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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Huang Y, Herbst EB, Xie Y, Yin L, Islam ZH, Kent EW, Wang B, Klibanov AL, Hossack JA. In Vivo Validation of Modulated Acoustic Radiation Force-Based Imaging in Murine Model of Abdominal Aortic Aneurysm Using VEGFR-2-Targeted Microbubbles. Invest Radiol 2023; 58:865-873. [PMID: 37433074 PMCID: PMC10784413 DOI: 10.1097/rli.0000000000001000] [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] [Indexed: 07/13/2023]
Abstract
OBJECTIVES The objective of this study is to validate the modulated acoustic radiation force (mARF)-based imaging method in the detection of abdominal aortic aneurysm (AAA) in murine models using vascular endothelial growth factor receptor 2 (VEGFR-2)-targeted microbubbles (MBs). MATERIALS AND METHODS The mouse AAA model was prepared using the subcutaneous angiotensin II (Ang II) infusion combined with the β-aminopropionitrile monofumarate solution dissolved in drinking water. The ultrasound imaging session was performed at 7 days, 14 days, 21 days, and 28 days after the osmotic pump implantation. For each imaging session, 10 C57BL/6 mice were implanted with Ang II-filled osmotic pumps, and 5 C57BL/6 mice received saline infusion only as the control group. Biotinylated lipid MBs conjugated to either anti-mouse VEGFR-2 antibody (targeted MBs) or isotype control antibody (control MBs) were prepared before each imaging session and were injected into mice via tail vein catheter. Two separate transducers were colocalized to image the AAA and apply ARF to translate MBs simultaneously. After each imaging session, tissue was harvested and the aortas were used for VEGFR-2 immunostaining analysis. From the collected ultrasound image data, the signal magnitude response of the adherent targeted MBs was analyzed, and a parameter, residual-to-saturation ratio ( Rres - sat ), was defined to measure the enhancement in the adherent targeted MBs signal after the cessation of ARF compared with the initial signal intensity. Statistical analysis was performed with the Welch t test and analysis of variance test. RESULTS The Rres - sat of abdominal aortic segments from Ang II-challenged mice was significantly higher compared with that in the saline-infused control group ( P < 0.001) at all 4 time points after osmotic pump implantation (1 week to 4 weeks). In control mice, the Rres - sat values were 2.13%, 1.85%, 3.26%, and 4.85% at 1, 2, 3, and 4 weeks postimplantation, respectively. In stark contrast, the Rres - sat values for the mice with Ang II-induced AAA lesions were 9.20%, 20.6%, 22.7%, and 31.8%, respectively. It is worth noting that there was a significant difference between the Rres - sat for Ang II-infused mice at all 4 time points ( P < 0.005), a finding not present in the saline-infused mice. Immunostaining results revealed the VEGFR-2 expression was increased in the abdominal aortic segments of Ang II-infused mice compared with the control group. CONCLUSIONS The mARF-based imaging technique was validated in vivo using a murine model of AAA and VEGFR-2-targeted MBs. Results in this study indicated that the mARF-based imaging technique has the ability to detect and assess AAA growth at early stages based on the signal intensity of adherent targeted MBs, which is correlated with the expression level of the desired molecular biomarker. The results may suggest, in very long term, a pathway toward eventual clinical implementation for an ultrasound molecular imaging-based approach to AAA risk assessment in asymptomatic patients.
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Affiliation(s)
- Yi Huang
- From the Department of Biomedical Engineering, University of Virginia, Charlottesville, VA (Y.H., Y.X., J.A.H.); Philips Research North America, Cambridge, MA (E.B.H.); Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA (L.Y., Z.H.I., E.W.K., B.W.); and Division of Cardiovascular Medicine, Cardiovascular Research Center and Department of Biomedical Engineering, University of Virginia, Charlottesville, VA (A.L.K.)
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Zottola ZR, Kong DS, Medhekar AN, Frye LE, Hao SB, Gonring DW, Hirad AA, Stoner MC, Richards MS, Mix DS. Intermediate pressure-normalized principal wall strain values are associated with increased abdominal aortic aneurysmal growth rates. Front Cardiovasc Med 2023; 10:1232844. [PMID: 37719977 PMCID: PMC10501562 DOI: 10.3389/fcvm.2023.1232844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Current abdominal aortic aneurysm (AAA) assessment relies on analysis of AAA diameter and growth rate. However, evidence demonstrates that AAA pathology varies among patients and morphometric analysis alone is insufficient to precisely predict individual rupture risk. Biomechanical parameters, such as pressure-normalized AAA principal wall strain (ε ρ + ¯ /PP, %/mmHg), can provide useful information for AAA assessment. Therefore, this study utilized a previously validated ultrasound elastography (USE) technique to correlate ε ρ + ¯ /PP with the current AAA assessment methods of maximal diameter and growth rate. Methods Our USE algorithm utilizes a finite element mesh, overlaid a 2D cross-sectional view of the user-defined AAA wall, at the location of maximum diameter, to track two-dimensional, frame-to-frame displacements over a full cardiac cycle, using a custom image registration algorithm to produce ε ρ + ¯ /PP. This metric was compared between patients with healthy aortas and AAAs (≥3 cm) and compared between small and large AAAs (≥5 cm). AAAs were then separated into terciles based on ε ρ + ¯ /PP values to further assess differences in our metric across maximal diameter and prospective growth rate. Non-parametric tests of hypotheses were used to assess statistical significance as appropriate. Results USE analysis was conducted on 129 patients, 16 healthy aortas and 113 AAAs, of which 86 were classified as small AAAs and 27 as large. Non-aneurysmal aortas showed higher ε ρ + ¯ /PP compared to AAAs (0.044 ± 0.015 vs. 0.034 ± 0.017%/mmHg, p = 0.01) indicating AAA walls to be stiffer. Small and large AAAs showed no difference in ε ρ + ¯ /PP. When divided into terciles based on ε ρ + ¯ /PP cutoffs of 0.0251 and 0.038%/mmHg, there was no difference in AAA diameter. There was a statistically significant difference in prospective growth rate between the intermediate tercile and the outer two terciles (1.46 ± 2.48 vs. 3.59 ± 3.83 vs. 1.78 ± 1.64 mm/yr, p = 0.014). Discussion There was no correlation between AAA diameter and ε ρ + ¯ /PP, indicating biomechanical markers of AAA pathology are likely independent of diameter. AAAs in the intermediate tercile of ε ρ + ¯ /PP values were found to have nearly double the growth rates than the highest or lowest tercile, indicating an intermediate range of ε ρ + ¯ /PP values for which patients are at risk for increased AAA expansion, likely necessitating more frequent imaging follow-up.
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Affiliation(s)
- Zachary R. Zottola
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Daniel S. Kong
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Ankit N. Medhekar
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Lauren E. Frye
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Scarlett B. Hao
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Dakota W. Gonring
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Adnan A. Hirad
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael C. Stoner
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael S. Richards
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | - Doran S. Mix
- Division of Vascular Surgery, Department of Surgery, Cardiovascular Engineering Lab, University of Rochester Medical Center, Rochester, NY, United States
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Mulorz J, Spin JM, Mulorz P, Wagenhäuser MU, Deng A, Mattern K, Rhee YH, Toyama K, Adam M, Schelzig H, Maegdefessel L, Tsao PS. E-cigarette exposure augments murine abdominal aortic aneurysm development: role of Chil1. Cardiovasc Res 2023; 119:867-878. [PMID: 36413508 PMCID: PMC10409905 DOI: 10.1093/cvr/cvac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS Abdominal aortic aneurysm (AAA) is a common cardiovascular disease with a strong correlation to smoking, although underlying mechanisms have been minimally explored. Electronic cigarettes (e-cigs) have gained recent broad popularity and can deliver nicotine at comparable levels to tobacco cigarettes, but effects on AAA development are unknown. METHODS AND RESULTS We evaluated the impact of daily e-cig vaping with nicotine on AAA using two complementary murine models and found that exposure enhanced aneurysm development in both models and genders. E-cigs induced changes in key mediators of AAA development including cytokine chitinase-3-like protein 1 (CHI3L1/Chil1) and its targeting microRNA-24 (miR-24). We show that nicotine triggers inflammatory signalling and reactive oxygen species while modulating miR-24 and CHI3L1/Chil1 in vitro and that Chil1 is crucial to e-cig-augmented aneurysm formation using a knockout model. CONCLUSIONS In conclusion our work shows increased aneurysm formation along with augmented vascular inflammation in response to e-cig exposure with nicotine. Further, we identify Chil1 as a key mediator in this context. Our data raise concerns regarding the potentially harmful long-term effects of e-cig nicotine vaping.
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Affiliation(s)
- Joscha Mulorz
- Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
| | - Joshua M Spin
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
| | - Pireyatharsheny Mulorz
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
| | - Markus Udo Wagenhäuser
- Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Alicia Deng
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
| | - Karin Mattern
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Medical University of Göttingen, Göttingen, Germany
| | - Yae H Rhee
- Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
| | - Kensuke Toyama
- Department of Pharmacology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Hubert Schelzig
- Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
- German Center for Cardiovascular Research (DZHK), Berlin, Germany (partner site: Munich)
| | - Philip S Tsao
- Department of Medicine, Stanford University, 300 Pasteur Drive, Standford, CA 94305, USA
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
- Department of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Standford, CA 94305, USA
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Mogi M. LOX prevents abdominal aortic aneurysm ruptures. Hypertens Res 2023; 46:801-802. [PMID: 36635531 DOI: 10.1038/s41440-023-01172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Masaki Mogi
- Department of Pharmacology, Ehime University, Graduate School of Medicine, Shitsukawa, Tohon, Ehime, 791-0295, Japan.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1023] [Impact Index Per Article: 1023.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Bian S, Yang L, Zhao D, Lv L, Wang T, Yuan H. HMGB1/TLR4 signaling pathway enhances abdominal aortic aneurysm progression in mice by upregulating necroptosis. Inflamm Res 2023; 72:703-713. [PMID: 36745209 DOI: 10.1007/s00011-023-01694-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE AND DESIGN The age-associated increases in aseptic inflammation and necroptosis are closely related to the emergence of various age-associated diseases. METHODS In this study, the role of HMGB1/TLR4-induced necroptosis in abdominal aortic aneurysm (AAA) formation was investigated. First, the levels of sterile inflammatory mediators (HMGB1, TLR4) and necroptosis markers were measured in the abdominal aortas of young and old C57BL/6JNifdc mice. We observed that sterile inflammatory mediators and necroptosis markers were greatly increased in the abdominal aortas of old mice. Then, angiotensin II (Ang II)-induced AAA model in APOE-/- mice was used in this study. Mice AAA models were treated with the RIP1 inhibitor necrostatin-1 (Nec-1) or the TLR4 inhibitor TAK-242, respectively. RESULTS We found that HMGB1, TLR4, and necroptosis markers were elevated in old mice compared with those in young mice. Same elevation was also found in the development of AAA in APOE-/- mice. In addition, the necroptosis inhibitor Nec-1 alleviated Ang II-induced AAA development while downregulating the expression of HMGB1/TLR4. After blocking TLR4 with TAK-242, the expression of necroptosis markers decreased significantly, and the progression of AAA was also alleviated in APOE-/- mice. CONCLUSIONS Our results indicated that HMGB1/TLR4-mediated necroptosis enhances AAA development in the Ang II-induced AAA model in APOE-/- mice and that TLR4 might be a potential therapeutic target for AAA management.
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Affiliation(s)
- Shuai Bian
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Invasive Therapy, Anqing Municipal Hospital (Anqing Hospital Affiliated to Anhui Medical University), Anqing, China
| | - Le Yang
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | - Lizhi Lv
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tiezheng Wang
- Department of Medical Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.,Department of Medical Ultrasound, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China
| | - Hai Yuan
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China. .,Department of Vascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China.
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2268] [Impact Index Per Article: 1134.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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10
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Mei X, Chen SY. Circular RNAs in cardiovascular diseases. Pharmacol Ther 2021; 232:107991. [PMID: 34592203 DOI: 10.1016/j.pharmthera.2021.107991] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/08/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
In eukaryotes, precursor mRNAs (pre-mRNAs) produce a unique class of biologically active molecules namely circular RNAs (circRNAs) with a covalently closed-loop structure via back-splicing. Because of this unconventional circular form, circRNAs exhibit much higher stability than linear RNAs due to the resistance to exonuclease degradation and thereby play exclusive cellular regulatory roles. Recent studies have shown that circRNAs are widely expressed in eukaryotes and display tissue- and disease-specific expression patterns, including in the cardiovascular system. Although numerous circRNAs are discovered by in silico methods, a limited number of circRNAs have been studied. This review intends to summarize the current understanding of the characteristics, biogenesis, and functions of circRNAs and delineate the practical approaches for circRNAs investigation. Moreover, we discuss the emerging roles of circRNAs in cardiovascular diseases.
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Affiliation(s)
- Xiaohan Mei
- Departments of Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America
| | - Shi-You Chen
- Departments of Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America; Department of Medical Pharmacology & Physiology, University of Missouri School of Medicine, Columbia, MO, United States of America.
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11
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Otaka N, Uchida HA, Okuyama M, Hada Y, Onishi Y, Kakio Y, Takeuchi H, Umebayashi R, Tanabe K, Subramanian V, Daugherty A, Sato Y, Wada J. Vasohibin-2 Aggravates Development of Ascending Aortic Aneurysms but not Abdominal Aortic Aneurysms nor Atherosclerosis in ApoE-Deficient Mice. Am J Hypertens 2021; 34:467-475. [PMID: 33180898 DOI: 10.1093/ajh/hpaa181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/18/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vasohibin-2 (VASH2) has been isolated as a homologue of vasohibin-1 (VASH1) that promotes angiogenesis counteracting with VASH1. Chronic angiotensin II (AngII) infusion promotes both ascending and abdominal aortic aneurysms (AAs) in mice. The present study aimed to investigate whether exogenous VASH2 influenced AngII-induced vascular pathology in apolipoprotein E-deficient (ApoE-/-) mice. METHODS Male, ApoE-/- mice (9-14 weeks old) were injected with Ad LacZ or Ad VASH2. After a week, saline or AngII (1,000 ng/kg/minute) was infused into the mice subcutaneously via mini-osmotic pumps for 3 weeks. Consequently, all these mice were divided into 4 groups: saline + LacZ (n = 5), saline + VASH2 (n = 5), AngII + LacZ (n = 18), and AngII + VASH2 (n = 17). RESULTS Exogenous VASH2 had no significant effect on ex vivo maximal diameters of abdominal aortas (AngII + LacZ: 1.67 ± 0.17 mm, AngII + VASH2: 1.52 ± 0.16 mm, n.s.) or elastin fragmentation and accumulation of inflammatory cells. Conversely, exogenous VASH2 significantly increased intima areas of aortic arches (AngII + LacZ: 16.6 ± 0.27 mm2, AngII + VASH2: 18.6 ± 0.64 mm2, P = 0.006). VASH2 effect of AngII-induced ascending AAs was associated with increased cleaved caspase-3 abundance. AngII-induced atherosclerosis was not altered by VASH2. CONCLUSIONS The present study demonstrated that augmented VASH2 expression had no effect of AngII-induced abdominal AAs or atherosclerosis, while increasing dilation in the ascending aorta.
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Affiliation(s)
- Nozomu Otaka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Haruhito A Uchida
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Michihiro Okuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Saha Cardiovascular Research Center, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Yoshiko Hada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiro Onishi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Kakio
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryoko Umebayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Tanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Venkateswaran Subramanian
- Saha Cardiovascular Research Center, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Alan Daugherty
- Saha Cardiovascular Research Center, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Yasufumi Sato
- Department of Vascular Biology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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12
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Konno N, Harada T, Akamatsu D, Goto H, Miki T, Kamei T, Kohzuki M. The area under curve for time-course analysis parameters is associated with abdominal aortic aneurysms and the severity of peripheral artery disease in men. Int J Cardiol Hypertens 2021; 8:100080. [PMID: 33644742 PMCID: PMC7893437 DOI: 10.1016/j.ijchy.2021.100080] [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: 11/15/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background Abdominal aortic aneurysm (AAA) and peripheral artery disease (PAD) are associated with vascular endothelial dysfunction. To date, flow-mediated vasodilatation (FMD) and nitroglycerin-mediated vasodilatation (NMD) have been used to evaluate vascular function. Recently, parameters of time-course analysis have been proposed as useful evaluations for arteriosclerotic diseases. In this study, the correlation between the parameters of time-course analysis, to the degree of vascular endothelial damage in AAA and PAD, together with their applicability as a vascular function test, was investigated. Methods Brachial artery vasoreactivity was assessed in male patients with AAA (n = 150) and PAD (n = 50). The percentage change in peak diameters (ΔFMD and ΔNMD), the time to diameter change, the time to peak diameter from the diameter change, the blood flow decay time constant, the area under the curve (AUC), the maximum dilation rate and the extended time constant were measured. Results Among the groups of aneurysm diameter in AAA, the FMD-AUC was highly different (p = .01), while the ΔFMD was not significantly different (p = .36). Among the Fontaine stages in PAD, the FMD-AUC was inversely associated with severity (p = .01) although the ΔFMD was not significantly different (p = .71). Among the Fontaine stages, the NMD-AUC was also inversely associated with severity (p = .03) although the ΔNMD was not significantly different (p = .11). Conclusion This study suggests that FMD-AUC and NMD-AUC are useful for estimating vascular endothelial and vascular smooth muscle dysfunction, serving as supplementary markers for the diagnosis and evaluation of PAD and AAA.
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Affiliation(s)
- Nao Konno
- Department of Internal Medicine and Rehabilitation Science, Graduate School of Medicine, Tohoku University.,Department of Clinical Physiological Laboratory Center, Tohoku University
| | - Taku Harada
- Department of Internal Medicine and Rehabilitation Science, Graduate School of Medicine, Tohoku University
| | - Daijirou Akamatsu
- Department of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University
| | - Hitoshi Goto
- Department of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University
| | - Takashi Miki
- Department of Clinical Physiological Laboratory Center, Tohoku University
| | - Takashi Kamei
- Department of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Graduate School of Medicine, Tohoku University
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13
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 2942] [Impact Index Per Article: 980.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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14
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Schlieder I, Kontopidis I, Blackwood S, Krol E, Dietzek AM. Increasing disparity between Society for Vascular Surgery guidelines for infrarenal abdominal aortic aneurysm repair and real-world practice. J Vasc Surg 2020; 73:1227-1233.e1. [PMID: 32889077 DOI: 10.1016/j.jvs.2020.08.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/04/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The current Society for Vascular Surgery (SVS) guidelines, based on randomized controlled trials published more than a decade ago, recommend a minimum threshold diameter of 5.5 cm for infrarenal abdominal aortic aneurysm (iAAA) repair. It is unknown whether practice patterns with respect to size of repair have changed since the publication of these guidelines. We aimed to evaluate the real-world practice of vascular surgeons in our region with respect to iAAA size at the time of repair, whether this has changed over the past 12 years and if any changes were associated with the repair type, open vs endovascular. METHODS The Vascular Study Group of New England (VSGNE) database was used to identify all patients who received iAAA repair between 2003 and 2015. The primary end point was to quantify the annual percentage of iAAAs repaired in different size categories (≥5.5 cm; <5.5 cm but ≥5.0 cm; <5.0 cm) over the study time period and by type of repair. The secondary end points were morbidity and mortality in these groups. We excluded nonelective cases (ruptured or symptomatic), patients with coexisting iliac artery aneurysms, and those missing critical data. RESULTS A total of 5314 patients with iAAA repairs (1538 open, 3776 endovascular) were identified in the VSGNE database during the study period. In 40% (2110 of 5314) of patients, repair was performed for aneurysms <5.5 cm, with endovascular aneurysm repair (EVAR) comprising 75% (1581 of 2110) and open 25% (529 of 2110). More EVARs were performed for <5.5 cm in 2015 (46%) compared with 2003 (33%) (P < .05, n - 1 χ2) with an average increase of 1.1%/y. There was also a non-statistically significant increase in open repair of small aneurysms (0.7%/y; P = .759). Overall, 30-day mortality was 1.11% in the EVAR group (0.54% in <5.0 cm, 0.91% in ≥5.0 but <5.5 cm, and 1.55% in ≥5.5 cm), compared with 3% in the open group (2.88%, 1.79%, and 3.77%, respectively) with no significant change in mortality in either group over time. CONCLUSIONS Despite the SVS guidelines suggesting surveillance rather than repair of iAAA <5.5 cm, an increasing proportion of repairs in the VSGNE database were performed below that threshold. The reasons for this are likely multifactorial and might include a lesser complexity and lower operative mortality for smaller aneurysms and markedly improved third- and fourth-generation stent graft technology with possibly better long-term survival. As such, it may be time to re-examine the current guidelines for iAAA repair.
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Affiliation(s)
- Ian Schlieder
- Department of Vascular Surgery, Danbury Hospital, Danbury, Conn
| | | | | | - Emilia Krol
- Department of Vascular Surgery, Danbury Hospital, Danbury, Conn
| | - Alan M Dietzek
- Department of Vascular Surgery, Danbury Hospital, Danbury, Conn.
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15
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Chen X, Li Y, Xiao J, Zhang H, Yang C, Wei Z, Chen W, Du X, Liu J. Modulating Neuro-Immune-Induced Macrophage Polarization With Topiramate Attenuates Experimental Abdominal Aortic Aneurysm. Front Pharmacol 2020; 11:565461. [PMID: 32982758 PMCID: PMC7485436 DOI: 10.3389/fphar.2020.565461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022] Open
Abstract
The development of abdominal aortic aneurysm (AAA) is attributed to psychological and physical factors. Topiramate, which is an agonist of the GABAA receptor, makes contributions to neuronal disease and is partially involved in immune regulation, may be effective upon abdominal aortic aneurysm progression. We used experimental abdominal aortic aneurysm models: Angiotensin II (Ang II)–induced ApoE−/− male mice (Ang II/APOE model) in our study. In the Ang II/APOE model, all mice (n=64) were divided into four groups: sham group (PBS treatment), control group (Ang II treatment), low-dose group (Ang II + low-dose topiramate, 3 mg/day per mouse), and high-dose group (Ang II + high-dose topiramate, 6 mg/day per mouse). All treatments began on the day after surgery. Moreover, collected tissues and cultured cell were used for histology and biochemical examination. In vitro, the effects of topiramate on bone marrow-derived macrophage stimulated by LPS were investigated. Our data implied that topiramate treatment significantly promoted macrophages preservation and conversion of M1 to M2 macrophage phenotypes in vivo and in vitro. Accordingly, proinflammatory activities mediated by the M1 macrophages were decreased and the repair process mediated by M2 macrophages was enhanced. The low-dose and high-dose groups had abdominal aortic aneurysm incidences of 50% and 37.5%, respectively, compared with 75% in the control group. Topiramate, a promising drug for the psychological disease, that target neuro-immune-induced macrophage polarization may attenuate experimental abdominal aortic aneurysm progression.
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Affiliation(s)
- Xing Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Xiao
- Department of Cardiovascular Surgery, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuanlei Yang
- Department of Cardiovascular Surgery, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
| | - Zhanjie Wei
- Department of Thyroid and Breast Surgery, Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
| | - Weiqiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinling Du
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinping Liu
- Department of Cardiovascular Surgery, Zhongnan Hospital, Wuhan University, Wuhan, China
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16
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High plasma microfibrillar-associated protein 4 is associated with reduced surgical repair in abdominal aortic aneurysms. J Vasc Surg 2020; 71:1921-1929. [DOI: 10.1016/j.jvs.2019.08.253] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/15/2019] [Indexed: 12/16/2022]
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17
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Etienne H, Journé C, Rouchaud A, Senemaud J, Louedec L, Pellenc Q, Coscas R, Gouya L, Dupont S, Michel JB. Persistence of Intraluminal Thrombus Makes Saccular Aneurysm More Biologically Active than Fusiform in an Experimental Rat Model. J Vasc Res 2020; 57:164-176. [PMID: 32222706 DOI: 10.1159/000506159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/26/2020] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Saccular aneurysms are thought to have a worse prognosis than fusiform aneurysms in humans, due to hemodynamic reasons. However, data comparing hemodynamic and biology in saccular and fusiform aneurysms are lacking. The main objective was to evaluate the impact of aneurysm morphology on intra-luminal thrombus (ILT) formation and activity. METHODS Forty Lewis rats were ran-domly divided into 2 groups of 20: "saccular" (Group A) and "fusiform" (Group B) aneurysms. Decellularized thoracic aortas from guinea pigs were xenografted to create saccular or fusiform aneurysms. Final imaging evaluation of the aneurysms was carried out during the third week, by quantitative Doppler ultrasound and magnetic resonance imaging. Assays of myeloperoxidase (MPO), platelet factor 4 (PF4), advanced oxidation protein products (AOPPs) iron and matrix metallopeptidase-9 (MMP-9) were performed as biological criteria. RESULTS Quantitatively, saccular aneurysms are characterized by a more thicker ILT, lower inflow velocities and more important relative backflow velocities as compared to fusiform aneurysms. Compared to fusiform, saccular aneurysms released significantly more MPO (p = 0.004), PF4 (p = 0.02), AOPPs (p < 0.002), iron (p < 0.0001) and MMP-9 (p < 0.04). CONCLUSION Experimental saccular and fusiform aneurysms show differential specific hemodynamics, which seem to impact the histology and the biology of the ILT in each type of aneurysm.
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Affiliation(s)
- Harry Etienne
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France,
| | - Clément Journé
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France.,UMS 34, Fédération de Recherche en Imagerie Multimodalités, Paris, France
| | - Aymeric Rouchaud
- Université Limoges, CNRS, XLIM, UMR 7252, Limoges, France.,Department of interventional neuroradiology, CHU Dupuytren, Limoges, France
| | - Jean Senemaud
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France.,Department of Vascular, Thoracic Surgery and Lung Transplantation, Hôpital Xavier Bichat, Paris, France
| | - Liliane Louedec
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France
| | - Quentin Pellenc
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France.,Department of Vascular, Thoracic Surgery and Lung Transplantation, Hôpital Xavier Bichat, Paris, France
| | - Raphaël Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France
| | - Laurent Gouya
- Paris Diderot University, INSERM U1149, Hème, fer et pathologies inflammatoires, Assistance Publique des Hôpitaux de Paris, Hôpital Louis Mourier, Paris, France
| | - Sébastien Dupont
- UMR 1148, Inserm-Denis Diderot University, Hôpital Xavier Bichat, Paris, France
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18
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Guo S, Li Y, Li R, Zhang P, Wang Y, Gopinath SCB, Gong K, Wan P. High-performance detection of an abdominal aortic aneurysm biomarker by immunosensing. Biotechnol Appl Biochem 2020; 67:383-388. [PMID: 31876964 DOI: 10.1002/bab.1877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a serious, life-threatening vascular disease that presents as an enlarged area of the aorta, which is the main artery that carries blood away from the heart. AAA may occur at any location in the aorta, but it is mainly found in the abdominal region. A ruptured AAA causes serious health issues, including death. Traditional imaging techniques, such as computed tomography angiogram, magnetic resonance imaging, and ultrasound sonography, have been used to identify AAAs. Circulating biomarkers have recently become attractive for diagnosing AAAs due to their cost-effectiveness compared to imaging. Insulin-like growth factor 1 (IGF-1), a secreted hormone vital for human atherosclerotic plaque stability, has been found to be an efficient biomarker for AAA identification. In this report, immunosensing was performed by using an InterDigitated electrode (IDE) sensor to detect circulating levels of IGF-1. The detection limit of IGF-1 was found to be 100 fM with this sensor. Moreover, related protein controls (IGF-2 and IGFBP3) were not detected with the same antibody, indicating selective IGF-1 detection. Thus, immunosensing by using an IDE sensor may help to effectively diagnose AAAs and represents a basic platform for further development.
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Affiliation(s)
- Shikui Guo
- Department of General Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yuejin Li
- Department of General Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Rougang Li
- Department of General Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Peng Zhang
- Department of General Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yongzhi Wang
- Department of General Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Subash C B Gopinath
- Institute of Nano Electronic Engineering, Kangar, Perlis, Malaysia.,School of Bioprocess Engineering, Universiti Malaysia Perlis, Arau, Perlis, Malaysia
| | - Kunmei Gong
- Department of Gastroenterology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Ping Wan
- The Digestive Medicine Department, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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19
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Sangiorgi G, Biondi-Zoccai G, Pizzuto A, Martelli E. Commentary: Biochemical Markers for Diagnosis and Follow-up of Aortic Diseases: An Endless Search for the Holy Grail. J Endovasc Ther 2019; 26:836-842. [PMID: 31608740 DOI: 10.1177/1526602819879941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Giuseppe Sangiorgi
- Department of Systemic Medicine, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Alessandra Pizzuto
- Department of Systemic Medicine, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Eugenio Martelli
- Department of Medical, Surgical and Experimental Sciences, Division of Vascular Surgery, University of Sassari, Italy
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Tomimori Y, Manno A, Tanaka T, Futamura-Takahashi J, Muto T, Nagahira K. ASB17061, a novel chymase inhibitor, prevented the development of angiotensin II-induced abdominal aortic aneurysm in apolipoprotein E-deficient mice. Eur J Pharmacol 2019; 856:172403. [DOI: 10.1016/j.ejphar.2019.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/29/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
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A Novel Quality of Life Instrument for Patients with an Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2019; 57:809-815. [DOI: 10.1016/j.ejvs.2019.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 01/18/2019] [Indexed: 11/22/2022]
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Impact on Quality of Life of Men with Screening-Detected Abdominal Aortic Aneurysms Attending Regular Follow ups: A Narrative Literature Review. Eur J Vasc Endovasc Surg 2019; 57:589-596. [PMID: 30910494 DOI: 10.1016/j.ejvs.2018.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/09/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to review, summarise, and assess the available evidence regarding the impact on the quality of life (QoL) of men undergoing screening for abdominal aortic aneurysm (AAA) and attending regular follow ups. METHODS PubMed, MEDLINE, CINAHL, and PsycINFO were used for searching. The search was performed from April to July 2016, with an update in February-March 2018. The quality of the studies was appraised with respective checklists from the Critical Appraisal Skills Programme. A narrative synthesis of the included studies was performed. The analysis included studies evaluating QoL in relation to one or more of the following concepts: physical function, psychological impact and social life in men undergoing AAA screening, but excluded studies evaluating QoL in AAA patients diagnosed outside a screening program. RESULTS The initial results from the search were 128 articles. Duplicates were removed, titles and abstracts were screened, and 22 full text articles were collected. Based on the inclusion criteria, 11 quantitative studies were included. Inferior quality of life among men with detected AAA was identified compared to those without the diagnosis and the general population in the included studies. The self-perceived health decreased over time for the participants with AAA. Assessments after surgery showed that the participants returned to similar health as before the screening. A wide variety of factors regarding the methodologies, designs, measurements, sample sizes, and the time for the assessment were noted in the included studies. CONCLUSION Quality of life is an important outcome for AAA screening and studies have been conducted in an attempt to address the imbalance between benefits and harm. However, it is still difficult to draw clear conclusions, possibly due to the heterogeneity of the original studies. Nevertheless, it is important to identify men with an AAA who develop conditions influencing their health and QoL in order to understand their care needs to further support them and improve their situation.
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Ramachandran S, Afshan PT, Pitchai S, Goura P, Ramachandran H. Clinical profile of abdominal aortic aneurysms undergoing open surgical repair: A single-center experience. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_96_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Meta-analysis of randomized controlled trials on safety and efficacy of exercise training in patients with abdominal aortic aneurysm. J Vasc Surg 2018; 69:933-943. [PMID: 30578072 DOI: 10.1016/j.jvs.2018.07.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 07/26/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Low exercise capacity preoperatively leads to increased postoperative complications, perioperative mortality, length of stay, and inpatient costs among patients going through elective abdominal aortic aneurysm (AAA) surgery. Therefore, exercise training may be extremely important for reducing perioperative adverse events in AAA patients. This paper aimed to perform a meta-analysis of randomized controlled trials to evaluate the safety of exercise training and its effects on exercise capacity in AAA patients. METHODS We searched for randomized controlled trials published up to December 2017 that compared exercise training vs usual care without exercise training in AAA patients. The primary outcome was safety, specifically the occurrence of cardiovascular adverse events during the study. Secondary outcomes were changes in AAA diameter, inflammation markers, and exercise capacity based on peak oxygen consumption (peak V˙o2) and anaerobic threshold (AT). RESULTS We identified 341 trials, and after an assessment of relevance, 7 trials with a combined total of 489 participants were analyzed. There were a total of two cardiovascular adverse events during the exercise test and training, and the cardiovascular event rate and its 95% confidence interval (CI) were 0.8% and 0.2% to 3.1%. Exercise training did not tend to increase AAA diameter, and it also tended to decrease high-sensitivity C-reactive protein level in patients with AAA. All studies that evaluated the changes in AAA diameter or high-sensitivity C-reactive protein level involved patients with AAA diameter <55 mm at baseline; there was no study involving participants with AAA diameter ≥55 mm at baseline. Exercise training significantly increased peak V˙o2 (pooled mean difference, 1.67 mL/kg/min; 95% CI, 0.69-2.65; P < .001) and AT (pooled mean difference, 1.98 mL/kg/min; 95% CI, 0.77-3.19; P < .001) in AAA patients. The result of meta-regression suggested that the effects of exercise training on peak V˙o2 and AT were not modulated by the exercise duration. CONCLUSIONS Our analyses suggested that exercise training among AAA patients is generally safe, although future research should be carried out to further clarify the safety among patients with large AAAs. Exercise training improved peak V˙o2 and AT in AAA patients. More data are required to identify the optimal exercise duration for improving exercise capacity in patients with AAA.
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Ouarab C, Brouri M, Laroche JP, Ayoub S. [Prevalence and risk factors of sub-renal abdominal aortic aneurysm in an Algerian population aged over 60]. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:361-368. [PMID: 30522708 DOI: 10.1016/j.jdmv.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/30/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The prevalence of abdominal aortic aneurysm (AAA) in the general population in our country is not known, our aim was to evaluate it in patients over 60 years of age, to specify the risk factors and to evaluate the extension of aneurysmal disease and multisite subclinical atherosclerosis. METHODS Descriptive, transversal, study collecting the data of a systematic ultrasound screening of sub-renal AAA in subjects receiving care in two Algerian hospital structures. Epidemiological data, AAA risk factors, cardiovascular disease risk factors (CVD RF) and the personal history (cardiovascular diseases, chronic obstructive pulmonary disease) and family history of AAA were collected during the screening. An abdominal echography was performed in all patients. A biological and morphological assessment was carried out for AAA cases detected. Multivariate logistic regression analysis was used to study the factors associated with AAA. RESULTS Systematic screening for 600 patients revealed an overall AAA prevalence of 2.2% (n=13). In multivariate analysis a positive association with AAA was observed with active smoking, its duration in years and its intensity in year-packages; with hypertension, dyslipidemia and a history of cardiovascular events. While a negative association was observed with a smoking cessation of more than 20 years, type 2 diabetes and android obesity. The study of detected AAA cases found five cases of aneurysm isolated from the primary iliac artery but no popliteal and/or femoral aneurysm. The carotids were atheromatous in more than 80% of cases and the arteries of the lower limbs in more than one-third of cases. CONCLUSION The prevalence of AAA in our population (2.2%) corresponds to the prevalence reported recently in Europe, but it would have been higher if the screening had targeted males and smokers. The factors associated with AAA in our patients are similar to those described in the literature.
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Affiliation(s)
- C Ouarab
- Service de médecine interne, CHU Beni-Messous, Alger, Algérie.
| | - M Brouri
- Service de médecine interne, clinique Arezki-Kehhal, EPH EL Biar, Alger, Algérie
| | - J P Laroche
- Service de médecine vasculaire, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier cedex 5, France
| | - S Ayoub
- Service de médecine interne, CHU Beni-Messous, Alger, Algérie
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Cornejo Saucedo M, García-Gil D, Brun Romero F, Torres do Rego A, Beltrán Romero L, Rodilla Sala E, Acosta Guerra G, Villanueva Martínez J, Casas Rojo J, Torres Macho J, García de Casasola-Sánchez G. Prevalence of abdominal aortic aneurysm in patients with high cardiovascular risk. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Belloch García S. Abdominal aortic aneurysm. Prevalence and associated risk factors in a population of patients hospitalised in Internal Medicine. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Cornejo Saucedo M, García-Gil D, Brun Romero F, Torres do Rego A, Beltrán Romero L, Rodilla Sala E, Acosta Guerra G, Villanueva Martínez J, Casas Rojo J, Torres Macho J, García de Casasola-Sánchez G. Prevalencia de aneurisma de aorta abdominal en pacientes con alto riesgo cardiovascular. Rev Clin Esp 2018; 218:461-467. [DOI: 10.1016/j.rce.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/17/2018] [Accepted: 08/10/2018] [Indexed: 01/27/2023]
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Baba T, Ohki T, Kanaoka Y, Maeda K, Ito E, Shukuzawa K, Momose M, Hara M. Risk Factor Analyses of Abdominal Aortic Aneurysms Growth in Japanese Patients. Ann Vasc Surg 2018; 55:196-202. [PMID: 30287295 DOI: 10.1016/j.avsg.2018.07.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to retrospectively demonstrate the growth rate (mm/year) of abdominal aortic aneurysm (AAA) diameters (ADs) and to analyze risk factors for AAA expansion. METHODS We retrospectively investigated the clinical data of 319 patients with AAAs who were followed up as outpatients for >2 years after their initial visit and who underwent computed tomography >4 times. RESULTS The mean follow-up period was 3.7 ± 1.5 years. The annual average growth rates according to varying ADs were as follows: 1.9 ± 0.8 (AD 30-34 mm), 2.6 ± 1.2 (AD 35-39 mm), 2.8 ± 1.1 (AD 40-44 mm), 3.1 ± 1.3 (AD 45-49 mm), 3.4 ± 1.6 (AD 50-54 mm), and 3.5 ± 1.4 mm (AD ≥55 mm). Factors associated with AAA expansion were smoking (P = 0.017), hypertension (P < 0.001), and ADs (P < 0.001). In the subgroup analysis, data regarding growth rates of ≥3 mm were extracted, and a statistically significant difference between smoking status and ADs of ≥40 mm was observed. CONCLUSIONS Factors associated with AAA expansion in Japanese patients included smoking, hypertension, and ADs, and a statistically significant difference was observed between smoking status and ADs of ≥40 mm.
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Affiliation(s)
- Takeshi Baba
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kanaoka
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Koji Maeda
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Eisaku Ito
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Kota Shukuzawa
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masamichi Momose
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Hara
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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Yokoyama U, Arakawa N, Ishiwata R, Yasuda S, Minami T, Goda M, Uchida K, Suzuki S, Matsumoto M, Koizumi N, Taguri M, Hirano H, Yoshimura K, Ogino H, Masuda M, Ishikawa Y. Proteomic analysis of aortic smooth muscle cell secretions reveals an association of myosin heavy chain 11 with abdominal aortic aneurysm. Am J Physiol Heart Circ Physiol 2018; 315:H1012-H1018. [DOI: 10.1152/ajpheart.00329.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abdominal aortic aneurysm (AAA) is a life-threatening disease, and no disease-specific circulating biomarkers for AAA screening are currently available. We have identified a smooth muscle cell (SMC)-specific biomarker for AAA. We cultured aneurysmal tunica media that were collected from eight patients undergoing elective open-repair surgeries. Secreted proteins in culture medium were subjected to liquid chromatography/tandem mass spectrometry. Myosin heavy chain 11 (myosin-11) was identified as a SMC-specific protein in the tunica media-derived secretions of all patients. We then examined myosin-11 protein concentrations by ELISA in plasma samples from patients with AAA ( n = 35) and age-matched healthy control subjects ( n = 34). Circulating myosin-11 levels were significantly higher in patients with AAA than control subjects. The area under the receiver-operating characteristic curve (AUC) of myosin-11 was 0.77, with a specificity of 65% at a sensitivity of 91%. Multivariate logistic regression analysis showed a significant association between the myosin-11 level and presence of AAA. When the myosin-11 level was combined with hypertension, it improved the prediction of AAA (AUC 0.88) more than hypertension per se. We then investigated the correlation between aortic diameter and circulating myosin-11 levels using AAA serum samples from patients undergoing endovascular aneurysm repair ( n = 20). Circulating myosin-11 levels were significantly correlated with maximum aortic diameter. Furthermore, changes in myosin-11 concentrations from the baseline 12 mo after endovascular aneurysm repair were associated with those in aortic diameter. These data suggest that circulating levels of myosin-11, which is a SMC-specific myosin isoform, may be useful as a biomarker for AAA. NEW & NOTEWORTHY Extensive studies have revealed that inflammation- or proteolysis-related proteins are proposed as biomarkers for abdominal aortic aneurysm (AAA). Changes in these protein concentrations are not specific for smooth muscle, which is a major part of AAA pathologies. Hence, no disease-specific circulating markers for AAA are currently available. We found, using secretome-based proteomic analysis on human AAA tunica media, that myosin heavy chain 11 was associated with AAA. Circulating myosin heavy chain 11 may be a new tissue-specific AAA marker.
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Affiliation(s)
- Utako Yokoyama
- Cardiovascular Research Institute, Yokohama City University, Yokohama, Japan
| | - Noriaki Arakawa
- Department of Medical Life Science, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Japan
- Division of Medicinal Safety Science, National Institute of Health Sciences, Kawasaki, Japan
| | - Ryo Ishiwata
- Cardiovascular Research Institute, Yokohama City University, Yokohama, Japan
| | - Shota Yasuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tomoyuki Minami
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Motohiko Goda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shinichi Suzuki
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masataka Matsumoto
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Nobusato Koizumi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Hisashi Hirano
- Advanced Medical Research Center, Yokohama City University, Yokohama, Japan
| | - Koichi Yoshimura
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
- Graduate School of Health and Welfare, Yamaguchi Prefectural University, Yamaguchi, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Munetaka Masuda
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yoshihiro Ishikawa
- Cardiovascular Research Institute, Yokohama City University, Yokohama, Japan
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Abdominal aortic aneurysm. Prevalence and associated risk factors in a population of patients hospitalised in Internal Medicine. Rev Clin Esp 2018; 218:455-460. [PMID: 29858036 DOI: 10.1016/j.rce.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/06/2018] [Accepted: 04/17/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To determine the prevalence of previously undiagnosed abdominal aortic aneurysm (AAA) in patients hospitalised in a department of internal medicine, as well as the associated risk factors. PATIENTS AND METHODS An observational, cross-sectional, single-centre, randomised study was conducted on 241 patients hospitalised in Internal Medicine. The patients were older than 50 years, had no previous diagnosis of AAA and underwent clinical ultrasonography. The dependent variable was the presence or absence of an aneurysm. The independent variables were age, sex, cardiovascular risk factors, cardiovascular disease, renal function, ankle brachial index (ABI), family history (first degree) of AAA or of early ischaemic heart disease. A bivariate and multivariate analysis was conducted in the statistical analysis. RESULTS The prevalence of AAA was 2.9% (95% CI: 0.8-5). The cases were confirmed through ultrasonography or computed tomography by the Department of Radiology. All patients were men with a history of smoking and with an age≥65 years. The bivariate analysis found an association between being male (OR, 9.39), smoking (OR, 13.08), ischaemic heart disease (OR, 5.6; 95% CI: 1.21-25.91; P<.05) and ABI<0.9 (OR, 12.50; 95% CI: 2.34-66.77; P<.05). In the multivariate analysis, the independently associated variable was an ABI<0.9 (OR, 10.758; 95% CI: 1.968-58.815; P=.006). CONCLUSIONS The prevalence of undiagnosed AAA in patients older than 50 years hospitalised in internal medicine was 2.9%. The data lead us to recommend AAA screening for this population of male patients with a history of smoking and an ABI<0.9. Clinical ultrasonography enables this screening in a reliable manner.
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Kays JK, Liang TW, Zimmers TA, Milgrom DP, Abduljabar H, Young A, Kim BJ, Bell TM, Fajardo A, Murphy MP, Koniaris LG. Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair. JCSM CLINICAL REPORTS 2018. [DOI: 10.17987/jcsm-cr.v3i1.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract Background: Repair of abdominal aortic aneurysms (AAA) decreases the incidence of rupture and death. In cancer patients, sarcopenia has been associated with increased surgical complications and mortality. The impact of sarcopenia on survival after AAA repair has yet to be described. Methods: Patient demographic, laboratory, body composition measurements and survival data were obtained from patients undergoing AAA repair at the Indiana University medical campus over a 5-year period. Univariate and multivariate analyses were performed to identify factors associated with overall survival. Results: Overall, 58.2% presented with sarcopenia. Sarcopenic patients were older (71.8±8.3 versus 66.8±8.1 years; p<0.001), had lower body mass index (BMI) (26.3±5.2 versus 31.5±5.9 kg/m2; p<0.001), higher rates of myosteatosis (84.4% versus 52.%; p<0.001), greater AAA diameter (60.6±14.0 versus 57.8±11.7 mm; p=0.016), higher Charlson Comorbidity Index (CCI) (32.3% versus 25.1% ³6; p=0.034), and increased rates of rupture (8.2% versus 3.8%; p=0.047). Sarcopenic and nonsarcopenic patients had no difference in 30-day morbidity (8.5% versus 8.5%; p=0.991) or mortality (3.7% versus 0.9%; p=0.07). Univariate analysis demonstrated age, sarcopenia, myosteatosis, CCI, and BMI to be associated with long-term survival. There was no correlation between BMI and sarcopenia. Both sarcopenia and myosteatosis resulted in decreased one-, three-, and five-year survivals compared to their counterparts. On multivariate analysis sarcopenia is independently associated with survival, conferring a 1.6-fold increase in death (p=0.04). The combination of sarcopenia plus myosteatosis doubled the risk of death compared to sarcopenia alone. Conclusions: This is the first study to demonstrate that over half of all patients undergoing AAA repair are sarcopenic, a condition associated with increased mortality. Sarcopenia with myosteatosis is associated with double the mortality of sarcopenia alone. CT scan, but not BMI, accurately identifies sarcopenia and myosteatosis. Defining the mechanisms through which sarcopenia contributes to late death after AAA repair is critical to developing novel interventions that may improve survival in this high risk population.
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Abstract
Abdominal aortic aneurysm (AAA) is most commonly defined as a maximal diameter of the abdominal aorta in excess of 3 cm in either anterior-posterior or transverse planes or, alternatively, as a focal dilation ≥ 1.5 times the diameter of the normal adjacent arterial segment. Risk factors for the development of AAA include age > 60, tobacco use, male gender, Caucasian race, and family history of AAA. Aneurysm growth and rupture risk appear to be associated with persistent tobacco use, female gender, and chronic pulmonary disease. The majority of AAAs are asymptomatic and detected incidentally on various imaging studies, including abdominal ultrasound, and computed tomographic angiography. Symptoms associated with AAA may include abdominal or back pain, thromboembolization, atheroembolization, aortic rupture, or development of an arteriovenous or aortoenteric fistula. The Screening Abdominal Aortic Aneurysms Efficiently (SAAAVE) Act provides coverage for a one-time screening abdominal ultrasound at age 65 for men who have smoked at least 100 cigarettes and women who have family history of AAA disease. Medical management is recommended for asymptomatic patients with AAAs < 5 cm in diameter and focuses on modifiable risk factors, including smoking cessation and blood pressure control. Primary indications for intervention in patients with AAA include development of symptoms, rupture, rapid aneurysm growth (> 5 mm/6 months), or presence of a fusiform aneurysm with maximum diameter of 5.5 cm or greater. Intervention for AAA includes conventional open surgical repair and endovascular aortic stent graft repair.
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Tratamiento multidisciplinario de aneurisma aórtico con anatomía hostil. ANGIOLOGIA 2018. [DOI: 10.1016/j.angio.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lin YT, Chen HJ, Chen PC, Sung FC. Increased Risk of Peripheral Arterial Disease in Patients With Abdominal Aortic Aneurysm: A Retrospective Cohort Study (Version 5). Angiology 2018; 70:41-46. [PMID: 29444589 DOI: 10.1177/0003319718757615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Studies evaluating the risk of peripheral arterial disease (PAD) in patients with abdominal aortic aneurysm (AAA) are limited. We used insurance claims data of Taiwan to establish a cohort of 6590 patients with AAA newly diagnosed from 2000 to 2008 and 6590 controls without AAA matched by propensity score. The subsequent incidence density rates of PAD were estimated in both cohorts by the end of 2011, and the AAA cohort to the non-AAA cohort hazard ratios (HRs) of PAD were calculated using Cox proportional hazards models. The incidence density of PAD in the AAA cohort was 3.7-fold greater than that in the non-AAA cohort (14.1 vs 3.66 per 1000 person-years) with an adjusted HR of 3.56 (95% confidence interval [CI] = 2.89-4.39). For those without comorbidities, PAD in the AAA cohort was 7.4-fold greater than that in the non-AAA cohort (12.0 vs 1.61 per 1000 person-years) with an adjusted HR of 6.70 (95% CI = 4.43-10.1). The incidence of PAD in patients with ruptured AAA was lower than that in patients without rupture (6.95 vs 15.0 per 1000 person-years). This study demonstrates that patients with AAA are at increased risk of developing PAD.
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Affiliation(s)
- Yi-Ting Lin
- 1 Department of Emergency Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Hsuan-Ju Chen
- 2 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Chun Chen
- 2 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,3 Department of Public Health, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- 2 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,4 Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.,5 Department of Health Services Administration, China Medical University, Taichung, Taiwan
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Common First-Pass CT Angiography Findings Associated With Rapid Growth Rate in Abdominal Aorta Aneurysms Between 3 and 5 cm in Largest Diameter. AJR Am J Roentgenol 2018; 210:431-437. [DOI: 10.2214/ajr.17.18094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Takahara Y, Tokunou T, Ichiki T. Suppression of Abdominal Aortic Aneurysm Formation in Mice by Teneligliptin, a Dipeptidyl Peptidase-4 Inhibitor. J Atheroscler Thromb 2018; 25:698-708. [PMID: 29321388 PMCID: PMC6099070 DOI: 10.5551/jat.42481] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: Dipeptidyl peptidase-4 (DPP-4) inhibitors lower blood glucose levels through inhibition of incretin degradation, which stimulates insulin secretion. Recent studies reported that DPP-4 inhibitors suppressed atherogenesis in apolipoprotein E-knockout (ApoEKO) mice. In this study, we investigated whether teneligliptin, a DPP-4 inhibitor, affects the development of abdominal aortic aneurysms (AAA) in ApoEKO mice. Methods: ApoEKO mice were fed a high-fat diet (HFD) and infused with angiotensin (Ang) II by osmotic mini pumps for 4 weeks to induce AAA with (DPP-4i group) or without (control group) teneligliptin administered orally from 1 week before HFD and Ang II infusion to the end of the experiment. Confluent rat vascular smooth muscle cells (VSMCs) were serum-starved for 48 hours, then incubated with or without teneligliptin for another 24 hours and stimulated with Ang II. Results: Treatment with teneligliptin significantly reduced the AAA formation rate (30.7% vs. 71.4% vs. control, P < 0.05), aortic dilatation (1.32 ± 0.09 mm vs. 1.76 ± 0.18 mm in the control, P < 0.05) and severity score (0.75 ± 0.28 vs. 1.91 ± 0.4 in the control, P < 0.05). Elastin degradation grade was also attenuated in DPP-4i group (2.83 ± 0.17 vs. 3.45 ± 0.16 in the control, P < 0.05). The number of macrophages infiltrating into the abdominal aorta was decreased in the DPP-4i group (51.8 ± 29.8/section vs. 219.5 ± 78.5/section in the control, P < 0.05). Teneligliptin attenuated Ang II-induced phosphorylation of extracellular signal-regulated kinase (ERK) and Akt, and mRNA expression of monocyte chemoattractant protein-1 in VSMCs. Conclusion: Treatment with teneligliptin suppressed AAA formation in ApoEKO mice with HFD and Ang II infusion. Suppression of macrophage infiltration by teneligliptin may be involved in the inhibition of AAA formation.
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Affiliation(s)
- Yusuke Takahara
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Kyushu University
| | - Tomotake Tokunou
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Kyushu University.,Center for Disruptive Cardiovascular Medicine, Department of Advanced Cardiovascular Regulation and Therapeutics, Kyushu University
| | - Toshihiro Ichiki
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Kyushu University.,Department of Cardiology, Harasanshin Hospital
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Patel R, Powell JT, Sweeting MJ, Epstein DM, Barrett JK, Greenhalgh RM. The UK EndoVascular Aneurysm Repair (EVAR) randomised controlled trials: long-term follow-up and cost-effectiveness analysis. Health Technol Assess 2018; 22:1-132. [PMID: 29384470 PMCID: PMC5817412 DOI: 10.3310/hta22050] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Short-term survival benefits of endovascular aneurysm repair (EVAR) compared with open repair (OR) of intact abdominal aortic aneurysms have been shown in randomised trials, but this early survival benefit is soon lost. Survival benefit of EVAR was unclear at follow-up to 10 years. OBJECTIVE To assess the long-term efficacy of EVAR against OR in patients deemed fit and suitable for both procedures (EVAR trial 1; EVAR-1); and against no intervention in patients unfit for OR (EVAR trial 2; EVAR-2). To appraise the long-term significance of type II endoleak and define criteria for intervention. DESIGN Two national, multicentre randomised controlled trials: EVAR-1 and EVAR-2. SETTING Patients were recruited from 37 hospitals in the UK between 1 September 1999 and 31 August 2004. PARTICIPANTS Men and women aged ≥ 60 years with an aneurysm of ≥ 5.5 cm (as identified by computed tomography scanning), anatomically suitable and fit for OR were randomly assigned 1 : 1 to either EVAR (n = 626) or OR (n = 626) in EVAR-1 using computer-generated sequences at the trial hub. Patients considered unfit were randomly assigned to EVAR (n = 197) or no intervention (n = 207) in EVAR-2. There was no blinding. INTERVENTIONS EVAR, OR or no intervention. MAIN OUTCOME MEASURES The primary end points were total and aneurysm-related mortality until mid-2015 for both trials. Secondary outcomes for EVAR-1 were reinterventions, costs and cost-effectiveness. RESULTS In EVAR-1, over a mean of 12.7 years (standard deviation 1.5 years; maximum 15.8 years), we recorded 9.3 deaths per 100 person-years in the EVAR group and 8.9 deaths per 100 person-years in the OR group [adjusted hazard ratio (HR) 1.11, 95% confidence interval (CI) 0.97 to 1.27; p = 0.14]. At 0-6 months after randomisation, patients in the EVAR group had a lower mortality (adjusted HR 0.61, 95% CI 0.37 to 1.02 for total mortality; HR 0.47, 95% CI 0.23 to 0.93 for aneurysm-related mortality; p = 0.031), but beyond 8 years of follow-up patients in the OR group had a significantly lower mortality (adjusted HR 1.25, 95% CI 1.00 to 1.56, p = 0.048 for total mortality; HR 5.82, 95% CI 1.64 to 20.65, p = 0.0064 for aneurysm-related mortality). The increased aneurysm-related mortality in the EVAR group after 8 years was mainly attributable to secondary aneurysm sac rupture, with increased cancer mortality also observed in the EVAR group. Overall, aneurysm reintervention rates were higher in the EVAR group than in the OR group, 4.1 and 1.7 per 100 person-years, respectively (p < 0.001), with reinterventions occurring throughout follow-up. The mean difference in costs over 14 years was £3798 (95% CI £2338 to £5258). Economic modelling based on the outcomes of the EVAR-1 trial showed that the cost per quality-adjusted life-year gained over the patient's lifetime exceeds conventional thresholds used in the UK. In EVAR-2, patients died at the same rate in both groups, but there was suggestion of lower aneurysm mortality in those who actually underwent EVAR. Type II endoleak itself is not associated with a higher rate of mortality. LIMITATIONS Devices used were implanted between 1999 and 2004. Newer devices might have better results. Later follow-up imaging declined, particularly for OR patients. Methodology to capture reinterventions changed mainly to record linkage through the Hospital Episode Statistics administrative data set from 2009. CONCLUSIONS EVAR has an early survival benefit but an inferior late survival benefit compared with OR, which needs to be addressed by lifelong surveillance of EVAR and reintervention if necessary. EVAR does not prolong life in patients unfit for OR. Type II endoleak alone is relatively benign. FUTURE WORK To find easier ways to monitor sac expansion to trigger timely reintervention. TRIAL REGISTRATION Current Controlled Trials ISRCTN55703451. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and the results will be published in full in Health Technology Assessment; Vol. 22, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rajesh Patel
- Vascular Surgery Research Group, Imperial College London, London, UK
| | - Janet T Powell
- Vascular Surgery Research Group, Imperial College London, London, UK
| | - Michael J Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - David M Epstein
- Centre for Health Economics, University of York, York, UK.,Department of Applied Economics, University of Granada, Granada, Spain
| | - Jessica K Barrett
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Phillips EH, Chang MS, Gorman S, Qureshi HJ, Ejendal KFK, Kinzer-Ursem TL, Blaize AN, Goergen CJ. Angiotensin II Infusion Does Not Cause Abdominal Aortic Aneurysms in Apolipoprotein E-Deficient Rats. J Vasc Res 2017; 55:1-12. [PMID: 29166645 DOI: 10.1159/000484086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 10/07/2017] [Indexed: 12/31/2022] Open
Abstract
The apolipoprotein E-deficient (apoE-/-) mouse model has advanced our understanding of cardiovascular disease mechanisms and experimental therapeutics. This spontaneous model recapitulates aspects of human atherosclerosis, and allows for the development of dissecting abdominal aortic aneurysms (AAAs) when combined with angiotensin II. We characterized apoE-/- rats and hypothesized that, similar to mice, they would develop dissecting AAAs. We created rats with a 16-bp deletion of the apoE gene using transcription activator-like effector nucleases. We imaged the suprarenal aorta for 28 days after implantation of miniosmotic pumps that infuse angiotensin II (AngII, 200 ng/kg/min). Blood pressure (BP), serum lipids and lipoproteins, and histology were also analyzed. These rats did not develop pathological aortic dissection, but we did observe a decrease in circumferential cyclic strain, a rise in BP, and microstructural changes in the aortic medial layer. We also measured increased serum lipids with and without administration of a high-fat diet, but did not detect atherosclerotic plaques. Chronic infusion of AngII did not lead to the formation of dissecting AAAs or atherosclerosis in the rats used in this study. While reduced amounts of atherosclerosis may explain this resistance to dissecting aneurysms, further investigation is needed to fully characterize species-specific differences.
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Affiliation(s)
- Evan H Phillips
- Weldon School of Biomedical Engineering, West Lafayette, IN, USA
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Shen Y, Russo V, Zeglinski MR, Sellers SL, Wu Z, Oram C, Santacruz S, Merkulova Y, Turner C, Tauh K, Zhao H, Bozin T, Bohunek L, Zeng H, Seidman MA, Bleackley RC, McManus BM, Ruoslahti E, Järvinen TAH, Granville DJ. Recombinant Decorin Fusion Protein Attenuates Murine Abdominal Aortic Aneurysm Formation and Rupture. Sci Rep 2017; 7:15857. [PMID: 29158532 PMCID: PMC5696466 DOI: 10.1038/s41598-017-16194-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/02/2017] [Indexed: 01/23/2023] Open
Abstract
Decorin (DCN) is a small-leucine rich proteoglycan that mediates collagen fibrillogenesis, organization, and tensile strength. Adventitial DCN is reduced in abdominal aortic aneurysm (AAA) resulting in vessel wall instability thereby predisposing the vessel to rupture. Recombinant DCN fusion protein CAR-DCN was engineered with an extended C-terminus comprised of CAR homing peptide that recognizes inflamed blood vessels and penetrates deep into the vessel wall. In the present study, the role of systemically-administered CAR-DCN in AAA progression and rupture was assessed in a murine model. Apolipoprotein E knockout (ApoE-KO) mice were infused with angiotensin II (AngII) for 28 days to induce AAA formation. CAR-DCN or vehicle was administrated systemically until day 15. Mortality due to AAA rupture was significantly reduced in CAR-DCN-treated mice compared to controls. Although the prevalence of AAA was similar between vehicle and CAR-DCN groups, the severity of AAA in the CAR-DCN group was significantly reduced. Histological analysis revealed that CAR-DCN treatment significantly increased DCN and collagen levels within the aortic wall as compared to vehicle controls. Taken together, these results suggest that CAR-DCN treatment attenuates the formation and rupture of Ang II-induced AAA in mice by reinforcing the aortic wall.
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Affiliation(s)
- Yue Shen
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Valerio Russo
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew R Zeglinski
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- Department of Radiology, University of British Columbia & St. Paul's Hospital, Vancouver, BC, Canada
| | - Zhengguo Wu
- Imaging Unit, Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, BC, Canada
- Photomedicine Institute, Department of Dermatology and Skin Science, University of British Columbia & Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Cameron Oram
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie Santacruz
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yulia Merkulova
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Turner
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Keerit Tauh
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hongyan Zhao
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tatjana Bozin
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Lubos Bohunek
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Haishan Zeng
- Imaging Unit, Integrative Oncology Department, BC Cancer Agency Research Centre, Vancouver, BC, Canada
- Photomedicine Institute, Department of Dermatology and Skin Science, University of British Columbia & Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Michael A Seidman
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - R Chris Bleackley
- Department of Biochemistry, University of Alberta, Edmonton, AB, Canada
| | - Bruce M McManus
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- PROOF Centre of Excellence, University of British Columbia & Providence Health Care, Vancouver, BC, Canada
| | - Erkki Ruoslahti
- Cancer Research Center, Sanford-Burnham Prebys Medical Discovery Institute, La Jolla, CA, 92037, USA
- Center for Nanomedicine and Department of Molecular Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, CA, 93106-9610, USA
| | - Tero A H Järvinen
- Faculty of Medicine & Life Sciences, University of Tampere & Department of Orthopedics & Traumatology, Tampere University Hospital, Tampere, Finland
| | - David J Granville
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
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Overbey DM, Glebova NO, Chapman BC, Hosokawa PW, Eun JC, Nehler MR. Morbidity of endovascular abdominal aortic aneurysm repair is directly related to diameter. J Vasc Surg 2017; 66:1037-1047.e7. [DOI: 10.1016/j.jvs.2017.01.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/31/2017] [Indexed: 02/05/2023]
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Nakao T, Horie T, Baba O, Nishiga M, Nishino T, Izuhara M, Kuwabara Y, Nishi H, Usami S, Nakazeki F, Ide Y, Koyama S, Kimura M, Sowa N, Ohno S, Aoki H, Hasegawa K, Sakamoto K, Minatoya K, Kimura T, Ono K. Genetic Ablation of MicroRNA-33 Attenuates Inflammation and Abdominal Aortic Aneurysm Formation via Several Anti-Inflammatory Pathways. Arterioscler Thromb Vasc Biol 2017; 37:2161-2170. [PMID: 28882868 DOI: 10.1161/atvbaha.117.309768] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/21/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) is an increasingly prevalent and ultimately fatal disease with no effective pharmacological treatment. Because matrix degradation induced by vascular inflammation is the major pathophysiology of AAA, attenuation of this inflammation may improve its outcome. Previous studies suggested that miR-33 (microRNA-33) inhibition and genetic ablation of miR-33 increased serum high-density lipoprotein cholesterol and attenuated atherosclerosis. APPROACH AND RESULTS MiR-33a-5p expression in central zone of human AAA was higher than marginal zone. MiR-33 deletion attenuated AAA formation in both mouse models of angiotensin II- and calcium chloride-induced AAA. Reduced macrophage accumulation and monocyte chemotactic protein-1 expression were observed in calcium chloride-induced AAA walls in miR-33-/- mice. In vitro experiments revealed that peritoneal macrophages from miR-33-/- mice showed reduced matrix metalloproteinase 9 expression levels via c-Jun N-terminal kinase inactivation. Primary aortic vascular smooth muscle cells from miR-33-/- mice showed reduced monocyte chemotactic protein-1 expression by p38 mitogen-activated protein kinase attenuation. Both of the inactivation of c-Jun N-terminal kinase and p38 mitogen-activated protein kinase were possibly because of the increase of ATP-binding cassette transporter A1 that is a well-known target of miR-33. Moreover, high-density lipoprotein cholesterol derived from miR-33-/- mice reduced expression of matrix metalloproteinase 9 in macrophages and monocyte chemotactic protein-1 in vascular smooth muscle cells. Bone marrow transplantation experiments indicated that miR-33-deficient bone marrow cells ameliorated AAA formation in wild-type recipients. MiR-33 deficiency in recipient mice was also shown to contribute the inhibition of AAA formation. CONCLUSIONS These data strongly suggest that inhibition of miR-33 will be effective as a novel strategy for treating AAA.
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Affiliation(s)
- Tetsushi Nakao
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Takahiro Horie
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Osamu Baba
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Masataka Nishiga
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Tomohiro Nishino
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Masayasu Izuhara
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Yasuhide Kuwabara
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Hitoo Nishi
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Shunsuke Usami
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Fumiko Nakazeki
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Yuya Ide
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Satoshi Koyama
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Masahiro Kimura
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Naoya Sowa
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Satoko Ohno
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Hiroki Aoki
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Koji Hasegawa
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Kazuhisa Sakamoto
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Kenji Minatoya
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Takeshi Kimura
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan
| | - Koh Ono
- From the Departments of Cardiovascular Medicine (T.N., T.H., O.B., M.N., T.N., M.I., Y.K., H.N., S.U., F.N., Y.I., S.K., M.K., N.S., T.K., K.O.) and Cardiovascular Surgery (K.S., K.M.), Graduate School of Medicine, Kyoto University, Japan; The Cardiovascular Research Institute, Kurume University, Japan (S.O., H.A.); and Division of Translational Research, National Hospital Organization, Kyoto Medical Center, Japan.
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Inhibition of Receptor-Interacting Protein Kinase 1 with Necrostatin-1s ameliorates disease progression in elastase-induced mouse abdominal aortic aneurysm model. Sci Rep 2017; 7:42159. [PMID: 28186202 PMCID: PMC5301478 DOI: 10.1038/srep42159] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 01/09/2017] [Indexed: 01/30/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) is a common aortic disease with a progressive nature. There is no approved pharmacological treatment to effectively slow aneurysm growth or prevent rupture. Necroptosis is a form of programmed necrosis that is regulated by receptor-interacting protein kinases (RIPs). We have recently demonstrated that the lack of RIP3 in mice prevented aneurysm formation. The goal of the current study is to test whether perturbing necroptosis affects progression of existing aneurysm using the RIP1 inhibitors Necrostatin-1 (Nec-1) and an optimized form of Nec-1, 7-Cl-O-Nec-1 (Nec-1s). Seven days after aneurysm induction by elastase perfusion, mice were randomly administered DMSO, Nec-1 (3.2 mg/kg/day) and Nec-1s (1.6 mg/kg/day) via intraperitoneal injection. Upon sacrifice on day 14 postaneurysm induction, the aortic expansion in the Nec-1s group (64.12 ± 4.80%) was significantly smaller than that of the DMSO group (172.80 ± 13.68%) (P < 0.05). The mean aortic diameter of Nec-1 treated mice appeared to be smaller (121.60 ± 10.40%) than the DMSO group, though the difference was not statistically significant (P = 0.1). Histologically, the aortic structure of Nec-1s-treated mice appeared normal, with continuous and organized elastin laminae and abundant αActin-expressing SMCs. Moreover, Nect-1s treatment diminished macrophage infiltration and MMP9 accumulation and increased aortic levels of tropoelastin and lysyl oxidase. Together, our data suggest that pharmacological inhibition of necroptosis with Nec-1s stabilizes pre-existing aneurysms by diminishing inflammation and promoting connective tissue repair.
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Rössel T, Paul R, Richter T, Ludwig S, Hofmockel T, Heller AR, Koch T. [Management of anesthesia in endovascular interventions]. Anaesthesist 2016; 65:891-910. [PMID: 27900415 DOI: 10.1007/s00101-016-0241-9] [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: 10/20/2022]
Abstract
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach. Endovascular procedures can be carried out with the patient under general or regional anesthesia (RA); however, in the currently available literature there is no evidence for an advantage of RA over general anesthesia regarding morbidity and mortality, although a reduction in pulmonary complications could be found for some endovascular interventions. Epidural and spinal RA procedures should be carefully considered with respect to the risk-benefit ratio and consideration of the recent guidelines on anesthesia against the background of the current study situation and the regular use of therapy with anticoagulants. The following article elucidates the specific characteristics of anesthesia management as exemplified by some selected endovascular interventions.
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Affiliation(s)
- T Rössel
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - R Paul
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - T Richter
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - S Ludwig
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, TU Dresden, Dresden, Deutschland
| | - T Hofmockel
- Institut und Poliklinik für Radiologische Diagnostik, TU Dresden, Dresden, Deutschland
| | - A R Heller
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - T Koch
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Takeuchi H, Okuyama M, Uchida HA, Kakio Y, Umebayashi R, Okuyama Y, Fujii Y, Ozawa S, Yoshida M, Oshima Y, Sano S, Wada J. Chronic Kidney Disease Is Positively and Diabetes Mellitus Is Negatively Associated with Abdominal Aortic Aneurysm. PLoS One 2016; 11:e0164015. [PMID: 27764090 PMCID: PMC5072712 DOI: 10.1371/journal.pone.0164015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/19/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIMS Chronic kidney disease (CKD) and diabetes mellitus (DM) are considered as risk factors for cardiovascular diseases. The purpose of this study was to clarify the relationship of CKD and DM with the presence of abdominal aortic aneurysm (AAA). METHODS We enrolled 261 patients with AAA (AAA+) and age-and-sex matched 261 patients without AAA (AAA-) at two hospitals between 2008 and 2014, and examined the association between the risk factors and the presence of AAA. Furthermore, in order to investigate the prevalence of AAA in each group, we enrolled 1126 patients with CKD and 400 patients with DM. RESULTS The presence of CKD in patients with AAA+ was significantly higher than that in patients with AAA- (AAA+; 65%, AAA-; 52%, P = 0.004). The presence of DM in patients with AAA+ was significantly lower than that in patients with AAA- (AAA+; 17%, AAA-; 35%, P < 0.001). A multivariate logistic regression analysis demonstrated that hypertension, ischemic heart disease and CKD were independent determinants, whereas, DM was a negatively independent determinant, for the presence of AAA. The prevalence of AAA in patients with CKD 65 years old and above was 5.1%, whereas, that in patients with DM 65 years old and above was only 0.6%. CONCLUSION CKD is a positively associated with the presence of AAA. In contrast, DM is a negatively associated with the presence of AAA in Japanese population.
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Affiliation(s)
- Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Michihiro Okuyama
- Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Haruhito A. Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Kakio
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryoko Umebayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuka Okuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiro Fujii
- Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Susumu Ozawa
- Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Masashi Yoshida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yu Oshima
- Department of Cardiovascular Surgery, Kure Kyosai Hospital, Hiroshima, Japan
| | - Shunji Sano
- Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Ruff A, Patel K, Joyce JR, Gornik HL, Rothberg MB. The use of pre-existing CT imaging in screening for abdominal aortic aneurysms. Vasc Med 2016; 21:515-519. [DOI: 10.1177/1358863x16651505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ultrasound screening for abdominal aortic aneurysm (AAA) is recommended for male smokers >65 years of age, but screening rates remain low. If computed tomography (CT) performed for other indications could be considered adequate for screening, one-third of ultrasounds would potentially be unnecessary, and overall screening rates would be substantially higher. The objective of this study was to evaluate the sensitivity of CT imaging of the abdomen for the detection of AAA when performed for other clinical indications. We performed a retrospective study of patients eligible for AAA screening who had undergone an abdominal ultrasound as well as an abdominal CT scan for other indications within 3 years prior to that study. The primary outcome was identification of an AAA, recorded in the findings narrative or impression of the CT scan report. Of 142 patients with both a CT scan and an AAA on ultrasound, 127 (89.4%) were noted to have an AAA in the report of a CT scan performed within the 3 years prior to the ultrasound. An additional 10 films demonstrated an AAA that was not mentioned in the report. The sensitivity of pre-existing CT scans for AAA screening was 97.2% (137/141) [95% CI: 93.4–99.0%]; 123 (86.6%) of these positive findings were reported in the findings narrative and 120 (84.5%) were reported in the radiologist’s final impression. The sensitivity for AAA identification in the report of a pre-existing CT scan of the abdomen performed for alternate indications appears high enough to use as a screening test. When radiologists note an AAA, they should be sure to include it in the final impression.
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Affiliation(s)
- Allison Ruff
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Krishna Patel
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Heather L Gornik
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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Lacayo-Valenzuela M, Lecuona-Huet N, Códova-Quintal P, Flores-Aguilar S, Cárdenas-Sánchez Á. Endovascular treatment of an abdominal aortic aneurysm in the “Dr. Eduardo Liceaga” General Hospital of Mexico. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2016. [DOI: 10.1016/j.hgmx.2016.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Vänni V, Hakala T, Mustonen J, Turtiainen J, Rissanen TT, Kajander O, Ilveskoski E, Koivumäki J, Eskola M, Hernesniemi J. Ultrasound Screening of Men with Coronary Artery Disease for Abdominal Aortic Aneurysms: A Prospective Dual Center Study. Scand J Surg 2016; 105:235-240. [DOI: 10.1177/1457496915626839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background and Aims: According to the heterogeneous results of previous studies, the prevalence of abdominal aortic aneurysm seems high among men with coronary artery disease. The associating risk factors for abdominal aortic aneurysm in this population require clarification. Our objective was to assess the prevalence of non-diagnosed abdominal aortic aneurysms in men with angiographically verified coronary artery disease and to document the associated co-morbidities and risk factors. Material and Methods: Altogether, 407 men with coronary artery disease were screened after invasive coronary angiography in two series at independent centers. Risk factor data were recorded and analyzed. Results and Conclusion: The mean age of the study cohort was 70.0 years (standard deviation: 11.0). The prevalence of previously undiagnosed abdominal aortic aneurysms in the whole screened population of 407 men was 6.1% (n = 25/407). In a multivariate analysis of the whole study population, the only significant risk factors for abdominal aortic aneurysm were age (odds ratio: 1.04, 95% confidence interval: 1.00–1.09) and history of smoking (odds ratio: 3.13, 95% confidence interval: 1.26–7.80). Non-smokers with abdominal aortic aneurysm were significantly older than smokers (mean age: 80.7 (standard deviation: 8.0) vs 68.0 (standard deviation: 11.1), p = 0.003), and age was a significant risk factor only among non-smokers (p = 0.011; p = 0.018 for interaction). Among smokers, the prevalence of abdominal aortic aneurysm was 8.8%, and 72% (n = 18/25) of all diagnosed abdominal aortic aneurysm patients were smokers. Prevalence of undiagnosed abdominal aortic aneurysms among patients with coronary artery disease is high, and history of smoking is the most significant risk factor for abdominal aortic aneurysm. Effectiveness of selective screening of abdominal aortic aneurysm in male patients with coronary artery disease warrants further studies.
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Affiliation(s)
- V. Vänni
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland
| | - T. Hakala
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland
| | - J. Mustonen
- Heart Center, North Karelia Central Hospital, Joensuu, Finland
| | - J. Turtiainen
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland
| | - T. T. Rissanen
- Heart Center, North Karelia Central Hospital, Joensuu, Finland
| | - O. Kajander
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - E. Ilveskoski
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - J. Koivumäki
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - M. Eskola
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - J. Hernesniemi
- Heart Hospital, Tampere University Hospital, Tampere, Finland
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A national survey of disease-specific knowledge in patients with an abdominal aortic aneurysm. J Vasc Surg 2016; 63:1156-62. [DOI: 10.1016/j.jvs.2015.12.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
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Ben-Assuli O, Ziv A, Sagi D, Ironi A, Leshno M. Cost-Effectiveness Evaluation of EHR: Simulation of an Abdominal Aortic Aneurysm in the Emergency Department. J Med Syst 2016; 40:141. [PMID: 27114352 DOI: 10.1007/s10916-016-0502-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/18/2016] [Indexed: 11/24/2022]
Abstract
Health care organizations have installed electronic systems to increase efficiency in health care. Empirically assessing the cost-effectiveness of technologies to the health care system is a challenging and complex task. This study examined cost-effectiveness of additional clinical information supplied via an EHR system by simulating a case of abdominal aortic aneurysm devised and acted professionally by the Israel Center of Medical Simulation. We conducted a simulation-based study on physicians who were asked to treat a simulated patient for the prevalent medical scenario of hip and leg pain that actually corresponded to an abdominal aortic aneurysm. Half of the participating physicians from the Department of Emergency Medicine at Tel-Hashomer Hospital - Israel's largest - had access to an EHR system that integrates medical data from multiple health providers (community and hospitals) in addition to the local health record, and half did not. To model medical decision making, the results of the simulation were combined with a Markov Model within a decision tree. Cost-effectiveness was analyzed by comparing the effects of the admission/discharge decision in units of quality adjusted life years (QALYs) to the estimated costs. The results showed that using EHR in the ED increases the QALY of the patient and improves medical decision-making. The expenditure per patient for one QALY unit as a result of using the EHR was $1229, which is very cost-effective according to many accepted threshold values (less than all these values). Thus, using the EHR contributes to making a cost-effective decision in this specific but prevalent case.
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Affiliation(s)
| | - Amitai Ziv
- Sheba Medical Center, Tel-HaShomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Sagi
- Sheba Medical Center, Tel-HaShomer, Israel
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