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Piechocki M, Przewłocki T, Pieniążek P, Trystuła M, Podolec J, Kabłak-Ziembicka A. A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients-A Review PART II-Pharmacological Approach for Management of Elderly Patients with Peripheral Atherosclerotic Lesions outside Coronary Territory. J Clin Med 2024; 13:1508. [PMID: 38592348 PMCID: PMC10934701 DOI: 10.3390/jcm13051508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/23/2024] [Accepted: 03/03/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Aging is a key risk factor for atherosclerosis progression that is associated with increased incidence of ischemic events in supplied organs, including stroke, coronary events, limb ischemia, or renal failure. Cardiovascular disease is the leading cause of death and major disability in adults ≥ 75 years of age. Atherosclerotic occlusive disease affects everyday activity, quality of life, and it is associated with reduced life expectancy. As most multicenter randomized trials exclude elderly and very elderly patients, particularly those with severe comorbidities, physical or cognitive dysfunctions, frailty, or residence in a nursing home, there is insufficient data on the management of older patients presenting with atherosclerotic lesions outside coronary territory. This results in serious critical gaps in knowledge and a lack of guidance on the appropriate medical treatment. In addition, due to a variety of severe comorbidities in the elderly, the average daily number of pills taken by octogenarians exceeds nine. Polypharmacy frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and non-adherence. Therefore, we have attempted to gather data on the medical treatment in patients with extra-cardiac atherosclerotic lesions indicating where there is some evidence of the management in elderly patients and where there are gaps in evidence-based medicine. Public PubMed databases were searched to review existing evidence on the effectiveness of lipid-lowering, antithrombotic, and new glucose-lowering medications in patients with extra-cardiac atherosclerotic occlusive disease.
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Affiliation(s)
- Marcin Piechocki
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
- Department of Interventional Cardiology, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland;
| | - Piotr Pieniążek
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
| | - Mariusz Trystuła
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
| | - Jakub Podolec
- Department of Interventional Cardiology, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland;
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland
| | - Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland
- Noninvasive Cardiovascular Laboratory, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland
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Piechocki M, Przewłocki T, Pieniążek P, Trystuła M, Podolec J, Kabłak-Ziembicka A. A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients-A Review: Part I-Epidemiology, Risk Factors, and Atherosclerosis-Related Diversities in Elderly Patients. J Clin Med 2024; 13:1471. [PMID: 38592280 PMCID: PMC10935176 DOI: 10.3390/jcm13051471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Atherosclerosis is a generalized and progressive disease. Ageing is a key risk factor for atherosclerosis progression that is associated with the increased incidence of ischemic events in supplied organs, including stroke, coronary events, limb ischemia, or renal failure. Cardiovascular disease is the leading cause of death and major disability in adults ≥ 75 years of age. Atherosclerotic occlusive disease affects everyday activity and quality of life, and it is associated with reduced life expectancy. Although there is evidence on coronary artery disease management in the elderly, there is insufficient data on the management in older patients presented with atherosclerotic lesions outside the coronary territory. Despite this, trials and observational studies systematically exclude older patients, particularly those with severe comorbidities, physical or cognitive dysfunctions, frailty, or residence in a nursing home. This results in serious critical gaps in knowledge and a lack of guidance on the appropriate medical treatment and referral for endovascular or surgical interventions. Therefore, we attempted to gather data on the prevalence, risk factors, and management strategies in patients with extra-coronary atherosclerotic lesions.
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Affiliation(s)
- Marcin Piechocki
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
- Department of Interventional Cardiology, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland;
| | - Piotr Pieniążek
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland;
| | - Mariusz Trystuła
- Department of Vascular and Endovascular Surgery, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland; (M.P.); (P.P.); (M.T.)
| | - Jakub Podolec
- Department of Interventional Cardiology, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland;
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland
| | - Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Krakow, Poland
- Noninvasive Cardiovascular Laboratory, The St. John Paul II Hospital, Prądnicka 80, 31-202 Krakow, Poland
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Yi J, Wang L, Guo X, Ren X. Association between 5-year change in cardiovascular risk and the incidence of atherosclerotic cardiovascular diseases: a multi-cohort study. J Transl Med 2023; 21:589. [PMID: 37660053 PMCID: PMC10475181 DOI: 10.1186/s12967-023-04488-7] [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: 05/02/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The influence of the historical cardiovascular risk status on future risk of atherosclerotic cardiovascular disease (ASCVD) is poorly understood. We aimed to investigate the association between 5-year changes in cardiovascular risk and ASCVD incidence. METHODS We analyzed pooled data from seven community-based prospective cohort studies with up to 20 years of follow-up data. The study populations included White or Black participants aged 40-75 years without prevalent ASCVD. Cardiovascular risk was assessed using the pooled cohort equation and was categorized into non-high (< 20%) or high risk (≥ 20%). Changes in cardiovascular disease (CVD) risk over a 5-year interval were recorded. The main outcome was incident ASCVD. RESULTS Among 11,026 participants (mean [SD] age, 60.0 [8.1] years), 4272 (38.7%) were female and 3127 (28.4%) were Black. During a median follow-up period of 9.9 years, 2560 (23.2%) ASCVD events occurred. In comparison with individuals showing a consistently high CVD risk, participants whose CVD risk changed from non-high to high (hazard ratio [HR], 0.67; 95% confidence interval [CI] 0.59-0.77) or high to non-high (HR, 0.57; 95% CI 0.41-0.80) and those with a consistently non-high risk (HR, 0.33; 95% CI 0.29-0.37) had a lower risk of incident ASCVD. In comparison with individuals showing a consistently non-high CVD risk, participants whose CVD risk changed from high to non-high (HR, 1.74; 95% CI 1.26-2.41) or from non-high to high risk (HR, 2.04; 95% CI 1.84-2.27) and those with a consistently high risk (HR 3.03; 95% CI 2.69-3.42) also showed an increased risk of incident ASCVD. CONCLUSIONS Individuals with the same current CVD risk status but different historical CVD risks exhibited varying risks of future ASCVD incidents. Dynamic risk evaluation may enable more accurate cardiovascular risk stratification, and decision-making regarding preventive interventions should take the historical risk status into account.
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Affiliation(s)
- Jiayi Yi
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lili Wang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xinli Guo
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xiangpeng Ren
- Department of Biochemistry, Medical College, Jiaxing University, No.899 Guangqiong Road, Jiaxing, 314001, Zhejiang, China.
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Rosellini M, Schulze A, Omer EA, Ali NT, Marini F, Küpper JH, Efferth T. The Effect of Plastic-Related Compounds on Transcriptome-Wide Gene Expression on CYP2C19-Overexpressing HepG2 Cells. Molecules 2023; 28:5952. [PMID: 37630204 PMCID: PMC10459118 DOI: 10.3390/molecules28165952] [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: 07/13/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
In recent years, plastic and especially microplastic in the oceans have caused huge problems to marine flora and fauna. Recently, such particles have also been detected in blood, breast milk, and placenta, underlining their ability to enter the human body, presumably via the food chain and other yet-unknown mechanisms. In addition, plastic contains plasticizers, antioxidants, or lubricants, whose impact on human health is also under investigation. At the cellular level, the most important enzymes involved in the metabolism of xenobiotic compounds are the cytochrome P450 monooxygenases (CYPs). Despite their extensive characterization in the maintenance of cellular balance, their interactions with plastic and related products are unexplored. In this study, the possible interactions between several plastic-related compounds and one of the most important cytochromes, CYP2C19, were analyzed. By applying virtual compound screening and molecular docking to more than 1000 commercially available plastic-related compounds, we identified candidates that are likely to interact with this protein. A growth inhibition assay confirmed their cytotoxic activity on a CYP2C19-transfected hepatic cell line. Subsequently, we studied the effect of the selected compounds on the transcriptome-wide gene expression level by conducting RNA sequencing. Three candidate molecules were identified, i.e., 2,2'-methylene bis(6-tert-butyl-4-methylphenol), 1,1-bis(3,5-di-tert-butyl-2-hydroxyphenyl) ethane, and 2,2'-methylene bis(6-cyclohexyl-4-methylphenol)), which bound with a high affinity to CYP2C19 in silico. They exerted a profound cytotoxicity in vitro and interacted with several metabolic pathways, of which the 'cholesterol biosynthesis process' was the most affected. In addition, other affected pathways involved mitosis, DNA replication, and inflammation, suggesting an increase in hepatotoxicity. These results indicate that plastic-related compounds could damage the liver by affecting several molecular pathways.
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Affiliation(s)
- Matteo Rosellini
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany; (M.R.); (E.A.O.); (N.T.A.)
| | - Alicia Schulze
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes, Gutenberg University, 55122 Mainz, Germany; (A.S.); (F.M.)
| | - Ejlal A. Omer
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany; (M.R.); (E.A.O.); (N.T.A.)
| | - Nadeen T. Ali
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany; (M.R.); (E.A.O.); (N.T.A.)
| | - Federico Marini
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes, Gutenberg University, 55122 Mainz, Germany; (A.S.); (F.M.)
- Research Center for Immunotherapy (FZI), Langenbeckstraße 1, 55131 Mainz, Germany
| | - Jan-Heiner Küpper
- Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, 03046 Senftenberg, Germany;
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany; (M.R.); (E.A.O.); (N.T.A.)
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Zhang T, Fan B, Li S, Wang X, Kong Y, Bazzano L, He J, Chen W, Yan Y. Long-Term Adiposity and Midlife Carotid Intima-Media Thickness Are Linked Partly Through Intermediate Risk Factors. Hypertension 2023; 80:160-168. [PMID: 36314120 PMCID: PMC9742127 DOI: 10.1161/hypertensionaha.122.20217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aims to determine quantitatively the mediation effects of multiple cardiovascular risk factors on the associations of childhood body mass index (BMI) and its cumulative burden with adult carotid intima-media thickness (cIMT). METHODS The longitudinal cohort consisted of 1391 adults who had been examined for BMI 4-15 times over 35.0 years on average since childhood and had data on adult cIMT, systolic blood pressure, low-density lipoprotein cholesterol, atherogenic index of plasma, and serum glucose. The area under the curve was used as a measure of cumulative burden of BMI. RESULTS After adjusting for covariates, the total effects (standardized regression coefficient) of childhood BMI (0.138), adult BMI (0.111), and area under the curve of BMI (0.150) on cIMT were all significant (P<0.001) without mediators included in the model. The mediation effects of adult systolic blood pressure, glucose, atherogenic index of plasma and low-density lipoprotein cholesterol were 8.0%, 4.3%, 3.6%, and 0.0%, respectively, in the model with childhood BMI as the predictor, 23.4%, 15.3%, 12.6%, and 7.2%, respectively, with adult BMI as the predictor, and 14.7%, 8.7%, 6.0%, and 2.0%, respectively, with area under the curve of BMI as the predictor. The direct effects on cIMT were 0.117 (P<0.001) for childhood BMI, 0.046 (P=0.224) for adult BMI, and 0.103 (P<0.001) for area under the curve of BMI after removing the mediation effects. CONCLUSIONS The long-term deleterious impact of adiposity on subclinical changes in vascular structure begins early in life and is accumulated over lifetime. Excess adiposity and higher cIMT are linked partly through other cardiovascular risk factors in later life, especially elevated blood pressure and glucose.
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Affiliation(s)
- Tao Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Institute of Health Data Science, Shandong University, Jinan, Shandong, China
| | - Bingbing Fan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Institute of Health Data Science, Shandong University, Jinan, Shandong, China
| | - Shengxu Li
- Children’s Minnesota Research Institute, Children’s Minnesota, Minneapolis, MN, USA
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yawei Kong
- Center for Non-communicable Disease Management, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Lydia Bazzano
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jiang He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Wei Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yinkun Yan
- Center for Non-communicable Disease Management, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
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Gebre AK, Sim M, Via JD, Rodríguez AJ, Hodgson JM, Bondonno CP, Thompson PL, Prince RL, Lewis JR. Measures of carotid atherosclerosis and fall-related hospitalization risk: The Perth Longitudinal Study of Ageing Women. Nutr Metab Cardiovasc Dis 2023; 33:95-104. [PMID: 36411216 DOI: 10.1016/j.numecd.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIMS We and others have identified links between cardiovascular conditions and poor musculoskeletal health. However, the relationship between measures of carotid atherosclerosis such as focal carotid plaque and common carotid intima media thickness (CCA-IMT) and falls remains understudied. This study examined the association between measures of carotid atherosclerosis and fall-related hospitalization over 11.5 years in community dwelling older women. METHODS AND RESULTS 1116 older women recruited in 1998 to a five-year randomized controlled trial to examine the effect of calcium supplementation in preventing fracture and who had undertaken B-mode ultrasound in 2001 (three years after the baseline clinical visit) were included in this study. The participants were followed for over 11.5 years as Perth Longitudinal Study of Ageing Women (PLSAW). Over the follow up period, 428 (38.4%) women experienced a fall-related hospitalization. Older women with carotid plaque had 44% a higher relative hazard for fall-related hospitalization (HR 1.44; 95%CI, 1.18 to 1.76) compared to those without carotid plaque. The association persisted after adjustment for established falls risk factors such as measures of muscle strength and physical function.Each SD increase in the mean and maximum CCA-IMT was also associated with a higher risk of fall-related hospitalizations (HR 1.10; 95%CI, 1.00 to 1.21 and HR 1.11; 95%CI, 1.01 to 1.22, respectively). CONCLUSIONS Measures of carotid atherosclerosis are associated with a higher risk of fall-related hospitalization independent of established falls risk factors. These findings suggest the importance of vascular health when considering falls risk.
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Affiliation(s)
- Abadi K Gebre
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Medical School, The University Western Australia, Perth, WA, Australia.
| | - Jack Dalla Via
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Alexander J Rodríguez
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Jonathan M Hodgson
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Medical School, The University Western Australia, Perth, WA, Australia
| | - Catherine P Bondonno
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Medical School, The University Western Australia, Perth, WA, Australia
| | - Peter L Thompson
- Medical School, The University Western Australia, Perth, WA, Australia; Department of Cardiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Richard L Prince
- Medical School, The University Western Australia, Perth, WA, Australia
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Medical School, The University Western Australia, Perth, WA, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Weiner S, Benton MH, Guraziu B, Yange Y, He J, Chen YT, Marston WA, McGinigle KL. High Stroke Rate in Patients With Medically Managed Asymptomatic Carotid Stenosis at an Academic Center in the Southeastern United States. Ann Vasc Surg 2022; 85:418-423. [PMID: 35472498 DOI: 10.1016/j.avsg.2022.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/25/2022] [Accepted: 04/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although the publication of randomized clinical trials defining the benefit of carotid endarterectomy (CEA) for asymptomatic carotid stenosis, medical management of carotid stenosis has changed significantly. With antiplatelet agents and statins, some question whether these trials are still relevant, suggesting that asymptomatic patients with >70% internal carotid artery (ICA) stenosis may do better with medial management alone, lessening the need for CEA and carotid stenting. The Vascular Quality Initiative (VQI) registry has shown that there are wide practice variations regarding the degree of stenosis that prompts surgical intervention but there are few reports of outcomes in patients who do not undergo intervention. We sought to determine the clinical outcomes of the >70% carotid stenosis patients who are treated with medical management alone at our institution. METHODS We identified all patients with ICA stenosis >70% based on hemodynamic consensus criteria (peak systolic velocity >230 cm/s) in our peripheral vascular laboratory from January 2013 through December 2016. With a retrospective chart review, demographics, comorbid conditions, medications, radiographic studies, clinical follow-up, interventions, and outcomes at 2 years were included. Descriptive statistics were used to define these variables. RESULTS One hundred and seventy three patients were identified with medically managed asymptomatic >70% ICA stenosis based on hemodynamic criteria on duplex ultrasound. The mean age was 67.5 years, 49% were male, 64% were White, 14% were Black, 13% race was undisclosed, 89% were prescribed antiplatelet therapy, 85% were prescribed a statin, and 60% had hypertension controlled to <140/90. Twenty patients (11.5%) experienced a cerebrovascular event during the 2-year study period. There were eight patients with transient ischemic attack, 10 with ipsilateral strokes, and 2 with strokes in unrelated territories. CONCLUSIONS Despite good adherence to current recommendations for medical therapy, patients at our institution are developing symptomatic carotid disease at a rate similar to that reported in historical clinical trials. These data supports the concept that advances in medical management have not resulted in reduced stroke rates in asymptomatic patients with high-grade carotid stenosis at a large academic institution located in the southeastern United States. CEA and stenting provide a significant risk reduction and should be considered more often in this patient population.
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Affiliation(s)
- Sarah Weiner
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mary Hunter Benton
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Benjana Guraziu
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yue Yange
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jie He
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yi Tang Chen
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - William A Marston
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katharine L McGinigle
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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The Role of Lipid-Lowering Treatment in the Secondary Prevention of Ischemic Stroke. Diseases 2021; 10:diseases10010003. [PMID: 35076490 PMCID: PMC8788422 DOI: 10.3390/diseases10010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 01/03/2023] Open
Abstract
Dyslipidemia is a major modifiable risk factor for ischemic stroke. Treatment with statins reduces the incidence of recurrent ischemic stroke and also reduces coronary events in patients with a history of ischemic stroke. Therefore, statins represent an important component of secondary prevention of ischemic stroke. In patients who do not achieve low-density lipoprotein cholesterol (LDL-C) targets despite treatment with the maximal tolerated dose of a potent statin, ezetimibe should be added to their lipid-lowering treatment and also appears to reduce the risk of cardiovascular events. Selected patients who do not achieve LDL-C targets despite statin/ezetimibe combination are candidates for receiving proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Finally, it appears that adding icosapent ethyl might also reduce cardiovascular morbidity in patients who have achieved LDL-C targets but have persistently elevated triglyceride levels.
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Sun J, Yuan C, Hatsukami TS. Stroke Prevention with Extracranial Carotid Artery Disease. Curr Cardiol Rep 2021; 23:161. [PMID: 34599416 DOI: 10.1007/s11886-021-01593-1] [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] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Carotid artery stenosis is a major risk factor for ischemic stroke. Although effective treatment options exist, careful assessment of benefits and risks for individual patients is needed in clinical decision-making. This article reviews contemporary treatments for carotid artery stenosis, the underlying evidence, and areas of uncertainties. RECENT FINDINGS Specific recommendations are available to guide the standard of care of carotid artery stenosis. Nonetheless, significant uncertainties are noted in patient selection for surgical treatment of asymptomatic carotid stenosis and in optimal treatment targets for pharmacological therapies. Advanced imaging has been used to predict future risk of ipsilateral stroke and clarify mechanisms of actions of pharmacological therapies, primarily in observational studies. Pharmacological and surgical treatments for extracranial carotid artery stenosis continue to evolve with many relevant clinical trials completed and clinical guidelines updated in recent years. Future clinical trials to tackle the areas of uncertainties are warranted.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Thomas S Hatsukami
- Department of Surgery/Vascular Surgery, University of Washington, 850 Republican St, Seattle, WA, 98109, USA.
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Whelton SP, McAuley PA, Dardari Z, Orimoloye OA, Michos ED, Brawner CA, Ehrman JK, Keteyian SJ, Blaha MJ, Al-Mallah MH. Fitness and Mortality Among Persons 70 Years and Older Across the Spectrum of Cardiovascular Disease Risk Factor Burden: The FIT Project. Mayo Clin Proc 2021; 96:2376-2385. [PMID: 34366139 DOI: 10.1016/j.mayocp.2020.12.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine whether fitness could improve mortality risk stratification among older adults compared with cardiovascular disease (CVD) risk factors. METHODS We examined 6509 patients 70 years of age and older without CVD from the Henry Ford ExercIse Testing Project (FIT Project) cohort. Patients performed a physician-referred treadmill stress test between 1991 and 2009. Traditional categorical CVD risk factors (hypertension, hyperlipidemia, diabetes, and smoking) were summed from 0 to 3 or more. Fitness was grouped as low, moderate, and high (<6, 6 to 9.9, and ≥10 metabolic equivalents of task). All-cause mortality was ascertained through US Social Security Death Master files. We calculated age-adjusted mortality rates, multivariable adjusted Cox proportional hazards, and Kaplan-Meier survival models. RESULTS Patients had a mean age of 75±4 years, and 3385 (52%) were women; during a mean follow-up of 9.4 years, there were 2526 deaths. A higher fitness level (P<.001), not lower CVD risk factor burden (P=.31), was associated with longer survival. The age-adjusted mortality rate per 1000 person-years was 56.7 for patients with low fitness and 0 risk factors compared with 24.9 for high fitness and 3 or more risk factors. Among patients with 3 or more risk factors, the adjusted mortality hazard was 0.68 (95% CI, 0.61 to 0.76) for moderate and 0.51 (95% CI, 0.44 to 0.60) for high fitness compared with the least fit. CONCLUSION Among persons aged 70 years and older, there was no significant difference in survival of patients with 0 vs 3 or more risk factors, but a higher fitness level identified older persons with good long-term survival regardless of CVD risk factor burden.
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Affiliation(s)
- Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Paul A McAuley
- Department of Health, Physical Education, and Sport Studies, Winston-Salem State University, Winston-Salem, NC
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Olusola A Orimoloye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
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Lindbohm JV, Sipilä PN, Mars N, Knüppel A, Pentti J, Nyberg ST, Frank P, Ahmadi-Abhari S, Brunner EJ, Shipley MJ, Singh-Manoux A, Tabak AG, Batty GD, Kivimäki M. Association between change in cardiovascular risk scores and future cardiovascular disease: analyses of data from the Whitehall II longitudinal, prospective cohort study. Lancet Digit Health 2021; 3:e434-e444. [PMID: 34167764 PMCID: PMC8474012 DOI: 10.1016/s2589-7500(21)00079-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/28/2021] [Accepted: 04/22/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Evaluation of cardiovascular disease risk in primary care, which is recommended every 5 years in middle-aged and older adults (typical age range 40-75 years), is based on risk scores, such as the European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE) and American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) algorithms. This evaluation currently uses only the most recent risk factor assessment. We aimed to examine whether 5-year changes in SCORE and ASCVD risk scores are associated with future cardiovascular disease risk. METHODS We analysed data from the Whitehall II longitudinal, prospective cohort study for individuals with no history of stroke, myocardial infarction, coronary artery bypass graft, percutaneous coronary intervention, definite angina, heart failure, or peripheral artery disease. Participants underwent clinical examinations in 5-year intervals between Aug 7, 1991, and Dec 6, 2016, and were followed up for incident cardiovascular disease until Oct 2, 2019. Levels of, and 5-year changes in, cardiovascular disease risk were assessed using the SCORE and ASCVD risk scores and were analysed as predictors of cardiovascular disease. Harrell's C index, continuous net reclassification improvement, the Akaike information criterion, and calibration analysis were used to assess whether incorporating change in risk scores into a model including only a single risk score assessment improved the predictive performance. We assessed the levels of, and 5-year changes in, SCORE and ASCVD risk scores as predictors of cardiovascular disease and disease-free life-years using Cox proportional hazards and flexible parametric survival models. FINDINGS 7574 participants (5233 [69·1%] men, 2341 [30·9%] women) aged 40-75 years were included in analyses of risk score change between April 24, 1997, and Oct 2, 2019. During a mean follow-up of 18·7 years (SD 5·5), 1441 (19·0%; 1042 [72·3%] men and 399 [27·7%] women) participants developed cardiovascular disease. Adding 5-year change in risk score to a model that included only a single risk score assessment improved model performance according to Harrell's C index (from 0·685 to 0·690, change 0·004 [95% CI 0·000 to 0·008] for SCORE; from 0·699 to 0·700, change 0·001 [0·000 to 0·003] for ASCVD), the Akaike information criterion (from 17 255 to 17 200, change -57 [95% CI -97 to -13] for SCORE; from 14 739 to 14 729, change -10 [-28 to 7] for ASCVD), and the continuous net reclassification index (0·353 [95% CI 0·234 to 0·447] for SCORE; 0·232 [0·030 to 0·344] for ASCVD). Both favourable and unfavourable changes in SCORE and ASCVD were associated with cardiovascular disease risk and disease-free life-years. The associations were seen in both sexes and all age groups up to the age of 75 years. At the age of 45 years, each 2-unit improvement in risk scores was associated with an additional 1·3 life-years (95% CI 0·4 to 2·2) free of cardiovascular disease for SCORE and an additional 0·9 life-years (95% CI 0·5 to 1·3) for ASCVD. At age 65 years, this same improvement was associated with an additional 0·4 life-years (95% CI 0·0 to 0·7) free of cardiovascular disease for SCORE and 0·3 life-years (95% CI 0·1 to 0·5) for ASCVD. These models were developed into an interactive calculator, which enables estimation of the number of cardiovascular disease-free life-years for an individual as a function of two risk score measurements. INTERPRETATION Changes in the SCORE and ASCVD risk scores over time inform cardiovascular disease risk prediction beyond a single risk score assessment. Repeat data might allow more accurate cardiovascular risk stratification and strengthen the evidence base for decisions on preventive interventions. FUNDING UK Medical Research Council, British Heart Foundation, Wellcome Trust, and US National Institute on Aging.
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Affiliation(s)
- Joni V Lindbohm
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK.
| | - Pyry N Sipilä
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland; Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Nina Mars
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Anika Knüppel
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jaana Pentti
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Public Health, University of Turku, Turku, Finland
| | - Solja T Nyberg
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Philipp Frank
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK; Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Adam G Tabak
- Department of Epidemiology and Public Health, University College London, London, UK; 1st Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK; School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA
| | - Mika Kivimäki
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK
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AbuRahma AF, Avgerinos ED, Chang RW, Darling RC, Duncan AA, Forbes TL, Malas MB, Perler BA, Powell RJ, Rockman CB, Zhou W. The Society for Vascular Surgery implementation document for management of extracranial cerebrovascular disease. J Vasc Surg 2021; 75:26S-98S. [PMID: 34153349 DOI: 10.1016/j.jvs.2021.04.074] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Ali F AbuRahma
- Department of Surgery, West Virginia University-Charleston Division, Charleston, WV.
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh School of Medicine, UPMC Hearrt & Vascular Institute, Pittsburgh, Pa
| | - Robert W Chang
- Vascular Surgery, Permanente Medical Group, San Francisco, Calif
| | | | - Audra A Duncan
- Division of Vascular & Endovascular Surgery, University of Western Ontario, London, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular & Endovascular Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mahmoud B Malas
- Vascular & Endovascular Surgery, University of California San Diego, La Jolla, Calif
| | - Bruce Alan Perler
- Division of Vascular Surgery & Endovascular Therapy, Johns Hopkins, Baltimore, Md
| | | | - Caron B Rockman
- Division of Vascular Surgery, New York University Langone, New York, NY
| | - Wei Zhou
- Division of Vascular Surgery, University of Arizona, Tucson, Ariz
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Rane M, Orkaby AR. Considerations for carotid artery disease management in a frail population. Exp Gerontol 2021; 152:111426. [PMID: 34051284 DOI: 10.1016/j.exger.2021.111426] [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: 03/28/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
Carotid artery stenosis is highly prevalent in older adults. Generally, symptomatic patients are treated with medical therapy and revascularization by either a carotid endarterectomy (CEA), carotid artery stent (CAS), or transcarotid artery revascularization (TCAR). In asymptomatic patients it remains unclear whether revascularization is beneficial. Novel and less invasive techniques mitigate some of the risk of revascularization, allowing patients who previously were too high risk to now be candidates. Despite this, any invasive procedure has risks and potential for complications. Furthermore, it can be unclear whether certain patient populations, such as older adults and those with multiple chronic medical conditions will derive benefit from an intervention. Frailty is an assessment tool that can be used to guide decision-making process for older patients. In this review we discuss the management of carotid artery stenosis in older adults, its relationship with frailty, and how a frailty assessment can be integrated into the shared decision-making process to determine the optimal treatment plan for each patient.
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Affiliation(s)
- Manas Rane
- VA Boston Healthcare System, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Ariela R Orkaby
- New England GRECC (Geriatric Research, Education, and Clinical Center) VA Boston Healthcare System, Boston, MA, USA; Division of Aging Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA
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14
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Tada H, Okada H, Nohara A, Yamagishi M, Takamura M, Kawashiri MA. Effect of Cumulative Exposure to Low-Density Lipoprotein-Cholesterol on Cardiovascular Events in Patients With Familial Hypercholesterolemia. Circ J 2021; 85:2073-2078. [PMID: 34011825 DOI: 10.1253/circj.cj-21-0193] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent studies suggest that cumulative exposure to low-density lipoprotein-cholesterol (LDL-C) leads to the development of atherosclerotic cardiovascular disease (ASCVD). However, few studies have investigated whether this link extends to individuals with familial hypercholesterolemia (FH), a relevant patient population.Methods and Results:We retrospectively investigated the health records of 1,050 patients with clinical FH diagnosis between April 1990 and March 2019. We used Cox proportional hazards models adjusted for established ASCVD risk factors to assess the association between cholesterol-year-score and major adverse cardiovascular events (MACEs), including death from any cause or hospitalization due to ASCVD events. Cholesterol-year-score was calculated as LDL-C max × [age at diagnosis/statin initiation] + LDL-C at inclusion × [age at inclusion - age at diagnosis/statin initiation]. The median follow-up period for MACE evaluation was 12.3 (interquartile range, 9.1-17.5) years, and 177 patients experienced MACEs during the observation period. Cholesterol-year-score was significantly associated with MACEs (hazard ratio, 1.35; 95% confidence interval, 1.07-1.53; P=0.0034, per 1,000 mg-year/dL), independent of other traditional risk factors including age and LDL-C, based on cross-sectional assessment. Cholesterol-year-score improved the discrimination ability of other traditional risk factors for ASCVD events (C-index, 0.901 vs. 0.889; P=0.00473). CONCLUSIONS Cumulative LDL-C exposure was strongly associated with MACEs in Japanese patients with FH, warranting early diagnosis and treatment initiation in these patients.
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Affiliation(s)
- Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Hirofumi Okada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Atsushi Nohara
- Department of Genetics, Ishikawa Prefectural Central Hospital
| | | | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
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15
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The Role of Carotid Stenosis in a Prediction of Prognosis of Coronary Artery Disease. ACTA ACUST UNITED AC 2021; 42:53-66. [PMID: 33894121 DOI: 10.2478/prilozi-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims: The aim of this paper is to indicate if carotid stenosis is predictive for the prognosis of coronary artery disease.Method and materials: Our study is a prospective cohort study. 1031 patients with proven coronary artery disease (CAD) were recruited consecutively. Carotid ultrasound was used to assess IMT, plaque, or stenosis. They were followed for 24 months for adverse cardiovascular events. Selected demographic date such as smoking history, dyslipidemia, hypertension, laboratory values, and clinical data (associated diseases and risk) were collected from each patient. Total cardiovascular events and mortality rate were followed up for the study population. The results were collected prospectively and retrospectively. The study was organized as a clinical, cross-sectional study and comparative study.From the data collected with the clinical research, a file was formed in the statistical program with the help of which the data were statistically analyzed.From the methods of descriptive statistics, absolute frequencies, percentages, arithmetic mean, median, measures of variability, minimum, maximum, standard deviation and logistic regression models were used.Result: Of the total number of patients 1026 had arterial hypertension (HTA). Data on hyperlipidemia (HLP) had been reported in 895 patients. 1.023 patients had peripheral artery disease (PAB). 1031 patients were presented with multivessel coronary artery disease (CAD). There were 1,029 patients with diabetes mellitus (DM), while 1,013 patients had coronary artery by-pass (CABG), and 1,012 had stroke (CVI). Elevated systolic blood pressure was reported in 966 patients. 184 patients had elevated triglycerides and 187 had elevated cholesterol. 1,008 patients have had a history of myocardial infarction. Carotid artery stenosis (CAS) has been found in 1,009 patients, increased body mass index (BMI) in 270 patients.1.031 patients were followed for 24 months. Cardiovascular events were reported in 54 patients (or 5.2%). Revascularization was performed in 28 (4.1%) patients, while 12 (1.8%) of patients died. Diabetes mellitus (OR 1.878 95% CI 0.491 7.184) and Carotid stenosis (OR 2.185 95% CI 0.731 6.53) were found to be predictive factors for future cardiovascular events.Conclusion: Due to our results carotid ultrasound may be a useful tool for risk stratification of coronary artery disease pts.
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16
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Bluth E, Mohammed A, Fort D, Bouche R, Collins J, Price-Haywood EG. Differential rates of progression of low-grade carotid stenosis detected by follow-up ultrasound: A single institution experience. Clin Imaging 2020; 67:170-176. [PMID: 32798965 DOI: 10.1016/j.clinimag.2020.06.048] [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: 04/03/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The growing body of evidence suggesting that lifestyle changes and aggressive medical management reduce the risk of strokes in patients with carotid stenosis has fostered interest in noninvasive screening. The objective of this study was to develop recommendations for follow-up carotid ultrasound surveillance of patients with <60% carotid stenosis. METHODS This retrospective observational cohort study includes 2956 patients seen between August 1998 and March 2015 in 4440 visits. Data analysis was restricted to 7710 carotid ultrasounds. Primary outcome was progression of carotid stenosis as defined by the "bulb" method: baseline stenosis of 0%-39% progressed to 40%-59% on subsequent examination, baseline stenosis of 0%-39% progressed to ≥60%, or baseline of 40%-59% progressed to ≥60%. Progression was estimated using Cox proportional hazard ratios and the Kaplan-Meier method. RESULTS More than 10% of patients progressed in the 40%-59% baseline group within 12 months compared to 78 months for the 0%-39% baseline group. Patients who progressed had a higher proportion of peripheral vascular disease, and current/former smoking compared to those who did not. While there were statistically significant correlations between medication classes and comorbidities, none of the medications studied appeared to slow carotid stenosis progression. CONCLUSIONS In our experience, for patients with a 0%-39% carotid stenosis, follow-up examination should be performed at 6-year intervals. For patients with 40%-59% carotid stenosis, follow-up should be obtained annually to identify those who progress to a level requiring intervention. Future studies should examine whether study findings can be replicated using other approaches for determining carotid stenosis.
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Affiliation(s)
- Edward Bluth
- Ochsner Clinic Foundation, New Orleans, LA, USA; Ochsner Clinical School, University of Queensland, New Orleans, LA, USA.
| | - Alaa Mohammed
- Ochsner Health System Center for Outcomes and Health Services Research, New Orleans, LA, USA.
| | - Daniel Fort
- Ochsner Health System Center for Outcomes and Health Services Research, New Orleans, LA, USA.
| | - Rhett Bouche
- Ochsner Clinical School, University of Queensland, New Orleans, LA, USA
| | - Johnathon Collins
- Ochsner Clinical School, University of Queensland, New Orleans, LA, USA
| | - Eboni G Price-Haywood
- Ochsner Clinic Foundation, New Orleans, LA, USA; Ochsner Clinical School, University of Queensland, New Orleans, LA, USA; Ochsner Health System Center for Outcomes and Health Services Research, New Orleans, LA, USA.
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Lian H, Xu X, Shen X, Chen J, Mao D, Zhao Y, Yao M. Early prediction of cerebral-cardiac syndrome after ischemic stroke: the PANSCAN scale. BMC Neurol 2020; 20:272. [PMID: 32641003 PMCID: PMC7341669 DOI: 10.1186/s12883-020-01833-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023] Open
Abstract
Background Cerebral-cardiac syndrome, newly developed cardiac damage manifestations subsequent to cerebral injuries, is a common complication of stroke and leads to increased morbidity and mortality. The current study is aimed to develop a risk prediction scale to stratify high-risk population of CCS among ischemic stroke patients. Methods The study included 410 cases from four tertiary medical centers from June 2018 to April 2019. The risk prediction model was established via logistic regression from the derivation cohort including 250 cases admitted between June 2018 and December 2018. Another 160 cases admitted from January 2019 to April 2019 were included as the validation cohort for external validation. The performance of the model was determined by the area under curve of the receiver operating characteristic curve. A rating scale was developed based on the magnitude of the logistic regression coefficient. Results The prevalence of CCS was 55.2% in our study. The predictive model derived from the derivation cohort showed good calibration by Hosmer-Lemeshow test (P = 0.492), and showed sensitivity of 0.935, specificity of 0.720, and Youden index of 0.655. The C-statistic for derivation and validation cohort were 0.888 and 0.813, respectively. Our PANSCAN score (0 to 10 points) was then established, which consists of the following independent risk factors: PT(12 s–14 s = 0; otherwise = 1), APTT(30s–45s = 0, otherwise = 1), Neutrophils(50–70% = 0; otherwise = 1), Sex(female = 1), Carotid artery stenosis(normal or mild = 0; moderate to severe = 2), Age(≥65 years = 1), NIHSS score(1 to 4 = 2; ≥5 = 3). Patients scored 3 or more points were stratified as high risk. Conclusion The risk prediction model showed satisfactory prediction effects. The PANSCAN scale provides convenient reference for preventative treatment and early management for high-risk patients. Trial registration The study was retrospectively registered in Chinese Trial Registry. The date of registration is April 17, 2019. Trial registration number: ChiCTR1900022587.
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Affiliation(s)
- Haijuan Lian
- Hangzhou Medical College, Hangzhou, 310053, China.,The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Medicine & Nursing Science School, Huzhou University, 1 Xueshi Road, Huzhou, 313000, China
| | - Xiaomeng Xu
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Second Road, Shanghai, 200025, China
| | - Xuhui Shen
- Medicine & Nursing Science School, Huzhou University, 1 Xueshi Road, Huzhou, 313000, China
| | - Jinhua Chen
- The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Dandan Mao
- Medicine & Nursing Science School, Huzhou University, 1 Xueshi Road, Huzhou, 313000, China
| | - Yan Zhao
- Medicine & Nursing Science School, Huzhou University, 1 Xueshi Road, Huzhou, 313000, China
| | - Meiqi Yao
- The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
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18
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Kim TI, Zhang Y, Amin HP, Ochoa Chaar CI. Presentation and outcomes of carotid endarterectomy in active smokers. J Vasc Surg 2020; 72:1720-1727.e1. [PMID: 32249043 DOI: 10.1016/j.jvs.2020.02.014] [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: 12/16/2019] [Accepted: 02/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Smoking is a significant modifiable risk factor in the pathogenesis of carotid artery disease and has been shown to be a predictor of worse outcomes after vascular surgery. However, the effect of active smoking on outcomes of patients undergoing carotid endarterectomy is unknown. This study analyzed the outcomes of carotid endarterectomy by smoking status in a large national database. METHODS The American College of Surgeons National Surgical Quality Improvement Program targeted carotid endarterectomy files (2011-2017) were reviewed. Patients were stratified according to smoking status, and outcomes were compared using propensity score matching (1:1) based on preoperative characteristics. RESULTS During the study period, 26,293 patients underwent carotid endarterectomy, with 19,282 (73.34%) nonsmokers and 7011 (26.66%) smokers. Smokers were more likely to be younger, to have chronic obstructive pulmonary disease, to have a symptomatic presentation, and to have higher anatomic risk (P < .05). Smokers were also more likely to have emergent surgery, to have general anesthesia, and to be reintubated (P < .05). After propensity matching, 5354 nonsmokers were matched with 5354 smokers who underwent carotid endarterectomy. Smokers were at significantly higher risk for death, with an odds ratio of 1.93 (confidence interval, 1.18-3.13). CONCLUSIONS Smokers are at increased risk for death after carotid endarterectomy compared with matched counterparts. Smoking should be considered an important risk factor for worse outcomes, and patients should be strongly counseled on the importance of smoking cessation before undergoing carotid endarterectomy.
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Affiliation(s)
- Tanner I Kim
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Yawei Zhang
- Department of Surgery, Yale School of Medicine, New Haven, Conn; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Conn
| | - Hardik P Amin
- Department of Neurology, Yale School of Medicine, New Haven, Conn
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19
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Wan H, Wang Y, Fang S, Chen Y, Zhang W, Xia F, Wang N, Lu Y. Associations between the Neutrophil-to-Lymphocyte Ratio and Diabetic Complications in Adults with Diabetes: A Cross-Sectional Study. J Diabetes Res 2020; 2020:6219545. [PMID: 32405503 PMCID: PMC7206875 DOI: 10.1155/2020/6219545] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and easily measurable laboratory index indicating systemic inflammation, while the application of many other inflammatory markers has been limited in daily clinical practice. However, large population studies about investigating the associations of the NLR level with diabetic complications including cardiovascular and cerebrovascular diseases (CVD), diabetic kidney disease (DKD), and diabetic retinopathy (DR) in the same population were limited. The aim of our study is to evaluate the associations between the NLR level and the prevalence of CVD, DKD, and DR in adults with diabetes simultaneously. METHODS A cross-sectional survey of 4,813 diabetic adults was conducted in seven communities in China. Persons underwent several medical examinations, including the measurement of anthropometric factors, blood pressure, routinely analyzed leukocyte characteristics, glucose, lipid profiles, urine albumin/creatinine ratio, and fundus photographs. RESULTS Compared with the first quartile of the NLR level, the odds of having CVD was significantly increased by 21% for participants in the highest quartile (OR 1.21; 95% CI 1.00, 1.47) (P for trend < 0.05). Similarly, the prevalence of DKD among participants in the highest quartile of the NLR level was significantly increased by 150% (OR 2.50; 95% CI 1.95, 3.19) (P for trend < 0.05). However, no association was found between the NLR level and the prevalence of DR (P for trend > 0.05). These associations were all fully adjusted. CONCLUSIONS A higher NLR level was associated with an increased prevalence of CVD and DKD, other than DR, in diabetic adults.
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Affiliation(s)
- Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sijie Fang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yap KH, Warren N, Allotey P, Reidpath DD. Understandings of stroke in rural Malaysia: ethnographic insights. Disabil Rehabil 2019; 43:345-353. [PMID: 31169419 DOI: 10.1080/09638288.2019.1624841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Stroke is a public health concern in Malaysia but local beliefs and lay understandings of stroke have not been examined before. Explanatory models provide a way for people to make sense of their illness and influence health seeking behaviors, in a locally relevant way. METHODS Drawing on ethnographic research from rural Malaysia, this descriptive article explores ethnic Malaysian-Chinese stroke survivors' lay understandings of stroke. Eighteen community-dwelling stroke survivors aged 50-83 took part in the study. RESULTS Causation of stroke was derived from cultural, biomedical and social sources. Participants also drew simultaneously from both biomedical and traditional explanations of stroke to develop their own understanding of etiology. Similarities with biomedical causation and other studies from different cultures were found. Participants' typically focused on the more immediate effects of stroke and often do not attribute causation and association with their comorbid conditions which are also risk factors of stroke. CONCLUSION Lack of knowledge about stroke and its symptoms was evident in participants' account. Findings emphasize the importance of knowledge based health interventions, especially in health education strategies for stroke survivors to reduce delays to diagnosis and potentially improve health outcomes post-stroke. Implications for rehabilitation Stroke survivors often form explanatory models of stroke that draw from both biomedical and traditional explanations of stroke. Understanding how people derive lay understandings of stroke can contribute towards developing the goals and activities that facilitate recovery and rehabilitation in similar settings. Health practitioners in the community should strengthen communication regarding the identification, etiology and risk factors of stroke with stroke survivors and their carers to improve compliance to medication, exercise and diet for better recovery. Sustained health education which is culturally relevant is recommended. Communication should also include non-physical impact of stroke (such as cognitive deficits and emotional difficulties) as the stroke survivors were unlikely to relate such symptoms to stroke.
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Affiliation(s)
- Kwong Hsia Yap
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Narelle Warren
- School of Social Sciences, Clayton Campus, Monash University, VIC, Australia
| | - Pascale Allotey
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia.,International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Daniel D Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia.,South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
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21
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Abstract
Stroke remains a leading cause of disability and death worldwide despite significant scientific and therapeutic advances. Therefore, there is a critical need to improve stroke prevention and treatment. In this review, we describe several examples that leverage nucleic acid therapeutics to improve stroke care through prevention, acute treatment, and recovery. Aptamer systems are under development to increase the safety and efficacy of antithrombotic and thrombolytic treatment, which represent the mainstay of medical stroke therapy. Antisense oligonucleotide therapy has shown some promise in treating stroke causes that are genetically determined and resistant to classic prevention approaches such as elevated lipoprotein (a) and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Targeting microRNAs may be attractive because they regulate factors involved in neuronal cell death and reperfusion-associated injury, as well as neurorestorative pathways. Lastly, microRNAs may aid reliable etiologic classification of stroke subtypes, which is important for effective secondary stroke prevention.
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Affiliation(s)
- Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA.
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA.
| | - Yunis Mayasi
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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22
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Geraci G, Buccheri D, Zanoli L, Fatuzzo P, Di Natale K, Zammuto MM, Nardi E, Geraci C, Mancia E, Zambelli G, Piraino D, Signorelli SS, Granata A, Cottone S, Mule G. Renal haemodynamics and coronary atherosclerotic burden are associated in patients with hypertension and mild coronary artery disease. Exp Ther Med 2019; 17:3255-3263. [PMID: 30906482 DOI: 10.3892/etm.2019.7279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 02/11/2019] [Indexed: 12/11/2022] Open
Abstract
Intrarenal hemodynamic alterations are independent predictors of cardiovascular events in different populations. It has been hypothesized that there is an association between renal hemodynamics and coronary atherosclerotic burden in patients with hypertension. Therefore, the present study examined the associations between renal hemodynamics, coronary atherosclerotic burden and carotid atherosclerotic disease. A total of 130 patients with hypertension aged between 30-80 years who had been referred for an elective coronary angiography were enrolled in the present study. A duplex ultrasound of the intrarenal vasculature was performed to evaluate the resistive index (RI), pulsatility index (PI) and acceleration time (AT). The carotid intima-media thickness was additionally assessed. A coronary angiography was performed to detect the atherosclerotic burden using the Gensini Score (GS). Based on the GS values, subjects were divided into quintiles (I: ≤9; II: 9-17; III: 17-30; IV: 30-44; and V: GS >44) as well as in subjects with mild (GS ≤30) or severe coronary disease (GS >30). A weak significant difference in PI was identified among quintiles (P=0.041), whereas, RI and AT did not differ significantly. PI was associated with GS in the group with low coronary atherosclerotic burden (GS ≤30; P=0.047), whereas, no association was detected in subjects with GS >30. This association remained following adjustment for age and left ventricular ejection fraction (P=0.025). In conclusion, renal vascular alterations were associated with coronary atherosclerotic burden in patients with hypertension with mild coronary disease.
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Affiliation(s)
- Giulio Geraci
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Dario Buccheri
- Unit of Interventional Cardiology, Hospital San Giovanni di Dio, I-92100 Agrigento, Italy
| | - Luca Zanoli
- Department of Clinical and Experimental Medicine, University of Catania, I-95100 Catania, Italy
| | - Pasquale Fatuzzo
- Department of Clinical and Experimental Medicine, University of Catania, I-95100 Catania, Italy
| | - Katia Di Natale
- Department of Interventional Cardiology, Paolo Giaccone University Hospital, I-90100 Palermo, Italy
| | - Marta M Zammuto
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Emilio Nardi
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Calogero Geraci
- Unit of Cardiology, S. Elia Hospital, I-93100 Caltanissetta, Italy
| | - Ettore Mancia
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Giulia Zambelli
- Department of Interventional Cardiology, Paolo Giaccone University Hospital, I-90100 Palermo, Italy
| | - Davide Piraino
- Department of Interventional Cardiology, Paolo Giaccone University Hospital, I-90100 Palermo, Italy
| | - Salvatore S Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, I-95100 Catania, Italy
| | - Antonio Granata
- Department of Nephrology and Dialysis, Hospital San Giovanni di Dio, I-92100 Agrigento, Italy
| | - Santina Cottone
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
| | - Giuseppe Mule
- Unit of Nephrology and Hypertension-European Society of Hypertension Excellence Centre, Paolo Giaccone University Hospital, I-90127 Palermo, Italy
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23
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Vegetable diversity in relation with subclinical atherosclerosis and 15-year atherosclerotic vascular disease deaths in older adult women. Eur J Nutr 2019; 59:217-230. [DOI: 10.1007/s00394-019-01902-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/10/2019] [Indexed: 12/24/2022]
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24
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El Khoury P, Couvert P, Elbitar S, Ghaleb Y, Abou-Khalil Y, Azar Y, Ayoub C, Superville A, Guérin M, Rabès JP, Varret M, Boileau C, Jambart S, Giral P, Carrié A, Le Goff W, Abifadel M. Identification of the first Tangier disease patient in Lebanon carrying a new pathogenic variant in ABCA1. J Clin Lipidol 2018; 12:1374-1382. [DOI: 10.1016/j.jacl.2018.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 01/07/2023]
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25
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Heit JJ, Wintermark M. New developments in clinical ischemic stroke prevention and treatment and their imaging implications. J Cereb Blood Flow Metab 2018; 38:1533-1550. [PMID: 28195500 PMCID: PMC6125964 DOI: 10.1177/0271678x17694046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Acute ischemic stroke results from blockage of a cerebral artery or impaired cerebral blood flow due to cervical or intracranial arterial stenosis. Ischemic stroke prevention seeks to minimize the risk of developing impaired cerebral perfusion by controlling vascular and cardiac disease risk factors. Similarly, ischemic stroke treatment aims to restore cerebral blood flow through recanalization of an occluded artery or dilation of a severely narrowed artery that supplies cerebral tissue. Stroke prevention and treatment are increasingly informed by imaging studies, and neurovascular and cerebral perfusion imaging has become essential in in guiding ischemic stroke prevention and treatment. Here we review the latest advances in ischemic stroke prevention and treatment with an emphasis on the neuroimaging principles emphasized in recent randomized trials. Future research directions that should be explored in ischemic stroke prevention and treatment are also discussed.
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Affiliation(s)
- Jeremy J Heit
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University Hospital, Stanford, CA, USA
| | - Max Wintermark
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University Hospital, Stanford, CA, USA
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26
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Blekkenhorst LC, Bondonno CP, Lewis JR, Woodman RJ, Devine A, Bondonno NP, Lim WH, Zhu K, Beilin LJ, Thompson PL, Prince RL, Hodgson JM. Cruciferous and Total Vegetable Intakes Are Inversely Associated With Subclinical Atherosclerosis in Older Adult Women. J Am Heart Assoc 2018; 7:JAHA.117.008391. [PMID: 29618474 PMCID: PMC6015430 DOI: 10.1161/jaha.117.008391] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Dietary patterns rich in fruits and vegetables are considered to reduce atherosclerotic disease presentation and are reported to be inversely associated with subclinical measures of atherosclerosis, such as carotid artery intima‐media thickness (IMT) and plaque. However, the effect of vegetable intake alone, and relationships to specific types of vegetables containing different phytochemical profiles, is important. The aim of this study was to investigate the associations of total vegetable intake and specific vegetables grouped according to phytochemical constituents with common carotid artery IMT (CCA‐IMT) and carotid plaque severity in a cohort of older adult women (aged ≥70 years). Methods and Results Total vegetable intake was calculated at baseline (1998) using a validated food frequency questionnaire. Vegetable types included cruciferous, allium, yellow/orange/red, leafy green, and legumes. In 2001, CCA‐IMT (n=954) and carotid focal plaque (n=968) were assessed using high‐resolution B‐mode carotid ultrasonography. Mean (SD) total vegetable intake was 199.9 (78.0) g/d. Women consuming ≥3 servings of vegetables each day had ≈4.6% to 5.0% lower mean CCA‐IMT (P=0.014) and maximum CCA‐IMT (P=0.004) compared with participants consuming <2 servings of vegetables. For each 10 g/d higher in cruciferous vegetable intake, there was an associated 0.006 mm (0.8%) lower mean CCA‐IMT (P<0.01) and 0.007 mm (0.8%) lower maximum CCA‐IMT (P<0.01). Other vegetable types were not associated with CCA‐IMT (P>0.05). No associations were observed between vegetables and plaque severity (P>0.05). Conclusions Increasing vegetables in the diet with a focus on consuming cruciferous vegetables may have benefits for the prevention of subclinical atherosclerosis in older adult women. Clinical Trial Registration URL: http://www.anzctr.org.au. Unique identifier: ACTRN12615000750583.
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Affiliation(s)
- Lauren C Blekkenhorst
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia .,Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia.,Medical School, Queen Elizabeth Medical Centre Unit, University of Western Australia, Nedlands, Western Australia, Australia
| | - Catherine P Bondonno
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Joshua R Lewis
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Medical School, Queen Elizabeth Medical Centre Unit, University of Western Australia, Nedlands, Western Australia, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia.,School of Public Health, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - Amanda Devine
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nicola P Bondonno
- Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Kun Zhu
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Lawrence J Beilin
- Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Peter L Thompson
- Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Richard L Prince
- Medical School, Queen Elizabeth Medical Centre Unit, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jonathan M Hodgson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
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Abstract
INTRODUCTION Some associations of high total cholesterol with dementia risk diminish as the outcome age-age at cognitive assessment-increases. METHODS The Framingham Heart Study provided 1897 participants with intact cognition at entry. Cox regression analysis for incident marked cognitive decline included "time-dependent" coefficients, with associations between total cholesterol and covariates changing by outcome age. Decline within age categories of 75-84 and 85-94 years was also examined. RESULTS Significant associations of rising total cholesterol linear slope, low entry age, low education, and statin nonuse with risk diminished significantly by outcome age. At 85-94 years, falling linear slope was significant. DISCUSSION The protected survival model posits a minority subpopulation with protection against mortality and cognitive decline associated with total cholesterol risk factors. It predicts the observed diminished or reversed cholesterol associations with increasing age. Protection is particularly likely for successful cognitive aging-intact cognition at very old age-despite increased risk from cholesterol.
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Affiliation(s)
- Jeremy M Silverman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Affairs Medical Center, Research & Development, Bronx, NY, USA.
| | - James Schmeidler
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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28
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Low-level cadmium exposure and cardiovascular outcomes in elderly Australian women: A cohort study. Int J Hyg Environ Health 2018; 221:347-354. [DOI: 10.1016/j.ijheh.2017.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 12/21/2022]
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29
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Polak JF, O'Leary DH. Carotid Intima-Media Thickness as Surrogate for and Predictor of CVD. Glob Heart 2018; 11:295-312.e3. [PMID: 27741977 DOI: 10.1016/j.gheart.2016.08.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/29/2016] [Accepted: 08/04/2016] [Indexed: 12/17/2022] Open
Abstract
Carotid artery intima-media thickness (IMT) is a noninvasive measurement of the artery wall thickness, inclusive of atherosclerotic plaque, obtained using ultrasound imaging. In the MESA (Multi-Ethnic Study of Atherosclerosis) study, IMT measurements are used as a surrogate for subclinical cardiovascular disease and as a variable predictive of cardiovascular events. IMT measurements of the common carotid artery are available in more than 99% of the MESA population and are predictive of cardiovascular events. More importantly, IMT and plaque thickness measurements made in the internal carotid artery and carotid bulb are also available in more than 98% of the population and are also strongly predictive of cardiovascular events. This article reviews the techniques used to obtain the MESA IMT values, compares them to those made in other epidemiological studies, and summarizes how they have been used in the MESA study as both surrogates for and predictors of cardiovascular disease.
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Affiliation(s)
- Joseph F Polak
- Department of Radiology, Tufts Medical Center, Boston, MA, USA; Ultrasound Reading Center, Boston, MA, USA.
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30
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Schade DS, Murphy S, Exil V, Eaton RP. A Pediatric Opportunity in Adolescents to Prevent Adult Heart Attacks. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/wjcd.2018.82009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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31
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Dietary inflammatory index in relation to sub-clinical atherosclerosis and atherosclerotic vascular disease mortality in older women. Br J Nutr 2017; 117:1577-1586. [PMID: 28673375 DOI: 10.1017/s0007114517001520] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Arterial wall thickening, stimulated by low-grade systemic inflammation, underlies many cardiovascular events. As diet is a significant moderator of systemic inflammation, the dietary inflammatory index (DIITM) has recently been devised to assess the overall inflammatory potential of an individual's diet. The primary objective of this study was to assess the association of the DII with common carotid artery-intima-media thickness (CCA-IMT) and carotid plaques. To substantiate the clinical importance of these findings we assessed the relationship of DII score with atherosclerotic vascular disease (ASVD)-related mortality, ischaemic cerebrovascular disease (CVA)-related mortality and ischaemic heart disease (IHD)-related mortality more. The study was conducted in Western Australian women aged over 70 years (n 1304). Dietary data derived from a validated FFQ (completed at baseline) were used to calculate a DII score for each individual. In multivariable-adjusted models, DII scores were associated with sub-clinical atherosclerosis: a 1 sd (2·13 units) higher DII score was associated with a 0·013-mm higher mean CCA-IMT (P=0·016) and a 0·016-mm higher maximum CCA-IMT (P=0·008), measured at 36 months. No relationship was seen between DII score and carotid plaque severity. There were 269 deaths during follow-up. High DII scores were positively associated with ASVD-related death (per sd, hazard ratio (HR): 1·36; 95 % CI 1·15, 1·60), CVA-related death (per sd, HR: 1·30; 95 % CI 1·00, 1·69) and IHD-related death (per sd, HR: 1·40; 95 % CI 1·13, 1·75). These results support the hypothesis that a pro-inflammatory diet increases systemic inflammation leading to development and progression of atherosclerosis and eventual ASVD-related death.
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32
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Niiranen TJ, McCabe EL, Larson MG, Henglin M, Lakdawala NK, Vasan RS, Cheng S. Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study. BMJ 2017; 357:j1949. [PMID: 28500036 PMCID: PMC5430541 DOI: 10.1136/bmj.j1949] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective To determine the role of early onset versus late onset hypertension as a risk factor for hypertension in offspring and cardiovascular death.Design Multigenerational, prospective cohort study.Setting Framingham Heart Study.Participants Two generations of community dwelling participants with blood pressure measurements performed at serial examinations spanning six decades: 3614 first generation participants with mortality data and 1635 initially non-hypertensive second generation participants with data available on parental blood pressure.Main outcome measures The main outcome measures were relation of parental early onset hypertension (age <55 years) with incidence of hypertension in offspring, using regression analyses, and relation of age at hypertension onset with cause specific mortality using a case (cardiovascular death) versus control (non-cardiovascular death) design.Results In second generation participants, having one or both parents with late onset hypertension did not increase the risk of hypertension compared with having parents with no hypertension; by contrast, the hazard ratios of hypertension were 2.0 (95% confidence interval 1.2 to 3.5) and 3.5 (1.9 to 6.1) in participants with one and both parents with early onset hypertension, respectively. In first generation decedents, 1151 cardiovascular deaths occurred (including 630 coronary deaths). The odds of cardiovascular death increased linearly with decreasing age of hypertension onset (P<0.001 for trend). Compared with non-hypertensive participants, hypertension onset at age <45 years conferred an odds ratios of 2.2 (1.8 to 2.7) for cardiovascular death and 2.3 (1.8 to 2.9) for coronary death, whereas hypertension onset at age ≥65 years conferred a lower magnitude odds ratios of 1.5 (1.2 to 1.9) for cardiovascular death and 1.4 (0.98 to 1.9) for coronary death (P≤0.002 for differences in odds ratios between hypertension onset at age <45 and age ≥65).Conclusions Early onset and not late onset hypertension in parents was strongly associated with hypertension in offspring. In turn, early onset compared with late onset hypertension was associated with greater odds of cardiovascular, and particularly coronary, death. These findings suggest it may be important to distinguish between early onset and late onset hypertension as a familial trait when assessing an individual's risk for hypertension, and as a specific type of blood pressure trait when estimating risk for cardiovascular outcomes in adults with established hypertension.
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Affiliation(s)
- Teemu J Niiranen
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - Elizabeth L McCabe
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Martin G Larson
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Mir Henglin
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Neal K Lakdawala
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Susan Cheng
- National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Kramer H, Colangelo L, Lewis CE, Jacobs DR, Pletcher M, Bibbins-Domingo K, Chang A, Siscovick D, Shlipak M, Peralta CA, Bansal N, Muntner P, Liu K. Cumulative Exposure to Systolic Blood Pressure During Young Adulthood Through Midlife and the Urine Albumin-to-Creatinine Ratio at Midlife. Am J Hypertens 2017; 30:502-509. [PMID: 28338726 PMCID: PMC5861543 DOI: 10.1093/ajh/hpx012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/15/2016] [Accepted: 02/06/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Higher blood pressure during young adulthood may increase cardiovascular and kidney disease risk later in life. This study examined the association of cumulative systolic blood pressure (SBP) exposure during young adulthood through midlife with urine albumin-to-creatinine ratios (ACR) measured during midlife. METHODS We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a biracial cohort recruited in 4 urban areas during years 1985-1986. Cumulative SBP was calculated as the average SBP between 2 exams multiplied by years between exams over 20 year years. ACR was measured 20 years after baseline when participants were age 43-50 years (midlife). A generalized additive model was used to examine the association of log ACR as a function of cumulative SBP with adjustment for covariates including SBP measured concurrently with ACR. RESULTS Cumulative SBP ranged from a low of 1,671 to a high of 3,260 mm Hg. Participants in the highest cumulative SBP quartile were more likely to be male (61.4% vs. 20.7%; P < 0.001), Black (61.5% vs. 25.6%; P < 0.001) and have elevated ACR (18.7% vs. 4.8%; P < 0.001) vs. lowest quartile. Spline regression curves of ACR vs. cumulative SBP demonstrated an inflection point in ACR with cumulative SBP levels >2,350 mm Hg with linear increases in ACR above this threshold. Adjusted geometric mean ACR values were significantly higher with cumulative SBP ≥2,500 vs. <2500 (9.18 [1.06] vs. 6.92 [1.02]; P < 0.0001). CONCLUSION Higher SBP during young adulthood through midlife is associated with higher ACR during midlife.
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Affiliation(s)
- Holly Kramer
- Department of Public Health Sciences, Division of Nephrology and Hypertension, Maywood, Illinois, USA
- Department of Medicine, Division of Nephrology and Hypertension, Maywood, Illinois, USA
| | - Laura Colangelo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Cora E Lewis
- Departments of Medicine, Division of Preventive Medicine, University of Alabama, Birmingham, Alabama, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health University of Minnesota, Minneapolis, MN and also affiliated with the Department of Nutrition, University of Oslo, Oslo,Norway
| | - Mark Pletcher
- Departments of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, California, USA
| | - Kirstin Bibbins-Domingo
- Departments of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, California, USA
- Department of Medicine, Division of Nephrology, University of California, San Francisco, California, USA
| | - Alex Chang
- Department of Medicine, Division of Nephrology, Geisinger Health Systems, Danville, Pennsylvania, USA
| | - David Siscovick
- The New York Academy of Medicine, New York, New York, USA
- Departments of Medicine and Epidemiology, University of Washington, Seattle Departments of Medicine, Seattle, Washington, USA
| | - Michael Shlipak
- General Internal Medicine Section, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California, USA
| | - Carmen A Peralta
- Department of Medicine, University of California, San Francisco, California, USA
- Department of Medicine, Division of Nephrology, University of California, San Francisco, California, USA
| | - Nisha Bansal
- Division of Nephrology, University of Washington, Seattle Departments of Medicine, Seattle, Washington, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama, Birmingham, Alabama, USA
| | - Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Parikh NI, Norberg M, Ingelsson E, Cnattingius S, Vasan RS, Domellöf M, Jansson JH, Edstedt Bonamy AK. Association of Pregnancy Complications and Characteristics With Future Risk of Elevated Blood Pressure: The Västerbotten Intervention Program. Hypertension 2017; 69:475-483. [PMID: 28137991 DOI: 10.1161/hypertensionaha.116.08121] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/10/2016] [Accepted: 01/03/2017] [Indexed: 11/16/2022]
Abstract
Pregnancy characteristics are associated with risk of cardiovascular diseases, but their independent associations with hypertension or blood pressure (BP) levels remain uncertain. We linked the Swedish Medical Birth Register with Västerbotten Intervention Program data (Northern Sweden). Using linear and logistic regression, we related pregnancy factors in any prior pregnancy with BP and hypertension at 40 years of age in 15 896 parous women free of prepregnancy hypertension. Pregnancy factors included parity, age at first delivery, preeclampsia, gestational diabetes mellitus, placental abruption, shortest gestational age small for gestational age baby (<third percentile for birth weight) or stillbirth. We defined hypertension as systolic BP ≥140 mm Hg and diastolic BP ≥90 mm Hg or antihypertensive use. Multivariable models were adjusted for all pregnancy factors and potential lifestyle and sociodemographic confounders. At 40 years of age, 1535 women (9.6%) had hypertension. In multivariable models, lower parity, younger age at first birth, preeclampsia, small for gestational age, and placental abruption were independently associated with higher systolic and diastolic BP levels at 40 years of age. Younger age at first birth, preeclampsia, gestational age <32 versus ≥37 weeks, and small for gestational age were independently associated with hypertension. Our findings raise the possibility that earlier and more frequent BP screening may be desirable in women with these pregnancy characteristics.
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Affiliation(s)
- Nisha I Parikh
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.).
| | - Margareta Norberg
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Erik Ingelsson
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Sven Cnattingius
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Ramachandran S Vasan
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Magnus Domellöf
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Jan Håkan Jansson
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
| | - Anna-Karin Edstedt Bonamy
- From the Division of Cardiology, Department of Medicine, University of California San Francisco (N.I.P.); Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden (M.N.); Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (E.I.); Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden (E.I.); Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden (S.C., A.-K.E.B.); Preventive Medicine and Cardiology Sections, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (R.S.V.); Department of Clinical Sciences, Unit of Pediatrics (M.D.) and Department of Public Health and Clinical Medicine, Research Unit Skellefteå (J.H.J.), Umeå University, Sweden; and Department of Women's Children's Health, Karolinska Institutet, Stockholm, Sweden (A.-K.E.B.)
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Jain P, Danaei G, Robins JM, Manson JE, Hernán MA. Smoking cessation and long-term weight gain in the Framingham Heart Study: an application of the parametric g-formula for a continuous outcome. Eur J Epidemiol 2016; 31:1223-1229. [PMID: 27704230 DOI: 10.1007/s10654-016-0200-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/23/2016] [Indexed: 12/27/2022]
Abstract
Weight gain after smoking cessation can lessen the health benefits of, and reduce the incentives for, quitting smoking. Randomized clinical trials of smoking cessation have estimated this weight gain only over short periods of follow-up. We provide an estimate of long-term post-cessation weight gain in the Framingham Heart Study, a prospective observational study. We identified 2001 smokers free of diabetes, cancer, and cardiovascular disease in 1952. Using the parametric g-formula we estimated mean weight in 1972 if all smokers had quit at baseline versus if all had continued smoking. Our estimates were adjusted for demographic, socio-economic, and clinical factors at baseline and during follow-up. The estimated mean weight (95 % CI) at 20 years if all smokers had quit smoking was 75.2 kg (73.5, 76.6), compared with 70.2 kg (68.7, 71.8) if they had smoked 20 cigarettes/day and 73.4 kg (71.9, 74.6) if they had smoked 5 cigarettes/day (i.e., an estimated mean weight gain of 5.1 kg (3.1, 6.6) and 1.8 kg (0.8, 2.8), respectively). Smokers who were overweight or obese at baseline had a greater post-cessation weight gain on average. Our estimates suggest that smoking cessation can result in increases in body weight over 20 years. While the benefits of smoking cessation outweigh the risks due to post-cessation weight gain, our results highlight the need for long-term weight management interventions in combination with smoking cessation.
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Affiliation(s)
- Priyanka Jain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Goodarz Danaei
- Departments of Epidemiology and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - James M Robins
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Miguel A Hernán
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health and Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
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Forsblad J, Gottsäter A, Mätzsch T, Lindgärde F. Predictors of carotid endarterectomy in middle-aged individuals. Vasc Med 2016. [DOI: 10.1177/1358836x0100600203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective was to investigate which screening variables in a population study predicted carotid endarterectomy. Among 793 carotid endarterectomies performed at Malmö University Hospital between 1991 and 1998, 85 patients (14 females) were identified that had participated in a population screening between 1974 and 1991. Median time from screening to operation was 16 years (range 6-26 years). Screening variables were compared with corresponding values from the background screening population ( n = 33261). As operated patients were older than the background population at screening (49 [37-60] vs. 46 [26-61] years; p < 0.0001), comparisons were age-adjusted. Operated patients had higher systolic blood pressure (SBP; 130 [126-133] vs. 125 [125-125] mmHg; p < 0.01), serum total cholesterol (6.1 [5.9-6.3] vs. 5.7 [5.7-5.7] mmol/l; p < 0.0001), serum triglyceride (1.4 [1.3-1.6] vs. 1.1 [1.1-1.1] mmol/l; p < 0.0001), serum glutamic acid transferase (0.46 [0.40-0.53] vs. 0.40 [0.40-0.41] μkat/l; p < 0.05), and plasma fibrinogen (3.77 [3.42-4.16] vs. 3.35 [3.30-3.41] mmol/l; p < 0.05) levels, a lower 120-min insulin/glucose ratio at an oral glucose tolerance test (OGTT; 0.48 [0.38-0.58] vs. 0.60 [0.59-0.61]; p < 0.05) and forced vital lung capacity (3.7 [3.6-3.9] vs. 3.9 [3.9-4.0] l/min; p < 0.05), and a higher prevalence of smoking at screening (68% vs. 45%; p < 0.0001). Smoking, SBP, serum total cholesterol, and the 120-min insulin/glucose ratio remained independent predictors for carotid surgery in multivariate analysis. No differences existed among patients operated on because of symptomatic and asymptomatic stenosis. In conclusion, increased SBP and total cholesterol, lower 2-h insulin/glucose ratio at an OGTT, and smoking predict carotid surgery at long-term follow-up.
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Affiliation(s)
- J Forsblad
- University of Lund, Department of Vascular Diseases, Malmo Hospital, Malmö, Sweden
| | - A Gottsäter
- University of Lund, Department of Vascular Diseases, Malmo Hospital, Malmö, Sweden,
| | - T Mätzsch
- University of Lund, Department of Vascular Diseases, Malmo Hospital, Malmö, Sweden
| | - F Lindgärde
- University of Lund, Department of Vascular Diseases, Malmo Hospital, Malmö, Sweden
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37
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The Association between Ideal Cardiovascular Health Metrics and Extracranial Carotid Artery Stenosis in a Northern Chinese Population: A Cross-Sectional Study. Sci Rep 2016; 6:31720. [PMID: 27572519 PMCID: PMC5004147 DOI: 10.1038/srep31720] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/26/2016] [Indexed: 01/05/2023] Open
Abstract
Past epidemiologic studies have indicated that the ideal cardiovascular health (CVH) metrics are associated with a lower risk of cardiovascular diseases (CVDs) and stroke. Carotid artery stenosis (CAS) causes approximately 10% of ischemic strokes. The association between ideal CVH and extracranial CAS has not yet been assessed. In the current study, extracranial CAS was assessed by carotid duplex ultrasonography. Logistic regression was used to analyze the association between ideal CVH metrics and extracranial CAS. A total of 3297 participants (52.2% women) aged 40 years and older were selected from the Jidong community in China. After adjusting for sex, age and other potential confounds, the odds ratios (95% confidence intervals) for extracranial CAS were 0.57 (0.39–0.84), 0.46 (0.26–0.80) and 0.29 (0.15–0.54), and for those quartiles, quartile 2 (9–10), quartile 3 (11) and quartile 4 (12–14), respectively, compared with quartile 1 (≤8). This negative correlation was particularly evident in women and the elderly (≥60 years). This cross-sectional study showed a negative correlation between the ideal CVH metrics and the prevalence of extracranial CAS in northern Chinese adults.
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38
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Pletcher MJ, Vittinghoff E, Thanataveerat A, Bibbins-Domingo K, Moran AE. Young Adult Exposure to Cardiovascular Risk Factors and Risk of Events Later in Life: The Framingham Offspring Study. PLoS One 2016; 11:e0154288. [PMID: 27138014 PMCID: PMC4854462 DOI: 10.1371/journal.pone.0154288] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/10/2016] [Indexed: 01/10/2023] Open
Abstract
Background It is unclear whether coronary heart disease (CHD) risk factor exposure during early adulthood contributes to CHD risk later in life. Our objective was to analyze whether extent of early adult exposures to systolic and diastolic blood pressure (SBP, DBP) and low-and high-density lipoprotein cholesterol (LDL, HDL) are independent predictors of CHD events later in life. Methods and Findings We used all available measurements of SBP, DBP, LDL, and HDL collected over 40 years in the Framingham Offspring Study to estimate risk factor trajectories, starting at age 20 years, for all participants. Average early adult (age 20–39) exposure to each risk factor was then estimated, and used to predict CHD events (myocardial infarction or CHD death) after age 40, with adjustment for risk factor exposures later in life (age 40+). 4860 participants contributed an average of 6.3 risk factor measurements from in-person examinations and 24.5 years of follow-up after age 40, and 510 had a first CHD event. Early adult exposures to high SBP, DBP, LDL or low HDL were associated with 8- to 30-fold increases in later life CHD event rates, but were also strongly correlated with risk factor levels later in life. After adjustment for later life levels and other risk factors, early adult DBP and LDL remained strongly associated with later life risk. Compared with DBP≤70 mmHg, adjusted hazard ratios (HRs) were 2.1 (95% confidence interval: 0.8–5.7) for DBP = 71–80, 2.6 (0.9–7.2) for DBP = 81–90, and 3.6 (1.2–11) for DBP>90 (p-trend = 0.019). Compared with LDL≤100 mg/dl, adjusted HRs were 1.5 (0.9–2.6) for LDL = 101–130, 2.2 (1.2–4.0) for LDL = 131–160, and 2.4 (1.2–4.7) for LDL>160 (p-trend = 0.009). While current levels of SBP and HDL were also associated with CHD events, we did not detect an independent association with early adult exposure to either of these risk factors. Conclusions Using a mixed modeling approach to estimation of young adult exposures with trajectory analysis, we detected independent associations between estimated early adult exposures to non-optimal DBP and LDL and CHD events later in life.
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Affiliation(s)
- Mark J. Pletcher
- Departments of Epidemiology and Biostatistics, & Medicine, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Eric Vittinghoff
- Departments of Epidemiology and Biostatistics, & Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Anusorn Thanataveerat
- Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Kirsten Bibbins-Domingo
- Departments of Epidemiology and Biostatistics, & Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Andrew E. Moran
- Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
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Babaka K, Sarr SA, Kane AD, Mbaye A, Ngaïde AA, Fobang Djiogap DH, Bodian M, Ndiaye MB, Ndour-Mbaye M, Diao M, Diack B, Kane M, Diagne-Sow D, Kane A. [Prevalence of atherosclerotic carotid plaques in semi-rural Gueoul, Senegal: Survey of 1411 subjects]. ACTA ACUST UNITED AC 2016; 41:176-81. [PMID: 27090099 DOI: 10.1016/j.jmv.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/24/2016] [Indexed: 11/19/2022]
Abstract
AIMS The purpose of this study was to investigate the prevalence of atherosclerotic carotid plaques and association with cardiovascular risk factors and vascular diseases in a semi-rural area of Gueoul in Senegal. PATIENTS AND METHOD This was a cross-sectional, descriptive study over a period of one month in 2012 in Senegalese people who were older than 35 years, and resided in semi-rural Gueoul for at least six months. Carotid plaques were measured with a portable Doppler Diadop 50(®) and defined by an intima-media thickness greater than 1.5mm. P-values less than 0.05 were considered statistically significant. RESULTS The survey involved 1411 individuals with a sex ratio of 2.93 and an average age of 48.5 years. Prevalence of risk factors was high: dyslipidemia (61.1 %), physical inactivity (56.2 %), abdominal obesity (53.9 %), hypertension (46.4 %), obesity (12 %), diabetes (7.2 %) and smoking (2.5 %). Prevalence of atherosclerotic carotid plaques was 6.8 %, including 42.7 % with bilateral plaques. Prevalence increased with age (P=0.001), hypertension (P=0.0001), diabetes (P=0.004) and metabolic syndrome (P=0.008). There were no significant associations with the other risk factors. The presence of carotid plaques was associated with medical history of stroke (P=0.01), myocardial infarction (P=0.02) and peripheral artery obstructive disease (P=0.5). CONCLUSION Prevalence of atherosclerotic carotid plaques seems weak but it is associated with many cardiovascular risk factors. It requires measures for early diagnosis and prevention of cardiovascular diseases in Senegal.
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Affiliation(s)
- K Babaka
- Service de cardiologie, hôpital Aristide-Le-Dantec, BP 6633, Dakar-Étoile, Sénégal.
| | - S A Sarr
- Service de cardiologie, hôpital Aristide-Le-Dantec, BP 6633, Dakar-Étoile, Sénégal
| | - A D Kane
- Service de cardiologie, hôpital Aristide-Le-Dantec, BP 6633, Dakar-Étoile, Sénégal
| | - A Mbaye
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - A A Ngaïde
- Service de cardiologie, hôpital Aristide-Le-Dantec, BP 6633, Dakar-Étoile, Sénégal
| | - D H Fobang Djiogap
- Service de cardiologie, hôpital Aristide-Le-Dantec, BP 6633, Dakar-Étoile, Sénégal
| | - M Bodian
- Service de cardiologie, hôpital Aristide-Le-Dantec, BP 6633, Dakar-Étoile, Sénégal
| | - M B Ndiaye
- Service de cardiologie, hôpital Aristide-Le-Dantec, BP 6633, Dakar-Étoile, Sénégal
| | - M Ndour-Mbaye
- Service de médecine interne, hôpital Abass-Ndao, BP 5866, Dakar-Fann, Sénégal
| | - M Diao
- Service de cardiologie, hôpital Aristide-Le-Dantec, BP 6633, Dakar-Étoile, Sénégal
| | - B Diack
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - M Kane
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - D Diagne-Sow
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
| | - A Kane
- Service de cardiologie, hôpital général de Grand-Yoff, BP 3270, Dakar, Sénégal
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40
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Wang W, Shen G, Shahar E, Bidulescu A, Kimberly WT, Sheth KN, Campbell BW, Horbal S, Correa A, Griswold ME. Forced Expiratory Volume in the First Second and Aldosterone as Mediators of Smoking Effect on Stroke in African Americans: The Jackson Heart Study. J Am Heart Assoc 2016; 5:e002689. [PMID: 26819252 PMCID: PMC4859388 DOI: 10.1161/jaha.115.002689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 10/25/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cigarette smoking is a risk factor for stroke, but the mechanisms by which smoking contributes to stroke are not well understood. This study aimed to evaluate the roles of lung function (represented by forced expiratory volume in the first second (FEV1)) and aldosterone as potential mediators of the association of smoking with stroke. METHODS AND RESULTS The data were derived from 5010 Jackson Heart Study participants who had mean follow-up of 97.9 months. Using the Cox proportional hazards model, we estimated the hazard ratios of smoking for total stroke with and without adjustment for FEV1 and/or aldosterone at baseline after controlling for the confounders. The hazard ratio for current smoking (versus never smoking) was 2.70 (95% CI 1.71 to 4.25) for total stroke after adjustment for the confounders. Additional adjustment for FEV1 and aldosterone reduced the hazard ratio to 2.32 (95% CI 1.42 to 3.79), suggesting that 22.4% of the excess risk of current smoking for total stroke is mediated by these factors. FEV1 and aldosterone account for 13.1% and 12.1%, respectively, of the excess risk. The hazard ratio for FEV1 increased (0.61 versus 0.65) after including systemic inflammatory marker C-reactive protein, and the hazard ratios for aldosterone were comparable for the models that included all confounders and smoking status with or without different blood pressure measurements. CONCLUSIONS Our findings suggest that the difference in stroke risk between current and never smokers may develop partially through pathways involving lung function and aldosterone and that the mediation effect through aldosterone is independent of blood pressure.
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Affiliation(s)
- Wei Wang
- Center of Biostatistics and BioinformaticsUniversity of Mississippi Medical CenterJacksonMS
| | - Gui Shen
- Department of Mathematics and StatisticsMississippi State UniversityMississippi StateMS
| | - Eyal Shahar
- Department of Epidemiology and BiostatisticsMel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonAZ
| | - Aurelian Bidulescu
- Department of Epidemiology and BiostatisticsIndiana University School of Public HealthBloomingtonIN
| | | | - Kevin N. Sheth
- Division of Neurocritical Care & Emergency NeurologySchool of MedicineYale UniversityNew HavenCT
| | | | - Steven Horbal
- Department of Epidemiology and BiostatisticsIndiana University School of Public HealthBloomingtonIN
| | - Adolfo Correa
- Jackson Heart StudyDepartment of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Michael E. Griswold
- Center of Biostatistics and BioinformaticsUniversity of Mississippi Medical CenterJacksonMS
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41
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Seshadri S, Wolf PA. Modifiable Risk Factors and Determinants of Stroke. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Liu YL, Szklo M, Davidson KW, Bathon JM, Giles JT. Differential Association of Psychosocial Comorbidities With Subclinical Atherosclerosis in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2015; 67:1335-44. [PMID: 26274015 DOI: 10.1002/acr.22635] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/05/2015] [Accepted: 06/02/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is associated with an elevated risk of cardiovascular disease (CVD) events and subclinical atherosclerosis, but the reasons for the excess risk are unclear. We explored whether psychosocial comorbidities, which may be associated with CVD in the general population, are differentially associated with subclinical atherosclerosis in RA compared to controls. METHODS Data were from a longitudinal cohort study of 195 RA patients and 1,073 non-RA controls. Using validated scales, heterogeneity in the associations of psychosocial measures (depression, stress, anxiety/anger, support, discrimination/hassles) with measures of subclinical atherosclerosis (coronary artery calcium [CAC] and carotid intima-media thickness [IMT]/plaque) were compared in RA and non-RA groups using multivariable generalized linear models. Computed tomography and ultrasound were used to identify CAC and IMT/plaque, respectively. CAC >100 units was used to define moderate/severe CAC. RESULTS In RA, per-unit higher anxiety scores (odds ratio [OR] 1.10, P = 0.029), anger scores (OR 1.14, P = 0.037), depressive symptoms (OR 3.41, P = 0.032), and caregiver stress (OR 2.86, P = 0.014) were associated with increased odds of CAC >100 units after adjustment for relevant covariates. These findings persisted despite adjustment for markers of inflammation (C-reactive protein and interleukin-6 levels) and were seen only in RA, not in controls (adjusted multiplicative interaction P = 0.001-0.077). In RA, job stress was associated with an increased risk of carotid plaque (adjusted OR = 3.21, P = 0.019), and increasing social support was associated with lower internal carotid IMT (adjusted P = 0.024). CONCLUSION Depressive symptoms, stress, anger/anxiety, and social support may preferentially affect CVD risk in RA, and screening/treatment for psychosocial morbidities in RA may help ameliorate the additional CVD burden.
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Affiliation(s)
- Ying L Liu
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Moyses Szklo
- Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Karina W Davidson
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joan M Bathon
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jon T Giles
- College of Physicians and Surgeons, Columbia University, New York, New York
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Simunek L, Krajickova D, Vysata O, Valis M. Trends in the treatment of risk factors for stroke in a Czech stroke unit. Open Med (Wars) 2015; 10:364-369. [PMID: 28352720 PMCID: PMC5368851 DOI: 10.1515/med-2015-0060] [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: 09/04/2013] [Accepted: 09/29/2015] [Indexed: 11/19/2022] Open
Abstract
The goal of this study is to evaluate therapeutic trends for several diseases that represent risk factors for stroke. The relative frequency of therapy with compounds that influence the risk factors for stroke was monitored in a group of 3,290 patients who were hospitalised in the Stroke Unit at the University Hospital in Hradec Kralove between 2005 and 2012. For most drugs monitored, the reasons for the significant decrease or increase in use were causes other than the reduction of stroke risk. Despite this finding, the majority of statistically significant changes had, according to review of comparative studies, a positive effect on prevention of stroke. Motivation to change treatment of stroke risk factors, such as hypertension, diabetes mellitus and hypercholesterolemia, was mainly aimed at sufficient disease management with a minimum of adverse effects. On the other hand, optimization of stroke recurrence and economic factors were motivations to treatment changes in prevention with antiplatelets. Antidiabetics were associated with an increase in metformin use and reduction in insulin use. For antihypertensives, the most significant reduction was associated with the use of diuretics, although calcium channel blockers and beta-blockers are also less used. Additionally, the use of the ACE inhibitor ramipril increased
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Affiliation(s)
- Libor Simunek
- University Hospital in Hradec Králové, Hradec Kralove, Czech Republic
| | - Dagmar Krajickova
- University Hospital in Hradec Králové, Hradec Kralove, Czech Republic
| | - Oldrich Vysata
- University Hospital in Hradec Králové, Hradec Kralove, Czech Republic
| | - Martin Valis
- University Hospital in Hradec Králové, Hradec Kralove, Czech Republic
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da Silva SM, Luiz RR, Pereira RA. Risk and protection factors for cardiovascular diseases among adults of Cuiabá, Mato Grosso, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18:425-38. [PMID: 26083513 DOI: 10.1590/1980-5497201500020011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 08/08/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases are the leading cause of death and hospital expenses in the state of Mato Grosso, Brazil. OBJECTIVE To describe the temporal variation on risk and protective factors for cardiovascular diseases in adults (≥ 18 years old). METHODS Data were obtained from population-based telephone surveys carried out between 2006 and 2009 in Cuiabá, the capital of Mato Grosso, Brazil. The prevalence of smoking, alcohol abuse, markers of diet quality consumption, physical activities, leisure, domestic work, and commute was estimated. Statistical significance of temporal variations in these estimators was estimated by logistic regression models, whose dependent variables were the analyzed risk factors (absent = 0; present = 1) and independent variable was the year of the survey. RESULTS There was an increase in the proportion of men who reported to never have smoked (from 53 to 61%, p = 0.04). The frequency of regular soft drink consumption was reduced by 23% (p < 0.01). Overall, the reference to the consumption of fruits and vegetables increased by 19% (p = 0.02), and among men this increase was clearer (49%; p < 0.01). There was a reduction in domestic work (p < 0.01) and in leisure physical activity among women (from 14 to 10%; p = 0.02). Conversely, there was an increase in the proportion of women and individuals older than 40 years of age who make active commuting every day. CONCLUSION Favorable changes in cardiovascular risk and protective factors were mostly observed among men, young adults, and those with more than eight schooling years.
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Affiliation(s)
| | - Ronir Raggio Luiz
- Institute of Public Health Studies, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Rosangela Alves Pereira
- Institute of Nutrition Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Castilla-Guerra L, Fernández-Moreno M, Serrano-Rodríguez L. Manejo actual de la estenosis carotídea asintomática. Rev Clin Esp 2015; 215:224-9. [DOI: 10.1016/j.rce.2014.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 11/22/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
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Current management of asymptomatic carotid stenosis. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lin CH, Chang WC, Kuo CN, Yu HC, Yang CC, Lin YW, Hung KS, Chang WP. A population-based five-year study on the risk of stroke in patients with osteoporosis in Taiwan. Bone 2015; 72:9-13. [PMID: 25460575 DOI: 10.1016/j.bone.2014.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 10/17/2014] [Accepted: 11/13/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Osteoporosis and stroke are common diseases in elder patients. The relationship between these two diseases is unclear. This study was intended to estimate the risk of stroke among elder persons aged ≥ 50 years within five years of being diagnosed with osteoporosis. METHODS We retrieved data from the Longitudinal Health Insurance Database 2005 (LHID2005) in Taiwan to perform a nationwide population-based study. There were 2580 patients with osteoporosis aged 50 years of age and older in the study cohort. All of them had at least 2 ambulatory care claims or at least 1 inpatient service claim. Each osteoporotic patient was matched to 5 non-osteoporotic patients based on gender, age, and the index year. Subjects in both groups were followed up for five years. Risk of developing stroke and 5-year stroke-free survival rates were evaluated. RESULTS The risk of developing stroke was 1.24 times higher in osteoporotic patients within a 5-year follow-up period compared to an age- and gender-matched cohort without osteoporosis (95% confidence interval = 1.11-1.39; p < 0.001). Patients with osteoporosis also had a significantly lower 5-year stroke-free survival rate. CONCLUSIONS Our results indicated that patients with osteoporosis history had higher risk for development of stroke.
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Affiliation(s)
- Chia-Hsien Lin
- Department of Health Industry Management, Kainan University, Taoyuan, Taiwan
| | - Wei-Chiao Chang
- Department of Clinical Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chun-Nan Kuo
- Department of Clinical Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hann-Chin Yu
- Department of Obstetrics and Gynecology, Branch of Hsinchu, Taipei Veterans General Hospital, Taiwan
| | - Chien-Chang Yang
- Department Human Resource, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yea-Wen Lin
- Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Kuo-Sheng Hung
- Department of Neurosurgery, Clinical Research Center, Graduate Institute of Injury Prevention and Control, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Wei-Pin Chang
- Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
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Yan B, Peng L, Han D, Sun L, Dong Q, Yang P, Zheng F, Ong H, Zeng L, Wang G. Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients. Medicine (Baltimore) 2015; 94:e604. [PMID: 25761180 PMCID: PMC4602459 DOI: 10.1097/md.0000000000000604] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Nocturnal variations in blood pressure (BP) were associated with carotid intima-media thickness. However, the precise relationship between circadian variations of BP and carotid plaques remains unknown. Therefore, the prognostic value of reverse-dipper pattern of BP for carotid plaque was investigated. In this cross-sectional study, a total of 524 hypertensive patients were recruited and evaluated with ambulatory BP monitoring between April 2012 and June 2013. Carotid plaque was classified into Grade 0 (normal or no observable plaque), Grade 1 (mild stenosis, 1%-24% narrowing), and Grade 2 (moderate stenosis, ≥25% narrowing). Multinomial logistic regression was applied to analyze the relationship between different degrees of carotid plaque and ambulatory BP monitoring results. Reverse-dipper pattern of BP was more common in older patients, smokers, and those with elevated fasting glucose. The incidences of coronary artery disease, lacunar infarction, and diabetes were also higher among hypertensive with reverse-dipper pattern. Multinomial logistic regression analysis showed that reverse dipper (odds ratio [OR] 2.500; 95% confidence interval [CI] 1.320-4.736; P = 0.005), age (OR 1.089; 95% CI 1.067-1.111; P < 0.001), smoke (OR 1.625; 95% CI 1.009-2.617; P = 0.046), and diabetes (OR 1.759; 95% CI 1.093-2.830; P = 0.020) were significantly different between mild carotid plaque and normal. Our results also suggested that mild carotid plaque was closely related to reverse-dipper pattern of BP (2.308; 95% CI 1.223-4.355; P = 0.010). Reverse-dipper pattern of BP may be a risk factor for carotid atherosclerosis and play a crucial role in the early formation of carotid plaque.
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Affiliation(s)
- Bin Yan
- From the Department of Emergency Medicine (BY, GW); Department of Cardiology (LP); Department of Ultrasound (DH, LS); Department of Neurosurgery (QD, FZ); Department of Oncology, the Second Affiliated Hospital, Xi'an Jiaotong University Xi'an, China (PY); Division of Cardiology, Khoo Teck Puat Hospital, Singapore (HYO); and Cardiovascular division, King's College London, British Heart Foundation Centre, London, United Kingdom (LZ)
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Abstract
Stroke is the third leading cause of death in developed nations. Up to 88% of strokes are ischemic in nature. Extracranial carotid artery atherosclerotic disease is the third leading cause of ischemic stroke in the general population and the second most common nontraumatic cause among adults younger than 45 years. This article provides comprehensive, evidence-based recommendations for the management of extracranial atherosclerotic disease, including imaging for screening and diagnosis, medical management, and interventional management.
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Affiliation(s)
- Yinn Cher Ooi
- Department of Neurosurgery, University of California, Los Angeles
| | - Nestor R. Gonzalez
- Department of Neurosurgery and Radiology, University of California, Los Angeles, 100 UCLA Med Plaza Suite# 219, Los Angeles, CA 90095, +1(310)825-5154
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Sarikaya H, Ferro J, Arnold M. Stroke Prevention - Medical and Lifestyle Measures. Eur Neurol 2015; 73:150-7. [DOI: 10.1159/000367652] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 08/17/2014] [Indexed: 11/19/2022]
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