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Mundisugih J, Kumar S, Kizana E. Adeno-associated virus-mediated gene therapy for cardiac tachyarrhythmia: A systematic review and meta-analysis. Heart Rhythm 2024; 21:939-949. [PMID: 38336191 DOI: 10.1016/j.hrthm.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Cardiac tachyarrhythmia presents a significant health care challenge, causing notable morbidity and mortality. Conventional treatments have limitations and potential risks, resulting in an elevated disease burden. Adeno-associated virus (AAV)-mediated gene therapy holds promise as a potential future treatment option. Therefore, we aimed to provide a measured overview of the latest developments in this rapidly growing field. PubMed and Embase databases were searched up to January 2024. Studies that employed AAV as a vector for delivery of therapeutic agents to treat cardiac tachyarrhythmia were included. Of the 26 studies included, 20 published in the last 5 years. There were 22 novel molecular targets identified. More than 80% of the included studies employed small-animal models or used AAV9. In atrial fibrillation preclinical studies, AAV-mediated gene therapy reduced atrial fibrillation inducibility by 81% (odds ratio, 0.19 [0.08-0.45]; P < .01). Similarly, for acquired and inherited ventricular arrhythmia, animal models receiving gene therapy had less inducible ventricular arrhythmia (odds ratio, 0.06 [0.03-0.11]; P < .01). This review highlights the rapid progress of AAV-mediated gene therapy for cardiac tachyarrhythmia. Although these investigations are currently in the early stages of clinical application, they present promising prospects for gene therapy. (PROSPERO registry: CRD42023479448).
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Affiliation(s)
- Juan Mundisugih
- Centre for Heart Research, Westmead Institute for Medical Research, New South Wales, Australia; Department of Cardiology, Westmead Hospital, New South Wales, Australia; Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, New South Wales, Australia; Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Eddy Kizana
- Centre for Heart Research, Westmead Institute for Medical Research, New South Wales, Australia; Department of Cardiology, Westmead Hospital, New South Wales, Australia; Sydney Medical School, The University of Sydney, New South Wales, Australia.
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2
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Huang W, Xu S, Zhou H, Ji W, Chen Y. Global association of incidence between atrial fibrillation and the major gastrointestinal cancers: An analysis based on the 2019 Global burden of disease study. Heliyon 2024; 10:e29929. [PMID: 38699016 PMCID: PMC11064153 DOI: 10.1016/j.heliyon.2024.e29929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
Atrial Fibrillation (AF) and gastrointestinal (GI) cancers are age-related diseases with shared environmental risk factors and underlying biological mechanisms. This study aimed to assess the association between AF and GI cancers on a global scale, analyzing incidence data from 204 countries. This ecological study utilized data from the Global Burden of Disease. Spearman's correlation and logistic regression analyses were employed to assess the association between AF and specific GI cancers, including esophagus cancer (EC), colon and rectum cancer (CRC), liver cancer (LC), pancreatic cancer (PC), and stomach cancer (SC). AF, CRC and PC exhibited increasing crude incidence rates from 2000 to 2019, whereas EC and SC demonstrated decreasing trends specifically in females. From 2000 to 2010, there was a noticeable fall in the incidence rate of LC, which was followed by a minor growth through 2019. The age-standardized incidence rate (ASIR) of AF was positively correlated with CRC and PC, but a negative relationship with AF was revealed for EC. Unexpectedly, no significant relationship was discovered for SC and LC associated with AF. Logistic regression analysis revealed a positive correlation between a country's ASIR of AF and its ASIR of CRC, LC and PC. Conversely, these countries demonstrated a decreased ASIR for EC. Our findings showed a significant correlation between national incidence rates of AF with CRC and PC, worldwide. Countries with higher ASIR of AF had higher ASIR of CRC and PC. Additional research is necessary to confirm the association between GI cancers and AF at the individual level.
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Affiliation(s)
- Weipeng Huang
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Shangbo Xu
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Haoyue Zhou
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Weibiao Ji
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
| | - Yangbo Chen
- Department of Cardiology, Jieyang People's Hospital, 522000, Jieyang, Guangdong, China
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3
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Danpanichkul P, Wattanachayakul P, Duangsonk K, Ongsupankul S, Sripusanapan A, Uawithya E, Benjanuwattra J, Trongtorsak A, Nathisuwan S, Navaravong L. The burden of alcohol-related cardiovascular complications in young and middle-aged adults: rising burden of atrial fibrillation and hypertensive heart disease. Acta Cardiol 2024:1-8. [PMID: 38699921 DOI: 10.1080/00015385.2024.2346872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND AIMS The burden of alcohol-related complications is high and rising. However, there are notable deficiencies in comprehensive epidemiological study focusing on cardiovascular complications from alcohol, especially among young and middle-aged adults. We thus aimed to determine the burden of these conditions in young and middle-aged adults globally. METHODS AND RESULTS We used data from the Global Burden of Disease Study 2019 and analysed the mortality and disability-adjusted life years of alcohol-associated cardiovascular complications in young and middle-aged adults. The findings were classified by sex, region, country, and Sociodemographic Index (SDI). The highest age-standardized death rates (ASDR) were observed in stroke 0.84 (95% UI 0.60-1.09), followed by alcoholic cardiomyopathy 0.57 (95% UI 0.47-0.66) per 100,000 population. The overall burden of alcohol-associated cardiovascular complications decreased globally but increased in atrial fibrillation and hypertensive heart disease. Regionally, most regions underwent a decrease in ASDR, but an increase was observed in Southeast Asia (+2.82%), Western Pacific (+1.48%), low-middle (+1.81%), and middle SDI (+0.75%) countries. Nevertheless, the ASDR and ASDALYs were highest in Europe. CONCLUSIONS The impact of alcohol-associated atrial fibrillation and hypertensive heart disease has increased over the last decades. Regarding region, the burden in Europe and the rising burden in Asia, require immediate public health policy to lessen these cardiovascular complications from alcohol in young and middle-aged adults.
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Affiliation(s)
- Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | | | - Kwanjit Duangsonk
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sorawit Ongsupankul
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | | | - Ekdanai Uawithya
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Juthipong Benjanuwattra
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Surakit Nathisuwan
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Leenhapong Navaravong
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Intermountain Heart Institute - Utah Valley Hospital, Provo, Utah, USA
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4
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Kistler PM, Sanders P, Amarena JV, Bain CR, Chia KM, Choo WK, Eslick AT, Hall T, Hopper IK, Kotschet E, Lim HS, Ling LH, Mahajan R, Marasco SF, McGuire MA, McLellan AJ, Pathak RK, Phillips KP, Prabhu S, Stiles MK, Su RW, Thomas SP, Toy T, Watts TW, Weerasooriya R, Wilsmore BR, Wilson L, Kalman JM. 2023 Cardiac Society of Australia and New Zealand Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation. Heart Lung Circ 2024:S1443-9506(24)00170-7. [PMID: 38702234 DOI: 10.1016/j.hlc.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 05/06/2024]
Abstract
Catheter ablation for atrial fibrillation (AF) has increased exponentially in many developed countries, including Australia and New Zealand. This Expert Position Statement on Catheter and Surgical Ablation for Atrial Fibrillation from the Cardiac Society of Australia and New Zealand (CSANZ) recognises healthcare factors, expertise and expenditure relevant to the Australian and New Zealand healthcare environments including considerations of potential implications for First Nations Peoples. The statement is cognisant of international advice but tailored to local conditions and populations, and is intended to be used by electrophysiologists, cardiologists and general physicians across all disciplines caring for patients with AF. They are also intended to provide guidance to healthcare facilities seeking to establish or maintain catheter ablation for AF.
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Affiliation(s)
- Peter M Kistler
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia.
| | - Prash Sanders
- University of Adelaide, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Chris R Bain
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Karin M Chia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Wai-Kah Choo
- Gold Coast University Hospital, Gold Coast, Qld, Australia; Royal Darwin Hospital, Darwin, NT, Australia
| | - Adam T Eslick
- University of Sydney, Sydney, NSW, Australia; The Canberra Hospital, Canberra, ACT, Australia
| | | | - Ingrid K Hopper
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Emily Kotschet
- Victorian Heart Hospital, Monash Health, Melbourne, Vic, Australia
| | - Han S Lim
- University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia; Northern Health, Melbourne, Vic, Australia
| | - Liang-Han Ling
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Rajiv Mahajan
- University of Adelaide, Adelaide, SA, Australia; Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Silvana F Marasco
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | | | - Alex J McLellan
- University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia; St Vincent's Hospital, Melbourne, Vic, Australia
| | - Rajeev K Pathak
- Australian National University and Canberra Heart Rhythm, Canberra, ACT, Australia
| | - Karen P Phillips
- Brisbane AF Clinic, Greenslopes Private Hospital, Brisbane, Qld, Australia
| | - Sandeep Prabhu
- The Alfred Hospital, Melbourne, Vic, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Martin K Stiles
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Raymond W Su
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Stuart P Thomas
- University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Sydney, NSW, Australia
| | - Tracey Toy
- The Alfred Hospital, Melbourne, Vic, Australia
| | - Troy W Watts
- Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Rukshen Weerasooriya
- Hollywood Private Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia
| | | | | | - Jonathan M Kalman
- University of Melbourne, Melbourne, Vic, Australia; Royal Melbourne Hospital, Melbourne, Vic, Australia
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5
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Vlachakis PK, Tsiachris D, Doundoulakis I, Tsioufis P, Kordalis A, Botis M, Leontsinis I, Antoniou CK, Papachrysostomou C, Dimitroula V, Maneta E, Chalkitis V, Kotsakis T, Skantzikas P, Kafkas N, Sidiropoulos G, Roussos D, Trikas A, Koudounis G, Kolettis TM, Smyrnioudis N, Christakos D, Chasikidis C, Gatzoulis KA, Tsioufis K. Therapeutic inertia in rhythm control strategies in hospitalized patients with fibrillation: Insights from Hellenic Cardiorenal Morbidity Snapshot (HECMOS) study. J Cardiol 2024; 83:313-317. [PMID: 37979719 DOI: 10.1016/j.jjcc.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Current guidelines recommend a rhythm control strategy in patients with symptomatic atrial fibrillation (AF) while catheter ablation has been shown to be a safer and more efficacious approach than antiarrhythmic medications. METHODS HECMOS was a nationwide snapshot survey of cardiorenal morbidity in hospitalized cardiology patients. In this sub-study, we included 276 cases who had a history of AF, particularly on the rhythm strategy, and catheter ablation procedures had been performed before the index admission. RESULTS Among 276 AF patients (mean age: 76.4 ± 11.5 years, 58 % male), 60.9 % (N = 168) had persistent AF and 39.1 % (N = 108) had paroxysmal AF. Heart failure was the main cause of admission in 54.3 % (N = 145) of the patients, while 14.1 % (N = 39) were admitted due to paroxysmal AF, 7.3 % (N = 20) due to bradyarrhythmic reasons, and 6.5 % (N = 18) suffered from acute coronary syndrome. Most importantly, heart failure with reduced ejection fraction was present in 76 (27 %) patients. Only 10 patients out of the total (3 %, mean age 59.7 years) had undergone AF ablation while electrical cardioversion had been attempted in 37 (13.4 %) patients. Interestingly, in this AF population with heart failure, 3.6 % (N = 10) had a defibrillator implanted (4 single-chamber), and only 1.5 % (N = 4) had a cardiac resynchronization therapy defibrillator (CRT-D). CONCLUSION High prevalence of persistent AF was detected in hospitalized patients, with heart failure being the leading cause of admission and main co-morbidity. Rhythm control strategies are notably underused, along with CRT-D implantation in patients with AF and heart failure.
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Affiliation(s)
- Panayotis K Vlachakis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Dimitris Tsiachris
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece.
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Michail Botis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece
| | | | - Vasiliki Dimitroula
- Department of Cardiology, G. Hatzikosta General Hospital of Ioannina, Ioannina, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Theodoros Kotsakis
- Department of Cardiology, Democritus University of Thrace, Medical School, Alexandroupoli, Greece
| | | | - Nikolaos Kafkas
- Department of Cardiology, General Hospital of Attica "KAT", Athens, Greece
| | - Georgios Sidiropoulos
- Department of Cardiology, Georgios Papanikolaou General Hospital, Thessaloniki, Greece
| | - Dimitris Roussos
- Department of Cardiology, Argos General Hospital, Nafplio, Argolis, Greece
| | | | - Georgios Koudounis
- Cardiology Department & Department of Cardiac Catheterization, General Hospital of Messinia, Kalamata, Greece
| | | | | | | | - Christos Chasikidis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
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Ceasovschih A, Șorodoc V, Covantsev S, Balta A, Uzokov J, Kaiser SE, Almaghraby A, Lionte C, Stătescu C, Sascău RA, Onofrei V, Haliga RE, Stoica A, Bologa C, Ailoaei Ș, Şener YZ, Kounis NG, Șorodoc L. Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects. J Multidiscip Healthc 2024; 17:1695-1719. [PMID: 38659633 PMCID: PMC11041971 DOI: 10.2147/jmdh.s445549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
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Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Victorița Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, Moscow, Russia
| | - Anastasia Balta
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Jamol Uzokov
- Department of Cardiology, Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - Sergio E Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Abdallah Almaghraby
- Department of Cardiology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah, United Arab Emirates
| | - Cătălina Lionte
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristian Stătescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Radu A Sascău
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Viviana Onofrei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Raluca Ecaterina Haliga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Alexandra Stoica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristina Bologa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Ștefan Ailoaei
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Yusuf Ziya Şener
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Nicholas G Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Laurențiu Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
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7
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Wass SY, Hahad O, Asad Z, Li S, Chung MK, Benjamin EJ, Nasir K, Rajagopalan S, Al-Kindi SG. Environmental Exposome and Atrial Fibrillation: Emerging Evidence and Future Directions. Circ Res 2024; 134:1029-1045. [PMID: 38603473 PMCID: PMC11060886 DOI: 10.1161/circresaha.123.323477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
There has been increased awareness of the linkage between environmental exposures and cardiovascular health and disease. Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting millions of people worldwide and contributing to substantial morbidity and mortality. Although numerous studies have explored the role of genetic and lifestyle factors in the development and progression of atrial fibrillation, the potential impact of environmental determinants on this prevalent condition has received comparatively less attention. This review aims to provide a comprehensive overview of the current evidence on environmental determinants of atrial fibrillation, encompassing factors such as air pollution, temperature, humidity, and other meteorologic conditions, noise pollution, greenspace, and the social environment. We discuss the existing evidence from epidemiological and mechanistic studies, critically evaluating the strengths and limitations of these investigations and the potential underlying biological mechanisms through which environmental exposures may affect atrial fibrillation risk. Furthermore, we address the potential implications of these findings for public health and clinical practice and identify knowledge gaps and future research directions in this emerging field.
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Affiliation(s)
- Sojin Youn Wass
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (M.K.C., S.Y.W.)
| | - Omar Hahad
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany (O.H.)
| | - Zain Asad
- Division of Cardiovascular Medicine, University of Oklahoma Medical Center, Oklahoma City (Z.A.)
| | - Shuo Li
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH (S.L.)
| | - Mina K Chung
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (M.K.C., S.Y.W.)
| | - Emelia J Benjamin
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.)
| | - Khurram Nasir
- Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, TX (K.N., S.G.A.-K.)
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (S.R.)
- Case Western Reserve University School of Medicine, Cleveland, OH (S.R.)
| | - Sadeer G Al-Kindi
- Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, TX (K.N., S.G.A.-K.)
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8
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Alam AB, Toledo-Atucha E, Romaguera D, Alonso-Gómez AM, Martínez-Gonzalez MA, Tojal-Sierra L, Mora MN, Mas-Llado C, Li L, Gonzalez-Casanova I, Salas-Salvadó J, Fitó M, Alonso A. Associations of Alcohol Consumption With Left Atrial Morphology and Function in a Population at High Cardiovascular Risk. J Am Heart Assoc 2024; 13:e031915. [PMID: 38533958 DOI: 10.1161/jaha.123.031915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/28/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Excessive alcohol consumption has been associated with increased risk of atrial fibrillation, although the underlying mechanisms remain unclear. An enlarged left atrium and impaired left atrial function may lead to atrial fibrillation. The association of alcohol consumption with structural and functional left atrial measures, however, has received limited attention. METHODS AND RESULTS We studied 503 participants from the PREDIMED-Plus (Prevención con Dieta Mediterránea) trial, a randomized trial testing intensive weight loss intervention with an energy-reduced Mediterranean diet and physical activity promotion in preventing cardiovascular disease in adults with metabolic syndrome. Participants underwent transthoracic echocardiography at baseline, year 3, and year 5 of the study. Outcomes of interest included volume index and reservoir, conduit, and contractile strains of the left atrium. Alcohol consumption was calculated through food frequency questionnaires and presented as drinks consumed per day. Multiple linear regression and mixed models estimated the association of alcohol consumption with left atrial measurements at baseline and through follow-up. Cross-sectionally, higher alcohol consumption (per 1 drink/day increases) was associated with larger left atrial volume (0.65 mL/m2 [95% CI, 0.18-1.11]) and lower left atrial reservoir and contractile strain (-0.44% [95% CI, -0.87 to -0.01]; and -0.44% [95% CI, -0.75 to -0.14]). Baseline alcohol consumption was not associated with changes in left atrial measurements, but increases in alcohol consumption (per 1 drink/day increase) during follow-up were associated with left atrial enlargement (0.71 mL/m2 [95% CI, 0.17-1.26]). CONCLUSIONS In a population at high cardiovascular risk, increased alcohol consumption was associated with left atrial enlargement and worsening atrial function. REGISTRATION URL: http://www.controlled-trials.com; Unique identifier: ISRCTN89898870.
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Affiliation(s)
- Aniqa B Alam
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
| | - Estefania Toledo-Atucha
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn) Carlos III Health Institute (ISCIII) Madrid Spain
- Navarra's Health Research Institute (IdiSNA), Navarra Institute for Health Research Pamplona Spain
- Department of Preventive Medicine and Public Health University of Navarra Pamplona Spain
| | - Dora Romaguera
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn) Carlos III Health Institute (ISCIII) Madrid Spain
- Health Research Institute of the Balearic Islands (IdISBa) Palma de Mallorca Spain
| | - Angel M Alonso-Gómez
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn) Carlos III Health Institute (ISCIII) Madrid Spain
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU Vitoria-Gasteiz Spain
| | - Miguel A Martínez-Gonzalez
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn) Carlos III Health Institute (ISCIII) Madrid Spain
- Navarra's Health Research Institute (IdiSNA), Navarra Institute for Health Research Pamplona Spain
- Department of Preventive Medicine and Public Health University of Navarra Pamplona Spain
| | - Lucas Tojal-Sierra
- Navarra's Health Research Institute (IdiSNA), Navarra Institute for Health Research Pamplona Spain
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU Vitoria-Gasteiz Spain
| | - Marta Noris Mora
- Health Research Institute of the Balearic Islands (IdISBa) Palma de Mallorca Spain
- Department of Cardiology Hospital Universitari Son Espases Palma Spain
| | - Caterina Mas-Llado
- Health Research Institute of the Balearic Islands (IdISBa) Palma de Mallorca Spain
- Cardiology Department, Hospital de Manacor Manacor Spain
- Facultad de Medicina Universitat de les Illes Balears (UIB) Palma Spain
| | - Linzi Li
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
| | - Ines Gonzalez-Casanova
- Department of Applied Health Science Indiana University-Bloomington, School of Public Health Bloomington Indiana USA
| | - Jordi Salas-Salvadó
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn) Carlos III Health Institute (ISCIII) Madrid Spain
- Human Nutrition Unit, Department of Biochemistry and Biotechnology Rovira i Virigili University Reus Spain
- Human Nutrition Unit, Pere Virgili Health Research Institute (IISPV) Reus Spain
| | - Montserrat Fitó
- CIBER Consortium, M.P. Physiopathology of Obesity and Nutrition (CIBERObn) Carlos III Health Institute (ISCIII) Madrid Spain
- Cardiovascular Risk and Nutrition Group, Hospital del Mar Medical Research Institute (IMIM) Barcelona Spain
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
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9
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Hussain S, Srinivasan N, Ahsan S, Papageorgiou N. The Role of Risk Factor Modification in Atrial Fibrillation: Outcomes in Catheter Ablation. J Cardiovasc Dev Dis 2024; 11:97. [PMID: 38667715 PMCID: PMC11050342 DOI: 10.3390/jcdd11040097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/07/2024] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
The management of atrial fibrillation has evolved significantly over the last ten years with advancements in medical and catheter ablation approaches, but these have limited success when used in isolation. Trends in the management of lifestyle modifications have surfaced, as it is now better understood that modifiable risk factors contribute significantly to the development and propagation of atrial fibrillation, as well as failure of treatment. International guidelines have integrated the role of lifestyle modification in the management of atrial fibrillation and specifically in the persistent form of atrial fibrillation; these guidelines must be addressed prior to considering catheter ablation. Effective risk factor modification is critical in increasing the likelihood of an arrhythmia-free survival following catheter ablation.
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Affiliation(s)
- Shahana Hussain
- Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (S.H.); (S.A.)
| | - Neil Srinivasan
- Department of Cardiac Electrophysiology, Essex Cardiothoracic Centre, Basildon SS16 5NL, UK;
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Syed Ahsan
- Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (S.H.); (S.A.)
| | - Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St Bartholomew’s Hospital, London EC1A 7BE, UK; (S.H.); (S.A.)
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
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10
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Junejo RT, Gupta D, Snowdon RL, Lip GYH, Fisher JP. Relationship of Warfarin and Apixaban with Vascular Function in Patients with Atrial Fibrillation. J Vasc Res 2024; 61:59-67. [PMID: 38447552 PMCID: PMC10997243 DOI: 10.1159/000535618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/30/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is associated with endothelial damage/dysfunction. Herein, we tested the hypothesis that brachial artery flow-mediated dilation (FMD) is superior in AF patients taking apixaban compared to warfarin. METHODS AF patients on apixaban (n = 46; 67 [7] years; mean [standard deviation]; 15 women) and warfarin (n = 27; 73 [9] years (p < 0.01); 11 women) were recruited. Duplex Doppler ultrasound imaging was undertaken during baseline (2 min), cuff inflation (5 min), and following cuff deflation (3 min). FMD was defined as peak increase in brachial artery diameter following cuff deflation and analysed as percentage change in diameter, as a ratio of FMD, shear rate area under the curve (SRAUC; FMD-to-SRAUC), and using SRAUC as a covariate (FMDSR). RESULTS Baseline artery diameter (4.96 [1.14] vs. 4.89 [0.88] mm), peak diameter (5.12 [1.17] vs. 5.14 [0.93] mm), and FMDSR (3.89 [3.62] vs. 4.80 [3.60] %) were not different between warfarin and apixaban (p > 0.05; analysis of covariance with age, CHA2DS2-VASc, years since AF diagnosis, number of diabetics, alcohol drinkers, and units of alcohol consumed per week as covariates). Stepwise multiple regression identified independent association of fibrillation, hypertension, and increased age with FMD. CONCLUSION AF patients on warfarin and apixaban exhibit similar endothelium-dependent vasodilation. Increased blood pressure negatively impacts vasodilator capacity in AF patients.
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Affiliation(s)
- Rehan T Junejo
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK,
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK,
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Richard L Snowdon
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - James P Fisher
- Department of Physiology, Faculty of Medical and Health Sciences, Manaaki Manawa - The Centre for Heart Research, University of Auckland, Auckland, New Zealand
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11
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Leszto K, Frąk W, Kurciński S, Sinkowska J, Skwira S, Młynarska E, Rysz J, Franczyk B. Associations of Dietary and Lifestyle Components with Atrial Fibrillation. Nutrients 2024; 16:456. [PMID: 38337740 PMCID: PMC10856828 DOI: 10.3390/nu16030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia that still remains a significant health concern, especially due to its consequences, including stroke and heart failure. This review explores the intricate interplay between AF, lifestyle choices, and dietary habits. It is particularly focused on findings from diverse studies about non-pharmacological methods of managing AF. Moreover, its purpose is to elucidate the implementation of lifestyle changes such as physical activity or proper diet choices in the integrated treatment strategy of patients with AF.
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Affiliation(s)
- Klaudia Leszto
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland; (K.L.); (J.S.); (S.S.)
| | - Weronika Frąk
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland; (K.L.); (J.S.); (S.S.)
| | - Szymon Kurciński
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland; (K.L.); (J.S.); (S.S.)
| | - Julia Sinkowska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland; (K.L.); (J.S.); (S.S.)
| | - Sylwia Skwira
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland; (K.L.); (J.S.); (S.S.)
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland; (K.L.); (J.S.); (S.S.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland; (K.L.); (J.S.); (S.S.)
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12
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Shantsila E, Choi EK, Lane DA, Joung B, Lip GY. Atrial fibrillation: comorbidities, lifestyle, and patient factors. THE LANCET REGIONAL HEALTH. EUROPE 2024; 37:100784. [PMID: 38362547 PMCID: PMC10866737 DOI: 10.1016/j.lanepe.2023.100784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/25/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
Modern anticoagulation therapy has dramatically reduced the risk of stroke and systemic thromboembolism in people with atrial fibrillation (AF). However, AF still impairs quality of life, increases the risk of stroke and heart failure, and is linked to cognitive impairment. There is also a recognition of the residual risk of thromboembolic complications despite anticoagulation. Hence, AF management is evolving towards a more comprehensive understanding of risk factors predisposing to the development of this arrhythmia, its' complications and interventions to mitigate the risk. This review summarises the recent advances in understanding of risk factors for incident AF and managing these risk factors. It includes a discussion of lifestyle, somatic, psychological, and socioeconomic risk factors. The available data call for a practice shift towards a more individualised approach considering an increasingly broader range of health and patient factors contributing to AF-related health burden. The review highlights the needs of people living with co-morbidities (especially with multimorbidity), polypharmacy and the role of the changing population demographics affecting the European region and globally.
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Affiliation(s)
- Eduard Shantsila
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Brownlow Group GP Practice, Liverpool, United Kingdom
| | - Eue-Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Denmark
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13
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Gao P, Gao X, Xie B, Tse G, Liu T. Aging and atrial fibrillation: A vicious circle. Int J Cardiol 2024; 395:131445. [PMID: 37848123 DOI: 10.1016/j.ijcard.2023.131445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/17/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023]
Abstract
Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia observed in clinical practice. Its prevalence increases dramatically with advancing age. This review article discusses the recent advances in studies investigating the relationship between aging and AF and the possible underlying mechanisms.
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Affiliation(s)
- Pan Gao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xinyi Gao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Bingxin Xie
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
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14
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Lee JW, Roh SY, Yoon WS, Kim J, Jo E, Bae DH, Kim M, Lee JH, Kim SM, Choi WG, Bae JW, Hwang KK, Kim DW, Cho MC, Kim YS, Kim Y, You HS, Kang HT, Lee DI. Changes in alcohol consumption habits and risk of atrial fibrillation: a nationwide population-based study. Eur J Prev Cardiol 2024; 31:49-58. [PMID: 37672594 DOI: 10.1093/eurjpc/zwad270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/04/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
AIMS Heavy alcohol consumption is an established risk factor for atrial fibrillation (AF). However, the association between habitual changes in heavy habitual drinkers and incident AF remains unclear. The aim of this study was to evaluate whether absolute abstinence or reduced drinking decreases incident AF in heavy habitual drinkers. METHODS AND RESULTS Atrial fibrillation-free participants with heavy alcohol consumption registered in the Korean National Health Insurance Service database between 2005 and 2008 were enrolled. Habitual changes in alcohol consumption between 2009 and 2012 were classified as sustained heavy drinking, reduced drinking, and absolute abstinence. The primary outcome measure was new-onset AF during the follow-up. To minimize the effect of confounding variables on outcome events, inverse probability of treatment weighting (IPTW) analysis was performed. Overall, 19 425 participants were evaluated. The absolute abstinence group showed a 63% lower incidence of AF (IPTW hazard ratio: 0.379, 95% confidence interval: 0.169-0.853) than did the sustained heavy drinking group. Subgroup analysis identified that abstinence significantly reduced incident AF in participants with normal body mass index and without hypertension, diabetes, dyslipidaemia, heart failure, stroke, chronic kidney disease, or coronary artery disease (all P-value <0.05). There was no statistical difference in incident AF in participants with reduced drinking compared with sustained heavy alcohol group. CONCLUSION Absolute abstinence could reduce the incidence of AF in heavy alcohol drinkers. Comprehensive clinical measures and public health policies are warranted to motivate alcohol abstinence in heavy drinkers.
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Affiliation(s)
- Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Chungju-si, South Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, South Korea
| | - Woong-Su Yoon
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheonju-si 28644, Chungcheonbuk-do, South Korea
| | - Jinseob Kim
- Department of Statistical Analysis, Zarathu Co., Ltd, Seoul, South Korea
| | - Eunseo Jo
- Department of Statistical Analysis, Zarathu Co., Ltd, Seoul, South Korea
| | - Dae-Hwan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheonju-si 28644, Chungcheonbuk-do, South Korea
| | - Min Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheonju-si 28644, Chungcheonbuk-do, South Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheonju-si 28644, Chungcheonbuk-do, South Korea
| | - Sang Min Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheonju-si 28644, Chungcheonbuk-do, South Korea
| | - Woong Gil Choi
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheonju-si 28644, Chungcheonbuk-do, South Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheonju-si 28644, Chungcheonbuk-do, South Korea
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Chungju-si 28644, South Korea
| | - Kyung-Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheonju-si 28644, Chungcheonbuk-do, South Korea
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Chungju-si 28644, South Korea
| | - Dong-Woon Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheonju-si 28644, Chungcheonbuk-do, South Korea
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Chungju-si 28644, South Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, 776, 1sunhwan-ro, Seowon-gu, Cheonju-si 28644, Chungcheonbuk-do, South Korea
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Chungju-si 28644, South Korea
| | - Ye-Seul Kim
- Department of Family Medicine, Chungbuk National University Hospital, Chungju-si, South Korea
| | - Yonghwan Kim
- Department of Family Medicine, Chungbuk National University Hospital, Chungju-si, South Korea
| | - Hyo-Sun You
- Department of Family Medicine, Chungbuk National University Hospital, Chungju-si, South Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae-In Lee
- Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, South Korea
- Department of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
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15
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Randhawa S, Da S, Aronow WS. Risk factors modification in atrial fibrillation: a brief review. Expert Rev Cardiovasc Ther 2024; 22:7-12. [PMID: 38108793 DOI: 10.1080/14779072.2023.2294728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) is a supraventricular arrhythmia characterized by fibrillatory waves in the atria with an irregular ventricular rhythm. It is the most common arrhythmia treated in clinical practice. AF is associated with approximately five-fold increase in risk of cerebrovascular accident (stroke) and two-fold increase in cognitive dysfunction and all-cause mortality. AREAS COVERED Multiple risk factors have been identified for development of AF including age, hypertension, diabetes, and obesity. Primary and secondary prevention strategies aimed at reducing the incidence of AF can have a dramatic clinical and economic impact. Multiple studies have shown that lifestyle interventions can reduce predisposing factors, reverse the pathophysiology behind AF, and decrease disease burden. In this brief review we aim at exploring the current state of knowledge regarding risk factor modifications that decrease incidence and prevalence of AF. EXPERT OPINION This is an evolving field of research and further studies to elucidate the magnitude of effect of these interventions as well as the pathophysiological mechanisms driving these effects are underway.
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Affiliation(s)
- Sukhbir Randhawa
- Department of Graduate Medical Education, Samaritan Medical Center, Watertown, NY, USA
| | - Subrat Da
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
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16
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Park CS, Choi J, Choi J, Lee KY, Ahn HJ, Kwon S, Lee SR, Choi EK, Kwak SH, Oh S. Risk of newly developed atrial fibrillation by alcohol consumption differs according to genetic predisposition to alcohol metabolism: a large-scale cohort study with UK Biobank. BMC Med 2023; 21:509. [PMID: 38129845 PMCID: PMC10740225 DOI: 10.1186/s12916-023-03229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The predictive relationship between mild-to-moderate alcohol consumption and the risk of incident atrial fibrillation (AF) remains controversial. OBJECTIVE We investigated whether the relationship between alcohol consumption and the risk of incident AF could be associated with the genetic predisposition to alcohol metabolism. METHODS A total of 399,329 subjects with genetic data from the UK Biobank database, enrolled between 2006 and 2010, were identified and followed for incident AF until 2021. Genetic predisposition to alcohol metabolism was stratified according to the polygenic risk score (PRS) tertiles. Alcohol consumption was categorized as non-drinkers, mild-to-moderate drinkers (< 30 g/day), and heavy drinkers (≥ 30 g/day). RESULTS During the follow-up (median 12.2 years), 19,237 cases of AF occurred. When stratified by PRS tertiles, there was a significant relationship between genetic predisposition to alcohol metabolism and actual alcohol consumption habits (P < 0.001). Mild-to-moderate drinkers showed a decreased risk of AF (HR 0.96, 95% CI 0.92-0.99), and heavy drinkers showed an increased risk of AF (HR 1.06, 95% CI 1.02-1.10) compared to non-drinkers. When stratified according to PRS tertiles for genetic predisposition to alcohol metabolism, mild-to-moderate drinkers had equivalent AF risks, and heavy drinkers showed increased AF risk in the low PRS tertile group. However, mild-to-moderate drinkers had decreased AF risks and heavy drinkers showed similar risks of AF in the middle/high PRS tertile groups. CONCLUSIONS Differential associations between alcohol consumption habits and incident AF across genetic predisposition to alcohol metabolism were observed; individuals with genetic predisposition to low alcohol metabolism were more susceptible to AF.
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Affiliation(s)
- Chan Soon Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaewon Choi
- Division of Data Science Research, Innovative Biomedical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - JungMin Choi
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Yeon Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo Heon Kwak
- Division of Data Science Research, Innovative Biomedical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seil Oh
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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17
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Wang N, Yu Y, Sun Y, Zhang H, Wang Y, Chen C, Tan X, Wang B, Lu Y. Acquired risk factors and incident atrial fibrillation according to age and genetic predisposition. Eur Heart J 2023; 44:4982-4993. [PMID: 37723974 PMCID: PMC10719493 DOI: 10.1093/eurheartj/ehad615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/06/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND AND AIMS Atrial fibrillation (AF) is the most common sustained arrhythmia in adults. Investigations of risk factor profiles for AF according to age and genetic risk groups are essential to promote individualized strategies for the prevention and control of AF. METHODS A total of 409 661 participants (mean age, 56 years; 46% men) free of AF at baseline and with complete information about risk factors were included from the UK Biobank cohort. The hazard ratios and population-attributable risk (PAR) percentages of incident AF associated with 23 risk factors were examined, including 3 social factors, 7 health behaviours, 6 cardiometabolic factors, 6 clinical comorbidities, and the genetic risk score (GRS), across 3 age groups (40-49, 50-59, and 60-69 years) and 3 genetic risk groups (low, moderate, and high GRS). RESULTS After a follow-up of 5 027 587 person-years, 23 847 participants developed AF. Most cardiometabolic factors and clinical comorbidities showed a significant interaction with age, whereby the associations were generally strengthened in younger groups (Pinteraction < .002). However, only low LDL cholesterol, renal dysfunction, and cardiovascular disease showed a significant interaction with genetic risk, and the associations with these factors were stronger in lower genetic risk groups (Pinteraction < .002). Cardiometabolic factors consistently accounted for the largest number of incident AF cases across all age groups (PAR: 36.2%-38.9%) and genetic risk groups (34.0%-41.9%), with hypertension and overweight/obesity being the two leading modifiable factors. Health behaviours (PAR: 11.5% vs. 8.7%) and genetic risk factors (19.1% vs. 14.3%) contributed to more AF cases in the 40-49 years group than in the 60-69 years group, while the contribution of clinical comorbidities remained relatively stable across different age groups. The AF risk attributable to overall cardiometabolic factors (PAR: 41.9% in the low genetic risk group and 34.0% in the high genetic risk group) and clinical comorbidities (24.7% and 15.9%) decreased with increasing genetic risk. The impact of social factors on AF was relatively low across the groups by age and genetic risk. CONCLUSIONS This study provided comprehensive information about age- and genetic predisposition-related risk factor profiles for AF in a cohort of UK adults. Prioritizing risk factors according to age and genetic risk stratifications may help to achieve precise and efficient prevention of AF.
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Affiliation(s)
- Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Yuefeng Yu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Ying Sun
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Haojie Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Xiao Tan
- School of Public Health, Zhejiang University, Hangzhou, China
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bin Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China
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18
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Abbas D, Ciricillo JA, Elom HA, Moon AM. Extrahepatic Health Effects of Alcohol Use and Alcohol-associated Liver Disease. Clin Ther 2023; 45:1201-1211. [PMID: 37806811 DOI: 10.1016/j.clinthera.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Alcohol use disorder (AUD) is a growing public health concern and an important contributor to global morbidity and mortality. While the hepatotoxic effects of alcohol are well known, the adverse effects of alcohol are manifested in almost every organ system. With the growing public health impact of AUD, the aim of this narrative review is to highlight the epidemiology and burden of AUD and its association with extrahepatic diseases including malignancy and disorders of the gastrointestinal (GI), cardiovascular, immunologic, neurologic, endocrine, and hematologic systems. METHODS A narrative review of the literature was performed to identify studies addressing the epidemiology, pathophysiology, clinical manifestations, and therapy of extrahepatic health manifestations of alcohol use. FINDINGS In the United States, an estimated 14.5 million people have AUD and approximately 88,000 adults die yearly due to alcohol-related causes. The consumption of alcohol and AUD is associated with injuries, violence, cancers, nonmalignant conditions of the GI system, infections, effects on the cardiovascular system, and neurodegenerative diseases. These conditions contribute to the increased mortality associated with AUD and are burdensome to patients and caregivers. IMPLICATIONS Increased awareness of the extrahepatic manifestations of AUD, screening for AUD using validated screening tools, such as the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score, and offering evidence-based interventions to patients with AUD is imperative to reduce the public health burden of AUD. Although historically controversial, recent evidence suggests that any level of alcohol consumption can have negative health consequences. Further research is warranted to determine if any amount of alcohol is safe for consumption. Public health efforts are warranted to help curtail the growing burden of AUD.
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Affiliation(s)
- Daniyal Abbas
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Jacob A Ciricillo
- Department of Internal Medicine, University of Cincinnati Medicine Center, Cincinnati, Ohio
| | - Hilary A Elom
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Andrew M Moon
- Department of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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19
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Gaffey AE, Rosman L, Lampert R, Yaggi HK, Haskell SG, Brandt CA, Enriquez AD, Mazzella AJ, Skanderson M, Burg MM. Insomnia and Early Incident Atrial Fibrillation: A 16-Year Cohort Study of Younger Men and Women Veterans. J Am Heart Assoc 2023; 12:e030331. [PMID: 37791503 PMCID: PMC10757545 DOI: 10.1161/jaha.123.030331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/24/2023] [Indexed: 10/05/2023]
Abstract
Background There is growing consideration of sleep disturbances and disorders in early cardiovascular risk, including atrial fibrillation (AF). Obstructive sleep apnea confers risk for AF but is highly comorbid with insomnia, another common sleep disorder. We sought to first determine the association of insomnia and early incident AF risk, and second, to determine if AF onset is earlier among those with insomnia. Methods and Results This retrospective analysis used electronic health records from a cohort study of US veterans who were discharged from military service since October 1, 2001 (ie, post-9/11) and received Veterans Health Administration care, 2001 to 2017. Time-varying, multivariate Cox proportional hazard models were used to examine the independent contribution of insomnia diagnosis to AF incidence while serially adjusting for demographics, lifestyle factors, clinical comorbidities including obstructive sleep apnea and psychiatric disorders, and health care utilization. Overall, 1 063 723 post-9/11 veterans (Mean age=28.2 years, 14% women) were followed for 10 years on average. There were 4168 cases of AF (0.42/1000 person-years). Insomnia was associated with a 32% greater adjusted risk of AF (95% CI, 1.21-1.43), and veterans with insomnia showed AF onset up to 2 years earlier. Insomnia-AF associations were similar after accounting for health care utilization (adjusted hazard ratio [aHR], 1.27 [95% CI, 1.17-1.39]), excluding veterans with obstructive sleep apnea (aHR, 1.38 [95% CI, 1.24-1.53]), and among those with a sleep study (aHR, 1.26 [95% CI, 1.07-1.50]). Conclusions In younger adults, insomnia was independently associated with incident AF. Additional studies should determine if this association differs by sex and if behavioral or pharmacological treatment for insomnia attenuates AF risk.
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Affiliation(s)
- Allison E. Gaffey
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Lindsey Rosman
- Division of Cardiology, Department of MedicineUniversity of North Carolina, Chapel HillChapel HillNCUSA
| | - Rachel Lampert
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Henry K. Yaggi
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Pulmonary, Critical Care & Sleep Medicine)Yale School of MedicineCTNew HavenUSA
| | - Sally G. Haskell
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (General Medicine)Yale School of MedicineNew HavenCTUSA
| | - Cynthia A. Brandt
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Emergency MedicineYale School of MedicineNew HavenCTUSA
- Yale Center for Medical InformaticsYale School of MedicineNew HavenCTUSA
| | - Alan D. Enriquez
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Anthony J. Mazzella
- Division of Cardiology, Department of MedicineUniversity of North Carolina, Chapel HillChapel HillNCUSA
| | | | - Matthew M. Burg
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
- Department of AnesthesiologyYale School of MedicineNew HavenCTUSA
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20
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Lin N, Zhang Y, Su S, Feng Y, Wang B, Li Z. Exposure characteristics of legacy and novel per- and polyfluoroalkyl substances in blood and association with hypertension among low-exposure population. JOURNAL OF HAZARDOUS MATERIALS 2023; 459:132185. [PMID: 37531760 DOI: 10.1016/j.jhazmat.2023.132185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/11/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023]
Abstract
The exposure characteristics of per- and polyfluoroalkyl substances (PFAS) in blood and their associations with hypertension have been well investigated in high-exposure populations, yet limited information is available concerning low-exposure populations. We conducted a cross-sectional study in a low-exposure population in China. A total of 394 females, including 162 with hypertension, were recruited and 30 PFAS were measured in whole blood samples. General linear model, generalized additive model, and logistic model were used to identify the associations with hypertension. Additionally, a Bayesian kernel machine regression model was conducted to test the mixture effects. Fourteen PFAS, including two novel species, 6:2 and 8:2 chlorinated polyfluorinated ether sulfonates (Cl-PFESAs), were detected, among which PFOS predominated with the highest median level of 1.47 ng/mL. The median levels of individual PFAS were, however, below the 25th, and even the 5th percentile of previous reports, except for PFHxA, which was above the 50th percentile (median of 0.10 ng/mL). After adjusting for covariates, PFHxA showed a positive association with hypertension (OR=1.54, 95% CI: 1.25, 1.89), while 6:2 Cl-PFESA showed a negative association (OR=0.73, 95% CI: 0.56, 0.95). PFAS didn't show significant mixture effects. We proposed that PFHxA may contribute to hypertension and 6:2 Cl-PFESA may have a hormesis effect.
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Affiliation(s)
- Nan Lin
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, PR China
| | - Yanyan Zhang
- Key Laboratory of Coastal Environment and Resources of Zhejiang Province, School of Engineering, Westlake University, Hangzhou 310024, PR China
| | - Shu Su
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing 100083, PR China
| | - Yanqiu Feng
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing 100083, PR China
| | - Bin Wang
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing 100083, PR China
| | - Zhiwen Li
- Institute of Reproductive and Child Health / National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing 100083, PR China.
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21
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Ricchiuti N, Chenoweth K, Gao X, Bare DJ, Yan J, Ai X. Long-Term Alcohol-Activated c-Jun N-terminal Kinase Isoform 2 Preserves Cardiac Function but Drives Ca 2+-Triggered Arrhythmias. Cells 2023; 12:2233. [PMID: 37759456 PMCID: PMC10527640 DOI: 10.3390/cells12182233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Long-term alcohol consumption leads to cardiac arrhythmias including atrial fibrillation (AF), the most common alcohol-related arrhythmia. While AF significantly increases morbidity and mortality in patients, it takes years for an alcoholic individual undergoing an adaptive status with normal cardiac function to reach alcoholic cardiomyopathy. The underlying mechanism remains unclear to date. In this study, we assessed the functional role of JNK2 in long-term alcohol-evoked atrial arrhythmogenicity but preserved cardiac function. Wild-type (WT) mice and cardiac-specific JNK2dn mice (with an overexpression of inactive dominant negative (dn) JNK2) were treated with alcohol (2 g/kg daily for 2 months; 2 Mo). Confocal Ca2+ imaging in the intact mouse hearts showed that long-term alcohol prolonged intracellular Ca2+ transient decay, and increased pacing-induced Ca2+ waves, compared to that of sham controls, while cardiac-specific JNK2 inhibition in JNK2dn mice precluded alcohol-evoked Ca2+-triggered activities. Moreover, activated JNK2 enhances diastolic SR Ca2+ leak in 24 h and 48 h alcohol-exposed HL-1 atrial myocytes as well as HEK-RyR2 cells (inducible expression of human RyR2) with the overexpression of tGFP-tagged active JNK2-tGFP or inactive JNK2dn-tGFP. Meanwhile, the SR Ca2+ load and systolic Ca2+ transient amplitude were both increased in ventricular myocytes, along with the preserved cardiac function in 2 Mo alcohol-exposed mice. Moreover, the role of activated JNK2 in SR Ca2+ overload and enhanced transient amplitude was also confirmed in long-term alcohol-exposed HL-1 atrial myocytes. In conclusion, our findings suggest that long-term alcohol-activated JNK2 is a key driver in preserved cardiac function, but at the expense of enhanced cardiac arrhythmogenicity. Modulating JNK2 activity could be a novel anti-arrhythmia therapeutic strategy.
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Affiliation(s)
| | | | | | | | - Jiajie Yan
- Department of Physiology and Cell Biology, College of Medicine/Wexner Medical Center, The Ohio State University, 333 W 10th Avenue, Columbus, OH 43210, USA
| | - Xun Ai
- Department of Physiology and Cell Biology, College of Medicine/Wexner Medical Center, The Ohio State University, 333 W 10th Avenue, Columbus, OH 43210, USA
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22
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Zhang Y, Kim C, Wasif N, Li Y, Huang Y, Kobayashi S, Udo-Bellner L, Stout R, Ojamaa K. Alcohol and caffeine synergistically induce spontaneous ventricular tachyarrhythmias: ameliorated with dantrolene treatment. Heart Rhythm O2 2023; 4:549-555. [PMID: 37744935 PMCID: PMC10513921 DOI: 10.1016/j.hroo.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Alcohol and caffeine are the 2 frequently consumed substances in the general population, and the 2 substances are frequently co-consumed. Both substances may increase cardiac arrhythmia risk. However, it is unknown whether alcohol and caffeine co-consumption can synergistically enhance cardiac arrhythmogenesis. Objective The study sought to investigate whether caffeine and binge drinking synergistically affect cardiac arrhythmogenesis. Methods A binge drinking rat model (alcohol 2 g/kg, intraperitoneal, every other day for 3 times) was used. Rats (4 months old, both sexes) were randomized into the following 4 groups: binge alcohol-only group (A) (n = 8), nonalcohol, caffeine-only (60 mg/kg, intraperitoneal) group (C) (n = 8), binge alcohol plus caffeine group (A+C) (n = 8), and binge alcohol + caffeine + dantrolene group (A+D) (n = 7, treated with dantrolene 10 mg/kg before each alcohol injection). We also investigated whether alcohol induces Ca2+ sparks and dantrolene treatment attenuates alcohol-induced Ca2+ leak in ventricular myocytes. Results No arrhythmia was induced with caffeine alone (group C, n = 0 of 8) or alcohol alone (group A, n = 0 of 8). However, alcohol + caffeine induced spontaneous ventricular tachyarrhythmias in all rats (group A+C, n = 8 of 8; P < .001 vs group C or A). Dantrolene prevented ventricular tachyarrhythmia induction in all 7 rats (group A+D, n = 0 of 7; P < .001 vs group A+C). In isolated ventricular myocytes, alcohol significantly increased Ca2+ sparks and dantrolene treatment reduced alcohol-induced Ca2+ sparks. Conclusion Co-consumption of caffeine and binge drinking synergistically promote spontaneous ventricular tachyarrhythmias in rats. Dantrolene treatment can decrease alcohol-enhanced Ca2+ sparks in vitro and prevented alcohol and caffeine induced ventricular tachyarrhythmias in vivo.
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Affiliation(s)
- Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Christopher Kim
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Nawal Wasif
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Ying Li
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Yuan Huang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Satoru Kobayashi
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Lars Udo-Bellner
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Randy Stout
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Kaie Ojamaa
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
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23
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Mustroph J, Baier MJ, Unsin D, Provaznik Z, Kozakov K, Lebek S, Tarnowski D, Schildt S, Voigt N, Wagner S, Maier LS, Neef S. Ethanol-Induced Atrial Fibrillation Results From Late INa and Can Be Prevented by Ranolazine. Circulation 2023; 148:698-700. [PMID: 37603603 PMCID: PMC10437457 DOI: 10.1161/circulationaha.123.064561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Julian Mustroph
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Maria J. Baier
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Denise Unsin
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Zdenek Provaznik
- Cardiothoracic Surgery (Z.P., K.K.), University Medical Center Regensburg, Germany
| | - Kostiantyn Kozakov
- Cardiothoracic Surgery (Z.P., K.K.), University Medical Center Regensburg, Germany
| | - Simon Lebek
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Daniel Tarnowski
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Sönke Schildt
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Niels Voigt
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University Göttingen, Germany (N.V.)
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany (N.V.)
- Cluster of Excellence “Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Germany (N.V.)
| | - Stefan Wagner
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Lars S. Maier
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Stefan Neef
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
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24
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Frederiksen TC, Christiansen MK, Benjamin EJ, Overvad K, Olsen A, Dahm CC, Jensen HK. Five-year changes in alcohol intake and risk of atrial fibrillation: a Danish cohort study. Eur J Prev Cardiol 2023; 30:1046-1053. [PMID: 36508613 PMCID: PMC10442053 DOI: 10.1093/eurjpc/zwac293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
AIMS Alcohol intake is a well-established risk factor for atrial fibrillation (AF). However, evidence on the effects of changes in alcohol intake to primary AF prevention is sparse. The aim of this study was to examine the association between 5-year changes in alcohol intake and the risk of incident AF. METHODS AND RESULTS This study was based on the Danish cohort study Diet, Cancer and Health. Lifestyle factors were assessed using questionnaires at a recruitment research examination and a second examination 5 years later. Diagnoses of AF and comorbidities were retrieved from the Danish National Patient Registry. 43 758 participants without prior AF were included. The median age was 61 (25th-75th percentile 58-66) years and 54% were female. Over a median follow-up time of 15.7 years, 5312 participants had incident AF (incidence rate 8.6/1000 person-years). Compared with stable intake, increases in alcohol intake to ≥21 drinks/week from ≤6.9 drinks/week (HR: 1.38, 95% CI: 1.09-1.72) or 14-20.9 drinks/week (HR: 1.27, 95% CI: 1.01-1.59) at baseline were associated with a higher risk of AF. In contrast, we did not observe a statistically significant association between reductions in alcohol intake and the risk of AF. CONCLUSION A 5-year increase in alcohol intake was associated with a greater risk of AF compared with a stable low/moderate intake.
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Affiliation(s)
- Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
| | - Morten Krogh Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
| | - Emelia J Benjamin
- Sections of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, 725 Albany Street, MA 02118, USA
| | - Kim Overvad
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Anja Olsen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Christina Catherine Dahm
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
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25
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Kaul R, Kaul R, Paul P, Maksymiuk V, Frishman WH, Aronow WS. Alcohol and Atrial Fibrillation: A Pathophysiologic Perspective. Cardiol Rev 2023; 31:177-184. [PMID: 36398336 DOI: 10.1097/crd.0000000000000479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia responsible for significant morbidity and mortality. Its burden on patients and the health care system is only expected to increase. Several studies have established a dose-response relationship between the amount and frequency of alcohol consumption and the incidence of new onset AF independent of sex, age, and other risk factors. This causal relationship is mediated by the impact alcohol consumption has on conduction properties of the atrium, structural and cellular effect on cardiac myocytes, and dysregulation of the autonomic nervous system. This article reviews the current literature supporting the link between alcohol consumption and AF while attempting to provide an insight into pathophysiological mechanisms.
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Affiliation(s)
- Risheek Kaul
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Ridhima Kaul
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | - Pradipta Paul
- Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha, Qatar
| | | | | | - Wilbert S Aronow
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
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26
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Hu D, Barajas-Martinez H, Zhang ZH, Duan HY, Zhao QY, Bao MW, Du YM, Burashnikov A, Monasky MM, Pappone C, Huang CX, Antzelevitch C, Jiang H. Advances in basic and translational research in atrial fibrillation. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220174. [PMID: 37122214 PMCID: PMC10150218 DOI: 10.1098/rstb.2022.0174] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Atrial fibrillation (AF) is a very common cardiac arrhythmia with an estimated prevalence of 33.5 million patients globally. It is associated with an increased risk of death, stroke and peripheral embolism. Although genetic studies have identified a growing number of genes associated with AF, the definitive impact of these genetic findings is yet to be established. Several mechanisms, including electrical, structural and neural remodelling of atrial tissue, have been proposed to contribute to the development of AF. Despite over a century of exploration, the molecular and cellular mechanisms underlying AF have not been fully established. Current antiarrhythmic drugs are associated with a significant rate of adverse events and management of AF using ablation is not optimal, especially in cases of persistent AF. This review discusses recent advances in our understanding and management of AF, including new concepts of epidemiology, genetics and pathophysiological mechanisms. We review the current status of antiarrhythmic drug therapy for AF, new potential agents, as well as mechanism-based AF ablation. This article is part of the theme issue 'The heartbeat: its molecular basis and physiological mechanisms'.
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Affiliation(s)
- Dan Hu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, People's Republic of China
- Cardiovascular Research Institute of Wuhan University, Wuhan 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, People's Republic of China
| | - Hector Barajas-Martinez
- Lankenau Institute for Medical Research, and Lankenau Heart Institute, Wynnwood, PA 19096, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19104, USA
| | - Zhong-He Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, People's Republic of China
- Cardiovascular Research Institute of Wuhan University, Wuhan 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, People's Republic of China
| | - Hong-Yi Duan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, People's Republic of China
- Cardiovascular Research Institute of Wuhan University, Wuhan 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, People's Republic of China
| | - Qing-Yan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, People's Republic of China
- Cardiovascular Research Institute of Wuhan University, Wuhan 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, People's Republic of China
| | - Ming-Wei Bao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, People's Republic of China
- Cardiovascular Research Institute of Wuhan University, Wuhan 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, People's Republic of China
| | - Yi-Mei Du
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Alexander Burashnikov
- Lankenau Institute for Medical Research, and Lankenau Heart Institute, Wynnwood, PA 19096, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19104, USA
| | - Michelle M Monasky
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan 20097, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan 20097, Italy
- Vita-Salute San Raffaele University, Milan 20132, Italy
- Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan 20097, Italy
| | - Cong-Xin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, People's Republic of China
- Cardiovascular Research Institute of Wuhan University, Wuhan 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, People's Republic of China
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, and Lankenau Heart Institute, Wynnwood, PA 19096, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19104, USA
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, People's Republic of China
- Cardiovascular Research Institute of Wuhan University, Wuhan 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, People's Republic of China
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Delesie M, Knaepen L, Dendale P, Vijgen J, Ector J, Desteghe L, Heidbuchel H. Baseline demographics of a contemporary Belgian atrial fibrillation cohort included in a large randomised clinical trial on targeted education and integrated care (AF-EduCare/AF-EduApp study). Front Cardiovasc Med 2023; 10:1186453. [PMID: 37332586 PMCID: PMC10272799 DOI: 10.3389/fcvm.2023.1186453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Background As the prevalence of atrial fibrillation (AF) increases worldwide and AF management becomes ever more diversified and personalised, insights into (regional) AF patient demographics and contemporary AF management are needed. This paper reports the current AF management and baseline demographics of a Belgian AF population recruited for a large multicenter integrated AF study (AF-EduCare/AF-EduApp study). Methods We analyzed data from 1,979 AF patients, assessed between 2018 and 2021 for the AF-EduCare/AF-EduApp study. The trial randomised consecutive patients with AF (irrespective of AF history duration) into three educational intervention groups (in person-, online-, and application-based), compared with standard care. Baseline demographics of both the included and excluded/refused patients are reported. Results The mean age of the trial population was 71.2 ± 9.1 years, with a mean CHA2DS2-VASc score of 3.4 ± 1.8. Of all screened patients, 42.4% were asymptomatic at presentation. Being overweight was the most common comorbidty, present in 68.9%, while 65.0% were diagnosed with hypertension. Anticoagulation therapy was prescribed in 90.9% of the total population and in 94.0% of the patients with an indication for thromboembolic prophylaxis. Of the 1,979 assessed AF patients, 1,232 (62.3%) were enrolled in the AF-EduCare/AF-EduApp study, with transportation problems (33.4%) as the main reason for refusal/non-inclusion. About half of the included patients were recruited at the cardiology ward (53.8%). AF was first diagnosed, paroxysmal, persistent and permanent in 13.9%, 47.4%, 22.8% and 11.3%, respectively. Patients who refused or were excluded were older (73.3 ± 9.2 vs. 69.8 ± 8.9 years, p < 0.001) and had more comorbidities (CHA2DS2-VASc 3.8 ± 1.8 vs. 3.1 ± 1.7, p < 0.001). The four AF-EduCare/AF-EduApp study groups were comparable across the vast majority of parameters. Conclusions The population showed high use of anticoagulation therapy, in line with current guidelines. In contrast to other AF trials about integrated care, the AF-EduCare/AF-EduApp study managed to incorporate all types of AF patients, both out-patient and hospitalised, with very comparable patient demographics across all subgroups. The trial will analyze whether different approaches to patient education and integrated AF care have an impact on clinical outcomes. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT03707873?term=af-educare&draw=2&rank=1, identifier: NCT03707873; https://clinicaltrials.gov/ct2/show/NCT03788044?term=af-eduapp&draw=2&rank=1, identifier: NCT03788044.
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Affiliation(s)
- Michiel Delesie
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Lieselotte Knaepen
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Paul Dendale
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Johan Vijgen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Joris Ector
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
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Lim J, Sang H, Kim HI. Impact of metabolic risk factors on hepatic and cardiac outcomes in patients with alcohol- and non-alcohol-related fatty liver disease. JHEP Rep 2023; 5:100721. [PMID: 37138675 PMCID: PMC10149369 DOI: 10.1016/j.jhepr.2023.100721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/31/2023] [Accepted: 02/18/2023] [Indexed: 05/05/2023] Open
Abstract
Background & Aims Metabolic risk factors (MetRs) are associated with hepatic and cardiac outcomes in patients with fatty liver disease (FLD). We evaluated whether MetRs have different effects on alcoholic FLD (AFLD) and non-alcoholic FLD (NAFLD). Methods We used a standardised common data model to analyse data from seven university hospital databases between 2006 and 2015. MetRs included diabetes mellitus, hypertension, dyslipidaemia, and obesity. Follow-up data were analysed for the incidence of hepatic outcomes, cardiac outcomes, and death in patients with AFLD or NAFLD and based on MetRs within AFLD and NAFLD. Results Out of 3,069 and 17,067 patients with AFLD and NAFLD, respectively, 2,323 (75.7%) and 13,121 (76.9%) had one or more MetR, respectively. Patients with AFLD were at a higher risk of hepatic outcomes (adjusted risk ratio [aRR], 5.81) compared with those with NAFLD irrespective of MetR. The risk of cardiac outcomes in AFLD and NAFLD became similar with the increasing number of MetRs. Patients with NAFLD without MetRs demonstrated a lower risk of cardiac outcomes, but not hepatic outcomes, compared with those with MetRs (aRR, 0.66 and 0.61 for MetR ≥1 and MetR ≥2, respectively; p <0.05). In patients with AFLD, hepatic and cardiac outcomes were not associated with MetRs. Conclusions The clinical impact of MetRs in patients with FLD may differ between patients with AFLD and those with NAFLD. Impact and Implications With the increasing prevalence of fatty liver disease (FLD) and metabolic syndrome, the increase in associated complications, such as liver and heart diseases, has become an important social issue. Particularly in patients with FLD with excessive alcohol consumption, the incidence of liver and heart disease is pronounced because of the dominant effect of alcohol over the effects of other factors. Thus, appropriate screening and management of alcohol consumption in patients with FLD are vital.
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Affiliation(s)
- Jihye Lim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University College of Medicine, Seoul, Republic of Korea
| | - Hyunji Sang
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Ha Il Kim
- Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Guri, Republic of Korea
- Corresponding author. Address: Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, 153 Gyeongchun-ro, 11923, Guri, Republic of Korea. Tel.: +82-31-560-2232.
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Leventopoulos G, Koros R, Travlos C, Perperis A, Chronopoulos P, Tsoni E, Koufou EE, Papageorgiou A, Apostolos A, Kaouris P, Davlouros P, Tsigkas G. Mechanisms of Atrial Fibrillation: How Our Knowledge Affects Clinical Practice. Life (Basel) 2023; 13:1260. [PMID: 37374043 DOI: 10.3390/life13061260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Atrial fibrillation (AF) is a very common arrhythmia that mainly affects older individuals. The mechanism of atrial fibrillation is complex and is related to the pathogenesis of trigger activation and the perpetuation of arrhythmia. The pulmonary veins in the left atrium arei confirm that onfirm the most common triggers due to their distinct anatomical and electrophysiological properties. As a result, their electrical isolation by ablation is the cornerstone of invasive AF treatment. Multiple factors and comorbidities affect the atrial tissue and lead to myocardial stretch. Several neurohormonal and structural changes occur, leading to inflammation and oxidative stress and, consequently, a fibrotic substrate created by myofibroblasts, which encourages AF perpetuation. Several mechanisms are implemented into daily clinical practice in both interventions in and the medical treatment of atrial fibrillation.
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Affiliation(s)
| | - Rafail Koros
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
| | | | - Angelos Perperis
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
| | | | - Evropi Tsoni
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
| | | | | | | | - Panagiotis Kaouris
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
| | - Periklis Davlouros
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
| | - Grigorios Tsigkas
- Cardiology Department, University Hospital of Patras, 26504 Patras, Greece
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Li H, Xia N. Alcohol and the vasculature: a love-hate relationship? Pflugers Arch 2023:10.1007/s00424-023-02818-8. [PMID: 37165232 DOI: 10.1007/s00424-023-02818-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
Alcohol consumption is a leading risk factor and increases the risk of liver diseases, cancers, tuberculosis, and injuries. The relationship between alcohol use and cardiovascular risk is complex. While it is well established that heavy alcohol use and binge drinking harm cardiovascular health, the effect of light-to-moderate alcohol consumption remains controversial. Observational studies have repeatedly confirmed the U- or J-shaped relationship between alcohol consumption and cardiovascular disease risk, with the lowest risk observed in the light-to-moderate drinking group. However, the protective effect of low-level alcohol has been challenged by recent genetic epidemiological studies with Mendelian randomization. Such studies have their own limitations, and the application of this methodology in studying alcohol has been questioned. Results from the latest Global Burden of Diseases, Injuries, and Risk Factors Study suggest that the impact of alcohol consumption on health depends on the age structure and the distribution of disease burden and underlying causes in a given population. For young adults, even small amounts of alcohol cause heath loss. For older adults facing a high burden of cardiovascular diseases, light-to-moderate alcohol consumption may improve cardiovascular health outcomes. Mechanistically, all types of alcoholic beverages, including wine, spirits, and beer, have been shown to increase the levels of high-density lipoprotein cholesterol and adiponectin, and reduce the level of fibrinogen. Nonalcoholic components of wine, especially polyphenolic compounds like resveratrol, may additionally enhance endothelial nitric oxide production, and provide antioxidant and anti-inflammatory effects.
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Affiliation(s)
- Huige Li
- Department of Pharmacology, Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Ning Xia
- Department of Pharmacology, Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany
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Patel H, Patel UK, Chowdhury M, Assaf AD, Avanthika C, Nor MA, Rage M, Madapu A, Konatham S, Vodapally M, Bhat V, Gnawali A, Mohamed M, Abdi N, Malik FA, Zughaib M. Substance Use Disorders (SUDs) and Risk of Cardiovascular Disease (CVD) and Cerebrovascular Disease (CeVD): Analysis of the Nationwide Inpatient Sample (NIS) Database. Cureus 2023; 15:e39331. [PMID: 37351248 PMCID: PMC10284563 DOI: 10.7759/cureus.39331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Substance use continues to be on the rise in the United States and has been linked to new onset cardiovascular diseases (CVDs) and cerebrovascular disorders (CeVDs). We aimed to study the association between the types of substance use disorders (SUDs) with specific subtypes of CVDs and CeVDs among hospitalized patients using the National Inpatient Sample (NIS) Database. METHODS A retrospective study of the NIS database (2016-2017) using the ICD-10-CM codes was performed. The hospitalizations with a secondary diagnosis of SUDs were identified. Weighted univariate analysis using the Chi-square test and multivariate survey logistic regression analysis was performed to evaluate for the incidence, prevalence, and odds of association between vascular events and SUDs. RESULTS There were a total of 58,259,589 hospitalizations, out of which 21.42% had SUDs. SUDs were more common in the younger age group of 18-50, males, and the lower median household income group. We found a significant association of acute ischemic stroke (AIS) with amphetamine dependence (adjusted odds ratio, aOR 1.23, 95% confidence interval, CI 1.14-1.33), cocaine-related disorders (1.17, 1.12-1.23), and nicotine dependence (1.42, 1.40-1.43). There was a significant association between intracerebral hemorrhage with amphetamine dependence (2.58, 2.26-2.93), cocaine-related disorders (1.62, 1.46-1.79), and alcohol-related disorders (1.35, 1.01-1.82). The association of subarachnoid hemorrhage (SAH) was noted to be higher with amphetamine dependence (1.82, 1.48-2.24) and nicotine dependence (1.47, 1.39-1.55). The patients with nicotine dependence had greater odds of having a myocardial infarction (1.85, 1.83-1.87), those with cocaine-related disorders had higher odds of having angina pectoris (2.21, 1.86-2.62), and patients with alcohol-related disorders had higher odds of developing atrial fibrillation (1.14, 1.11-1.17) in comparison to non-SUDs. CONCLUSION Our study demonstrates the variability of CVD and CeVD in patients hospitalized for SUD. Findings from our study may help promote increased awareness and early management of these events. Further studies are needed to evaluate the specific effects of frequency and dose on the incidence and prevalence of CVD and CeVD in patients with SUD.
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Affiliation(s)
- Harshil Patel
- Cardiology, Ascension Providence Hospital, Southfield, USA
| | - Urvish K Patel
- Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Medhat Chowdhury
- Internal Medicine, Ascension Providence Hospital/MSUCHM, Southfield, USA
| | - Andrew D Assaf
- Cardiology, Ascension Providence Hospital, Southfield, USA
- Heart Institute, Ascension Providence Hospital, Southfield, USA
| | - Chaithanya Avanthika
- Pediatrics, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Mohammed A Nor
- Internal Medicine, Norman Bethune Health Science of Jilin University, Jilin, CHN
| | - Mohamed Rage
- Emergency Medicine, Northampton General Hospital, Northampton, GBR
| | | | - Sravani Konatham
- Internal Medicine, Kamineni Institute of Medical Sciences, Narketpalli, IND
| | | | - Vatsalya Bhat
- Internal Medicine, K. V. G. Medical College and Hospital, Sullia, IND
| | - Anupa Gnawali
- Family Medicine, University of Cape Town, Caledon Provincial Hospital, Caledon, ZAF
| | | | - Nawal Abdi
- Internal Medicine, Capital Medical University, Beijing, CHN
| | - Faizan A Malik
- Internal Medicine, Texas Tech University Health Sciences Center at Permian Basin, Odessa, USA
| | - Marcel Zughaib
- Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
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Larsen SB, Stephansen C, Mølgaard H. Syncope and Total Atrioventricular Block Associated With Alcohol Consumption in a Healthy Young Man. JACC: CASE REPORTS 2023; 11:101771. [PMID: 37077444 PMCID: PMC10106993 DOI: 10.1016/j.jaccas.2023.101771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 02/24/2023]
Abstract
Association between alcohol intake and atrioventricular block is rare. This case describes a previously healthy 27-year-old man experiencing syncopes preceded by moderate alcohol intake. An implantable loop recorder demonstrated episodes of total atrioventricular block coinciding with an additional syncope after alcohol intake, resulting in pacemaker implantation. (Level of Difficulty: Intermediate.).
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Haverkamp W, Sittner W, Haverkamp A, Knebel F. [Alternative treatment strategies for atrial fibrillation : Benefits from yoga?]. Herzschrittmacherther Elektrophysiol 2023; 34:59-65. [PMID: 36580092 PMCID: PMC9798365 DOI: 10.1007/s00399-022-00915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Atrial fibrillation, the most common sustained cardiac arrhythmia, is associated with significant morbidity, mortality, and healthcare utilization. Since the procedures used to treat atrial fibrillation have a number of limitations and risks, there is a growing interest in alternative treatment strategies for patients with atrial fibrillation. One such option is yoga. To date, only a few studies are available on its effect on atrial fibrillation. However, these suggest that yoga may indeed be able to reduce the frequency of the arrhythmia and its progression. The risk factors for atrial fibrillation and quality of life in affected patients are also positively affected. As adverse effects and complications are extremely rare with competent guidance, yoga may already be recommended now. However, further clinical studies are needed to provide recommendations that meet evidence-based criteria.
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Affiliation(s)
- Wilhelm Haverkamp
- Abteilung für Kardiologie und Metabolismus, Med. Klinik für Kardiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
- Klinik für Innere Medizin II: Schwerpunkt Kardiologie, Sana Klinikum Lichtenberg, Berlin, Deutschland.
- Kardiologie im Spreebogen, Berlin, Deutschland.
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Deutschland.
| | | | - Annika Haverkamp
- Fakultät für Medizin, Universität Regensburg, Regensburg, Deutschland
| | - Fabian Knebel
- Klinik für Innere Medizin II: Schwerpunkt Kardiologie, Sana Klinikum Lichtenberg, Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Akboga MK, Inanc IH, Keskin M, Sabanoglu C, Gorenek B. Current Evidence on Prevention of Atrial Fibrillation: Modifiable Risk Factors and the Effects of Risk Factor Intervention. Cardiol Rev 2023; 31:70-79. [PMID: 36735576 DOI: 10.1097/crd.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atrial fibrillation (AF) is one of the most encountered arrhythmias in clinical practice. It is also estimated that the absolute AF burden may increase by greater than 60% by 2050. It is inevitable that AF will become one of the largest epidemics in the world and may pose a major health problem for countries. Although AF rarely causes mortality in the acute period, it causes a significant increase in mortality and morbidity, including a fivefold increase in the risk of stroke, a twofold increase in dementia, and a twofold increase in myocardial infarction in the chronic period. Despite all the advances in the treatment of AF, it is better understood day by day that preventing AF may play a key role in reducing AF and its related complications. Modification of the main modifiable factors such as quitting smoking, abstaining from alcohol, changing eating habits, and exercise seems to be the first step in preventing AF. The strict adherence to the treatment process of secondary causes predisposing to AF such as DM, hypertension, obesity, and sleep apnea is another step in the prevention of AF. Both an individual approach and global public health campaigns can be highly beneficial to reduce the risk of AF. In this review, we aimed to summarize the current evidence on the relationship between modifiable risk factors and AF, and the impact of possible interventions on these factors in preventing or reducing the AF burden in the light of recently published guidelines and studies.
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Affiliation(s)
- Mehmet Kadri Akboga
- From the Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ibrahim Halil Inanc
- Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Bahcesehir University Faculty of Medicine, Istanbul, Turkey
| | - Cengiz Sabanoglu
- Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Bulent Gorenek
- Department of Cardiology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
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Ezeani M, Prabhu S. PI3K(p110α) as a determinant and gene therapy for atrial enlargement in atrial fibrillation. Mol Cell Biochem 2023; 478:471-490. [PMID: 35900667 PMCID: PMC9938077 DOI: 10.1007/s11010-022-04526-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation (AF) is an irregular heart rhythm, characterised by chaotic atrial activation, which is promoted by remodelling. Once initiated, AF can also propagate the progression of itself in the so-called ''AF begets AF''. Several lines of investigation have shown that signalling molecules, including reactive oxygen species, angiotensin II, and phosphoinositide 3-kinases (PI3Ks), in presence or absence of cardiovascular disease risk factors, stabilise and promote AF maintenance. In particular, reduced cardiac-specific PI3K activity that is not associated with oncology is cardiotoxic and increases susceptibility to AF. Atrial-specific PI3K(p110α) transgene can cause pathological atrial enlargement. Highlighting the crucial importance of the p110α protein in a clinical problem that currently challenges the professional health care practice, in over forty (40) transgenic mouse models of AF (Table1), currently existing, of which some of the models are models of human genetic disorders, including PI3K(p110α) transgenic mouse model, over 70% of them reporting atrial size showed enlarged, greater atrial size. Individuals with minimal to severely dilated atria develop AF more likely. Left atrial diameter and volume stratification are an assessment for follow-up surveillance to detect AF. Gene therapy to reduce atrial size will be associated with a reduction in AF burden. In this overview, PI3K(p110α), a master regulator of organ size, was investigated in atrial enlargement and in physiological determinants that promote AF.
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Affiliation(s)
- Martin Ezeani
- NanoBiotechnology Laboratory, Central Clinical School, Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, 3004, Australia.
| | - Sandeep Prabhu
- The Alfred, and Baker Heart and Diabetes Institute, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
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Butler T, Cowie A, McHale S, Horne S, O'Reilly M, Meelu OA, Ahmed F, Kirresh A, Thomson RJ, Brown J, Ahmad M, Lambiase PD, Manmathan GPR, Morselli F, Dawkes S. Interventions for alcohol cessation in people with atrial fibrillation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023. [PMCID: PMC9924033 DOI: 10.1002/14651858.cd015004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of interventions for alcohol cessation compared to usual treatment for people with atrial fibrillation.
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Affiliation(s)
| | - Tom Butler
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkUK
| | - Aynsley Cowie
- Cardiac Rehabilitation, Lister CenterUniversity Hospital CrosshouseKilmarnockUK
| | - Sheona McHale
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Sebastian Horne
- Department of CardiologyRussells Hall Hospital (The Dudley Group NHS Trust)DudleyUK
| | - Michelle O'Reilly
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | | | - Fareed Ahmed
- ITU DepartmentQueen Elizabeth the Queen Mother Hospital, East Kent Hospitals University Foundation TrustMargateUK
| | - Ali Kirresh
- Department of CardiologyRoyal Free Hospital, Royal Free London NHS Foundation TrustLondonUK
| | - Ross J Thomson
- William Harvey Research InstituteBarts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondonUK
| | - James Brown
- Department of CardiologyRoyal Free Hospital, Royal Free London NHS Foundation TrustLondonUK
| | - Mahmood Ahmad
- Department of CardiologyRoyal Free Hospital, Royal Free London NHS Foundation TrustLondonUK
| | - Pier D Lambiase
- Centre for Cardiology in the YoungThe Heart Hospital, University College London HospitalsLondonUK
| | - Gavin Paul Raphael Manmathan
- Department of CardiologyRoyal Free Hospital, Royal Free London NHS Foundation TrustLondonUK,Institute of Cardiovascular SciencesUniversity College LondonLondonUK
| | - Franca Morselli
- School of Cardiovascular Medicine and SciencesKing's College LondonLondonUK
| | - Susan Dawkes
- School of Nursing, Midwifery and Paramedic PracticeRobert Gordon UniversityAberdeenUK
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Chentsova VO, Bravo AJ, Pilatti A, Pautassi RM, Mezquita L, Hogarth L, Team CCAS. Age of First Use, Age of Habitual Use, and Problematic Alcohol Use: a Cross-cultural Examination Among Young Adults in Seven Countries. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Deng CY, Zou AL, Sun L, Ji Y. Development and Validation of a Postoperative Prognostic Nomogram to Predict Recurrence in Patients with Persistent Atrial Fibrillation: A Retrospective Cohort Study. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2023. [DOI: 10.15212/cvia.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Background: Patients with persistent atrial fibrillation (PsAF) have a high risk of recurrence after catheter radiofrequency ablation. Nevertheless, no effective prognostic tools have been developed to identify these high-risk patients to date. This study sought to develop and validate a simple linear predictive model for predicting postoperative recurrence in patients with PsAF.
Methods: From June 2013 to June 2021, patients with PsAF admitted to our hospital were enrolled in this single-center, retrospective, observational study. The characteristics substantially associated with recurrence in patients with PsAF were screened through univariate and multivariate logistic regression analysis. The receiver operating characteristic curve was used to assess the predictive significance of the nomogram model after nomogram development. Furthermore, to assess the clinical value of the nomogram, we performed calibration curve and decision curve analyses.
Results: A total of 209 patients were included in the study, 42 (20.10%) of whom were monitored up to 1 year for recurrent AF. The duration of AF episodes, left atrial diameter, BMI, CKMB, and alcohol consumption were found to be independent risk factors (P<0.05) and were integrated into the nomogram model development. The area under the curve was 0.895, the sensitivity was 93.3%, and the specificity was 71.4%, thus indicating the model’s excellent predictive ability. The C-index of the predictive nomogram model was 0.906. Calibration curve and decision curve analyses further revealed that the model had robust prediction and strong discrimination ability.
Conclusion: This simple, practical, and innovative nomogram can help clinicians in evaluation of the risk of PsAF recurrence after catheter ablation, thus facilitating preoperative evaluation, postoperative monitoring and ultimately the construction of more personalized therapeutic protocols.
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Affiliation(s)
- Cong-Ying Deng
- Department of Cardiovascular Medicine, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Ai-Lin Zou
- Department of Cardiovascular Medicine, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Ling Sun
- Department of Cardiovascular Medicine, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Yuan Ji
- Department of Cardiovascular Medicine, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
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Learning high-order interactions for polygenic risk prediction. PLoS One 2023; 18:e0281618. [PMID: 36763605 PMCID: PMC9916647 DOI: 10.1371/journal.pone.0281618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
Within the framework of precision medicine, the stratification of individual genetic susceptibility based on inherited DNA variation has paramount relevance. However, one of the most relevant pitfalls of traditional Polygenic Risk Scores (PRS) approaches is their inability to model complex high-order non-linear SNP-SNP interactions and their effect on the phenotype (e.g. epistasis). Indeed, they incur in a computational challenge as the number of possible interactions grows exponentially with the number of SNPs considered, affecting the statistical reliability of the model parameters as well. In this work, we address this issue by proposing a novel PRS approach, called High-order Interactions-aware Polygenic Risk Score (hiPRS), that incorporates high-order interactions in modeling polygenic risk. The latter combines an interaction search routine based on frequent itemsets mining and a novel interaction selection algorithm based on Mutual Information, to construct a simple and interpretable weighted model of user-specified dimensionality that can predict a given binary phenotype. Compared to traditional PRSs methods, hiPRS does not rely on GWAS summary statistics nor any external information. Moreover, hiPRS differs from Machine Learning-based approaches that can include complex interactions in that it provides a readable and interpretable model and it is able to control overfitting, even on small samples. In the present work we demonstrate through a comprehensive simulation study the superior performance of hiPRS w.r.t. state of the art methods, both in terms of scoring performance and interpretability of the resulting model. We also test hiPRS against small sample size, class imbalance and the presence of noise, showcasing its robustness to extreme experimental settings. Finally, we apply hiPRS to a case study on real data from DACHS cohort, defining an interaction-aware scoring model to predict mortality of stage II-III Colon-Rectal Cancer patients treated with oxaliplatin.
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Vandenberk B, Altieri MH, Liu H, Raj SR, Lee SS. Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension. Aliment Pharmacol Ther 2023; 57:290-303. [PMID: 36571829 DOI: 10.1111/apt.17368] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/16/2022] [Accepted: 12/08/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia and its management in cirrhosis can be challenging due to the altered hepatic metabolism of medications and increased risk of bleeding. AIMS To provide a comprehensive overview of the diagnosis, pathophysiology and management of AF in patients with cirrhosis from both a cardiology and a hepatology perspective. METHODS An extensive literature search was performed using the terms 'atrial fibrillation' and 'cirrhosis'. Guideline documents and consensus statements were explored. RESULTS The prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, while the incidence of new-onset AF in the post-operative period after liver transplant ranged between 6.8% and 10.2%. AF in patients with cirrhosis is associated with adverse outcomes in both pre-transplant and post-transplant settings, including an increased risk of stroke when compared to the general population. We review the pathogenesis of AF in general and in cirrhosis. This review also provides guidance on the management of AF, including the use of anticoagulation and rate versus rhythm control. In the absence of strict contraindications, all patients with cirrhosis and AF should be anticoagulated. The use of DOACs is preferred over vitamin K antagonists. In patients with a high bleeding risk, a DOAC with an approved antidote may be preferred. CONCLUSIONS Atrial fibrillation is increased in patients with cirrhosis. AF management requires careful consideration of treatment options. Since patients with cirrhosis were excluded from all major randomised clinical trials, dedicated research on the pathophysiology and management of AF in cirrhosis is needed.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Mario H Altieri
- Division of Gastroenterology, Hepatology and Nutrition, CHU Caen, Caen, France
| | - Hongqun Liu
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samuel S Lee
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Mirijello A, Sestito L, Antonelli M, Gasbarrini A, Addolorato G. Identification and management of acute alcohol intoxication. Eur J Intern Med 2023; 108:1-8. [PMID: 35985955 DOI: 10.1016/j.ejim.2022.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/03/2022] [Accepted: 08/11/2022] [Indexed: 02/07/2023]
Abstract
Acute alcohol intoxication (AAI) is a harmful clinical condition, potentially life-threatening, secondary to the intake of large amounts of alcohol. Clinical manifestations of AAI are characterized by behavioural and neurological symptoms, even if its effects involve several organs and apparatus. Moreover, severe alcohol intoxication can produce a global neurological impairment leading to autonomic dysfunction, respiratory depression, coma and cardiac arrest. The evaluation of blood alcohol concentrations (BAC) is useful to confirm the suspicion of intoxication, both for clinical and legal reasons. Most of patients with AAI are referred to Emergency Departments due to behavioural, social, traumatic or clinical complications. Patient's stabilization is the first step in the management of AAI, in order to support vital functions and to prevent complications. Metadoxine represents a useful drug to increase ethanol metabolism and elimination. Given that AAI could represent a sentinel event of chronic alcohol abuse, patients presenting with acute intoxication should be screened for the presence of an underlying alcohol use disorder and referred to and an alcohol addiction unit to start a multidisciplinary treatment to achieve long term alcohol abstinence. The present review will focus on clinical features, diagnostic criteria and treatment strategies of AAI.
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Affiliation(s)
- Antonio Mirijello
- Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Luisa Sestito
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Mariangela Antonelli
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Giovanni Addolorato
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy.
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Wong CX, Tu SJ, Marcus GM. Alcohol and Arrhythmias. JACC Clin Electrophysiol 2023; 9:266-279. [PMID: 36858701 DOI: 10.1016/j.jacep.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/12/2022] [Indexed: 03/03/2023]
Abstract
The association between alcohol consumption and abnormalities of heart rate and rhythm has long been recognized. Significant attention has focused on the risk of atrial fibrillation (AF) and sudden cardiac death (SCD) with excessive alcohol intake. Recent studies have advanced our understanding of these relationships and provided additional insights into potentially arrhythmogenic mechanisms. However, considerable uncertainty remains, such as the level of consumption at which harm begins and whether alcohol plays a role in other arrhythmias. This review characterizes the spectrum of conduction abnormalities and heart rhythm disorders in relation to alcohol consumption. In addition, it discusses the latest epidemiologic and experimental evidence, the potential importance of beverage type and constituent ingredients, and conflicting information on drink definitions, thresholds, and recommendations.
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Affiliation(s)
- Christopher X Wong
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA; Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Gregory M Marcus
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
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Chung JW, Lee SR, Choi EK, Park SH, Lee H, Choi J, Han M, Ahn HJ, Kwon S, Lee S, Han K, Kim S, Oh S, Lip GYH. Cumulative Alcohol Consumption Burden and the Risk of Stroke in Young Adults: A Nationwide Population-Based Study. Neurology 2023; 100:e505-e515. [PMID: 36323515 PMCID: PMC9931082 DOI: 10.1212/wnl.0000000000201473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/12/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Alcohol consumption is one of the important modifiable risk factors for stroke in young adults. The association between the cumulative burden of alcohol consumption and its impact on incident stroke in young adults is unknown. We aimed to investigate the association between cumulative alcohol burden and the risk for stroke among young adults. METHODS Using data from the Korean National Health Insurance Service database, patients age between 20 and 39 years, who underwent 4 consecutive annual health examinations between 2009 and 2012, were included. The cumulative alcohol burden score of moderate-to-heavy drinking was evaluated by assigning a score of 1 for alcohol consumption ≥105 g/wk at the health examination each year and calculating the sum of 4 years (0-4). The main outcome was incident stroke and its subtypes, ischemic stroke, and hemorrhagic stroke during the follow-up period. RESULTS Of 1 536 668 patients (mean age of 29.5 years, 71.5% male, and median follow-up of 6-year), 3 153 experienced an incident stroke (incidence rate, 0.37 per 1,000 person-years). After multivariable adjustment, patients with alcohol burden scores of 2, 3, and 4, who consumed more than 105 g/wk of alcohol for 2, 3, and 4 years, demonstrated significantly higher risks for stroke (hazard ratio [HR] 1.19, 95% CI 1.05-1.34 for 2; HR 1.22, 95% CI 1.09-1.38 for 3; HR 1.23, 95% CI 1.10-1.38 for 4) compared with those with a burden score of 0. This positive dose-response relationship was primarily driven by hemorrhagic rather than ischemic stroke. High alcohol burden scores (i.e., 2, 3, and 4) were significantly associated with higher risks for hemorrhagic stroke (HR 1.30, 95% CI 1.10-1.54 for 2; HR 1.42, 95% CI 1.21-1.67 for 3; HR 1.36, 95% CI 1.16-1.59 for 4) compared with a burden score of 0. DISCUSSION Young adults who engaged in moderate-to-heavy drinking demonstrated a higher risk for incident stroke, especially hemorrhagic stroke. Reducing alcohol consumption should be emphasized in young adults with heavy drinking habits as part of any stroke prevention strategy.
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Affiliation(s)
- Jae-Wook Chung
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - So-Ryoung Lee
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Eue-Keun Choi
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark.
| | - Sang-Hyeon Park
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - HuiJin Lee
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - JungMin Choi
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark.
| | - Minju Han
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Hyo-Jeong Ahn
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Soonil Kwon
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - SeungWoo Lee
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Kyungdo Han
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Sunhwa Kim
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Seil Oh
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Gregory Y H Lip
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
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Brilliant J, Yadav R, Akhtar T, Calkins H, Trayanova N, Spragg D. Clinical and Structural Factors Affecting Ablation Outcomes in Atrial Fibrillation Patients - A Review. Curr Cardiol Rev 2023; 19:83-96. [PMID: 36999694 PMCID: PMC10518883 DOI: 10.2174/1573403x19666230331103153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 04/01/2023] Open
Abstract
Catheter ablation is an effective and durable treatment option for patients with atrial fibrillation (AF). Ablation outcomes vary widely, with optimal results in patients with paroxysmal AF and diminishing results in patients with persistent or long-standing persistent AF. A number of clinical factors including obesity, hypertension, diabetes, obstructive sleep apnea, and alcohol use contribute to AF recurrence following ablation, likely through modulation of the atrial electroanatomic substrate. In this article, we review the clinical risk factors and the electro-anatomic features that contribute to AF recurrence in patients undergoing ablation for AF.
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Affiliation(s)
- Justin Brilliant
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Ritu Yadav
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Tauseef Akhtar
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Natalia Trayanova
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - David Spragg
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
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Haas EA, Saad MJA, Santos A, Vitulo N, Lemos WJF, Martins AMA, Picossi CRC, Favarato D, Gaspar RS, Magro DO, Libby P, Laurindo FRM, Da Luz PL. A red wine intervention does not modify plasma trimethylamine N-oxide but is associated with broad shifts in the plasma metabolome and gut microbiota composition. Am J Clin Nutr 2022; 116:1515-1529. [PMID: 36205549 PMCID: PMC9761755 DOI: 10.1093/ajcn/nqac286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/16/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gut microbiota profiles are closely related to cardiovascular diseases through mechanisms that include the reported deleterious effects of metabolites, such as trimethylamine N-oxide (TMAO), which have been studied as diagnostic and therapeutic targets. Moderate red wine (RW) consumption is reportedly cardioprotective, possibly by affecting the gut microbiota. OBJECTIVES To investigate the effects of RW consumption on the gut microbiota, plasma TMAO, and the plasma metabolome in men with documented coronary artery disease (CAD) using a multiomics assessment in a crossover trial. METHODS We conducted a randomized, crossover, controlled trial involving 42 men (average age, 60 y) with documented CAD comparing 3-wk RW consumption (250 mL/d, 5 d/wk) with an equal period of alcohol abstention, both preceded by a 2-wk washout period. The gut microbiota was analyzed via 16S rRNA high-throughput sequencing. Plasma TMAO was evaluated by LC-MS/MS. The plasma metabolome of 20 randomly selected participants was evaluated by ultra-high-performance LC-MS/MS. The effect of RW consumption was assessed by individual comparisons using paired tests during the abstention and RW periods. RESULTS Plasma TMAO did not differ between RW intervention and alcohol abstention, and TMAO concentrations showed low intraindividual concordance over time, with an intraclass correlation coefficient of 0.049 during the control period. After RW consumption, there was significant remodeling of the gut microbiota, with a difference in β diversity and predominance of Parasutterella, Ruminococcaceae, several Bacteroides species, and Prevotella. Plasma metabolomic analysis revealed significant changes in metabolites after RW consumption, consistent with improved redox homeostasis. CONCLUSIONS Modulation of the gut microbiota may contribute to the putative cardiovascular benefits of moderate RW consumption. The low intraindividual concordance of TMAO presents challenges regarding its role as a cardiovascular risk biomarker at the individual level. This study was registered at clinical trials.gov as NCT03232099.
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Affiliation(s)
- Elisa A Haas
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mario J A Saad
- Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Andrey Santos
- Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Nicola Vitulo
- Department of Biotechnology, Verona University, Verona, Italy
| | - Wilson J F Lemos
- Bioresources Unit, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Tulln, Austria
| | - Aline M A Martins
- Department of Medical Science, University of Brasília (UnB), Brasília, Brazil
| | | | - Desidério Favarato
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato S Gaspar
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniéla O Magro
- Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Francisco R M Laurindo
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Protasio L Da Luz
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Lin AL, Nah G, Tang JJ, Vittinghoff E, Dewland TA, Marcus GM. Cannabis, cocaine, methamphetamine, and opiates increase the risk of incident atrial fibrillation. Eur Heart J 2022; 43:4933-4942. [PMID: 36257330 DOI: 10.1093/eurheartj/ehac558] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is now regarded as a preventable disease, requiring a search for modifiable risk factors. With legalization of cannabis and more lenient laws regarding the use of other illicit substances, investigation into the potential effects of methamphetamine, cocaine, opiate, and cannabis exposure on incident AF is needed. METHODS AND RESULTS Using Office of Statewide Health Planning and Development databases, a longitudinal analysis was performed of adult Californians ≥18 years of age who received care in an emergency department, outpatient surgery facility, or hospital from 1 January 2005 to 31 December 2015. Associations between healthcare coding for the use of each substance and a new AF diagnosis were assessed. Among 23,561,884 patients, 98 271 used methamphetamine, 48 701 used cocaine, 10 032 used opiates, and 132 834 used cannabis. Of the total population, 998 747 patients (4.2%) developed incident AF during the study period. After adjusting for potential confounders and mediators, use of methamphetamines, cocaine, opiates, and cannabis was each associated with increased incidence of AF: hazard ratios 1.86 [95% confidence interval (CI) 1.81-1.92], 1.61 (95% CI 1.55-1.68), 1.74 (95% CI 1.62-1.87), and 1.35 (95% CI 1.30-1.40), respectively. Negative control analyses in the same cohort failed to reveal similarly consistent positive relationships. CONCLUSION Methamphetamine, cocaine, opiate, and cannabis uses were each associated with increased risk of developing incident AF. Efforts to mitigate the use of these substances may represent a novel approach to AF prevention.
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Affiliation(s)
- Anthony L Lin
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Gregory Nah
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Janet J Tang
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Thomas A Dewland
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Yan J, Ai X. Holiday Heart Syndrome, Atrial Fibrillation, and RyR2 Antagonist. J Cardiovasc Pharmacol 2022; 80:636-638. [PMID: 35976144 PMCID: PMC10508393 DOI: 10.1097/fjc.0000000000001352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Holiday Heart Syndrome (HHS) refers to binge alcohol-associated cardiac arrhythmia of which atrial fibrillation (AF) being the most occurred arrhythmia type. Excessive alcohol consumption is a serious public health and economic issue in the US and globally. Despite a tremendous education effort, binge drinking among the population of young and older adults continues to rise. During this current COVID-19 pandemic, social isolation has significantly increased alcohol consumption nationwide. In this issue, Greco et al. reported a straightforward study on the role of RyR2 dysfunction in binge alcohol-evoked AF using an HHS rat model, and evaluated the anti-AF potential of dantrolene, an RyR channel blocker. However, further investigations including off-target effects of dantrolene and therapeutic potential of other RyR2 blockers in AF are needed.
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Affiliation(s)
- Jiajie Yan
- Department of Physiology and Cell Biology, College of Medicine/Wexner
Medical Center, 5078 Graves Hall, 333 W. 10th Avenue, Columbus, Ohio 43210
USA
| | - Xun Ai
- Department of Physiology and Cell Biology, College of Medicine/Wexner
Medical Center, 5078 Graves Hall, 333 W. 10th Avenue, Columbus, Ohio 43210
USA
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Jiang H, Mei X, Jiang Y, Yao J, Shen J, Chen T, Zhou Y. Alcohol consumption and atrial fibrillation risk: An updated dose-response meta-analysis of over 10 million participants. Front Cardiovasc Med 2022; 9:979982. [PMID: 36247447 PMCID: PMC9561500 DOI: 10.3389/fcvm.2022.979982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe treatment of atrial fibrillation (AF) has made significant progress, but the prevention of AF has not received the attention it deserves. A few recent large-sized studies have conducted dose response analysis and reported different conclusions from previous studies on alcohol consumption and AF risk.ObjectivesThe aim of this study is to examine the potential non-linear association between alcohol consumption and risk of AF and explore the potential differences of gender.MethodsIn this updated dose-response meta-analysis, PubMed, Embase and Cochrane databases were searched until June 2022. Risk estimates were reported as relative risk (RR) with 95% confidence intervals (CIs). The random-effects restricted cubic spline models are used to evaluate the potential non-linear association between alcohol consumption and AF risk.ResultsA total of 10,151,366 participants with 214,365 cases of AF enrolled in 13 prospective studies. The overall meta-analysis showed that a 1 drink/day increase in alcohol consumption increased the risk of AF by 6% (RR: 1.06; 95% CI: 1.03–1.08). In gender subgroup analysis, pooled results were different between men (RR: 1.08; 95% CI: 1.05–1.11) and women (RR: 1.05; 95% CI: 0.96–1.14). A linear relationship between alcohol consumption and risk of AF was found in men (p = 0.87) while a J-shaped curve was observed in women (p = 0.00). Regional subgroup analysis yielded broadly comparable results in Americas (RR: 1.07; 95% CI: 1.03–1.12), Europe (RR: 1.04; 95% CI: 0.99–1.1) and Asia (RR: 1.07; 95% CI: 0.99–1.14).ConclusionThe relationship between AF risk and alcohol consumption is linear in men, while a potential non-linear J-shaped relationship is shown in women.Condensed abstractWe conducted a dose-response meta-analysis on the relationship between alcohol consumption and risk of atrial fibrillation. We merged the data of over 10 million participants and found gender differences in the pattern of association with AF and alcohol consumption. The relationship between AF risk and alcohol consumption is linear in men, while a potential non-linear J-shaped relationship is shown in women. In summary, this research is vital in furthering our understanding of the role of alcohol consumption in new-onset AF, especially among different genders.
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Evbayekha EO, Nriagu BN, Alugba G, Okobi OE, Okorare O, Nsofor G, Ngoladi IA, Igweike C, Boms MG, Onyechi NP, Abubakar AM, Olamilehin E, Afolabi AR, Udo UA, Ohikhuai EE. Percutaneous Coronary Intervention Outcomes Among Patients With Alcoholic Cardiomyopathy: An Analysis of the National Inpatient Sample. Cureus 2022; 14:e29490. [PMID: 36312622 PMCID: PMC9595240 DOI: 10.7759/cureus.29490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction High consumption of alcohol has an enormous toll on the health status of individuals. A direct affectation of cardiac integrity concerns cardiologists, primary care physicians, and the healthcare system because this increases the disease burden. Alcoholic cardiomyopathy (ACM) results from the enormous consumption of alcohol over a long period of time. The prevalence varies between regions and sex and ranges between 4% and 40%. Viewing the entire spectrum of cardiomyopathies, ACM makes up about 4% of all cardiomyopathies. However, it causes dilated-type cardiomyopathy and is the second most common cause of dilated cardiomyopathy. We sought to explore the outcomes of percutaneous coronary intervention (PCI) among patients with ACM. Methods This was a retrospective, cross-sectional study of the National Inpatient Sample (NIS) for hospital discharges in the United States between 2012 and 2014. We identified the number of patients with a primary or secondary diagnosis of ACM using the International Classification of Diseases, Ninth Revision (ICD-9) code of 4.255. Using the ICD-9 codes for PCI (00.66, 36.01, 36.02, 36.05, 36.06, 36.07, and 17.55), we identified patients diagnosed with ACM who underwent a PCI (ACPCI). The racial and sexual prevalence, hospital length of stay (LOS), mortality, cost of hospitalization, and cardiovascular outcomes (ventricular fibrillation (VF) and atrial fibrillation (AF)) were compared between patients with and without ACM who underwent a PCI. Results A total of 2,488,293 PCIs were performed between 2012 and 2014. Of these, there were a total of 161 admissions for ACM. About 93% (151) of the ACM PCI group were men. Ethnic distribution revealed a majority of Caucasians with 69% (98), and blacks and Asians at 13.4% (19) and 11.3% (16), respectively. The mean age was 59.8 (SD = 9). The patients with ACPCI were likely to stay longer in the hospital, with an average stay of 6.6 days (SD = 6.2) compared to patients without ACM undergoing PCI (NOACPCI) (3.7 days; SD = 5.0) (p = 0.0001). The mean cost of hospital admission for patients with ACPCI was $120,225 (SD = 101,044), while that of those without ACM who underwent PCI (NOACPCI) was $87,936 (SD = 83,947) (p = 0.0001). A higher death rate during hospitalization (3.7%) was recorded in the ACPCI category vs. 2.3% in patients without ACM who underwent PCI (p = 0.0001). Patients with ACPCI had a higher prevalence of AF (30.4%) than VF (7.5%). Conclusion The ACPCI group had overall poorer hospital outcomes. The majority affected were older Caucasian men with an increased prevalence of AF, higher cost of hospitalization, and longer hospital stays. Further studies are needed to explore the burden of long-term alcohol consumption on cardiovascular disease treatment outcomes.
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Han M, Lee SR, Choi EK, Choi J, Chung J, Park SH, Lee H, Ahn HJ, Kwon S, Lee SW, Han KD, Oh S, Lip GYH. Habitual Alcohol Intake and Risk of Atrial Fibrillation in Young Adults in Korea. JAMA Netw Open 2022; 5:e2229799. [PMID: 36053532 PMCID: PMC9440398 DOI: 10.1001/jamanetworkopen.2022.29799] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Guidelines recommend that all risk factors for early-onset atrial fibrillation, including lifestyle factors, be proactively managed, considering the poor prognosis of the disease. Not much is known about the association of cumulative alcohol intake with the risk of atrial fibrillation in young adults aged 20 to 39 years, especially among heavy drinkers. OBJECTIVE To explore the association of alcohol consumption with the risk of incident atrial fibrillation in young adults. DESIGN, SETTING, AND PARTICIPANTS Using the National Health Insurance Service database, a nationwide population-based cohort study of adults aged 20 to 39 years without prior atrial fibrillation who underwent 4 serial annual health examinations between 2009 and 2012 was conducted. The cumulative alcohol consumption burden over 4 years was calculated by assigning 1 point to more than moderate drinking (≥105 g of alcohol per week) each year. Additionally, a semiquantitative cumulative burden was calculated by assigning 0, 1, 2, and 3 points to non, mild (<105 g per week), moderate (105-210 g per week), and heavy (≥210 g per week) drinking, respectively. Data were analyzed from May to June 2021. EXPOSURE Amount of alcohol intake in 4 years. MAIN OUTCOMES AND MEASURES The primary outcome was incident atrial fibrillation during the follow-up period. RESULTS A total of 1 537 836 participants (mean [SD] age 29.5 [4.1] years, 1 100 099 [71.5%] male) were included in the final analysis. According to the 4-year cumulative burden of alcohol consumption stratified by moderate to heavy drinking, 889 382 participants (57.8%) were in the burden 0 group, 203 374 participants (13.2%) in the burden 1 group, 148 087 participants (9.6%) in the burden 2 group, 144 023 participants (9.4%) in the burden 3 group, and 152 970 participants (9.9%) in the burden 4 group. During a median (IQR) follow-up of 6.13 (4.59-6.48) years, atrial fibrillation was newly diagnosed in 3066 participants (0.36 per 1000 person-years). Participants with a cumulative burden of 4 points who continued more than moderate drinking for 4 years showed a 25% higher risk of atrial fibrillation compared with 0-point participants who kept non-to-mild drinking over 4 years (adjusted HR, 1.25; 95% CI, 1.12-1.40). In a semiquantitative analysis, participants who sustained heavy drinking for 4 consecutive years were associated with a 47% higher atrial fibrillation risk than those who remained nondrinkers over 4 years (aHR, 1.47, CI 1.18-1.83). CONCLUSIONS AND RELEVANCE Persistent moderate to heavy drinking and higher cumulative alcohol consumption burden might increase the risk of atrial fibrillation even in young adults aged 20 to 39 years.
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Affiliation(s)
- Minju Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaewook Chung
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hyeon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - HuiJin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Woo Lee
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y. H. Lip
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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