyzed jointly and separately. Active treatment in the blood pressure-lowering arm reduced blood pressure by 5.6/2.2 mmHg compared with placebo, and the relative risks of major vascular events, all deaths and cardiovascular deaths by 9% (p = 0.043), 14% (p = 0.025) and 18% (p = 0.027), respectively. These effects appeared independent of the initial blood pressure level or the use of concomitant treatments. Intensive glucose control lowered glycated hemoglobin levels to a mean of 6.5% and reduced the relative risk of major vascular events by 10% (p = 0.01), primarily through a 21% (p = 0.006) reduction in nephropathy. Intensive glucose control was not associated with a significant reduction in macrovascular events; however, unlike reports from the recently reported Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, there was no evidence of any increase in all-cause mortality or cardiovascular death with more intensive glucose control. This trial has provided important new evidence with direct implications for clinical management of blood pressure and blood glucose in patients with Type 2 diabetes.
Collapse
|
13395
|
Abstract
BACKGROUND/AIMS Despite the clinical importance and widespread use of pulse wave velocity (PWV), there are no standards for pulse sensors or for system requirements to ensure accurate pulse wave measurement. We assessed the reproducibility of PWV values using a newly developed PWV measurement system. METHODS The system used in this study was the PP-1000, which simultaneously provides regional PWV values from arteries at four different sites (carotid, femoral, radial, and dorsalis pedis). Seventeen healthy male subjects without any cardiovascular disease participated in this study. Two observers performed two consecutive measurements in the same subject in random order. To evaluate the reproducibility of the system, two sets of analyses (within-observer and between-observer) were performed. RESULTS The means+/-SD of PWV for the aorta, arm, and leg were 7.0+/-1.48, 8.43+/-1.14, and 8.09+/-0.98 m/s as measured by observer A and 6.76+/-1.00, 7.97+/-0.80, and 7.97+/-0.72 m/s by observer B, respectively. Betweenobserver differences for the aorta, arm, and leg were 0.14+/-0.62, 0.18+/-0.84, and 0.07+/-0.86 m/s, respectively, and the correlation coefficients were high, especially for aortic PWV (r=0.93). All the measurements showed significant correlation coefficients, ranging from 0.94 to 0.99. CONCLUSIONS The PWV measurement system used in this study provides accurate analysis results with high reproducibility. It is necessary to provide an accurate algorithm for the detection of additional features such as flow wave, reflection wave, and dicrotic notch from a pulse waveform.
Collapse
|
13396
|
Li S, Arning E, Liu C, Vitvitsky V, Hernandez C, Banerjee R, Bottiglieri T, Lin JD. Regulation of homocysteine homeostasis through the transcriptional coactivator PGC-1alpha. Am J Physiol Endocrinol Metab 2009; 296:E543-8. [PMID: 19158324 PMCID: PMC2660144 DOI: 10.1152/ajpendo.90719.2008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Plasma homocysteine (Hcy) is an independent risk factor for cardiovascular disease. Hcy is a nonprotein amino acid derivative that is generated from the methionine cycle, which provides the methyl group for essentially all biological methylation reactions. Although plasma Hcy levels are elevated in patients with cardiovascular disease, the mechanisms that regulate Hcy homeostasis remain poorly defined. In this study, we found that the expression of key enzymes involved in Hcy metabolism is induced in the liver in response to fasting. This induction coincides with increased expression of peroxisome proliferator-activated receptor-gamma coactivator (PGC)-1alpha, a transcriptional coactivator that regulates hepatic gluconeogenesis and mitochondrial function. PGC-1alpha stimulates the expression of genes involved in Hcy metabolism in cultured primary hepatocytes as well as in the liver. Adenoviral-mediated expression of PGC-1alpha in vivo leads to elevated plasma Hcy levels. In contrast, mice deficient in PGC-1alpha have lower plasma Hcy concentrations. These results define a novel role for the PGC-1alpha coactivator pathway in the regulation of Hcy homeostasis and suggest a potential pathogenic mechanism that contributes to hyperhomocysteinemia.
Collapse
|
13397
|
Schwartz A, Blum S, Asleh R, Pollak M, Kalet-Litman S, Levy AP. Pharmacogenomic application of the haptoglobin genotype in the treatment of HDL dysfunction. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2009; 2:1-8. [PMID: 23226030 PMCID: PMC3513196 DOI: 10.2147/pgpm.s4608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An emerging paradigm of research has suggested that in the setting of diabetes mellitus (DM) the quality or function of high-density lipoprotein (HDL) may be a determinant of cardiovascular disease risk. Specific structural modifications of HDL protein and lipid components, resulting from oxidative modification, have been proposed to mediate HDL’s loss of the ability to promote cholesterol efflux (reverse cholesterol transport), serve as an antioxidant and anti-inflammatory agent. Therefore, inhibiting HDL oxidative modification would be expected to improve its function and provide cardioprotection. Nevertheless, antioxidant strategies to reduce cardiovascular events from atherosclerosis in DM have failed. It has been proposed that this failure may have been due to the inadequate nature of patient selection. High dose antioxidant therapy may only provide benefit to a subset of DM individuals with oxidatively modified HDL. We will review evidence that haptoglobin (Hp) identifies such individuals who can be successfully treated with vitamin E. These data will suggest that a pharmacogenomic approach utilizing the Hp genotype may be useful in identifying individuals who will benefit from antioxidant therapy.
Collapse
|
13398
|
Pepine CJ, Faich G, Makuch R. Verapamil use in patients with cardiovascular disease: an overview of randomized trials. Clin Cardiol 2009; 21:633-41. [PMID: 9755379 PMCID: PMC6655547 DOI: 10.1002/clc.4960210906] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Several reports have questioned the lack of safety data on calcium antagonists as a drug class. Because this drug class is heterogeneous, unique features of certain calcium antagonists may set them apart in terms of safety and efficacy. HYPOTHESIS With in excess of 7,000 person-years of observation from randomized clinical trials, verapamil was selected to evaluate whether there was evidence of harm in patients with cardiovascular disease. METHODS MEDLINE search of English-language articles, Science Citation Index, Current Contents, manual review of cited references, pharmaceutical files, and investigator correspondence was performed. Independent review of 66 articles identified 14 randomized, parallel-group studies for inclusion. Independent, duplicate assessments were made of patient outcomes and trial characteristics (including study design, treatment dosage and schedule, duration of treatment, inclusion criteria, and sample size). Standard meta-analytic techniques were employed for analysis and interpretation of results. RESULTS Based on over 4,000 person-years of observation, patients with acute myocardial infarction (MI) treated with verapamil had a decreased risk of nonfatal reinfarction compared with placebo (relative risk 0.79; 2-sided 95% confidence interval 0.65.0.97; p = 0.024). Verapamil had no significant effect on overall mortality compared with placebo (relative risk ranged from 0.93; 2-sided 95% confidence interval 0.78, 1.10; p = 0.40 to 0.86; 2-sided 95% confidence interval 0.71, 1.04; p = 0.13) depending on rules used to include or exclude patients from the pooling process. For the combined outcome of death or reinfarction, verapamil use was associated with a decreased risk compared with placebo (relative risk 0.82; 2-sided 95% confidence interval 0.70, 0.97; p = 0.016). In patients with angina involving a wide spectrum of disease severity, data were limited to 2,900 person-years of observation, and verapamil use did not appear to be associated with an apparent effect on mortality or MI. Data available from randomized studies of verapamil in patients with hypertension were too limited to reach conclusions (50 person-years of observation, with no deaths or MIs reported). Subgroups of hypertensive patients in two of the largest post-MI studies and the largest angina study, involving over 600 patients, yielded little useful added information. CONCLUSIONS In patients with MI, the risks of both nonfatal reinfarction and the combined outcome of death or nonfatal MI were reduced over intermediate-term follow-up among patients treated with verapamil compared with controls (p = 0.024 and p = 0.016, respectively). In patients with angina, no evidence for harm was noted, but in hypertension the data were too limited to draw conclusions. These findings support the need to distinguish among different calcium antagonist compounds and to emphasize the need for more data in patients with hypertension.
Collapse
|
13399
|
Abstract
Despite a totality of evidence indicating clear benefits of statin therapy in secondary and primary prevention of cardiovascular disease (CVD), a large number of additional trials are currently planned or in progress to help us better understand, treat, and prevent CVD. Both monotherapy and combination statin regimens are being studied to optimize treatment of the total patient and to assess mechanisms and benefits of various components of the total lipid profile.
Collapse
|
13400
|
Menke A, Muntner P, Silbergeld EK, Platz EA, Guallar E. Cadmium levels in urine and mortality among U.S. adults. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:190-6. [PMID: 19270787 PMCID: PMC2649219 DOI: 10.1289/ehp.11236] [Citation(s) in RCA: 186] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 09/03/2008] [Indexed: 05/04/2023]
Abstract
BACKGROUND Cadmium exposure has been associated with increased all-cause, cancer, and cardiovascular disease mortality. However, studies investigating this association have included participants with considerably higher levels of cadmium than those found in the general population. OBJECTIVE We aimed to evaluate the association of creatinine-corrected urinary cadmium levels with all-cause and cause-specific mortality in the U.S. general population. METHODS We analyzed the relationship between cadmium measured in 13,958 adults who participated in the Third National Health and Nutrition Examination Survey in 1988-1994 and were followed through 31 December 2000, and all-cause, cancer, cardiovascular disease, and coronary heart disease mortality. RESULTS The geometric mean levels of urinary cadmium per gram of urinary creatinine in study participants were 0.28 and 0.40 microg/g for men and women, respectively (p < 0.001). After multivariable adjustment, including smoking, a major source of cadmium exposure in nonoccupationally exposed populations, the hazard ratios [95% confidence interval (CI)] for all-cause, cancer, cardiovascular disease, and coronary heart disease mortality associated with a 2-fold higher creatinine-corrected urinary cadmium were, respectively, 1.28 (95% CI, 1.15-1.43), 1.55 (95% CI, 1.21-1.98), 1.21 (95% CI, 1.07-1.36), and 1.36 (95% CI, 1.11-1.66) for men and 1.06 (95% CI, 0.96-1.16), 1.07 (95% CI, 0.85-1.35), 0.93 (95% CI, 0.84-1.04), and 0.82 (95% CI, 0.76-0.89) for women. CONCLUSIONS Environmental cadmium exposure was associated with an increased risk of all-cause, cancer, and cardiovascular disease mortality among men, but not among women. Additional efforts are warranted to fully explain gender differences on the impact of environmental cadmium exposure.
Collapse
|