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Nagarathna R, Kumar S, Anand A, Acharya IN, Singh AK, Patil SS, Latha RH, Datey P, Nagendra HR. Effectiveness of Yoga Lifestyle on Lipid Metabolism in a Vulnerable Population-A Community Based Multicenter Randomized Controlled Trial. MEDICINES 2021; 8:medicines8070037. [PMID: 34357153 PMCID: PMC8303653 DOI: 10.3390/medicines8070037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/13/2021] [Accepted: 06/29/2021] [Indexed: 01/09/2023]
Abstract
Background: Dyslipidemia poses a high risk for cardiovascular disease and stroke in Type 2 diabetes (T2DM). There are no studies on the impact of a validated integrated yoga lifestyle protocol on lipid profiles in a high-risk diabetes population. Methods: Here, we report the results of lipid profile values of 11,254 (yoga 5932 and control 5322) adults (20–70 years) of both genders with high risk (≥60 on Indian diabetes risk score) for diabetes from a nationwide rural and urban community-based two group (yoga and conventional management) cluster randomized controlled trial. The yoga group practiced a validated integrated yoga lifestyle protocol (DYP) in nine day camps followed by daily one-hour practice. Biochemical profiling included glycated hemoglobin and lipid profiles before and after three months. Results: There was a significant difference between groups (p < 0.001 ANCOVA) with improved serum total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein in the yoga group compared to the control group. Further, the regulatory effect of yoga was noted with a significant decrease or increase in those with high or low values of lipids, respectively, with marginal or no change in those within the normal range. Conclusion: Yoga lifestyle improves and regulates (lowered if high, increased if low) the blood lipid levels in both genders of prediabetic and diabetic individuals in both rural and urban Indian communities.
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Affiliation(s)
- Raghuram Nagarathna
- Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru 560105, India; (A.K.S.); (S.S.P.); (H.R.N.)
- Correspondence: (R.N.); (A.A.)
| | - Saurabh Kumar
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India;
| | - Akshay Anand
- Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India;
- Centre for Mind Body Medicine, PGIMER, Chandigarh 160012, India
- Centre for Cognitive Science and Phenomenology, Panjab University, Chandigarh 160014, India
- Correspondence: (R.N.); (A.A.)
| | - Ishwara N. Acharya
- Central Council for Research in Yoga & Naturopathy (CCRYN), Delhi 110058, India;
| | - Amit Kumar Singh
- Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru 560105, India; (A.K.S.); (S.S.P.); (H.R.N.)
| | - Suchitra S. Patil
- Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru 560105, India; (A.K.S.); (S.S.P.); (H.R.N.)
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Zhao X, Wang D, Qin L. Lipid profile and prognosis in patients with coronary heart disease: a meta-analysis of prospective cohort studies. BMC Cardiovasc Disord 2021; 21:69. [PMID: 33535982 PMCID: PMC7860615 DOI: 10.1186/s12872-020-01835-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
Background This meta-analysis based on prospective cohort studies aimed to evaluate the associations of lipid profiles with the risk of major adverse cardiovascular outcomes in patients with coronary heart disease (CHD). Methods The PubMed, Embase, and Cochrane Library electronic databases were systematically searched for prospective cohort study published through December 2019, and the pooled results were calculated using the random-effects model. Results Twenty-one studies with a total of 76,221 patients with CHD met the inclusion criteria. The per standard deviation (SD) increase in triglyceride was associated with a reduced risk of major adverse cardiovascular events (MACE). Furthermore, the per SD increase in high-density lipoprotein cholesterol (HDL-C) was associated with a reduced risk of cardiac death, whereas patients with lower HDL-C were associated with an increased risk of MACE, all-cause mortality, and cardiac death. Finally, the risk of MACE was significantly increased in patients with CHD with high lipoprotein(a) levels. Conclusions The results of this study suggested that lipid profile variables could predict major cardiovascular outcomes and all-cause mortality in patients with CHD.
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Affiliation(s)
- Xiangmei Zhao
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Dongying Wang
- College of Food Science and Technology, Henan University of Technology, Zhengzhou, 450001, China
| | - Lijie Qin
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, Henan, China.
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Khadka R, Narang R, Jaryal AK, Patel C, Deepak KK. Severe Cardiac Dysautonomia and Sudden Death in a Patient Presenting with Anginal Symptoms in Absence of Cardiovascular and Other Diseases: A Case Report. ACTA ACUST UNITED AC 2020; 58:261-264. [PMID: 32417866 PMCID: PMC7580456 DOI: 10.31729/jnma.4828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Angina is a type of chest pain, experienced by patients with ischemic heart diseases. Cardiac autonomic modulation as assessed by heart rate variability and baroreflex sensitivity is found reduced in ischemic heart disease patients. Marked reduction in heart rate variability and baroreflex sensitivity in ischemic heart disease patients is found associated with sudden cardiac death. We report a case of a 35-year-old man who presented with angina for the last few months. Thorough investigations showed no evidence of any cardiac or other systemic diseases. However, his cardiovascular autonomic modulation (as assessed by heart rate variability) and spontaneous baroreflex sensitivity were markedly reduced. The patient had sudden death within 6 months of follow-up. Reportedly, no other specific abnormalities were found before death. This case report suggests that patients presenting with typical chest pain as angina may have severe dysautonomia and risk of sudden death even in the absence of cardiovascular or any other known end-organ diseases.
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Affiliation(s)
- Rita Khadka
- Department of Basic and Clinical Physiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore Kumar Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Inoue K, Matsumoto T, Yamashita S, Yoshiga R, Yoshiya K, Matsubara Y, Matsuda D, Morisaki K, Furuyama T, Mori M. Malnutrition diagnosed by controlling nutrition status is a negative predictor of life prognosis in aortic arch aneurysm patients treated with thoracic endovascular aneurysm repair. Vascular 2019; 28:31-41. [DOI: 10.1177/1708538119869458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Controlling Nutritional Status (CONUT) is a useful screening tool for malnutrition in patients with various diseases; however, how CONUT-diagnosed malnutrition affects patients with aortic arch aneurysm is unknown. This study aimed to reveal the utility of CONUT for detecting the patients with high-risk aortic arch aneurysm with malnutrition. Methods Sixty patients treated for aortic arch aneurysms with elective thoracic endovascular aneurysm repair from 2009 to 2015 were retrospectively analyzed at a single institution. Preoperative nutrition status was evaluated by CONUT, and a CONUT score ≥ 3 was defined as malnutrition. The influence of malnutrition on the patients’ overall survival, aneurysm-related death-free rates, and prevalence of re-interventions were also analyzed. Results Twenty-three patients were diagnosed with malnutrition. Overall survival was significantly lower in the malnutrition group ( P = 0.0036). The multivariate Cox proportional hazard analysis revealed that age ( P < 0.0001) and malnutrition ( P = 0.0457) were negative predictors of overall survival. Conversely, the two groups did not differ significantly in aneurysm-related death-free rates ( P = 0.7879) and the prevalence of re-interventions ( P = 0.7879). Conclusions Malnutrition diagnosed by CONUT as well as age is a negative predictor of survival prognosis in patients with aortic arch aneurysm.
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Affiliation(s)
- Kentaro Inoue
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare School of Health Sciences, Chiba, Japan
| | - Sho Yamashita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryosuke Yoshiga
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiji Yoshiya
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Matsubara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Matsuda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tadashi Furuyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abstract
Atherosclerosis and its late sequels are still the number one cause of death in Western societies. Platelets are a driving force not only during the genesis of atherosclerosis, but especially in its late stages, as evidenced by complications such as arterial thrombosis, myocardial infarction, and ischaemic stroke. Platelets are small, anucleate blood elements of critical importance in cardiovascular disease, a major cause of morbidity and mortality. Numerous risk scores exist to identify healthy individuals at increased risk of developing atherosclerosis and cardiovascular disease. However, markers of cardiovascular risk not routinely assessed (i.e. platelet activity, mean platelet volume and P-selectin) may also contribute to be useful in calculating cardiovascular risk. The present review and meta-analysis summarizes the evidence for measuring platelet function indices to identify patients at risk of developing cardiovascular events.
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Wang EY, Dixson J, Schiller NB, Whooley MA. Causes and Predictors of Death in Patients With Coronary Heart Disease (from the Heart and Soul Study). Am J Cardiol 2017; 119:27-34. [PMID: 27788932 DOI: 10.1016/j.amjcard.2016.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
Although the prevalence of coronary heart disease (CHD) in the United States has increased during the past 25 years, cardiovascular mortality has decreased due to advances in CHD therapy and prevention. We sought to determine the proportion of patients with CHD who die from cardiovascular versus noncardiovascular causes and the causes and predictors of death, in a cohort of patients with CHD. The Heart and Soul Study enrolled 1,024 participants with stable CHD from 2000 to 2002 and followed them for 10 years. Causes of mortality were assigned based on detailed review of medical records, death certificates, and coroner reports by blinded adjudicators. During 7,680 person-years of follow-up, 401 participants died. Of these deaths, 42.4% were cardiovascular and 54.4% were noncardiovascular. Myocardial infarction, stroke, and sudden death accounted for 72% of cardiovascular deaths. Cancer, pneumonia, and sepsis accounted for 67% of noncardiovascular deaths. Independent predictors of cardiac mortality were older age, inducible ischemia on stress echocardiography, higher heart rate at rest, smoking, lower hemoglobin, and higher N-terminal pro-brain natriuretic peptide (all p values <0.05); independent predictors of noncardiac mortality included older age, inducible ischemia, higher heart rate, lower exercise capacity, and nonuse of statins (all p values <0.05). In conclusion, mortality in this cohort was more frequently due to noncardiovascular causes, and predictors of noncardiovascular mortality included factors traditionally associated with cardiovascular mortality.
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Liu X, Su X, Zeng H. Impact of admission serum total cholesterol level on in-hospital mortality in patients with acute aortic dissection. Pak J Med Sci 2016; 32:939-43. [PMID: 27648044 PMCID: PMC5017107 DOI: 10.12669/pjms.324.10124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To find out the association between serum total cholesterol (TC) on admission and in-hospital mortality in patients with acute aortic dissection (AAD). METHODS From January 2007 to January 2014, we enrolled 1492 consecutive AAD patients with serum TC measured immediately on admission. Baseline characteristics and in-hospital mortality were compared between the patients with serum TC above and below the median (4.00 mmol/L). Propensity score matching (PSM) was used to account for known confounders in the study. Cox proportional hazard model was performed to calculate the hazard ratio (HR) and 95% confidence interval (CI) for admission serum TC levels. RESULTS With the use of PSM, 521 matched pairs of patients with AAD were yielded in this analysis due to their similar propensity scores. Patients with admission serum TC < 4.00 mmol/L, as compared with those with admission serum TC ≥ 4.00 mmol/L, had higher in-hospital mortality (11.7% vs. 5.8%; HR, 2.06; 95% CI, 1.33-3.19, P = 0.001). Stratified analysis according to Stanford classification showed that the inverse association between admission serum TC and in-hospital mortality was observed in patients with Type-A AAD (24.0% vs. 11.3%; HR, 2.18; 95% CI, 1.33 - 3.57, P = 0.002) but not in those with Type-B AAD (3.8% vs. 2.2%; HR, 1.71; 95% CI, 0.67 - 4.34, P = 0.261). CONCLUSIONS Lower serum TC level on admission was strongly associated with higher in-hospital mortality in patients with Type-A AAD.
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Affiliation(s)
- Xintian Liu
- Xintian Liu, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Su
- Xi Su, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hesong Zeng
- Hesong Zeng, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Lee JH, Park SH, Yang DH, Park HS, Cho Y, Lee WK, Jeong MH, Kim YJ, Jun JE, Chae SC. Threshold level of low-density lipoprotein cholesterol for the short-term benefit of statin therapy in the acute phase of myocardial infarction. Clin Cardiol 2011; 35:211-8. [PMID: 22102488 DOI: 10.1002/clc.20984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 08/31/2011] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Little is known about the threshold level of low-density lipoprotein cholesterol (LDL-C) for statin therapy in acute myocardial infarction (AMI). HYPOTHESIS The aim of this study was to investigate the short-term benefit of the statin in post-MI patients with low LDL-C levels. METHODS Between November 2005 and January 2008, 6866 statin-naive patients were selected from the Korea AMI registry. Major adverse cardiac event (MACE) was defined as a composite of death, recurrent MI, and revascularizations. RESULTS The 6-month MACE and mortality showed a U-shaped curve, with the lowest rate at 114-122 mg/dL. Propensity scores for statin use were calculated for patients with LDL-C ≤ 113 mg/dL, and they were used to match the patients who received statin (statin user, n = 1031) with those who did not receive it (statin nonuser, n = 1031). The 6-month MACE was not significantly different between statin users and statin nonusers (9.4% vs 11.0%; hazard ratio [HR]: 0.847, 95% confidence interval [CI]: 0.646-1.111, P = 0.230), whereas the 6-month mortality was significantly lower in statin users (7.2% vs 9.7%; HR: 0.728, 95% CI: 0.539-0.984, P = 0.039). However, when the analyses were repeated in the patients with LDL-C ≤ 105 mg/dL, not only the 6-month MACE (9.5% vs 9.9%; HR: 0.945, 95% CI: 0.700-1.277, P = 0.713) but also the 6-month mortality (7.0% vs 8.7%; HR: 0.793, 95% CI: 0.566-1.111, P = 0.177) was not significantly different between statin users and statin nonusers (n = 876 in each group). CONCLUSIONS The beneficial effects of statin therapy seem to vanish when LDL-C is below a certain level in AMI patients.
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Affiliation(s)
- Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
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Kamat AM, Nelkin GM. Atorvastatin: a potential chemopreventive agent in bladder cancer. Urology 2006; 66:1209-12. [PMID: 16360444 DOI: 10.1016/j.urology.2005.06.075] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2005] [Revised: 05/14/2005] [Accepted: 06/10/2005] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate a commonly used 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor-atorvastatin-for potential activity against human bladder cancer. Patients with bladder cancer often have concomitant hyperlipidemia and cardiac disease due to common risk factors such as smoking and advanced age. As such, they are often prescribed HMG-CoA reductase inhibitors (statins), which have been suggested to affect tumor growth patterns. METHODS Two human transitional cell carcinoma cell lines--RT4 and KU-7--were exposed to atorvastatin at concentrations from 0 (control) to 100 microM for 48 or 72 hours. The effects on cell proliferation, DNA synthesis, and apoptosis were respectively evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide colorimetric assay and the thymidine incorporation assay and by quantifying DNA fragmentation by propidium iodide fluorescence and flow cytometry. RESULTS Atorvastatin inhibited cell proliferation and DNA synthesis in both bladder cancer cell lines. This led to significant cytotoxicity as demonstrated by DNA fragmentation and induction of apoptosis. CONCLUSIONS Atorvastatin exhibits significant antiproliferative and pro-apoptotic activity in human bladder cancer cells. This, coupled with its established clinical safety profile, provides a rationale for its use as a potential chemopreventive agent against bladder cancer.
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Affiliation(s)
- Ashish M Kamat
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Dellavalle RP, Drake A, Graber M, Heilig LF, Hester EJ, Johnson KR, McNealy K, Schilling L. Statins and fibrates for preventing melanoma. Cochrane Database Syst Rev 2005; 2005:CD003697. [PMID: 16235336 PMCID: PMC11102950 DOI: 10.1002/14651858.cd003697.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Effective treatment for advanced melanoma is lacking. While no drug therapy currently exists for prevention of melanoma, in vitro, case-control, and animal model evidence suggest that lipid-lowering medications, commonly taken for high cholesterol, might prevent melanoma. OBJECTIVES To assess the effects of statin or fibrate lipid-lowering medications on melanoma outcomes. SEARCH STRATEGY We searched the Cochrane Skin Group Specialised Register (February 2003), CENTRAL (The Cochrane Library Issue 1, 2005), MEDLINE (to March 2003), EMBASE (to September 2003), CANCERLIT (to October 2002), Web of Science (to May 2003), and reference lists of articles. We approached study investigators and pharmaceutical companies for additional information (published or unpublished studies). SELECTION CRITERIA Trials involving random allocation of study participants, where experimental groups used statins or fibrates and participants were enrolled for at least four years of therapy. DATA COLLECTION AND ANALYSIS Three authors screened 109 abstracts of articles with titles of possible relevance. We then thoroughly examined the full text of 72 potentially relevant articles. We requested unpublished melanoma outcomes data from the corresponding author of each qualifying trial. MAIN RESULTS We identified 16 qualifying randomised controlled trials (RCTs) (seven statin, nine fibrate). Thirteen of these trials (involving 62,197 participants) provided data on incident melanomas (six statin, seven fibrate). A total of 66 melanomas were reported in groups receiving the experimental drug and 86 in groups receiving placebo or other control therapies. For statin trials this translated to an odds ratio of 0.90 (95% confidence interval 0.56 to 1.44) and for fibrate trials an odds ratio of 0.58 (95% confidence interval 0.19 to 1.82). Subgroup analyses failed to show statistically significant differences in melanoma outcomes by gender, melanoma occurrence after two years of participation in trial, stage or histology, or trial funding. Subgroup analysis by type of fibrate or statin also failed to show statistically significant differences, except for the statin subgroup analysis which showed reduced melanoma incidence for lovastatin, based on one trial only (odds ratio 0.52, 95% confidence interval 0.27 to 0.99). AUTHORS' CONCLUSIONS The melanoma outcomes data collected in this review of RCTs of statins and fibrates does not exclude the possibility that these drugs prevent melanoma. There was a 10% and 42% reduction for participants on statins and fibrates, respectively, however these results were not statistically significant. Until further evidence is established, limiting exposure to ultraviolet radiation remains the most effective way to reduce the risk of melanoma.
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Affiliation(s)
- R P Dellavalle
- Denver Veterans Affairs Medical Center, Dermatology, 1055 Clermont Street, Mail Stop 165, Denver, Colorado 80220, USA.
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Stehbens WE. Coronary heart disease, hypercholesterolemia, and atherosclerosis. II. Misrepresented data. Exp Mol Pathol 2001; 70:120-39. [PMID: 11263955 DOI: 10.1006/exmp.2000.2339] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Early development of the hypercholesterolemic/lipid hypothesis of atherosclerosis was based on false premises including fallacious national mortality rates and misrepresentation of the vascular lesions in cholesterol-overfed animals and monogenic hypercholesterolemias (MH). Nonspecific coronary heart disease (CHD) was inappropriately used as a surrogate of atherosclerosis, unmeasured and unseen. Causality was assumed and implied by classifying statistical correlates of CHD as atherogenic risk factors. These faults were compounded by methodological errors, pooling of all causes of CHD, a large clinical diagnostic error, biased age selection of cohorts leading to confounding by age and MH, and emphasis on population and cohort mean values which conceal heterogeneity within cohorts and are inapplicable to individuals. Overzealous investigators neglected to review the premises and relevant pathology on which the hypothesis was based or to reconcile valid criticisms, inconsistencies, and invalidation of CHD epidemiology by pathological, experimental, and iatrogenic evidence. Statistical data, pertaining to CHD but with no scientific applicability to atherosclerosis, progressively imparted to readers a misleading perception of the relationship of serum cholesterol to CHD. Concurrently the statistical serum cholesterol range was unjustifiably abandoned. The evidence establishes that the lipid hypothesis of atherosclerosis lacks scientific basis.
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Affiliation(s)
- W E Stehbens
- Department of Pathology and Molecular Medicine, Wellington School of Medicine, Wellington, New Zealand
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Reicher-Reiss H, Jonas M, Goldbourt U, Boyko V, Modan B. Selectively increased risk of cancer in men with coronary heart disease. Am J Cardiol 2001; 87:459-62, A6. [PMID: 11179536 DOI: 10.1016/s0002-9149(00)01405-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cancer incidence was assessed among a cohort of 10,923 male coronary patients in Israel screened for participation in a secondary prevention trial and compared with national cancer incidence rates. Higher total and age-specific incidence rates of cancer were observed among male coronary patients than among the Israeli male population, but this excess was limited to cancers of the lung, bladder, and colon.
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Affiliation(s)
- H Reicher-Reiss
- Heart Institute, Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Israel
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Brockstein BE, Smiley C, Al-Sadir J, Williams SF. Cardiac and pulmonary toxicity in patients undergoing high-dose chemotherapy for lymphoma and breast cancer: prognostic factors. Bone Marrow Transplant 2000; 25:885-94. [PMID: 10808211 DOI: 10.1038/sj.bmt.1702234] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We sought to define risk factors predisposing breast cancer and lymphoma patients to cardiac and pulmonary toxicity when undergoing high-dose chemotherapy (HDC) and autologous stem cell rescue (ASCR). Additionally, we evaluated in depth the predictive value of the ejection fraction measured prior to HDC in determining cardiac toxicity. In this retrospective analysis, 24 variables were examined in 138 patients undergoing HDC and ASCR from 1990 until 1995. Logistic regression models were used to model the probability of experiencing cardiac and pulmonary toxicity as a function of the 24 prognostic covariates. Cardiac toxicity occurred in 12% of patients and pulmonary toxicity in 24% of patients. Bivariate analyses showed that patients with lymphoma (as opposed to breast cancer) and those with a higher cardiac risk factor score were more likely to experience cardiac toxicity. Multivariate logistic regression models predicted lymphoma and older age to be risk factors for cardiac toxicity. History of an abnormal ejection fraction and higher doses of anthracyclines prior to HDC may also contribute to cardiac toxicity. Pulmonary toxicity occurred more commonly in lymphoma than breast cancer patients, likely due to the busulfan used in the HDC regimen. No other risk factors for pulmonary toxicity were identified. We conclude that older patients with lymphoma should be carefully evaluated prior to being accepted for HDC programs. Older patients with breast cancer may tolerate this procedure well. There is a trend towards cardiac toxicity in patients with a past history of low ejection fraction, although seemingly poor cardiac risk patients may fare well with HDC if carefully selected with the aid of a thorough cardiac evaluation.
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Affiliation(s)
- B E Brockstein
- Department of Internal Medicine, Section of Hematology/Oncology, University of Chicago, IL, USA
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