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Chikumba S, Hu Y, Luo J. Deep learning-based fundus image analysis for cardiovascular disease: a review. Ther Adv Chronic Dis 2023; 14:20406223231209895. [PMID: 38028950 PMCID: PMC10657535 DOI: 10.1177/20406223231209895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
It is well established that the retina provides insights beyond the eye. Through observation of retinal microvascular changes, studies have shown that the retina contains information related to cardiovascular disease. Despite the tremendous efforts toward reducing the effects of cardiovascular diseases, they remain a global challenge and a significant public health concern. Conventionally, predicting the risk of cardiovascular disease involves the assessment of preclinical features, risk factors, or biomarkers. However, they are associated with cost implications, and tests to acquire predictive parameters are invasive. Artificial intelligence systems, particularly deep learning (DL) methods applied to fundus images have been generating significant interest as an adjunct assessment tool with the potential of enhancing efforts to prevent cardiovascular disease mortality. Risk factors such as age, gender, smoking status, hypertension, and diabetes can be predicted from fundus images using DL applications with comparable performance to human beings. A clinical change to incorporate DL systems for the analysis of fundus images as an equally good test over more expensive and invasive procedures may require conducting prospective clinical trials to mitigate all the possible ethical challenges and medicolegal implications. This review presents current evidence regarding the use of DL applications on fundus images to predict cardiovascular disease.
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Affiliation(s)
- Symon Chikumba
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Department of Optometry, Faculty of Healthy Sciences, Mzuzu University, Luwinga, Mzuzu, Malawi
| | - Yuqian Hu
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin RD, Changsha, Hunan, China
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Tian X, Chen S, Wang P, Zhang Y, Zhang X, Xu Q, Wu S, Wang A. Association of Multitrajectories of Lipid Indices With Premature Cardiovascular Disease: A Cohort Study. J Am Heart Assoc 2023; 12:e029173. [PMID: 37119078 PMCID: PMC10227234 DOI: 10.1161/jaha.122.029173] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/06/2023] [Indexed: 04/30/2023]
Abstract
Background The multitrajectory model can identify joint longitudinal patterns of different lipids simultaneously, which might help better understand the heterogeneous risk of premature cardiovascular disease (CVD) and facilitate targeted prevention programs. This study aimed to investigate the associations between multitrajectories of lipids with premature CVD. Methods and Results The study enrolled 78 526 participants from the Kailuan study, a prospective cohort study in Tangshan, China. Five distinct multitrajectories of triglyceride, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol over 6-year exposure were identified on the basis of Nagin's criteria, using group-based multitrajectory modeling. During a median follow-up of 6.75 years (507 645.94 person-years), 665 (0.85%) premature CVDs occurred. After adjustment for confounders, the highest risk of premature CVD was observed in group 4 (the highest and increasing triglyceride, optimal and decreasing LDL-C, low and decreasing high-density lipoprotein cholesterol) (hazard ratio [HR], 2.13 [95% CI, 1.36-3.32]), followed by group 5 (high and decreasing triglyceride, optimal and increasing LDL-C, low and decreasing high-density lipoprotein cholesterol) (HR, 2.07 [95% CI, 1.45-2.98]), and group 3 (optimal and increasing triglyceride, borderline high and increasing LDL-C, optimal and decreasing high-density lipoprotein cholesterol) (HR, 1.90 [95% CI, 1.32-2.73]). Conclusions Our results showed that the residual risk of premature CVD caused by increasing triglyceride levels remained high despite the fact that LDL-C levels were optimal or declining over time. These findings emphasized the importance of assessing the joint longitudinal patterns of lipids and undertaking potential interventions on triglyceride lowering to reduce the residual risk of premature CVD, even among individuals with optimal LDL-C levels.
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Affiliation(s)
- Xue Tian
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Department of Epidemiology and Health Statistics, School of Public HealthCapital Medical UniversityBeijingChina
- Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Shuohua Chen
- Department of Cardiology, Kailuan HospitalNorth China University of Science and TechnologyTangshanChina
| | - Penglian Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yijun Zhang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- Department of Epidemiology and Health Statistics, School of Public HealthCapital Medical UniversityBeijingChina
- Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Xiaoli Zhang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Qin Xu
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Shouling Wu
- Department of Cardiology, Kailuan HospitalNorth China University of Science and TechnologyTangshanChina
| | - Anxin Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
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Lönnberg L, Damberg M, Revenäs Å. Lifestyle counselling – a long-term commitment based on partnership. BMC PRIMARY CARE 2022; 23:35. [PMID: 35232396 PMCID: PMC8889657 DOI: 10.1186/s12875-022-01642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/16/2022] [Indexed: 11/22/2022]
Abstract
Background Lifestyle habits are important factors in the development of non-communicable diseases. Different ways of providing counselling in primary care to promote healthier lifestyle habits have been launched and evaluated in recent years. It is important to provide an insight into what makes lifestyle counselling useful for patients and healthcare providers. Objective The overall aim of this study was to explore patients´ and community health nurses´(CHNs) experiences of lifestyle counselling in primary care to support healthier lifestyle habits. Methods Patients and CHNs were interviewed, face to face. Sixteen patients (eight men, eight women, aged 51–75 years) diagnosed with hypertension or type 2 diabetes mellitus and three CHNs participated. Data material was analysed with qualitative content analysis to explore the participants experiences of lifestyle counselling. Results The theme demonstrates that lifestyle counselling is a long-term commitment based on partnership between patients and CHNs. Five categories describe this partnership: respect and mutual interest, understanding of illness, measurements and goal setting, long-term support, and a structure to support counselling within the primary care unit. Conclusion The results from this study are consistent with and add to previous understanding of how lifestyle counselling can be performed successfully in the context of primary health care. The results emphasize that lifestyle counselling should encompass a partnership based on mutual respect, recognition of the patient as the expert on his/her current life situation, and the need for both parties to engage in the process of lifestyle change. Practice implications A structured lifestyle program with five counselling sessions within primary care was experienced as helpful for enhanced lifestyle habits and considered to be feasible by both patients and CHNs.
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Kurniansyah N, Goodman MO, Kelly TN, Elfassy T, Wiggins KL, Bis JC, Guo X, Palmas W, Taylor KD, Lin HJ, Haessler J, Gao Y, Shimbo D, Smith JA, Yu B, Feofanova EV, Smit RAJ, Wang Z, Hwang SJ, Liu S, Wassertheil-Smoller S, Manson JE, Lloyd-Jones DM, Rich SS, Loos RJF, Redline S, Correa A, Kooperberg C, Fornage M, Kaplan RC, Psaty BM, Rotter JI, Arnett DK, Morrison AC, Franceschini N, Levy D, Sofer T. A multi-ethnic polygenic risk score is associated with hypertension prevalence and progression throughout adulthood. Nat Commun 2022; 13:3549. [PMID: 35729114 PMCID: PMC9213527 DOI: 10.1038/s41467-022-31080-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/31/2022] [Indexed: 12/12/2022] Open
Abstract
In a multi-stage analysis of 52,436 individuals aged 17-90 across diverse cohorts and biobanks, we train, test, and evaluate a polygenic risk score (PRS) for hypertension risk and progression. The PRS is trained using genome-wide association studies (GWAS) for systolic, diastolic blood pressure, and hypertension, respectively. For each trait, PRS is selected by optimizing the coefficient of variation (CV) across estimated effect sizes from multiple potential PRS using the same GWAS, after which the 3 trait-specific PRSs are combined via an unweighted sum called "PRSsum", forming the HTN-PRS. The HTN-PRS is associated with both prevalent and incident hypertension at 4-6 years of follow up. This association is further confirmed in age-stratified analysis. In an independent biobank of 40,201 individuals, the HTN-PRS is confirmed to be predictive of increased risk for coronary artery disease, ischemic stroke, type 2 diabetes, and chronic kidney disease.
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Affiliation(s)
- Nuzulul Kurniansyah
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew O Goodman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanika N Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Tali Elfassy
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kerri L Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Walter Palmas
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Henry J Lin
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jeffrey Haessler
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Yan Gao
- The Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer A Smith
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Bing Yu
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Elena V Feofanova
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Roelof A J Smit
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zhe Wang
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shih-Jen Hwang
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Simin Liu
- Center for Global Cardiometabolic Health and Departments of Epidemiology, Medicine, and Surgery, Brown University, Providence, RI, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology & Population Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adolfo Correa
- Departments of Medicine and Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Myriam Fornage
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert C Kaplan
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Donna K Arnett
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Levy
- The Population Sciences Branch of the National Heart, Lung and Blood Institute, Bethesda, MD, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Tamar Sofer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Molecular Biological and Clinical Understanding of the Statin Residual Cardiovascular Disease Risk and Peroxisome Proliferator-Activated Receptor Alpha Agonists and Ezetimibe for Its Treatment. Int J Mol Sci 2022; 23:ijms23073418. [PMID: 35408799 PMCID: PMC8998547 DOI: 10.3390/ijms23073418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 12/20/2022] Open
Abstract
Several randomized, double blind, placebo-controlled trials (RCTs) have demonstrated that low-density lipoprotein cholesterol (LDL-C) lowering by using statins, including high-doses of strong statins, reduced the development of cardiovascular disease (CVD). However, among the eight RCTs which investigated the effect of statins vs. placebos on the development of CVD, 56-79% of patients had the residual CVD risk after the trials. In three RCTs which investigated the effect of a high dose vs. a usual dose of statins on the development of CVD, 78-87% of patients in the high-dose statin arms still had the CVD residual risk after the trials. An analysis of the characteristics of patients in the RCTs suggests that elevated triglyceride (TG) and reduced high-density lipoprotein cholesterol (HDL-C), the existence of obesity/insulin resistance, and diabetes may be important metabolic factors which determine the statin residual CVD risk. To understand the association between lipid abnormalities and the development of atherosclerosis, we show the profile of lipoproteins and their normal metabolism, and the molecular and biological mechanisms for the development of atherosclerosis by high TG and/or low HDL-C in insulin resistance. The molecular biological mechanisms for the statin residual CVD risk include an increase of atherogenic lipoproteins such as small dense LDL and remnants, vascular injury and remodeling by inflammatory cytokines, and disturbed reverse cholesterol transport. Peroxisome proliferator-activated receptor alpha (PPARα) agonists improve atherogenic lipoproteins, reverse the cholesterol transport system, and also have vascular protective effects, such as an anti-inflammatory effect and the reduction of the oxidative state. Ezetimibe, an inhibitor of intestinal cholesterol absorption, also improves TG and HDL-C, and reduces intestinal cholesterol absorption and serum plant sterols, which are increased by statins and are atherogenic, possibly contributing to reduce the statin residual CVD risk.
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Anto EO, Frimpong J, Boadu WIO, Tamakloe VCKT, Hughes C, Acquah B, Acheampong E, Asamoah EA, Opoku S, Appiah M, Tawiah A, Annani-Akollor ME, Wiafe YA, Addai-Mensah O, Obirikorang C. Prevalence of Cardiometabolic Syndrome and its Association With Body Shape Index and A Body Roundness Index Among Type 2 Diabetes Mellitus Patients: A Hospital-Based Cross-Sectional Study in a Ghanaian Population. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 2:807201. [PMID: 36994331 PMCID: PMC10012128 DOI: 10.3389/fcdhc.2021.807201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022]
Abstract
Cardiometabolic syndrome (MetS) is closely linked to type 2 diabetes mellitus (T2DM) and is the leading cause of diabetes complications. Anthropometric indices could be used as a cheap approach to identify MetS among T2DM patients. We determined the prevalence of MetS and its association with sociodemographic and anthropometric indices among T2DM patients in a tertiary hospital in the Ashanti region of Ghana. A comparative cross-sectional study was conducted among 241 T2DM outpatients attending the Komfo Anokye Teaching Hospital (KATH) and the Kumasi South Hospital for routine check-up. Sociodemographic characteristics, clinicobiochemical markers, namely, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), and glycated hemoglobin (HbA1C) were measured. Anthropometric indices, namely, body mass index (BMI), Conicity index (CI), body adiposity index (BAI), A body shape index (ABSI), body roundness index (BRI), Waist-to-hip ratio (WHR), and Waist-to-height ratio (WHtR) were computed based on either the Height, Weight, Waist circumference (WC) or Hip circumference (HC) of the patients. Metabolic syndrome (MetS) was classified using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria. Data entry and analysis were done using Excel 2016 and SPSS version 25.0 respectively. Of the 241 T2DM patients, 99 (41.1%) were males whereas 144 (58.9%) were females. The prevalence of cardiometabolic syndrome (MetS) was 42.7% with dyslipidemia and hypertension recording a prevalence of 6.6 and 36.1%, respectively. Being a female T2DM patient [aOR = 3.02, 95%CI (1.59-5.76), p = 0.001] and divorced [aOR = 4.05, 95%CI (1.22-13.43), p = 0.022] were the independent sociodemographic predictors of MetS among T2DM patients. The 4th quartile for ABSI and 2nd to 4th quartiles for BSI were associated with MetS on univariate logistic regression (p <0.05). Multivariate logistic regression identified the 3rd quartile (aOR = 25.15 (2.02-313.81), p = 0.012) and 4th quartile (aOR = 39.00, 95%CI (2.68-568.49), p = 0.007) for BRI as the independent predictors of MetS among T2DM. The prevalence of cardiometabolic syndrome is high among T2DM patients and this was influenced by female gender, being divorced, and increased BRI. Integration of BRI as part of routine assessment could be used as early indicator of cardiometabolic syndrome among T2DM patients.
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Affiliation(s)
- Enoch Odame Anto
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Joseph Frimpong
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wina Ivy Ofori Boadu
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Charity Hughes
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benjamin Acquah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Acheampong
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Evans Adu Asamoah
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephen Opoku
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Appiah
- Department of Medical Laboratory Technology, Accra Technical University, Accra, Ghana
| | - Augustine Tawiah
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Max Efui Annani-Akollor
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Amo Wiafe
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Otchere Addai-Mensah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Bei Y, Peng W, Zhao J, Chen C, Deng X, Hu F, Zhou Y, Xiao J. Protocol of a Prospective Cohort Study of Physical Activity in Cardiovascular Outcomes (PACVO) in China: Objective, Design, and Baseline Characteristics. J Cardiovasc Transl Res 2022; 15:918-925. [PMID: 34997545 DOI: 10.1007/s12265-021-10194-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
Physical inactivity has been known as an independent risk factor for cardiovascular diseases (CVDs). The "Physical Activity in Cardiovascular Outcomes (PACVO)" study is a long-term community-based cohort study, which will prospectively observe the association of physical activity alone or combined with other contributor factors with CVD outcomes. From 2013 to 2014, a total of 8291 participants ≥ 18 years old were enrolled in the PACVO study from Jidong community (Tangshan, China). According to physical activity assessment, participants were divided into inactive, moderately active, and very active groups. The follow-up has been conducted once every year including physical examinations, blood biochemistry, cardiovascular imaging, and life quality questionnaires until 2034 or until the occurrence of cardiovascular events. The PACVO study will provide substantial information about the association of physical activity with CVD outcomes, therefore promote utilizing physical activity in the prevention and prediction of CVDs.
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Affiliation(s)
- Yihua Bei
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of Medicine, Shanghai University, Nantong, 226011, China.,Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Wenjing Peng
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of Medicine, Shanghai University, Nantong, 226011, China.,Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Juan Zhao
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of Medicine, Shanghai University, Nantong, 226011, China.,Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Chen Chen
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of Medicine, Shanghai University, Nantong, 226011, China.,Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Xuan Deng
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 85 Wu Jin Road, Shanghai, 200080, China
| | - Feifei Hu
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 85 Wu Jin Road, Shanghai, 200080, China
| | - Yong Zhou
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 85 Wu Jin Road, Shanghai, 200080, China.
| | - Junjie Xiao
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of Medicine, Shanghai University, Nantong, 226011, China. .,Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China.
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Di Minno A, Orsini RC, Chiesa M, Cavalca V, Calcaterra I, Tripaldella M, Anesi A, Fiorelli S, Eligini S, Colombo GI, Tremoli E, Porro B, Di Minno MND. Treatment with PCSK9 Inhibitors in Patients with Familial Hypercholesterolemia Lowers Plasma Levels of Platelet-Activating Factor and Its Precursors: A Combined Metabolomic and Lipidomic Approach. Biomedicines 2021; 9:biomedicines9081073. [PMID: 34440277 PMCID: PMC8391636 DOI: 10.3390/biomedicines9081073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Familial hypercholesterolemia (FH) is characterized by extremely high levels of circulating low-density lipoprotein cholesterol (LDL-C) and is caused by mutations of genes involved in LDL-C metabolism, including LDL receptor (LDLR), apolipoprotein B (APOB), or proprotein convertase subtilisin/Kexin type 9 (PCSK9). Accordingly, PCSK9 inhibitors (PCSK9i) are effective in LDL-C reduction. However, no data are available on the pleiotropic effect of PCSK9i. To this end, we performed an untargeted metabolomics approach to gather a global view on changes in metabolic pathways in patients receiving treatment with PCSK9i. METHODS Twenty-five FH patients starting treatment with PCSK-9i were evaluated by an untargeted metabolomics approach at baseline (before PCSK9i treatment) and after 12 weeks of treatment. RESULTS All the 25 FH subjects enrolled were on maximal tolerated lipid-lowering therapy prior to study entry. After a 12 week treatment with PCSK9i, we observed an expected significant reduction in LDL-cholesterol levels (from 201.0 ± 69.5 mg/dL to 103.0 ± 58.0 mg/dL, p < 0.001). The LDL-C target was achieved in 36% of patients. After peak validation and correction, after 12 weeks of PCSK9i treatment as compared to baseline, we observed increments in creatine (p-value = 0.041), indole (p-value = 0.045), and indoleacrylic acid (p-value= 0.045) concentrations. Conversely, significant decreases in choline (p-value = 0.045) and phosphatidylcholine (p-value < 0.01) together with a reduction in platelet activating factor (p-value = 0.041) were observed. CONCLUSIONS Taking advantage of untargeted metabolomics, we first provided evidence of concomitant reductions in inflammation and platelet activation metabolites in FH patients receiving a 12 week treatment with PCSK9i.
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Affiliation(s)
- Alessandro Di Minno
- Dipartimento di Farmacia, Università degli Studi di Napoli “Federico II”, 80131 Napoli, Italy
- CEINGE-Biotecnologie Avanzate, Università degli Studi di Napoli, 80131 Napoli, Italy
- Correspondence:
| | - Roberta Clara Orsini
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli “Federico II”, 80131 Napoli, Italy; (R.C.O.); (I.C.); (M.T.)
| | - Mattia Chiesa
- Bioinformatics and Artificial Intelligence Facility, Centro Cardiologico Monzino IRCCS, 38010 Milano, Italy;
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 38010 Milano, Italy
| | - Viviana Cavalca
- Centro Cardiologico Monzino, IRCCS, 38010 Milano, Italy; (V.C.); (S.F.); (S.E.); (G.I.C.); (E.T.); (B.P.)
| | - Ilenia Calcaterra
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli “Federico II”, 80131 Napoli, Italy; (R.C.O.); (I.C.); (M.T.)
| | - Maria Tripaldella
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli “Federico II”, 80131 Napoli, Italy; (R.C.O.); (I.C.); (M.T.)
| | - Andrea Anesi
- Fondazione Edmund Mach Research and Innovation Centre, Food Quality and Nutrition Department, Via E. Mach, 1, 38010 S. Michele all’ Adige, Italy;
| | - Susanna Fiorelli
- Centro Cardiologico Monzino, IRCCS, 38010 Milano, Italy; (V.C.); (S.F.); (S.E.); (G.I.C.); (E.T.); (B.P.)
| | - Sonia Eligini
- Centro Cardiologico Monzino, IRCCS, 38010 Milano, Italy; (V.C.); (S.F.); (S.E.); (G.I.C.); (E.T.); (B.P.)
| | - Gualtiero I. Colombo
- Centro Cardiologico Monzino, IRCCS, 38010 Milano, Italy; (V.C.); (S.F.); (S.E.); (G.I.C.); (E.T.); (B.P.)
| | - Elena Tremoli
- Centro Cardiologico Monzino, IRCCS, 38010 Milano, Italy; (V.C.); (S.F.); (S.E.); (G.I.C.); (E.T.); (B.P.)
| | - Benedetta Porro
- Centro Cardiologico Monzino, IRCCS, 38010 Milano, Italy; (V.C.); (S.F.); (S.E.); (G.I.C.); (E.T.); (B.P.)
| | - Matteo Nicola Dario Di Minno
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli “Federico II”, 80131 Napoli, Italy;
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9
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GC. Guía ESC 2020 sobre el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.024] [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]
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10
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1289-1367. [PMID: 32860058 DOI: 10.1093/eurheartj/ehaa575] [Citation(s) in RCA: 2579] [Impact Index Per Article: 859.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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11
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Jamaly S, Redfors B, Omerovic E, Carlsson L, Karason K. Prognostic significance of BMI after PCI treatment in ST-elevation myocardial infarction: a cohort study from the Swedish Coronary Angiography and Angioplasty Registry. Open Heart 2021; 8:openhrt-2020-001479. [PMID: 33589539 PMCID: PMC7887374 DOI: 10.1136/openhrt-2020-001479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 11/09/2022] Open
Abstract
Background Obesity along with clustering of cardiovascular risk factors is a promoter for coronary artery disease. On the other hand, a high body mass index (BMI) appears to exert a protective effect with respect to outcomes after a coronary artery event, termed the obesity paradox. Methods The Swedish Coronary Angiography and Angioplasty Registry collects information on all patients who undergo percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in Sweden along with demographic and procedure-related data. We studied the predictability of four categories of BMI for 1-year all-cause mortality in people with STEMI undergoing PCI. Results Among 25 384 patients, mean (SD) age 67.7 (12.1) years and 70.2% male, who underwent PCI for STEMI, a total of 5529 (21.8%) died within 1 year. Using normal weight (BMI 18.5–24.9 kg/m2) as a reference, subjects with obesity (BMI ≥30 kg/m2) had a low 1-year all-cause mortality risk in unadjusted analysis, HR 0.59 (95% CI 0.53 to 0.67). However, after adjustment for age, sex and other covariates, the difference became non-significant, HR 0.88 (95% CI 0.75 to 1.02). Patients with overweight (BMI 25.0–29.9 kg/m2) had the lowest 1-year mortality risk in analysis adjusted for age, sex and other covariates, HR 0.87 (95% CI 0.79 to 0.97), whereas those with underweight (BMI <18.5 kg/m2) had the highest mortality in both unadjusted HR 2.22 (95% CI 1.69 to 2.92) and adjusted analysis, HR 1.62 (95% CI 1.18 to 2.23). Conclusion The protective effect of obesity with respect to 1-year mortality after coronary intervention became non-significant after adjusting for age, sex and relevant covariates. Instead, overweight people displayed the lowest risk and underweight individuals the highest risk for adjusted all-cause mortality. Trial registration number NCT02311231.
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Affiliation(s)
- Shabbar Jamaly
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden .,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lena Carlsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kristjan Karason
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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Tous-Espelosin M, de Azua SR, Iriarte-Yoller N, MartínezAguirre-Betolaza A, Sanchez PM, Corres P, Arratibel-Imaz I, Sampedro A, Peña J, Maldonado-Martín S. Clinical, physical, physiological, and cardiovascular risk patterns of adults with schizophrenia: CORTEX-SP study: Characterization of adults with schizophrenia. Psychiatry Res 2021; 295:113580. [PMID: 33246589 DOI: 10.1016/j.psychres.2020.113580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022]
Abstract
Schizophrenia (SP) is a severe mental illness with high rates of premature morbidity and mortality, associated with an unhealthy lifestyle and the side effects of drug treatment. The aims of the study were: 1) to determine some key physical, physiological and biochemical markers of health status, including sleep quality, in adults (42±10 yr) with SP (n=126), 2) to estimate cardiovascular risk (CVR), and 3) to compare all studied variables with a healthy control (HC) population (n=30). Assessment was based on body composition, blood pressure, cardiorespiratory condition, sleep quality with triaxial accelerometry for eight days and biochemical analysis. Participants with SP showed a cardiovascular risk profile including "overweight metabolically abnormal", low cardiorespiratory fitness, and impairment of ventilatory efficiency. Although individuals with SP slept more compared to HC, similar sleep efficiency was shown by both groups, but with significantly higher levels of wake after sleep onset by SP. The assessment of CVR revealed significantly higher values in SP (moderate risk) compared to HC (low risk) regardless of the estimation system. The identification of specific clinical, physical, and physiological CVR profiles in SP illness compared to healthy people strongly suggests targeting a comprehensive approach including non-pharmacological interventions. Clinical Trials.gov identifier, NCT03509597. Date of registration: April 26th, 2018.
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Affiliation(s)
- Mikel Tous-Espelosin
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT). Society, Sports, and Physical Exercise Research Group. Department of Physical Education and Sport. Faculty of Education and Sport-Physical Activity and Sport Sciences Section. University of the Basque Country (UPV/EHU). Vitoria-Gasteiz. Araba/Álava. The Basque Country, Spain; Bioaraba, GIKAFIT, Vitoria-Gasteiz, The Basque Country, Spain
| | - Sonia Ruiz de Azua
- Department of Neuroscience, University of the Basque Country (UPV/EHU). Cibersam. The Basque Country, Spain
| | - Nagore Iriarte-Yoller
- Refractory Psychosis Unit, Hospital Psiquiátrico de Álava. Osakidetza. Vitoria-Gasteiz. Araba/Álava. The Basque Country, Spain
| | - Aitor MartínezAguirre-Betolaza
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT). Society, Sports, and Physical Exercise Research Group. Department of Physical Education and Sport. Faculty of Education and Sport-Physical Activity and Sport Sciences Section. University of the Basque Country (UPV/EHU). Vitoria-Gasteiz. Araba/Álava. The Basque Country, Spain; Bioaraba, GIKAFIT, Vitoria-Gasteiz, The Basque Country, Spain
| | - Pedro M Sanchez
- Refractory Psychosis Unit, Hospital Psiquiátrico de Álava. Osakidetza. Vitoria-Gasteiz. Araba/Álava. The Basque Country, Spain
| | - Pablo Corres
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT). Society, Sports, and Physical Exercise Research Group. Department of Physical Education and Sport. Faculty of Education and Sport-Physical Activity and Sport Sciences Section. University of the Basque Country (UPV/EHU). Vitoria-Gasteiz. Araba/Álava. The Basque Country, Spain
| | - Iñaki Arratibel-Imaz
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT). Society, Sports, and Physical Exercise Research Group. Department of Physical Education and Sport. Faculty of Education and Sport-Physical Activity and Sport Sciences Section. University of the Basque Country (UPV/EHU). Vitoria-Gasteiz. Araba/Álava. The Basque Country, Spain
| | - Agurne Sampedro
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Sara Maldonado-Martín
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT). Society, Sports, and Physical Exercise Research Group. Department of Physical Education and Sport. Faculty of Education and Sport-Physical Activity and Sport Sciences Section. University of the Basque Country (UPV/EHU). Vitoria-Gasteiz. Araba/Álava. The Basque Country, Spain; Bioaraba, GIKAFIT, Vitoria-Gasteiz, The Basque Country, Spain.
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13
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Fan Y, Shen BJ, Tay HY. Depression, anxiety, perceived stress, and their changes predicted medical adherence over 9 months among patients with coronary heart disease. Br J Health Psychol 2021; 26:748-766. [PMID: 33382184 DOI: 10.1111/bjhp.12496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/29/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Although effective medical treatments have proved to successfully improve prognoses and outcomes of patients with coronary heart disease (CHD), low adherence to treatments is still common among patients. Deleterious impact of psychological distress on medical adherence has been recognized; however, few studies examined the influence of change in psychological distress on attenuation in adherence. This study investigated whether three common manifestations of distress (depression, anxiety, and perceived stress) and their changes predicted decline in medical adherence among CHD patient over 9 months. DESIGN A three-wave longitudinal study. METHODS Participants were 255 CHD patients with a mean age of 63 years. Psychological distress, medication adherence, and specific treatment adherence were assessed at baseline, 3 months, and 9 months. Hierarchical regression analyses were conducted to examine the influences of psychological distress on medical adherence over 9 months. All models were adjusted for baseline medication or specific adherence, demographic, and medical covariates. RESULTS Baseline depression and its changes over time significantly predicted greater decline in both medication adherence (βs = .15-.20, ps < .05) and specific adherence (βs = -.21 to -.15, ps < .05). Anxiety showed a similar trend. For perceived stress, baseline and its change significantly predicted specific adherence over 9 months (βs = -.30 to -.23, ps < .01), but did not predict medication adherence at 3 and 9 months. CONCLUSIONS Findings underline the necessity of tracking various forms of psychological distress over time for CHD patients to promote medical adherence and further improve the disease prognosis.
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Affiliation(s)
- Yunge Fan
- Psychology Program, Nanyang Technological University, Singapore City, Singapore
| | - Biing-Jiun Shen
- Psychology Program, Nanyang Technological University, Singapore City, Singapore
| | - Hung Yong Tay
- Heart Wellness Center, Singapore Heart Foundation, Singapore City, Singapore
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14
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Ling P, Shan W, Zhai G, Qiu C, Liu Y, Xu Y, Yang X. Association between glutathione peroxidase-3 activity and carotid atherosclerosis in patients with type 2 diabetes mellitus. Brain Behav 2020; 10:e01773. [PMID: 32862561 PMCID: PMC7559603 DOI: 10.1002/brb3.1773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Deficiency of glutathione peroxidase 3 (GPx3) has been recognized as an independent risk factor for cardiovascular events. However, little is known regarding the role of GPx3 in carotid atherosclerosis, which is ubiquitously observed in type 2 diabetes mellitus (T2DM). This study aimed to investigate the relationship between GPx3 activity and carotid atherosclerosis among patients with T2DM. METHODS From January 2018 to December 2018, 245 consecutive patients with T2DM were enrolled in this observational study. Assessment of serum GPx3 activity was performed after admission. We also used carotid ultrasound to measure the mean carotid intima-media thickness (CIMT) and to assess the presence of carotid plaque. RESULTS Of the 245 patients, the median serum GPx3 activity was 22.5 U/ml (interquartile range, 12.4-35.9 U/ml). Carotid plaque was observed in 113 (46.1%) patients, and mean CIMT was 0.8 ± 0.1 mm. Univariate analysis showed that age, smoking, previous coronary heart disease, carotid plaque, and level of mean CIMT and hypersensitive C-reactive protein were significantly associated with decreasing tertile of GPx3. Furthermore, after adjusting for all potential confounders by multivariable logistic regression analysis, PGx3 activity was significantly and independently associated with the mean CIMT (β = -.406, p = .002) and carotid plaque (first tertile of GPx3, odds ratio, 1.870, 95% confidence intervals, 1.124-3.669, p = .024). CONCLUSIONS This study demonstrated that serum GPx3 activity was inversely associated with mean CIMT and carotid plaque, suggesting that lower GPx3 activity may be an independent predictor for carotid atherosclerosis in T2DM.
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Affiliation(s)
- Ping Ling
- Department of Neurology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Wanying Shan
- Department of Neurology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Guojie Zhai
- Department of Neurology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Chunfang Qiu
- Department of Neurology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Yuan Liu
- Department of Neurology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Yuan Xu
- Department of Neurology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Xiuyan Yang
- Department of Neurology, Suzhou Ninth People's Hospital, Suzhou, China
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15
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Dağistan Akgöz A, Gözüm S. Effectiveness of a nurse-led physical activity intervention to decrease cardiovascular disease risk in middle-aged adults: A pilot randomized controlled study. JOURNAL OF VASCULAR NURSING 2020; 38:140-148. [PMID: 32950115 DOI: 10.1016/j.jvn.2020.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the effectiveness of the nurse-led physical activity (PA) intervention on cardiovascular disease (CVD) risk reduction in individuals with moderate risk. A randomized controlled pilot trial was conducted with 12 individuals who have moderate cardiovascular risk meeting the inclusion criteria. Eleven individuals in the intervention group participated in a 12-week PA program (outdoor group walking with the group 5 days in a week, each lasting for 40 minutes) guided by a nurse. For determining the risk level of CVD, the "HeartScore program" was used. Height, weight, blood pressure, and cholesterol values of individuals in the intervention group were measured. At the end of nurse-led outdoor walking activity with the group for 12 weeks, systolic blood pressure (P = .041) and cholesterol (P = .001) values of individuals in the intervention group decreased based on the baseline levels and accordingly CVD risk levels decreased significantly (P = .019). There was no significant difference in the control group. This study demonstrates that health care professionals working in the family health centers can easily determine the CVD risk with the HeartScore. Outdoor group walking program guided by a nurse is effective in decreasing the CVD risk level.
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Affiliation(s)
| | - Sebahat Gözüm
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
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16
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Bohn L, Sa-Couto P, Ramoa Castro A, Ribeiro F, Oliveira J. Effects of a short health education intervention on physical activity, arterial stiffness and cardiac autonomic function in individuals with moderate-to-high cardiovascular risk. PATIENT EDUCATION AND COUNSELING 2020; 103:1856-1863. [PMID: 32173214 DOI: 10.1016/j.pec.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study evaluated the effects of a short health education and counseling intervention program, in a primary healthcare setting, on daily physical activity (PA), arterial stiffness, and cardiac autonomic function in individuals with moderate-to-high risk of cardiovascular disease. METHODS This was a parallel-group study with a 4-month-long intervention, plus 8 months of follow-up. 164 individuals with moderate-to-high cardiovascular risk were allocated to either an intervention (n = 87) or a control group (n = 77). The intervention consisted of 3 walking and face-to-face group sessions plus text messages. Primary outcome was daily PA (sedentary time, light and moderate-to-vigorous PA, all in min/day); secondary outcomes were arterial stiffness i.e., carotid-femoral pulse wave velocity (cfPWV, m/s)] and cardiac autonomic function [(i.e., standard deviation of all N-N intervals (SDNN, ms) and absolute high frequency (HF, ms2)]. RESULTS There were not significant group*time interactions for sedentary time [-7.4 (7.6); p = 0.331)], light PA [4.4 (6.4); p = 0.491] or moderate-to-vigorous PA [0.1 (2.6); p = 0.938]. Considering secondary outcomes, there were not significant group*time interactions for cfPWV [0.09 (0.18); p = 0.592], Ln_SDNN [0.09 (0.06); p = 0.148], or Ln_HF [0.16 (0.14); p = 0.263]. CONCLUSION The program did not improve daily PA, arterial stiffness, or the autonomic cardiac function. PRACTICE IMPLICATIONS Primary care staff should consider longer or other types of intervention to improve daily PA.
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Affiliation(s)
- Lucimére Bohn
- Research Centre in Physical Activity, Health and Leisure. Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200.450, Porto, Portugal.
| | - Pedro Sa-Couto
- Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, Aveiro, Portugal.
| | | | - Fernando Ribeiro
- School of Health Sciences and Institute of Biomedicine-iBiMED, University of Aveiro, Aveiro, Portugal.
| | - José Oliveira
- Faculty of Sport, University of Porto, Research Centre in Physical Activity, Health and Leisure, Porto, Portugal.
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17
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Prevalencia de prescripción del ácido acetilsalicílico a dosis bajas en prevención primaria en población española, evolución temporal y factores asociados. Med Clin (Barc) 2020; 155:104-111. [DOI: 10.1016/j.medcli.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/11/2019] [Accepted: 10/24/2019] [Indexed: 11/21/2022]
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18
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Coronary heart disease diagnosis by artificial neural networks including aortic pulse wave velocity index and clinical parameters. J Hypertens 2020; 37:1682-1688. [PMID: 30870247 DOI: 10.1097/hjh.0000000000002075] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cardiovascular disease, such as coronary heart disease (CHD), are the main cause of mortality and morbidity worldwide. CHD is not entirely predicted by classic risk factors; however, they are preventable. Facing this major problem, the development of novel methods for CHD risk prediction is of practical interest. The purpose of our study was to construct an artificial neural networks (ANNs)-based diagnostic model for CHD risk using a complex of clinical and haemodynamics factors of this disease and aortic pulse wave velocity (PWV) index. METHODS A total of 437 patients were included from 2012 to 2017: 99 CHD and 338 non-CHD patients. Theoretical PWV was calculated, on 93 patients free of hypertension, diabetes and CHD, according to age, blood pressure, sex and heart rate. The results were expressed as an index [(measured PWV - theoretical PWV)/theoretical PWV] for each patient. The original database for ANNs included clinical, haemodynamic and laboratory characteristics. Multilayered perceptron ANNs architecture were applied. The performance of prediction was evaluated by accuracy values based on standard definitions. RESULTS By changing the types of ANNs and the number of input factors applied, we created models that demonstrated 0.63-0.93 accuracy. The best accuracy was obtained with ANNs topology of multilayer perceptron with three hidden layers for models, parameters included by both biological factors, carotid plaque and PWV index. CONCLUSION ANNs models including a PWV index could be used as promising approaches for predicting CHD risk without the need for invasive diagnostic methods and may help in the clinical decision.
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19
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(The prevalence of major cardiovascular risk factors in the Czech population in 2015-2018. The Czech post-MONICA study). COR ET VASA 2020. [DOI: 10.33678/cor.2020.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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20
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Zhou P, Liu J, Wang L, Feng W, Cao Z, Wang P, Liu G, Sun C, Shen Y, Wang L, Xu J, Meng P, Li Z, Xu WY, Lan X. Association of Small Dense Low-Density Lipoprotein Cholesterol with Stroke Risk, Severity and Prognosis. J Atheroscler Thromb 2020; 27:1310-1324. [PMID: 32062644 PMCID: PMC7840160 DOI: 10.5551/jat.53132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: To investigate the association of small dense low-density lipoprotein cholesterol (sdLDL-C) and acute ischemic stroke (AIS) in terms of risk, severity, and outcomes. Prediction models were established to screen high-risk patients and predict prognosis of AIS patients. Methods: We enrolled in this study 355 AIS patients and 171 non-AIS controls. AIS was subtyped according to TOAST criteria, and the severity and outcomes of AIS were measured. Blood glucose and lipid profiles including total cholesterol, triglyceride, and lipoproteins were measured in all patients using automatic measure. Lipoprotein subfractions were detected by the Lipoprint LDL system. Results: As compared with the non-AIS control group, the AIS group had higher sdLDL-C levels. Pearson correlation analysis revealed that the sdLDL-C level and risk of AIS, especially non-cardioembolic stroke, were positively correlated. The area under the curve of sdLDL-C for AIS risk was 0.665, better than that of other lipids. Additionally, the sdLDL-C level was significantly correlated with AIS severity and bad outcomes. A logistic regression model for assessing the probability of AIS occurrence and a prognostic prediction model were established based on sdLDL-C and other variables. Conclusions: Elevated levels of sdLDL-C were associated with a higher prevalence of AIS, especially in non-cardioembolic stroke subtypes. After adjustment for other risk factors, sdLDL-C was found to be an independent risk factor for AIS. Also, sdLDL-C level was strongly associated with AIS severity and poor functional outcomes. Logistic regression models for AIS risk and prognosis prediction were established to help clinicians provide better prevention for high-risk subjects and monitor their prognosis.
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Affiliation(s)
- Peiyang Zhou
- Xiangyang No.1 People's Hospital, Hubei University of Medicine
| | - Jincheng Liu
- Xiangyang No.1 People's Hospital, Hubei University of Medicine
| | - Lingyun Wang
- Xiangyang No.1 People's Hospital, Hubei University of Medicine
| | - Wenmin Feng
- Xiangyang No.1 People's Hospital, Hubei University of Medicine
| | - Zhihua Cao
- Xiangyang No.1 People's Hospital, Hubei University of Medicine
| | - Pu Wang
- Xiangyang No.1 People's Hospital, Hubei University of Medicine
| | - Guangzhi Liu
- Xiangyang No.1 People's Hospital, Hubei University of Medicine
| | - Chenglin Sun
- Xiangyang No.1 People's Hospital, Hubei University of Medicine
| | - Yan Shen
- Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine
| | - Lijun Wang
- Biotecan Medical Diagnostics Co., Ltd, Zhangjiang Center for Translational Medicine.,Shanghai Zhangjiang Institute of Medical Innovation
| | - Jiahuan Xu
- Biotecan Medical Diagnostics Co., Ltd, Zhangjiang Center for Translational Medicine.,Shanghai Zhangjiang Institute of Medical Innovation
| | - Peng Meng
- Biotecan Medical Diagnostics Co., Ltd, Zhangjiang Center for Translational Medicine.,Shanghai Zhangjiang Institute of Medical Innovation
| | - Ziwei Li
- Biotecan Medical Diagnostics Co., Ltd, Zhangjiang Center for Translational Medicine.,Shanghai Zhangjiang Institute of Medical Innovation
| | - Wang-Yang Xu
- Biotecan Medical Diagnostics Co., Ltd, Zhangjiang Center for Translational Medicine.,Shanghai Zhangjiang Institute of Medical Innovation
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Paraskevas KI, Sillesen HH, Rundek T, Mathiesen EB, Spence JD. Carotid Intima-Media Thickness Versus Carotid Plaque Burden for Predicting Cardiovascular Risk. Angiology 2020; 71:108-111. [PMID: 31569951 DOI: 10.1177/0003319719878582] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of General and Vascular Surgery, Central Clinic of Athens, Athens, Greece
| | - Henrik H Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tatjana Rundek
- Department of Neurology, the Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL, USA
| | - Ellisiv B Mathiesen
- Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurology, University of North Norway, Tromsø, Norway
| | - J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
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22
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Frank U, Nikol S, Belch J, Boc V, Brodmann M, Carpentier PH, Chraim A, Canning C, Dimakakos E, Gottsäter A, Heiss C, Mazzolai L, Madaric J, Olinic DM, Pécsvárady Z, Poredoš P, Quéré I, Roztocil K, Stanek A, Vasic D, Visonà A, Wautrecht JC, Bulvas M, Colgan MP, Dorigo W, Houston G, Kahan T, Lawall H, Lindstedt I, Mahe G, Martini R, Pernod G, Przywara S, Righini M, Schlager O, Terlecki P. ESVM Guideline on peripheral arterial disease. VASA 2019; 48:1-79. [DOI: 10.1024/0301-1526/a000834] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Barolia R, Petrucka P, Higginbottom GA, Khan FFS, Clark AM. Motivators and Deterrents to Diet Change in Low Socio-Economic Pakistani Patients With Cardiovascular Disease. Glob Qual Nurs Res 2019; 6:2333393619883605. [PMID: 31819894 PMCID: PMC6882033 DOI: 10.1177/2333393619883605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 01/01/2023] Open
Abstract
This study explores factors that affect the people of low socioeconomic status regarding food choices after diagnosis with cardiovascular disease. Qualitative approach was used to identify the important factors associated with dietary changes as a result of their disease. Twenty-four participants were interviewed from two cardiac facilities in Karachi, the largest metropolitan city of Pakistan. Data were analyzed to identify the themes using the interpretative description approach. While most participants understood the need for dietary changes, few were able to follow recommended diets. Their food choices were primarily influenced by financial constraints as well as cultural, familial, and religious values and practices. The challenge for health care providers lies in understanding the economical, sociocultural, and religious factors that influence behavioral changes which, in turn, affect dietary choices. It is apparent that cardiovascular risk and disease outcomes for the people of low socioeconomic status are likely to escalate. Thus, it is necessary to address the sociocultural, religious, and behavioral factors affecting dietary choices. Achieving this imperative requires an intersectorial, multilevel intervention for the prevention of cardiovascular diseases in people of low socioeconomic status.
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Kähkönen O, Kyngäs H, Saaranen T, Kankkunen P, Miettinen H, Oikarinen A. Support from next of kin and nurses are significant predictors of long-term adherence to treatment in post-PCI patients. Eur J Cardiovasc Nurs 2019; 19:339-350. [PMID: 31744316 DOI: 10.1177/1474515119887851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adherence to treatment is a crucial factor in preventing the progression of coronary heart disease. More evidence of the predictors of long-term adherence is needed. AIMS The purpose of this study was to identify the predictive factors of adherence to treatment six years after percutaneous coronary intervention. METHODS Baseline data (n=416) was collected in 2013 and follow-up data in 2019 (n=169) at two university hospitals and three central hospitals in Finland. The self-reported Adherence of Patients with Chronic Disease Instrument was used. Data were analysed using descriptive statistics and binary logistic regression analysis. RESULTS The respondents reported higher adherence to a healthy lifestyle six years after percutaneous coronary intervention in comparison to four months post-percutaneous coronary intervention; adherence was seen in their healthy behaviour, such as decreased smoking and reduced alcohol consumption. Participating in regular follow-up control predicted adherence. Support from next of kin predicted physical activity and normal cholesterol levels; this outcome was associated with close relationships, which also predicted willingness to be responsible for treatment adherence. Women perceived lower support from nurses and physicians, and they had more fear of complications. Fear was more common among respondents with a longer duration of coronary heart disease. Physical activity and male gender were associated with perceived results of care. CONCLUSION Support from next of kin, nurses and physicians, results of care, responsibility, fear of complication and continuum of care predicted adherence to treatment in long term. These issues should be emphasised among women, patients without a close relationship, physically inactive and those with a longer duration of coronary heart disease.
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Affiliation(s)
- Outi Kähkönen
- Research Unit of Nursing Science and Health Management, University of Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Finland
| | - Terhi Saaranen
- Department of Nursing Science, University of Eastern Finland, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, University of Eastern Finland, Finland
| | | | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Finland
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Pokhrel S, Shrestha S, Timilsina A, Sapkota M, Bhatt MP, Pardhe BD. Self-Care Adherence And Barriers To Good Glycaemic Control In Nepalese Type 2 Diabetes Mellitus Patients: A Hospital-Based Cross-Sectional Study. J Multidiscip Healthc 2019; 12:817-826. [PMID: 31632050 PMCID: PMC6791337 DOI: 10.2147/jmdh.s216842] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/13/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose The patient believes in adherence to medication rather than to self-care adherence and lifestyle changes for the management of diabetes. This study was carried out to establish the association of self-care adherence and their barriers in poor glycemic control in our diabetic population. Patients and methods This cross-sectional study was conducted among 480 already diagnosed diabetes outpatients attended in our two hospitals. Glycaemic control was defined by levels of HbA1c. Socio-demographic data, lifestyle variables and anthropometric measurements were recorded using a standard questionnaire. Fasting blood glucose, HbA1c and lipid profiles were estimated using the manufacturer’s guideline. Student’s t-test and one-way ANOVA were used for comparison between different groups and the correlation was established by Spearman correlation. Risk factors associated with poor glycaemic control were verified by logistic regression analysis. Results The mean HbA1c of the study population was 7.4±1.3% and 65.4% had poor glycaemic control with mean 8.0±1.1%. Higher HbA1c levels were significantly associated with duration of diabetes, a number of drugs used, patient–physician relationship and knowledge about diabetes. The poor glycaemic control was significantly associated with low adherence of following the meal plan, regular medication and regular exercising (p<0.001). Among all the barriers, a too busy schedule for following the meal plan, taking medications and exercising regularly was significantly correlated with HbA1c levels. Multivariable logistic regression analysis showed irregular meal plan (OR=5.27), irregular exercise (OR=2.25), number of medication used (OR= 0.19) and lesser extent patient–physician relationship (OR=2.68) were independent risk factors for poor glycaemic control. Conclusion The poor glycaemic control was associated with poor adherence to self-care adherence and their barriers in our diabetic population. Integrated knowledge on diabetes management should be targeted to improve glycaemic control in our communities.
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Affiliation(s)
- Sushant Pokhrel
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Sneha Shrestha
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Alaska Timilsina
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Manisha Sapkota
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Mahendra Prasad Bhatt
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Bashu Dev Pardhe
- Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
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26
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Affiliation(s)
- Paula Byrne
- JE Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - John Cullinan
- JE Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - Susan M Smith
- Royal College of Surgeons in Ireland-General Practice, Dublin, Ireland
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Affiliation(s)
| | | | - Jill Belch
- UK for the European Society of Vascular Medicine
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28
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Khasteganan N, Lycett D, Furze G, Turner AP. Health, not weight loss, focused programmes versus conventional weight loss programmes for cardiovascular risk factors: a systematic review and meta-analysis. Syst Rev 2019; 8:200. [PMID: 31400767 PMCID: PMC6689181 DOI: 10.1186/s13643-019-1083-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 07/02/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Obesity is a cardiovascular disease risk factor. Conventional weight loss (CWL) programmes focus on weight loss, however 'health, not weight loss, focused' (HNWL) programmes concentrate on improved health and well-being, irrespective of weight loss. What are the differences in CVD risk outcomes between these programmes? AIM To conduct a systematic review and meta-analysis to compare the effects of HNWL with CWL programmes on cardiovascular disease risk factors. METHODS We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, clinical trial registers, commercial websites and reference lists for randomised controlled trials comparing the two programmes (initially searched up to August 2015 and searched updated to 5 April 2019). We used the Mantel-Haneszel fixed-effect model to pool results. Sub-group and sensitivity analyses that accounted for variations in length of follow-up, enhanced programmes and risk of bias dealt with heterogeneity. RESULTS Eight randomised controlled trials of 20,242 potential studies were included. Improvements in total cholesterol-HDL ratio (mean difference - 0.21 mmol/L, 95% confidence interval [- 3.91, 3.50]) and weight loss (- 0.28 kg [- 2.00, 1.44]) favoured HNWL compared to CWL programmes in the long term (53-104 week follow-up), whereas improvements in systolic (- 1.14 mmHg, [- 5.84, 3.56]) and diastolic (- 0.15 mmHg, [- 3.64, 3.34]) blood pressure favoured CWL programmes. These differences did not reach statistical significance. Statistically significant improvements in body satisfaction (- 4.30 [- 8.32, - 0.28]) and restrained eating behaviour (- 4.30 [- 6.77, - 1.83]) favoured HNWL over CWL programmes. CONCLUSIONS We found no long-term significant differences in improved CVD risk factors; however, body satisfaction and restrained eating behaviour improved more with HNWL compared to CWL programmes. Yet firm conclusions cannot be drawn from small studies with high losses to follow-up and data sometimes arising from a single small study. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015019505.
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Affiliation(s)
| | - Deborah Lycett
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
| | - Gill Furze
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Andy P Turner
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Skalenius M, Mattsson CM, Dahlberg P, Bergfeldt L, Ravn-Fischer A. Performance and cardiac evaluation before and after a 3-week training camp for 400-meter sprinters - An observational, non-randomized study. PLoS One 2019; 14:e0217856. [PMID: 31150507 PMCID: PMC6544373 DOI: 10.1371/journal.pone.0217856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/20/2019] [Indexed: 11/18/2022] Open
Abstract
Objective To study the performance and cardiovascular function after a 3-week training camp in athletes competing in an anaerobically dominant sport. Methods Twenty-three competitive 400-m athletes were enrolled in this non-randomized study, 17 took part in a 3-week training camp in South-Africa (intervention), but one declined follow-up assessment, while 6 pursued in-door winter training in Sweden and served as controls. Electrocardiography, transthoracic echocardiography, blood test analyses, maximal exercise tolerance test, and a 300-m sprint test with lactate measurements ([La]peak) were performed before and after the training camp period. Results At baseline, there were no clinically significant pathological findings in any measurements. The training period resulted in improved 300m-sprint performance [n = 16; running time 36.71 (1.39) vs. 35.98 (1.13) s; p<0.01] and higher peak lactate values. Despite 48% more training sessions than performed on home ground (n = 6), myocardial biomarkers decreased significantly (NT-pro BNP -38%; p<0.05, troponin T -16%; p<0.05). Furthermore, resting heart rate (-7%; p<0.01) and left ventricular systolic and diastolic volumes decreased -6% (p<0.01) and -10% (p<0.05), respectively. Conclusions Intense physical activity at training camp improved the performance level, likely due to improved anaerobic capacity indicated by higher [La]peak. There were no clinically significant adverse cardiac changes after this period of predominantly anaerobic training.
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Affiliation(s)
- Michael Skalenius
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- * E-mail:
| | - C. Mikael Mattsson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Silicon Valley Exercise Analytics (SVExA), Menlo Park, CA, United States of America
| | - Pia Dahlberg
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - Annica Ravn-Fischer
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
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30
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Lönnberg L, Ekblom-Bak E, Damberg M. Improved unhealthy lifestyle habits in patients with high cardiovascular risk: results from a structured lifestyle programme in primary care. Ups J Med Sci 2019; 124:94-104. [PMID: 31063003 PMCID: PMC6566702 DOI: 10.1080/03009734.2019.1602088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background. Physical activity, healthful dietary habits, and not smoking are associated with reduced cardiovascular morbidity and mortality. However, few studies have examined how counselling to improve poor lifestyle habits might be carried out in clinical practice. In Swedish primary care, structured lifestyle counselling is still not integrated into everyday clinical practice. The aim of the present study was two-fold: (1) to describe a novel lifestyle intervention programme in primary care; and (2) to evaluate change in unhealthy lifestyle habits over 1 year in men and women with high cardiovascular risk who participated in the lifestyle intervention programme. Method. A single-group study with a 1-year follow-up was carried out. A total of 417 people was enrolled, median age 62 years (54% women), with either hypertension (69%), type 2 diabetes mellitus, or impaired glucose tolerance. The 1-year intervention included five counselling sessions that focused on lifestyle habits, delivered by a district nurse with postgraduate credits in diabetes care and the metabolic syndrome. All patients were offered in-depth counselling for one or more lifestyle habits when needed. Lifestyle habits were assessed by a questionnaire at baseline and 1-year follow-up. Total change was assessed using a nine-factor unhealthy lifestyle habit index. Results. Favourable, significant changes were observed for physical activity, dietary habits, smoking, and stress over 1 year. Similar improvements were seen for both sexes and type of diagnosis. Conclusions. The results support the utility of a multifactorial, structured approach to change unhealthy lifestyle habits for cardiovascular risk prevention in a primary care setting.
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Affiliation(s)
- Lena Lönnberg
- Center for Clinical Research, County of Västmanland, Uppsala University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
- CONTACT Lena Lönnberg Centrum för Klinisk Forskning, Västerås Hospital, 721 89, Västerås, Sweden
| | - Elin Ekblom-Bak
- The Swedish School of Sports and Health Sciences, Stockholm, Sweden
| | - Mattias Damberg
- Center for Clinical Research, County of Västmanland, Uppsala University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
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Quirós-Fernández R, López-Plaza B, Bermejo LM, Palma-Milla S, Gómez-Candela C. Supplementation with Hydroxytyrosol and Punicalagin Improves Early Atherosclerosis Markers Involved in the Asymptomatic Phase of Atherosclerosis in the Adult Population: A Randomized, Placebo-Controlled, Crossover Trial. Nutrients 2019; 11:nu11030640. [PMID: 30884808 PMCID: PMC6470561 DOI: 10.3390/nu11030640] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 01/05/2023] Open
Abstract
Hydroxytyrosol (HT) and Punicalagin (PC) exert cardioprotective and anti-atherosclerotic effects. This study evaluates the effect of oral supplementation with HT and PC (SAx) on early atherosclerosis markers in middle-aged, seemingly healthy adults. A randomized, double-blinded, placebo-controlled, crossover trial was performed for 20 weeks. There were two treatment sequences (Placebo/SAx, n = 41; SAx/Placebo, n = 43) for which the intervention periods (Placebo and SAx) were 8 weeks long, followed by a 4-week wash out period. The supplement was composed of 9.9 mg of HT and 195 mg of PC, and the placebo was composed of maltodextrin. SAx increased endothelial function (Flow-mediated dilatation [FMD]: 2.36%; p < 0.001) in the endothelial dysfunction subgroup compared to the placebo (2.36 ± 3.9 vs. 0.76 ± 3.5%, p < 0.05). SAx also reduced oxLDL by -28.74 ng/mL (p < 0.05) in subjects with higher levels of oxLDL, which was an improvement compared with the placebo (-28.74 ± 40.2 vs. 25.64 ± 93.8 ng/mL, p < 0.001). The prehypertension and hypertension subgroups exhibited decreased systolic (-15.75 ± 9.9 mmHg; p < 0.001) and diastolic (-6.36 ± 8.7 mmHg; p < 0.001) blood pressure after SAx consumption. Moreover, the systolic prehypertension and hypertension subgroups presented significant differences in systolic blood pressure compared to the placebo (-15.75 ± 9.9 vs. -2.67 ± 12.0 mmHg, p < 0.05). In conclusion, the supplement exerted anti-atherosclerotic effects by improving endothelial function, blood pressure, and levels of circulating oxLDL, especially for persons in whom these parameters were altered.
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Affiliation(s)
- Rebeca Quirós-Fernández
- Nutrition Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain.
| | - Bricia López-Plaza
- Nutrition Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain.
| | - Laura M Bermejo
- Nutrition Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain.
| | - Samara Palma-Milla
- Nutrition Department, La Paz University Hospital, Hospital La Paz Institute for Health Research (IdiPAZ), Autonomous University of Madrid, 28046 Madrid, Spain.
| | - Carmen Gómez-Candela
- Nutrition Department, La Paz University Hospital, Hospital La Paz Institute for Health Research (IdiPAZ), Autonomous University of Madrid, 28046 Madrid, Spain.
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Boc V, Božic Mijovski M, Pohar Perme M, Blinc A. Diabetes and smoking are more important for prognosis of patients with peripheral arterial disease than some genetic polymorphisms. VASA 2018; 48:229-235. [PMID: 30526437 DOI: 10.1024/0301-1526/a000766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The role of genetic polymorphisms in peripheral arterial disease (PAD) is incompletely understood. We tested whether selected single nucleotide polymorphisms (SNPs) were associated with PAD and with adverse events in an observational study cohort. Also, the role of diabetes and smoking was studied. Patients and methods: 742 patients with PAD and 713 age- and gender-matched control subjects were subjected to yearly physical and laboratory investigations and were managed for 5 years according to the European guidelines on cardiovascular disease prevention. The occurrence of all-cause death, cardiovascular death, non-fatal myocardial infarction, ischemic stroke or critical limb ischemia (major events) and revascularization procedures (minor events) was recorded. In 655 patients with PAD and 612 control subjects the following SNPs were determined: rs1466408, rs13428968 and rs12803 of NR4A2 gene, rs10499563 of IL6 gene, rs668 and rs12953 of PECAM1 gene, and rs10861032 of Chr12 locus. Results: The distribution of selected SNPs did not differ between patients with PAD and control subjects, and neither between subjects with or without major adverse events. In contrast, diabetes and smoking affected survival and event-free survival. Among patients with PAD, diabetes doubled the hazard ratio (HR) for cardiovascular death and smoking doubled the HR for death or major event. The 5-year survival of diabetics with PAD was 0.80 (CI 0.75-0.85) and of non-diabetics with PAD 0.87 (CI 0.84-0.90), p = 0.045. The 5-year survival of active smokers with PA D was 0.80 (CI 0.75-0.62), of former smokers 0.83 (CI 0.79-0.88), and of never-smokers 0.89 (CI 0.86-0.93), p = 0.024. Conclusions: SNPs of NR4A2, IL6, PECAM1 and Chr12 were not associated with PAD or with major adverse events. However, diabetes and smoking were associated with worse survival and event-free survival in patients with PAD.
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Affiliation(s)
- Vinko Boc
- 1 University Medical Centre Ljubljana, Department of Vascular Diseases, Ljubljana, Slovenia
| | - Mojca Božic Mijovski
- 1 University Medical Centre Ljubljana, Department of Vascular Diseases, Ljubljana, Slovenia
| | - Maja Pohar Perme
- 2 Medical Faculty, University of Ljubljana, Institute of Bomedical Informatics, Ljubljana, Slovenia
| | - Ales Blinc
- 1 University Medical Centre Ljubljana, Department of Vascular Diseases, Ljubljana, Slovenia.,3 Medical Faculty, University of Ljubljana, Division of Internal Medicine, Ljubljana, Slovenia
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Laleman N, Henrard S, van den Akker M, Goderis G, Buntinx F, Van Pottelbergh G, Vaes B. Time trends in statin use and incidence of recurrent cardiovascular events in secondary prevention between 1999 and 2013: a registry-based study. BMC Cardiovasc Disord 2018; 18:209. [PMID: 30400778 PMCID: PMC6220501 DOI: 10.1186/s12872-018-0941-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background The current study evaluated time trends of statin use and incidence of recurrent CVD in secondary prevention from 1999 to 2013 and investigated which factors were associated with statin use in secondary prevention. Methods Intego is a primary care registration network with 111 general practitioners working in 48 practices in Flanders, Belgium. This retrospective registry-based study included patients aged 50 years or older with a history of CVD. The time trends of statin use and incidence of recurrent CVD in secondary prevention were determined by using a joinpoint regression analysis. Multivariable mixed-effect logistic regression analysis was used to assess factors associated with statin use in patients in secondary prevention in 2013. Results The overall prevalence of statin use increased and showed two trends: a sharp increase from 1999 to 2005 (annual percentage change (APC) 25.4%) and a weaker increase from 2005 to 2013 (APC 3.7%). The average increase in statin use was the highest in patients aged 80 and older. Patients aged 70–79 years received the most statins. Men used more statins than women did, but both genders showed similar time trends. The incidence of CVD decreased by an average APC of 3.9%. There were no differences between men and women and between different age groups. A significant decrease was only observed in older patients without statins prescribed. In 2013, 61% of the patients in secondary prevention did not receive a statin. The absence of other secondary preventive medication was strongly associated with less statin use. Gender, age and comorbidity were associated with statin use to a lesser degree. Conclusions The prevalence of statin use in secondary prevention increased strongly from 1999 to 2013. Less than 50% of patients with a history of CVD received a statin in 2013. Especially patients who did not receive other secondary preventive medication were more likely to not receive a statin. Despite the strong increase in statin use, there was only a small decrease in the incidence of recurrent CVD, and this occurred mainly in older patients without statins prescribed.
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Affiliation(s)
- Nele Laleman
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium
| | - Séverine Henrard
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium.,Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Marjan van den Akker
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium.,Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Geert Goderis
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium
| | - Frank Buntinx
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium.,Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Universiteit Leuven (KU Leuven), Kapucijnenvoer 33, Blok J, 3000, Leuven, Belgium. .,Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium.
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Abstract
Despite significant risk reduction with statin therapy, there remains a residual cardiovascular risk. It has been seen that aggressive statin therapy in high risk patients may not lower the low-density lipoprotein cholesterol to goal in up to 40% of patients. Niacin is a potent high-density lipoprotein cholesterol-raising drug, and has been proposed as an attractive approach to reduce cardiac events in patients with or at risk of atherosclerotic cardiovascular disease. However, previous evidence for niacin has been challenged by negative outcomes in two large, randomized, controlled trials comparing niacin to placebo with background statin therapy. In this review, summarize the currently available evidence for the role of niacin treatment for reducing the risk of cardiovascular events in current practice.
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Affiliation(s)
- Abhishek Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA - .,Institute of Cardiovascular Research and Technology, Brooklyn, NY, USA -
| | - Nidhi Madan
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
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Gavurova B, Vagasova T. Potential gains in life expectancy by eliminating deaths from cardiovascular diseases and diabetes mellitus in the working life ages among Slovak population. HEALTH ECONOMICS REVIEW 2018; 8:16. [PMID: 30136004 PMCID: PMC6104529 DOI: 10.1186/s13561-018-0202-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In recent years, high mortality from cardiovascular diseases (chronic ischemic heart disease, acute coronary syndrome, cerebrovascular diseases, atherosclerosis, hypertensive diseases) and diabetes mellitus have burdened economic and health system of the Slovak Republic considerably. By eliminating these deaths, the life expectancy could be prolonged. Since the mortality of population during working period has higher importance in terms of economic consequences of diseases, this article aims to assess the potential gains in life expectancy (PGLEs) of the Slovak population comparing the entire life span and working life-time. METHODS Data are obtained from the National Health Information Center mortality reports by sex during 1996-2014, and the method of constructing abridged life tables is used to compute the corresponding PGLEs. The added years, which would be gained by eliminating causes of deaths, are decomposed by the two sets of working age groups population (25-44 and 45-64 years). RESULTS The highest impact on life expectancy was recorded in chronic ischemic heart disease for both sexes aged 45-64 years (0.078 for males, 0.019 added years for females) over 1996-2014. However, they showed a small declining trend (- 16%) for males and even an increasing trend (2%) for females. At present, the labour force potential of working group (25-44 years) is most threatened by deaths from cerebrovascular diseases, while population of working age (45-64 years) by deaths from chronic ischemic heart disease. Relative importance of acute coronary syndrome for males (45-64 years) increased, when comparing the entire with working time life. CONCLUSIONS The findings pose new and immediate challenges to policy makers and provoke discussion about prevention program strategies leading to increasing the life expectancy.
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Affiliation(s)
- Beata Gavurova
- Faculty of Economics, Technical University of Kosice, Nemcovej 32, 040 01 Kosice, Slovakia
| | - Tatiana Vagasova
- Faculty of Economics, Technical University of Kosice, Nemcovej 32, 040 01 Kosice, Slovakia
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Brea A, Millán J, Ascaso JF, Blasco M, Díaz A, Hernández-Mijares A, Mantilla T, Pedro-Botet JC, Pintó X. Fibrates in primary prevention of cardiovascular disease. Comments on the results of a systematic review of the Cochrane Collaboration. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2018; 30:188-192. [PMID: 29789212 DOI: 10.1016/j.arteri.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/06/2018] [Accepted: 04/11/2018] [Indexed: 06/08/2023]
Abstract
Fibrates are drugs that reduce triglycerides, elevate high-density lipoproteins, as well as decrease small, dense LDL particles. The results of a study have recently been published by the Cochrane Collaboration on fibrates efficacy and safety in the primary prevention of cardiovascular disease. This study includes a systematic review and a meta-analysis of 6 studies (16,135 patients) that evaluated the clinical benefits of fibrates compared to placebo use or other lipid-lowering drugs. This review showed evidence of a protective effect of the fibrates compared with placebo as regards a reduction 16% of a compound objective of death due to cardiovascular disease, non-fatal myocardial infarction, or non-fatal cerebrovascular accident (NNT: 112), and that reduce coronary morbidity and mortality by 21% (NNT: 125). In addition, fibrates could reduce previously established diabetic retinopathy. However, fibrates do not influence total mortality, or non-cardiovascular mortality. Its joint use with statins does not benefit patients without established cardiovascular disease, compared to the use of statins in monotherapy. Fibrates are safe, although they can elevate serum creatinine levels.
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Affiliation(s)
- Angel Brea
- Grupo de Trabajo sobre la Dislipemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, La Rioja, España.
| | - Jesús Millán
- Grupo de Trabajo sobre la Dislipemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos, Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, España
| | - Juan F Ascaso
- Grupo de Trabajo sobre la Dislipemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Servicio de Endocrinología, Hospital Clínico, Valencia, España
| | - Mariano Blasco
- Grupo de Trabajo sobre la Dislipemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Área Sanitaria de Delicias, Atención Primaria, Zaragoza, España
| | - Angel Díaz
- Grupo de Trabajo sobre la Dislipemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Centro de Salud de Bembibre, Bembibre, León, España
| | - Antonio Hernández-Mijares
- Grupo de Trabajo sobre la Dislipemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Servicio de Endocrinología, Hospital Universitario Dr. Peset, Universitat de Valencia, Valencia, España
| | - Teresa Mantilla
- Grupo de Trabajo sobre la Dislipemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Centro de Salud de Prosperidad, Atención Primaria, Madrid, España
| | - Juan C Pedro-Botet
- Grupo de Trabajo sobre la Dislipemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Grupo de Trabajo sobre la Dislipemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Centre d'Investigació Biomèdica en Xarxa-Fisiopatologia de l'Obesitat i la Nutrició (CIBEROBN), L'Hospitalet de Llobregat, Barcelona, España
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Selak V, Webster R, Stepien S, Bullen C, Patel A, Thom S, Arroll B, Bots ML, Brown A, Crengle S, Dorairaj P, Elley CR, Grobbee DE, Harwood M, Hillis GS, Laba TL, Neal B, Peiris D, Rafter N, Reid C, Stanton A, Tonkin A, Usherwood T, Wadham A, Rodgers A. Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials. Heart 2018; 105:42-48. [DOI: 10.1136/heartjnl-2018-313108] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/17/2018] [Accepted: 05/24/2018] [Indexed: 01/11/2023] Open
Abstract
ObjectiveThe aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy.MethodsWe conducted an individual participant data meta-analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75% male, mean age 62 years and 76% with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy.ResultsThose randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62% vs 58%, risk ratio (RR) 1.08, 95% CI 1.02 to 1.15), LDL (39% vs 34%, RR 1.13, 95% CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24% vs 19%, RR 1.27, 95% CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96% vs 96%, RR 1.00, 95% CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0–1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95% CI 0.94 to 1.30, 22% vs 20%), 1.62 (95% CI 1.09 to 2.42, 27% vs 17%) and 3.07 (95% CI 1.77 to 5.33, 35% vs 11%), respectively.ConclusionsPolypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therapy compared with usual care, particularly among those undertreated at baseline.
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Inherited primary arrhythmia disorders: cardiac channelopathies and sports activity. Herz 2018; 45:142-157. [PMID: 29744527 DOI: 10.1007/s00059-018-4706-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/25/2018] [Accepted: 04/14/2018] [Indexed: 01/02/2023]
Abstract
Sudden cardiac death (SCD) in an apparently healthy individual is a tragedy. It is important to identify the cause of death and to prevent SCD in potentially at-risk family members. Inherited primary arrhythmia disorders are associated with exercise-related SCD. Despite the well-known benefits of exercise, exercise restriction has been a historical mainstay of therapy for these conditions. However, since familiarity with inherited arrhythmia conditions has increased and patients are often children and young adults, it is necessary to reassess the treatment guidelines regarding exercise constraints. The aim of this review is to analyze the risk of exercise-induced SCD in patients with inherited cardiac conditions and explore the challenges faced when advising patients about exercise limitations. We searched for publications on cardiac channelopathies in PubMed with the following medical subject headings (MeSH): "long QT syndrome"; "short QT syndrome"; "Brugada syndrome"; and "catecholaminergic polymorphic ventricular tachycardia". The abstracts of these articles were scanned, and articles of relevance, along with pertinent references, were read in full. The analysis was restricted to reports published in English. The findings of this analysis suggest that exercise with low-to-moderate cardiovascular demand may be possible under regular clinical follow-up in inherited primary arrhythmia disorders. Recent data show that patients with inherited primary arrhythmia disorders are at low risk for events once a comprehensive treatment program has been established. Recreational activity is likely safe for these individuals, with personalized management based on individual patient preferences and priorities.
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Duff O, Walsh D, Malone S, McDermott L, Furlong B, O'Connor N, Moran K, Woods C. MedFit App, a Behavior-Changing, Theoretically Informed Mobile App for Patient Self-Management of Cardiovascular Disease: User-Centered Development. JMIR Form Res 2018; 2:e8. [PMID: 30684426 PMCID: PMC6334713 DOI: 10.2196/formative.9550] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/21/2018] [Accepted: 03/19/2018] [Indexed: 01/22/2023] Open
Abstract
Background The MedFit app is designed to facilitate participation of people with cardiovascular disease (CVD) in an exercise-based rehabilitation program remotely. This paper details the development for the MedFit app. Objective The aim of this research was to develop a behavior change, theoretically informed exercise rehabilitation mobile app for adults with CVD by following the early stages of the formative research: development and feasibility testing. Methods Adhering to the mobile health (mHealth) development evaluation framework, the stages of the formative research process including (1) development and (2) feasibility were undertaken. The content and format of the MedFit app were developed based on (1) theory, (2) usability testing, and (3) content design. Results A systematic review of the literature was undertaken to identify the most appropriate theories from which to develop the app. This led to the creation of the MedFit app. The app went through iterative rounds of usability focus group testing with adults with CVD to provide feedback on the app. This process was framed by the unified theory of acceptance and use of technology model. Feedback was then translated into feasible technical improvements to be executed through close collaboration with the technical team, who adapted and made modifications to the app based on this codesign process. Conclusions The formative research process of the app development involved theoretical underpinning, usability testing, and content design. mHealth interventions may play a key role in the future of health care, potentially addressing the barriers to participation in cardiac rehabilitation. This work will provide guidance for future research aiming to develop mobile apps by incorporating a best practice framework for mHealth intervention development and a user-centered design approach.
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Affiliation(s)
- Orlaith Duff
- Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | | | - Shauna Malone
- Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Lauri McDermott
- Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Brona Furlong
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Noel O'Connor
- Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Kieran Moran
- Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland.,School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Catherine Woods
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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Schnoeller TJ, Jentzmik F, Schrader AJ, Steinestel J. Influence of serum cholesterol level and statin treatment on prostate cancer aggressiveness. Oncotarget 2018; 8:47110-47120. [PMID: 28445145 PMCID: PMC5564548 DOI: 10.18632/oncotarget.16943] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/14/2017] [Indexed: 01/19/2023] Open
Abstract
Both cholesterol levels and the use of statins have been described to influence the development and prognosis of prostate cancer (PC). In this retrospective, cross-sectional analysis of consecutive cases from a tertiary referral center we evaluated an association between hypercholesterolemia (≥5.0mmol/l), the use of statins, and advanced/aggressive PC in 767 men with histologically confirmed, clinically localized PC awaiting radical prostatectomy. We found that patients with HCE (n=287, 37.4%) had a significantly higher incidence of poorly differentiated PC (Gleason score ≥7b, 81.1% vs. 4.9%), advanced local tumor stage (≥pT3, 57.7% vs. 22.2%), and nodal involvement (19.8% vs. 1.6%). Multivariate logistic regression analysis identified hypercholesterolemia as a risk factor for aggressive and/or advanced PC (OR 2.01, p<0.001) whereas statin intake showed an odds ratio of 0.49 (p=0.005) indicating a negative association with high-risk PC. Despite a limited number of patients using statins (~9.5%), adjusted and weighed multivariate logistic regression models revealed that preoperative hypercholesterolemia is associated with a diagnosis of high-risk PC which is negatively influenced by statin intake.
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Affiliation(s)
| | - Florian Jentzmik
- Department of Urology, Ulm University Medical Center, Ulm, Germany.,Department of Urology, St. Elisabeth Hospital, Ravensburg, Germany
| | - Andres J Schrader
- Department of Urology, Muenster University Medical Center, Muenster, Germany
| | - Julie Steinestel
- Department of Urology, Muenster University Medical Center, Muenster, Germany
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Ding R, Ye P, Zhao S, Zhao D, Yan X, Dong Y, Li J, Ran Y, Hu D. Effect of physician characteristics and knowledge on the quality of dyslipidemia management and LDL-C target goal achievement in China: Subgroup analysis of the Dyslipidemia International Study. J Glob Health 2018; 7:020702. [PMID: 29057073 PMCID: PMC5644362 DOI: 10.7189/jogh.07.020702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective This study aimed to investigate the effect of physicians’ characteristics and knowledge of LDL–C target goals on the quality of lipid management in China. Methods A total of 25 317 dyslipidemia patients who had taken lipid–lowering medication for >3 months were enrolled in our study. Patients’ demographic data, medical history, lipid profile, their physician’s specialty and professional title and their hospital level as well as their LDL–C goal opinions were recorded. Results Questionnaires were completed by 926 physicians with 6 different specialties and 4 professional statuses, in 3 different–level hospitals. Most (74.5%) of the physicians recognized the importance of considering LDL–C serum concentration for treating dyslipidemia, and set target LDL–C goals according to the 2007 Chinese guidelines for 83.4% of their patients. The LDL–C goal achievement rate was significantly higher for patients whose physicians’ knowledge of LDL–C target goals was consistent with guideline recommendations, compared with those whose physicians’ knowledge was inconsistent with the guidelines (60.4% vs 31.1%, P < 0.0001). Physicians working in tier 1 (odds ration (OR) = 2.95; 95% CI 2.37–3.67), (OR = 1.56; 95% CI 1.34–1.81) and tier 2 (OR = 2.53; 95% CI 2.22–2.88), (OR = 1.16; 95% CI 1.06–1.27) hospitals, specialized in neurology (OR = 1.13; 95% CI 0.93–1.36), (OR = 1.57; 95% CI 1.40–1.77), internal medicine (OR = 1.07; 95% CI 0.90–1.27), (OR = 1.58; 95% CI 1.39–1.80), endocrinology (OR = 1.02; 95% CI 0.87–1.21), (OR = 1.63; 95% CI 1.47–1.82) and being a resident vs attending physician (OR = 1.05; 95% CI 0.92–1.20), (OR = 1.00; 95% CI 1.00–1.19) were independent risk factors for low knowledge of LDL–C target goals and low LDL–C goal achievement. Conclusion Chinese physicians’ characteristics and knowledge of LDL–C target goals were associated with patients’ LDL–C goal achievement.
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Affiliation(s)
- Rongjing Ding
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Ping Ye
- Department of Gerontology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Shuiping Zhao
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Dong Zhao
- Institute of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jihu Li
- Outcome Research, Merck Sharp & Dohme (China) Holding Ltd., Shanghai, China
| | - Yuqin Ran
- Medical Affairs, Merck Sharp & Dohme (China) Holding Ltd., Shanghai, China
| | - Dayi Hu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
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Ivanovs R, Kivite A, Ziedonis D, Mintale I, Vrublevska J, Rancans E. Association of depression and anxiety with cardiovascular co-morbidity in a primary care population in Latvia: a cross-sectional study. BMC Public Health 2018; 18:328. [PMID: 29510681 PMCID: PMC5840840 DOI: 10.1186/s12889-018-5238-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/28/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cardiovascular (CV) diseases (CVDs) are the leading cause of mortality worldwide. Globally, there is a growing interest in understanding and addressing modifiable psychosocial risk factors, particularly depression and anxiety, to prevent CVDs and to reduce morbidity and mortality. Despite the high premature mortality rate from CVDs in Latvia, this is the first Latvian study to examine the association of depression and anxiety with CVD morbidity in a primary care population. METHODS This cross-sectional study was carried out in 2015 within the framework of the National Research Program BIOMEDICINE at 24 primary care facilities throughout Latvia. Consecutive adult patients during a one-week time period at each facility were invited to join the study. Assessments onsite included a 9-item Patient Health Questionnaire (PHQ-9) and a 7-item Generalized Anxiety Disorder scale (GAD-7) followed by a socio-demographic questionnaire and measurements of height, weight, waist circumference, blood pressure, and total cholesterol. The diagnostic Mini International Neuropsychiatric Interview (MINI) was conducted over the telephone within 2 weeks after the visit to the general practitioner. A multivariate model was developed using binary logistic regression. RESULTS From the 1565 subjects (31.2% male), CVD was detected in 17.1%. Depression screening was positive (PHQ-9 ≥ 10) for 14.7%, and anxiety screening was positive (GAD-7 ≥ 10) for 10.1% of the study subjects. According to the MINI, 10.3% had current and 28.1% had lifetime depressive episode, and 16.1% had an anxiety disorder. Depression, not anxiety, was statistically significantly related to CVDs with an odds ratio (OR) of 1.52 (p = 0.04) for current depressive symptoms (PHQ-9 ≥ 10) and 2.08 (p = 0.002) for lifetime depressive episode (MINI). CONCLUSIONS Current depressive symptoms (PHQ-9 ≥ 10) and a lifetime depressive episode (according to the MINI) were significantly associated with increased risk of CV morbidity. Therefore, CV patients should be screened and treated for depression to potentially improve the prognosis of CVDs. Enhanced training and integration of mental health treatment in Latvian primary care settings may improve clinical outcomes.
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Affiliation(s)
- R Ivanovs
- Department of Psychiatry and Narcology, Riga Stradins University, 2 Tvaika Str, Riga, LV-1005, Latvia.
| | - A Kivite
- Department of Public Health and Epidemiology, Riga Stradins University, 9 Kronvalda Ave, Riga, LV-1010, Latvia
| | - D Ziedonis
- Associate Vice Chancellor for Health Sciences, University of California San Diego, Biomedical Sciences Building, Room 1310, 9500 Gilman Drive #0602, La Jolla, CA, 92093, USA
| | - I Mintale
- Department of Cardiology, University Clinic of Paul Stradins, 13 Pilsonu Str, Riga, LV-1002, Latvia
| | - J Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, 2 Tvaika Str, Riga, LV-1005, Latvia
| | - E Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, 2 Tvaika Str, Riga, LV-1005, Latvia
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Galema-Boers AM, Lenzen MJ, Engelkes SR, Sijbrands EJ, Roeters van Lennep JE. Cardiovascular risk in patients with familial hypercholesterolemia using optimal lipid-lowering therapy. J Clin Lipidol 2018; 12:409-416. [DOI: 10.1016/j.jacl.2017.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 12/30/2022]
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Patti AM, Al-Rasadi K, Giglio RV, Nikolic D, Mannina C, Castellino G, Chianetta R, Banach M, Cicero AF, Lippi G, Montalto G, Rizzo M, Toth PP. Natural approaches in metabolic syndrome management. Arch Med Sci 2018; 14:422-441. [PMID: 29593818 PMCID: PMC5868676 DOI: 10.5114/aoms.2017.68717] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/26/2017] [Indexed: 12/25/2022] Open
Abstract
Metabolic syndrome (MetS) is characterized as a group of cardiometabolic risk factors that raise the risk for heart disease and other health problems, such as diabetes mellitus and stroke. Treatment strategies include pharmacologic interventions and supplementary (or "alternative") treatments. Nutraceuticals are derived from food sources (isolated nutrients, dietary supplements and herbal products) that are purported to provide health benefits, in addition to providing basic nutritional value. Nutraceuticals are claimed to prevent chronic diseases, improve health, delay the aging process, increase life expectancy, and support the structure and function of the body. The study of the beneficial effects of nutraceuticals in patients with MetS, including product standardization, duration of supplementation and definition of optimal dosing, could help better define appropriate treatment. This review focuses on widely marketed nutraceuticals (namely polyphenols, omega-3 fatty acids, macroelements and vitamins) with clinically demonstrated effects on more than one component of MetS.
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Affiliation(s)
- Angelo Maria Patti
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Khalid Al-Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University, Muscat, Oman
| | - Rosaria Vincenza Giglio
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Carlo Mannina
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Giuseppa Castellino
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Roberta Chianetta
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Arrigo F.G. Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Giuseppe Montalto
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Peter P. Toth
- CGH Medical Center, Sterling, Illinois; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Hopstock LA, Eggen AE, Løchen ML, Mathiesen EB, Njølstad I, Wilsgaard T. Secondary prevention care and effect: Total and low-density lipoprotein cholesterol levels and lipid-lowering drug use in women and men after incident myocardial infarction – The Tromsø Study 1994–2016. Eur J Cardiovasc Nurs 2018; 17:563-570. [DOI: 10.1177/1474515118762541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Secondary prevention guidelines after myocardial infarction (MI) are gender neutral, but underutilisation of treatment in women has been reported. Design: We investigated the change in total and low-density lipoprotein (LDL) cholesterol levels and lipid-lowering drug (LLD) use after first-ever MI in a population-based study. Methods: We followed 10,005 participants (54% women) attending the Tromsø Study 1994–1995 and 8483 participants (55% women) attending the Tromsø Study 2007–2008 for first-ever MI up to their participation in 2007–2008 and 2015–2016, respectively. We used linear and logistic regression models to investigate sex differences in change in lipid levels. Results: A total of 395 (MI cohort I) and 132 participants (MI cohort II) had a first-ever MI during 1994–2008 and 2007–2013, respectively. Mean change in total cholesterol was −2.34 mmol/L (SD 1.15) in MI cohort I, and in LDL cholesterol was −1.63 mmol/L (SD 1.12) in MI cohort II. Men had a larger decrease in lipid levels compared to women: the linear regression coefficient for change was −0.33 (95% confidence interval [CI] −0.51 to −0.14) for total cholesterol and −0.21 (95% CI −0.37 to −0.04) for LDL cholesterol, adjusted for baseline lipid value, age and cohort. Men had 73% higher odds (95% CI 1.15−2.61) of treatment target achievement compared to women, adjusted for baseline lipid value, age and cohort. LLD use was reported in 85% of women and 92% of men in MI cohort I, and 80% in women and 89% in men in MI cohort II. Conclusions: Compared to men, women had significantly less decrease in lipid levels after MI, and a smaller proportion of women achieved the treatment target.
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Affiliation(s)
- Laila A Hopstock
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø Norway
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Prediction of cardiovascular risk factors from retinal fundus photographs via deep learning. Nat Biomed Eng 2018; 2:158-164. [PMID: 31015713 DOI: 10.1038/s41551-018-0195-0] [Citation(s) in RCA: 748] [Impact Index Per Article: 124.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/12/2018] [Indexed: 12/19/2022]
Abstract
Traditionally, medical discoveries are made by observing associations, making hypotheses from them and then designing and running experiments to test the hypotheses. However, with medical images, observing and quantifying associations can often be difficult because of the wide variety of features, patterns, colours, values and shapes that are present in real data. Here, we show that deep learning can extract new knowledge from retinal fundus images. Using deep-learning models trained on data from 284,335 patients and validated on two independent datasets of 12,026 and 999 patients, we predicted cardiovascular risk factors not previously thought to be present or quantifiable in retinal images, such as age (mean absolute error within 3.26 years), gender (area under the receiver operating characteristic curve (AUC) = 0.97), smoking status (AUC = 0.71), systolic blood pressure (mean absolute error within 11.23 mmHg) and major adverse cardiac events (AUC = 0.70). We also show that the trained deep-learning models used anatomical features, such as the optic disc or blood vessels, to generate each prediction.
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Byrne P, Cullinan J, Murphy C, Smith SM. Cross-sectional analysis of the prevalence and predictors of statin utilisation in Ireland with a focus on primary prevention of cardiovascular disease. BMJ Open 2018; 8:e018524. [PMID: 29439070 PMCID: PMC5829660 DOI: 10.1136/bmjopen-2017-018524] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the prevalence of statin utilisation by people aged over 50 years in Ireland and the factors associated with the likelihood of using a statin, focusing particularly on those using statins for primary prevention of cardiovascular disease (CVD). METHODS This is a cross-sectional analysis of cardiovascular risk and sociodemographic factors associated with statin utilisation from wave 1 of The Irish Longitudinal Study on Ageing. A hierarchy of indications for statin utilisation, consisting of eight mutually exclusive levels of CVD-related diagnoses, was created. Participants were assigned one level of indication. The prevalence of statin utilisation was calculated. The likelihood that an individual was using a statin was estimated using a multivariable logistic regression model, controlling for cardiovascular risk and sociodemographic factors. RESULTS In this nationally representative sample (n=5618) of community-dwelling participants aged 50 years and over, 1715 (30.5%) were taking statins. Of these, 65.0% (57.3% of men and 72.7% of women) were doing so for the primary prevention of CVD. Thus, almost two-thirds of those taking statins did so for primary prevention and there was a notable difference between women and men in this regard. We also found that statin utilisation was highest among those with a prior history of CVD and was significantly associated with age (compared with the base category 50-64 years; 65-74 years OR 1.38 (95% CI 1.16 to 1.65); 75+ OR 1.33 (95% CI 1.04 to 1.69)), living with a spouse or partner (compared with the base category living alone; OR 1.35 (95% CI 1.10 to 1.65)), polypharmacy (OR 1.74 (95% CI 1.39 to 2.19)) and frequency of general practitioner visits (compared with the base category 0 visits per year; 1-2 visits OR 2.46 (95% CI 1.80 to 3.35); 3-4 visits OR 3.24 (95% CI 2.34 to 4.47); 5-6 visits OR 2.98 (95% CI 2.08 to 4.26); 7+ visits OR 2.51 (95% CI 1.73 to 3.63)), even after controlling for clinical need. There was no association between using statins and gender, education, income, social class, health insurance status, location or Systematic Coronary Risk Evaluation (SCORE) risk in the multivariable analysis. CONCLUSION Statin utilisation among those with no history of CVD accounted for almost two-thirds of all statin use, in part reflecting the high proportion of the population with no history of CVD, although utilisation rates were highest among those with a history of CVD.
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Affiliation(s)
- Paula Byrne
- National University of Ireland Galway, Galway, Ireland
| | - John Cullinan
- National University of Ireland Galway, Galway, Ireland
| | - Catríona Murphy
- Dublin City University, Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Dublin, Ireland
| | - Susan M Smith
- Royal College of Surgeons in Ireland, Dublin, Ireland
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48
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Qiu Z, Zhou J, Hu J, Wu Y, Zheng G. Total flavonoids from Ampelopsis megalophylla suppress proliferation of vascular smooth muscle cells in vivo and in vitro. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902017000300215] [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] Open
Affiliation(s)
- Zhenpeng Qiu
- Hubei University of Chinese Medicine, People’s Republic of China
| | - Junxuan Zhou
- Hubei University of Chinese Medicine, People’s Republic of China
| | - Junjie Hu
- Hubei University of Chinese Medicine, People’s Republic of China
| | - Yong Wu
- Hubei University of Chinese Medicine, People’s Republic of China
| | - Guohua Zheng
- Hubei University of Chinese Medicine, People’s Republic of China
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Amara A, Mrad M, Sayeh A, Haggui A, Lahideb D, Fekih-Mrissa N, Haouala H, Nsiri B. Association of FV G1691A Polymorphism but not A4070G With Coronary Artery Disease. Clin Appl Thromb Hemost 2017; 24:330-337. [PMID: 29179580 PMCID: PMC6714679 DOI: 10.1177/1076029617744320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Coronary artery disease (CAD) is one of the chief causes of death in the world. Several
hypotheses have been promoted as for the origin of the disease, among which are genetic
predispositions and/or environmental factors. The aim of this study was to determine the
effect of factor V (FV) gene polymorphisms (Leiden, G1691A [FVL] and HR2 A4070G) and to
analyze their association with traditional risk factors in assessing the risk of CAD. Our
study population included 200 Tunisian patients with symptomatic CAD and a control group
of 300 participants matched for age and sex. All participants were genotyped for the FVL
and HR2 polymorphisms. Multivariate logistic regression was applied to analyze independent
factors associated with the risk of CAD. Our analysis showed that the FVL A allele
frequency (P < 10–3, odds ratio [OR] = 2.81, 95% confidence
interval [CI] = 1.6-4.9) and GA genotype (P < 10–3, OR =
4.03, 95% CI = 2.1-7.6) are significantly more prevalent among patients with CAD compared
to those controls and may be predisposing to CAD. We further found that the FVL mutation
is an independent risk factor whose effect is not modified by other factors (smoking,
diabetes, hypertension, dyslipidemia, and a family history of CAD) in increasing the risk
of the disease. However, analysis of FV HR2 variation does not show any statistically
significant association with CAD. The FVL polymorphism may be an independent risk factor
for CAD. However, further investigations on these polymorphisms and their possible
synergisms with traditional risk factors for CAD could help to ascertain better
predictability for CAD susceptibility.
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Affiliation(s)
- Ahmed Amara
- 1 Hôpital Militaire de Tunis, Service d'Hématologie, Laboratoire de Biologie Moléculaire, Montfleury, Tunisie.,2 Université Tunis el Manar, Faculté des Sciences de Tunis, Tunisie
| | - Meriem Mrad
- 1 Hôpital Militaire de Tunis, Service d'Hématologie, Laboratoire de Biologie Moléculaire, Montfleury, Tunisie.,2 Université Tunis el Manar, Faculté des Sciences de Tunis, Tunisie
| | - Aicha Sayeh
- 1 Hôpital Militaire de Tunis, Service d'Hématologie, Laboratoire de Biologie Moléculaire, Montfleury, Tunisie.,2 Université Tunis el Manar, Faculté des Sciences de Tunis, Tunisie
| | - Abdeddayem Haggui
- 3 Hôpital Militaire de Tunis, Service de Cardiologie, Montfleury, Tunisie.,4 Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - Dhaker Lahideb
- 3 Hôpital Militaire de Tunis, Service de Cardiologie, Montfleury, Tunisie.,4 Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - Najiba Fekih-Mrissa
- 1 Hôpital Militaire de Tunis, Service d'Hématologie, Laboratoire de Biologie Moléculaire, Montfleury, Tunisie.,5 Académie Militaire Fondouk Jédid, Nabeul, Tunisie
| | - Habib Haouala
- 3 Hôpital Militaire de Tunis, Service de Cardiologie, Montfleury, Tunisie.,4 Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - Brahim Nsiri
- 1 Hôpital Militaire de Tunis, Service d'Hématologie, Laboratoire de Biologie Moléculaire, Montfleury, Tunisie.,6 Université de Monastir, Faculté de Pharmacie, Monastir, Tunisie
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Carotid Intima-Media Thickness as a Cardiovascular Risk Factor and Imaging Pathway of Atherosclerosis. Crit Pathw Cardiol 2017; 15:152-160. [PMID: 27846007 DOI: 10.1097/hpc.0000000000000087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Assessment of carotid intima-media thickness (IMT) has emerged as a simple and noninvasive technique for measuring atherosclerotic burden. Although serum biomarkers have been linked to the risk of developing atherosclerosis, carotid IMT has the theoretical advantage of directly visualizing a final consequence of the disease itself, namely atherosclerosis in the vessel wall. The current widespread application of carotid IMT measurements has been based on the validity, standardization, and reproducibility of the measurement and the evidence that an increased carotid IMT can be regarded as an attractive biomarker of atherosclerosis and of increased cardiovascular risk, potentially useful as a therapeutic target in those at increased cardiovascular risk. The utilization of carotid IMT measurements as a surrogate end point in clinical trials evaluating a specific drug intervention may result in considerably smaller efforts and costs than when using a hard end point such as myocardial infarction, stroke, or death. In addition, the use of carotid IMT measurement as a screening tool in clinical practice in association with traditional risk factors may improve risk classification and decisions regarding therapeutic interventions. However, although carotid IMT may be correlated with clinical outcomes, changes in surrogate end points over time that result from a particular therapy may not necessarily be predictive of future cardiovascular events. Therefore, it is necessary to perform more clinical studies to clearly define the relationship between the modifications in carotid IMT and the changes in cardiovascular events. In an era of economic burden, when there is a clear combination of limited resources with high expense of innovation in drug development, carotid IMT represents a reasonable, worthwhile surrogate trial end point with a history of nearly 30 years of technical progress and clinical research. Current data strongly suggest that carotid IMT will continue to successfully be used as a valuable tool in clinical atherosclerosis research.
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