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Jones W, Klaiman C, Richardson S, Aoki C, Smith C, Minjarez M, Bernier R, Pedapati E, Bishop S, Ence W, Wainer A, Moriuchi J, Tay SW, Klin A. Eye-Tracking-Based Measurement of Social Visual Engagement Compared With Expert Clinical Diagnosis of Autism. JAMA 2023; 330:854-865. [PMID: 37668621 PMCID: PMC10481242 DOI: 10.1001/jama.2023.13295] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/29/2023] [Indexed: 09/06/2023]
Abstract
Importance In the US, children with signs of autism often experience more than 1 year of delay before diagnosis and often experience longer delays if they are from racially, ethnically, or economically disadvantaged backgrounds. Most diagnoses are also received without use of standardized diagnostic instruments. To aid in early autism diagnosis, eye-tracking measurement of social visual engagement has shown potential as a performance-based biomarker. Objective To evaluate the performance of eye-tracking measurement of social visual engagement (index test) relative to expert clinical diagnosis in young children referred to specialty autism clinics. Design, Setting, and Participants In this study of 16- to 30-month-old children enrolled at 6 US specialty centers from April 2018 through May 2019, staff blind to clinical diagnoses used automated devices to measure eye-tracking-based social visual engagement. Expert clinical diagnoses were made using best practice standardized protocols by specialists blind to index test results. This study was completed in a 1-day protocol for each participant. Main Outcomes and Measures Primary outcome measures were test sensitivity and specificity relative to expert clinical diagnosis. Secondary outcome measures were test correlations with expert clinical assessments of social disability, verbal ability, and nonverbal cognitive ability. Results Eye-tracking measurement of social visual engagement was successful in 475 (95.2%) of the 499 enrolled children (mean [SD] age, 24.1 [4.4] months; 38 [8.0%] were Asian; 37 [7.8%], Black; 352 [74.1%], White; 44 [9.3%], other; and 68 [14.3%], Hispanic). By expert clinical diagnosis, 221 children (46.5%) had autism and 254 (53.5%) did not. In all children, measurement of social visual engagement had sensitivity of 71.0% (95% CI, 64.7% to 76.6%) and specificity of 80.7% (95% CI, 75.4% to 85.1%). In the subgroup of 335 children whose autism diagnosis was certain, sensitivity was 78.0% (95% CI, 70.7% to 83.9%) and specificity was 85.4% (95% CI, 79.5% to 89.8%). Eye-tracking test results correlated with expert clinical assessments of individual levels of social disability (r = -0.75 [95% CI, -0.79 to -0.71]), verbal ability (r = 0.65 [95% CI, 0.59 to 0.70]), and nonverbal cognitive ability (r = 0.65 [95% CI, 0.59 to 0.70]). Conclusions and Relevance In 16- to 30-month-old children referred to specialty clinics, eye-tracking-based measurement of social visual engagement was predictive of autism diagnoses by clinical experts. Further evaluation of this test's role in early diagnosis and assessment of autism in routine specialty clinic practice is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT03469986.
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Affiliation(s)
- Warren Jones
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shana Richardson
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Christa Aoki
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Mendy Minjarez
- Seattle Children’s Autism Center and Department of Psychiatry, University of Washington, Seattle
| | - Raphael Bernier
- Seattle Children’s Autism Center and Department of Psychiatry, University of Washington, Seattle
| | - Ernest Pedapati
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | | - Ami Klin
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
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Jones W, Klaiman C, Richardson S, Lambha M, Reid M, Hamner T, Beacham C, Lewis P, Paredes J, Edwards L, Marrus N, Constantino JN, Shultz S, Klin A. Development and Replication of Objective Measurements of Social Visual Engagement to Aid in Early Diagnosis and Assessment of Autism. JAMA Netw Open 2023; 6:e2330145. [PMID: 37669054 PMCID: PMC10481232 DOI: 10.1001/jamanetworkopen.2023.30145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/11/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Autism spectrum disorder is a common and early-emerging neurodevelopmental condition. While 80% of parents report having had concerns for their child's development before age 2 years, many children are not diagnosed until ages 4 to 5 years or later. Objective To develop an objective performance-based tool to aid in early diagnosis and assessment of autism in children younger than 3 years. Design, Setting, and Participants In 2 prospective, consecutively enrolled, broad-spectrum, double-blind studies, we developed an objective eye-tracking-based index test for children aged 16 to 30 months, compared its performance with best-practice reference standard diagnosis of autism (discovery study), and then replicated findings in an independent sample (replication study). Discovery and replication studies were conducted in specialty centers for autism diagnosis and treatment. Reference standard diagnoses were made using best-practice standardized protocols by specialists blind to eye-tracking results. Eye-tracking tests were administered by staff blind to clinical results. Children were enrolled from April 27, 2013, until September 26, 2017. Data were analyzed from March 28, 2018, to January 3, 2019. Main Outcomes and Measures Prespecified primary end points were the sensitivity and specificity of the eye-tracking-based index test compared with the reference standard. Prespecified secondary end points measured convergent validity between eye-tracking-based indices and reference standard assessments of social disability, verbal ability, and nonverbal ability. Results Data were collected from 1089 children: 719 children (mean [SD] age, 22.4 [3.6] months) in the discovery study, and 370 children (mean [SD] age, 25.4 [6.0] months) in the replication study. In discovery, 224 (31.2%) were female and 495 (68.8%) male; in replication, 120 (32.4%) were female and 250 (67.6%) male. Based on reference standard expert clinical diagnosis, there were 386 participants (53.7%) with nonautism diagnoses and 333 (46.3%) with autism diagnoses in discovery, and 184 participants (49.7%) with nonautism diagnoses and 186 (50.3%) with autism diagnoses in replication. In the discovery study, the area under the receiver operating characteristic curve was 0.90 (95% CI, 0.88-0.92), sensitivity was 81.9% (95% CI, 77.3%-85.7%), and specificity was 89.9% (95% CI, 86.4%-92.5%). In the replication study, the area under the receiver operating characteristic curve was 0.89 (95% CI, 0.86-0.93), sensitivity was 80.6% (95% CI, 74.1%-85.7%), and specificity was 82.3% (95% CI, 76.1%-87.2%). Eye-tracking test results correlated with expert clinical assessments of children's individual levels of ability, explaining 68.6% (95% CI, 58.3%-78.6%), 63.4% (95% CI, 47.9%-79.2%), and 49.0% (95% CI, 33.8%-65.4%) of variance in reference standard assessments of social disability, verbal ability, and nonverbal cognitive ability, respectively. Conclusions and Relevance In two diagnostic studies of children younger than 3 years, objective eye-tracking-based measurements of social visual engagement quantified diagnostic status as well as individual levels of social disability, verbal ability, and nonverbal ability in autism. These findings suggest that objective measurements of social visual engagement can be used to aid in autism diagnosis and assessment.
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Affiliation(s)
- Warren Jones
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shana Richardson
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Meena Lambha
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Morganne Reid
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Taralee Hamner
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Chloe Beacham
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Peter Lewis
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Jose Paredes
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Laura Edwards
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Natasha Marrus
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
- Intellectual and Developmental Disabilities Research Center, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - John N. Constantino
- Intellectual and Developmental Disabilities Research Center, Washington University in St Louis School of Medicine, St Louis, Missouri
- Now with Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia
- Now with Division of Behavioral and Mental Health, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Shultz
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Ami Klin
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
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Wald NJ, Duffy SW, Hackshaw A. The Risk-Screening Converter. J Med Screen 2023; 30:1-2. [PMID: 36617846 DOI: 10.1177/09691413221149640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Nicholas J Wald
- Institute of Health Informatics, University College London, London, UK
| | - Stephen W Duffy
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Rodríguez-Vera D, Vergara-Castañeda A, Lazcano-Orozco DK, Ramírez-Vélez G, Vivar-Sierra A, Araiza-Macías MJ, Hernández-Contreras JP, Naranjo-Navarro CR, Salazar JR, Loza-Mejía MA, Pinto-Almazán R. Inflammation Parameters Associated with Metabolic Disorders: Relationship Between Diet and Microbiota. Metab Syndr Relat Disord 2021; 19:469-482. [PMID: 34402660 DOI: 10.1089/met.2021.0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The metabolic syndrome (MetS) includes numerous interrelated clinical, anthropometric, biochemical, and metabolic components and has become a public health problem due to its impact on morbimortality. Inflammation is a central mechanism underlying the etiology and clinical manifestations of MetS, contributing to its related pathological outcomes. Dietary patterns have been associated with the promotion of the diversity of microbiota in the digestive tract. Recently, research has focused on the importance of microbiota changes associated with MetS and inflammation. Other studies have been performed to understand the impact of prebiotics, probiotics, and synbiotics as allies on diet, inflammation, and MetS parameters. This review analyses the correlation between metabolic disorders, inflammation parameters, gut microbiota, and how diet has been involved as treatment of MetS and the modulation of inflammation and microbiota.
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Affiliation(s)
- Diana Rodríguez-Vera
- Molecular Biology in Metabolic and Neurodegenerative Diseases Laboratory, Research Unit, High Specialty Regional Hospital of Ixtapaluca (HRAEI), Ixtapaluca, México.,Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional. Mexico City, Mexico
| | - Arely Vergara-Castañeda
- Basic and Clinical Health Sciences Research Group, Chemical Sciences School, Universidad La Salle-México, México City, Mexico
| | - Diana K Lazcano-Orozco
- Molecular Biology in Metabolic and Neurodegenerative Diseases Laboratory, Research Unit, High Specialty Regional Hospital of Ixtapaluca (HRAEI), Ixtapaluca, México
| | - Gabriela Ramírez-Vélez
- Design, Isolation, and Synthesis of Bioactive Molecules Research Group, Chemical Sciences School, Universidad La Salle-México, Mexico City, Mexico
| | - Alonso Vivar-Sierra
- Design, Isolation, and Synthesis of Bioactive Molecules Research Group, Chemical Sciences School, Universidad La Salle-México, Mexico City, Mexico
| | - María José Araiza-Macías
- Design, Isolation, and Synthesis of Bioactive Molecules Research Group, Chemical Sciences School, Universidad La Salle-México, Mexico City, Mexico
| | - José Patricio Hernández-Contreras
- Design, Isolation, and Synthesis of Bioactive Molecules Research Group, Chemical Sciences School, Universidad La Salle-México, Mexico City, Mexico
| | - Carlos Rogelio Naranjo-Navarro
- Design, Isolation, and Synthesis of Bioactive Molecules Research Group, Chemical Sciences School, Universidad La Salle-México, Mexico City, Mexico
| | - Juan Rodrigo Salazar
- Design, Isolation, and Synthesis of Bioactive Molecules Research Group, Chemical Sciences School, Universidad La Salle-México, Mexico City, Mexico
| | - Marco A Loza-Mejía
- Design, Isolation, and Synthesis of Bioactive Molecules Research Group, Chemical Sciences School, Universidad La Salle-México, Mexico City, Mexico
| | - Rodolfo Pinto-Almazán
- Molecular Biology in Metabolic and Neurodegenerative Diseases Laboratory, Research Unit, High Specialty Regional Hospital of Ixtapaluca (HRAEI), Ixtapaluca, México.,Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional. Mexico City, Mexico
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5
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Johansson K, Jansson JH, Johansson L, Ekblom K, Lind MM. Von Willebrand factor, ABO blood group, and risk of first-ever intracerebral hemorrhage: A prospective nested case-control study. Thromb Res 2020; 195:77-80. [DOI: 10.1016/j.thromres.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/14/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
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Abstract
Cholesterol metabolism and transport has been a major focus in cardiovascular disease risk modification over the past several decades. Hydroxymethylglutaryl-CoA reductase inhibitors (statins) have been the most commonly used agents, with the greatest benefit in reducing both the primary and secondary risks of cardiovascular disease. However, heart disease remains the leading cause of death in both men and women in the United States. Further investigation and intervention are required to further reduce the risk for cardiovascular disease and cardiovascular-related deaths. This review will focus on high-density lipoprotein metabolism and transport, looking particularly at cholesteryl ester transfer protein (CETP) inhibitors. While studies of the other CETP inhibitors in its class have not shown a significant improvement in the prevention of primary or secondary cardiovascular risk, anacetrapib, the fourth and latest of the CETP inhibitors to be investigated, may be more promising.
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7
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Johansson K, Jansson JH, Johansson L, Wiklund PG, Nilsson TK, Lind M. D-Dimer Is Associated With First-Ever Intracerebral Hemorrhage. Stroke 2019; 49:2034-2039. [PMID: 30354971 DOI: 10.1161/strokeaha.118.021751] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Hypertension is the most important risk factor for intracerebral hemorrhage (ICH), but further characterization is needed for groups at high risk of ICH. One way to predict the risk of developing a disease is with plasma biomarkers. This study aimed to investigate the association between the biomarker, D-dimer, and ICH risk. Methods- This population-based, nested case-control study was conducted using data from 2 population-based surveys; the Västerbotten Intervention Programme and MONICA Northern Sweden (Monitoring Trends and Determinants in Cardiovascular Disease). All participants underwent a health examination and blood sampling at baseline before the event. Cases (n=141) were diagnosed with a first-ever ICH between 1985 and March 2007. One or 2 controls (n=255) were matched to each case. Results- The median age was 60 years; 39% of participants were women; and the median time from blood sampling to ICH was 5.2 years. When D-dimer was evaluated as a continuous variable, it was significantly associated with ICH. After multivariable adjustment (for hypertension, body mass index, cholesterol levels, diabetes mellitus, and smoking), the odds ratio was 1.36 per SD of D-dimer (95% CI, 1.05-1.77). When participants were stratified in 3 groups according to time from blood sampling at health examination to ICH, we found that the association between D-dimer levels and ICH was most pronounced in individuals with the shortest time from blood sampling to ICH event (<3.5 years; odds ratio, 1.78; 95% CI, 1.05-3.05). Conclusions- High plasma concentrations of D-dimer were associated with increased risk of a future ICH, after adjusting for cardiovascular risk factors. This association was predominantly driven by the cases with the shortest time from blood sampling to ICH event.
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Affiliation(s)
- Kristina Johansson
- From the Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden (K.J., J.-H.J., L.J., M.L.)
| | - Jan-Håkan Jansson
- From the Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden (K.J., J.-H.J., L.J., M.L.)
| | - Lars Johansson
- From the Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden (K.J., J.-H.J., L.J., M.L.)
| | - Per-Gunnar Wiklund
- From the Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden (K.J., J.-H.J., L.J., M.L.).,Department of Public Health and Clinical Medicine (P.-G.W.)
| | - Torbjörn K Nilsson
- Department of Medical Biosciences/Clinical Chemistry (T.K.N.), Umeå University, Sweden
| | - Marcus Lind
- From the Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden (K.J., J.-H.J., L.J., M.L.)
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Park JYK, Koehler KM. Probabilistic Quantitative Assessment of Coronary Heart Disease Risk From Dietary Exposure to Industrially Produced Trans-Fatty Acids in Partially Hydrogenated Oils. Toxicol Sci 2019; 172:213-224. [PMID: 31397870 DOI: 10.1093/toxsci/kfz170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 01/07/2023] Open
Abstract
Abstract
We conducted a probabilistic evaluation of changes in coronary heart disease (CHD) risk and public health burdens from industrially produced trans-fatty acids (IP-TFAs) exposure from the uses of partially hydrogenated oils in food. Our analyses used four quantitative methods based on human studies considering the uncertainty associated with risk parameters for CHD and IP-TFA daily dietary exposure of 0.05% of energy. Method 1 used experimental controlled feeding trial data for changes in low-density lipoprotein cholesterol; Method 2 used changes in both low-density lipoprotein cholesterol and high-density lipoprotein cholesterol; Method 3 used changes in a combination of three emerging CHD risk factor biomarkers; and method 4 used prospective observational studies of CHD cases associated with long-term dietary exposure of trans-fatty acids. We estimated mean percent changes in CHD risk and annual CHD cases in U.S. adults, with lower and upper 95% uncertainty intervals. Our results show that consuming 0.05% of energy from IP-TFA, instead of cis-monounsaturated fatty acids, can cause annual mean increases in CHD cases of 814 (510–1151, method 1), 1502 (990–2043, method 2), or 6877 (3611–10 694, method 4) in U.S. adults. Results for method 3 were intermediate between those for methods 2 and 4. Sensitivity analyses using alternate risk parameters or an alternate exposure scenario resulted in minor changes in public health burden estimates. The results demonstrate that IP-TFA exposure as low as 0.05% of energy from partially hydrogenated oil uses in food can cause substantial public health burdens in the United States from increased CHD risk.
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Affiliation(s)
- Jin-Young K Park
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition (CFSAN), Office of Food Additive Safety (OFAS), Division of Food Contact Substances, College Park, Maryland 20740
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Sheikhi A, Djafarian K, Askarpour M, Shab-Bidar S. The effects of supplementation with L-carnitine on apolipoproteins: A systematic review and meta-analysis of randomized trials. Eur J Pharmacol 2019; 858:172493. [PMID: 31255604 DOI: 10.1016/j.ejphar.2019.172493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/31/2022]
Abstract
Randomized controlled trials (RCTs) have reported that L-carnitin may change serum apolipoproteins. However, the results of RCTs are contradictory. Our objective was to conduct a systematic review and meta-analysis to summarize earlier RCTs on the effects of L-carnitine supplementation on apolipoproteins B100 and AI. ISI web of science, Ovid, PubMed/Medline, Scopus, and Google Scholar were searched from inception to January 2019 using relevant keywords. Treatment effects were considered as weighted mean difference (MD) and the corresponding 95% confidence interval in concentrations of serum apolipoproteins. Random-effects model (Dersimonian-Liard) was used to estimate the overall summary effect. This meta-analysis was performed on fourteen trials. Our results indicated that L-carnitine supplementation has a non-significant effect on Apo B100 (mean difference (MD): 1.820 mg/dl; 95% CI: -3.367 to 7.006, p = 0.492) and Apo AI (MD: -0.119 mg/dl; 95% CI: -4.425 to 4.186, p = 0.957). We also found body mass index, L-carnitine dosage; health condition and intervention duration could change the results. We conclude that L-carnitine does not change Apo B100 and Apo AI concentration. Further trials with sufficient sample size are needed to confirm these findings.
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Affiliation(s)
- Ali Sheikhi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Askarpour
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
Since the early work of Mann and Spoerry, probiotics in the form of fermented milk products have been reputed to have cholesterol-lowering properties in humans. However, studies conducted since the early 1970s have produced equivocal findings, with interpretation of the outcomes complicated by use of excessive quantities of product, inadequate sample sizes, failure to control nutrient intake and energy expenditure and variations in baseline blood lipids. More recent studies are of better quality, but fail to provide convincing evidence that ‘live’ fermented milk products have cholesterol-lowering efficacy in man. Future studies using probiotics should ensure adequate sample sizes sufficient to detect relatively small changes in blood cholesterol and should be conducted over longer periods of time. The recent introduction of the concept of prebiotics has directed attention towards the possibility that alterations in gut microflora induced by the fermentation of non-digestible components of the diet may also have the potential to influence systemic lipid metabolism. This possibility has been strengthened by the observation that in animals, dietary oligofructosaccharides cause suppression of hepatic triglyceride and VLDL synthesis, resulting in marked reductions in triglyceride, and to a lesser extent cholesterol, levels. Evidence for similar effects in humans is sparse and more studies are needed, particularly with respect to effects on postprandial triglyceride concentrations.
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Park MY, Kim J, Kim S, Whang KY. Lactobacillus curvatusKFP419 andLeuconostoc mesenteroidessubsp.mesenteroidesKDK411 Isolated from Kimchi Ameliorate Hypercholesterolemia in Rats. J Med Food 2018; 21:647-653. [DOI: 10.1089/jmf.2017.4125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Min Young Park
- Division of Biotechnology, College of Life Science and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Jonggun Kim
- Division of Biotechnology, College of Life Science and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Saehun Kim
- Division of Food Bioscience and Technology, College of Life Science and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Kwang-Youn Whang
- Division of Biotechnology, College of Life Science and Biotechnology, Korea University, Seoul, Republic of Korea
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Liyanage T, Ninomiya T, Perkovic V, Woodward M, Stirnadel-Farrant H, Matsushita K, Iseki K, Seong HL, Monaghan H, Jha V. Chronic kidney disease in Asia: Protocol for a collaborative overview. Nephrology (Carlton) 2018; 22:456-462. [PMID: 27187157 DOI: 10.1111/nep.12821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/18/2016] [Accepted: 05/13/2016] [Indexed: 11/28/2022]
Abstract
AIM The burden of chronic kidney disease (CKD) is growing rapidly around the world. However, there is limited information on the overall regional prevalence of CKD, as well as the prognostic implications and treatment patterns in Asian region. We have established the Asian Renal Collaboration (ARC) with the goal of consolidating region-wide data regarding CKD. METHODS This collaborative project will synthesize data and perform meta-analyses of observational studies conducted in Asia. Studies will be identified through a systematic literature search including abstracts, proceedings of meetings, electronic databases such as MEDLINE and EMBASE. Personal enquiry among collaborators and experts in the region will identify additional studies, or other data sources such as registries. Both cross-sectional and longitudinal studies that describe the prevalence of CKD and its complications will be included, as will longitudinal studies that describe important clinical outcomes for people with CKD. Individual participant data will be sought, where possible, from each of the studies included in the collaboration for baseline parameters and subsequent outcomes, in order to maximize flexibility and consistency of data analyses. CONCLUSIONS This study is an initiative offering a unique opportunity to obtain information about the prevalence and manifestations of CKD in Asia, as well as its risk factors. The ARC will also provide insights into important outcomes including progression of CKD, CKD complications, cardiovascular disease and death. These findings will improve our understanding of kidney disease in Asia, and thus help inform service provision, preventive care and further research across the region.
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Affiliation(s)
- Thaminda Liyanage
- The George Institute for Global Health, School of Medicine, University of Sydney, New South Wales, Australia.,Armadale Kelmscott Memorial Hospital, South Metropolitan Health Service, Perth, Western Australia, Australia
| | - Toshiharu Ninomiya
- The George Institute for Global Health, School of Medicine, University of Sydney, New South Wales, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, School of Medicine, University of Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, School of Medicine, University of Sydney, New South Wales, Australia
| | | | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology Baltimore, USA
| | - Kunitoshi Iseki
- Okinawa Heart and Renal Association (OHRA) and Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Hooi Lai Seong
- Sultanah Aminah Hospital, Haemodialysis Unit, Johor Bahru, Malaysia
| | - Helen Monaghan
- The George Institute for Global Health, School of Medicine, University of Sydney, New South Wales, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, India, New Delhi, India.,Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Safiri S, Ayubi E. Comments on prospective study of metabolic syndrome as a mortality marker in chronic coronary heart disease patients. Eur J Intern Med 2018; 48:e37. [PMID: 28886895 DOI: 10.1016/j.ejim.2017.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/21/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Erfan Ayubi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Soran H, Adam S, Mohammad JB, Ho JH, Schofield JD, Kwok S, Siahmansur T, Liu Y, Syed AA, Dhage SS, Stefanutti C, Donn R, Malik RA, Banach M, Durrington PN. Hypercholesterolaemia - practical information for non-specialists. Arch Med Sci 2018; 14:1-21. [PMID: 29379528 PMCID: PMC5778427 DOI: 10.5114/aoms.2018.72238] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/03/2017] [Indexed: 12/21/2022] Open
Abstract
Hypercholesterolaemia is amongst the most common conditions encountered in the medical profession. It remains one of the key modifiable cardiovascular risk factors and there have been recent advances in the risk stratification methods and treatment options available. In this review, we provide a background into hypercholesterolaemia for non-specialists and consider the merits of the different risk assessment tools available. We also provide detailed considerations as to: i) when to start treatment, ii) what targets to aim for and iii) the role of low density lipoprotein cholesterol.
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Affiliation(s)
- Handrean Soran
- Cardiovascular Research Group, Faculty of Biology, Medicine & Health, University of Manchester, UK
- Cardiovascular Trials Unit, University Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Safwaan Adam
- Cardiovascular Research Group, Faculty of Biology, Medicine & Health, University of Manchester, UK
- Cardiovascular Trials Unit, University Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jamal B. Mohammad
- Department of Medicine, University of Duhok, Duhok, Kurdistan region, Iraq
| | - Jan H. Ho
- Cardiovascular Research Group, Faculty of Biology, Medicine & Health, University of Manchester, UK
- Cardiovascular Trials Unit, University Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jonathan D. Schofield
- Cardiovascular Research Group, Faculty of Biology, Medicine & Health, University of Manchester, UK
- Cardiovascular Trials Unit, University Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - See Kwok
- Cardiovascular Research Group, Faculty of Biology, Medicine & Health, University of Manchester, UK
- Cardiovascular Trials Unit, University Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tarza Siahmansur
- Cardiovascular Trials Unit, University Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Yifen Liu
- Cardiovascular Research Group, Faculty of Biology, Medicine & Health, University of Manchester, UK
| | - Akheel A. Syed
- Cardiovascular Research Group, Faculty of Biology, Medicine & Health, University of Manchester, UK
- Department of Diabetes, Endocrinology and Obesity Medicine, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Shaishav S. Dhage
- Cardiovascular Research Group, Faculty of Biology, Medicine & Health, University of Manchester, UK
- Cardiovascular Trials Unit, University Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Claudia Stefanutti
- Immunohematology and Transfusion Medicine, Department of Molecular Medicine, University of Rome, Rome, Italy
| | - Rachelle Donn
- Cardiovascular Research Group, Faculty of Biology, Medicine & Health, University of Manchester, UK
| | | | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Poland
| | - Paul N. Durrington
- Cardiovascular Research Group, Faculty of Biology, Medicine & Health, University of Manchester, UK
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Johansson K, Jansson JH, Johansson L, Bylesjö I, Nilsson TK, Eliasson M, Söderberg S, Lind M. Factor XII as a Risk Marker for Hemorrhagic Stroke: A Prospective Cohort Study. Cerebrovasc Dis Extra 2017; 7:84-94. [PMID: 28433996 PMCID: PMC5437482 DOI: 10.1159/000468994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/10/2017] [Indexed: 01/15/2023] Open
Abstract
Background Coagulation factor XII (FXII) is involved in pathological thrombus formation and is a suggested target of anticoagulants. It is unclear whether FXII levels are correlated with cardiovascular risk factors and whether they are associated with myocardial infarction or ischemic or hemorrhagic stroke. The aim of this study was to investigate the correlation between FXII and cardiovascular risk factors in the general population. We also aimed to study the associations between FXII levels and future myocardial infarction and ischemic and hemorrhagic stroke. Methods This prospective cohort study measured FXII levels in 1,852 randomly selected participants in a health survey performed in northern Sweden in 1994. Participants were followed until myocardial infarction, stroke, death, or until December 31, 2011. Results During the median follow-up of 17.9 years, 165 individuals were diagnosed with myocardial infarction, 108 with ischemic stroke, and 30 with hemorrhagic stroke. There were weak correlations between FXII and body mass index, cholesterol, and hypertension. There was no association between FXII and myocardial infarction or ischemic stroke, neither in univariable Cox regression analysis nor after adjustment for age, sex, smoking, body mass index, cholesterol, hypertension, and diabetes. In univariable Cox regression analysis, the hazard ratio for the association between FXII levels and hemorrhagic stroke was 1.42 per SD (95% confidence interval: 0.99–2.05). In the multivariable model, higher levels of FXII were associated with increased risk of hemorrhagic stroke (hazard ratio 1.51 per SD; 95% confidence interval: 1.03–2.21). Conclusion We found an independent association between FXII levels and the risk of hemorrhagic stroke, but not between FXII levels and ischemic stroke or myocardial infarction.
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Affiliation(s)
- Kristina Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
| | - Ingemar Bylesjö
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Torbjörn K Nilsson
- Department of Medical Biosciences/Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Marcus Lind
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Umeå, Sweden
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16
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Breitling LP, Mons U, Hahmann H, Koenig W, Rothenbacher D, Brenner H. The Longer, the Better? An Empirical Study of the Extent and Mechanisms of Attenuating Biomarker Associations in Cardiovascular Patient Cohorts. Clin Chem 2017; 63:673-682. [PMID: 28073900 DOI: 10.1373/clinchem.2016.263202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/18/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Identifying novel risk markers in cardiovascular patients remains a research priority. Longer follow-up generally is considered favorable in such studies, but associations of interest may become attenuated with increasing follow-up. This issue has not been adequately addressed in the context of patient cohorts. The current study analyzed the extent and mechanisms of attenuating associations in a cardiovascular patient cohort. METHODS The associations of numerous biomarkers with all-cause mortality were estimated by multiple Cox regression in the Langzeiterfolge der KARdiOLogischen Anschlussheilbehandlung (KAROLA) prospective cohort study of 1204 patients who had participated in an inpatient rehabilitation program after an acute coronary syndrome (ACS) or coronary bypass operation. Hazard ratios were estimated based on the entire follow-up period (13 years), and after truncation at previous follow-up times (3, 4.5, 6, 8, 10 years). RESULTS For the majority of markers, a clear and sometimes very pronounced attenuation of the hazard ratios could be observed with increasing follow-up duration. Differential attrition generally was not a sufficient explanation for this phenomenon, whereas further analyses suggested a role for reverse causality for some of the markers. Power analyses showed that the relationship of follow-up duration and statistical power can be counterintuitive in the presence of realistic amounts of attenuation. CONCLUSIONS The attenuation of estimates of association in patient cohorts is a much more substantial and complex issue than currently appreciated. This has important implications for the design and interpretation of prognostic, as well as etiologic, studies which may be particularly relevant in the case of patient cohorts defined by an initial acute event.
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Affiliation(s)
- Lutz P Breitling
- German Cancer Research Center, Division of Clinical Epidemiology and Aging Research, Heidelberg, Germany;
| | - Ute Mons
- German Cancer Research Center, Division of Clinical Epidemiology and Aging Research, Heidelberg, Germany
| | | | - Wolfgang Koenig
- University of Ulm Medical Center, Department of Internal Medicine II - Cardiology, Ulm, Germany.,Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | | | - Hermann Brenner
- German Cancer Research Center, Division of Clinical Epidemiology and Aging Research, Heidelberg, Germany
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17
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Tzoulaki I, Elliott P, Kontis V, Ezzati M. Worldwide Exposures to Cardiovascular Risk Factors and Associated Health Effects: Current Knowledge and Data Gaps. Circulation 2016; 133:2314-33. [PMID: 27267538 DOI: 10.1161/circulationaha.115.008718] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Information on exposure to, and health effects of, cardiovascular disease (CVD) risk factors is needed to develop effective strategies to prevent CVD events and deaths. Here, we provide an overview of the data and evidence on worldwide exposures to CVD risk factors and the associated health effects. Global comparative risk assessment studies have estimated that hundreds of thousands or millions of CVD deaths are attributable to established CVD risk factors (high blood pressure and serum cholesterol, smoking, and high blood glucose), high body mass index, harmful alcohol use, some dietary and environmental exposures, and physical inactivity. The established risk factors plus body mass index are collectively responsible for ≈9.7 million annual CVD deaths, with high blood pressure accounting for more CVD deaths than any other risk factor. Age-standardized CVD death rates attributable to established risk factors plus high body mass index are lowest in high-income countries, followed by Latin America and the Caribbean; they are highest in the region of central and eastern Europe and central Asia. However, estimates of the health effects of CVD risk factors are highly uncertain because there are insufficient population-based data on exposure to most CVD risk factors and because the magnitudes of their effects on CVDs in observational studies are likely to be biased. We identify directions for research and surveillance to better estimate the effects of CVD risk factors and policy options for reducing CVD burden by modifying preventable risk factors.
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Affiliation(s)
- Ioanna Tzoulaki
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.)
| | - Paul Elliott
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.)
| | - Vasilis Kontis
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.)
| | - Majid Ezzati
- From Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Greece (IT); MRC-PHE Centre for Environment and Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); School of Public Health, Imperial College London, London, UK (I.T., P.E., V.K., M.E.); Imperial College Wellcome Trust Centre for Global Health Research, London, UK (P.E., M.E.); and WHO Collaborating Centre on NCD Surveillance and Epidemiology, London, UK (P.E., M.E.).
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Abstract
Cardiovascular diseases remain extremely common and the United States and are the single most common cause for death in both men and women. Many risk factors including cigarette smoking, elevated cholesterol, high blood pressure, obesity and in inactive lifestyle carry a significant lifestyle component. This fact is recognized in the National Guidelines for the Treatment of many risk factors for cardiovascular disease. Moreover, lifestyle intervention, in combination with proper medical and/or surgical therapy can play a significant role in the management of existing cardiovascular disease. In this review, we provide background and rationale for interventions to reduce the risk of coronary heart disease with a particular emphasis on intervening to improve lifestyle related issues. To achieve the best outcomes clinicians must be skilled not only in pharmacologic and surgical therapies but also in counseling patients on various lifestyle interventions to lower the risk of cardiovascular disease.
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19
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Björck L, Rosengren A, Winkvist A, Capewell S, Adiels M, Bandosz P, Critchley J, Boman K, Guzman-Castillo M, O’Flaherty M, Johansson I. Changes in Dietary Fat Intake and Projections for Coronary Heart Disease Mortality in Sweden: A Simulation Study. PLoS One 2016; 11:e0160474. [PMID: 27490257 PMCID: PMC4973910 DOI: 10.1371/journal.pone.0160474] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/20/2016] [Indexed: 12/05/2022] Open
Abstract
Objective In Sweden, previous favourable trends in blood cholesterol levels have recently levelled off or even increased in some age groups since 2003, potentially reflecting changing fashions and attitudes towards dietary saturated fatty acids (SFA). We aimed to examine the potential effect of different SFA intake on future coronary heart disease (CHD) mortality in 2025. Methods We compared the effect on future CHD mortality of two different scenarios for fat intake a) daily SFA intake decreasing to 10 energy percent (E%), and b) daily SFA intake rising to 20 E%. We assumed that there would be moderate improvements in smoking (5%), salt intake (1g/day) and physical inactivity (5% decrease) to continue recent, positive trends. Results In the baseline scenario which assumed that recent mortality declines continue, approximately 5,975 CHD deaths might occur in year 2025. Anticipated improvements in smoking, dietary salt intake and physical activity, would result in some 380 (-6.4%) fewer deaths (235 in men and 145 in women). In combination with a mean SFA daily intake of 10 E%, a total of 810 (-14%) fewer deaths would occur in 2025 (535 in men and 275 in women). If the overall consumption of SFA rose to 20 E%, the expected mortality decline would be wiped out and approximately 20 (0.3%) additional deaths might occur. Conclusion CHD mortality may increase as a result of unfavourable trends in diets rich in saturated fats resulting in increases in blood cholesterol levels. These could cancel out the favourable trends in salt intake, smoking and physical activity.
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Affiliation(s)
- Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- * E-mail:
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Capewell
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Piotr Bandosz
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Julia Critchley
- St George's, University of London, Population Health Research Institute, Cranmer Terrace, London, United Kingdom
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Martin O’Flaherty
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
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Huang YK, Kang WM, Ma ZQ, Liu YQ, Zhou L, Yu JC. Body mass index, serum total cholesterol, and risk of gastric high-grade dysplasia: A case-control study among Chinese adults. Medicine (Baltimore) 2016; 95:e4730. [PMID: 27583914 PMCID: PMC5008598 DOI: 10.1097/md.0000000000004730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Obesity is related to an increased risk of gastric cardia cancer. However, the influences of excess body weight and serum total cholesterol on the risk of gastric high-grade dysplasia have not been fully characterized.A case-control study was conducted to explore the relationships between body mass index (BMI), serum total cholesterol level, and the risk of gastric high-grade dysplasia in Chinese adults. A total of 893 consecutive patients with gastric high-grade dysplasia (537 men and 356 women) and 902 controls (543 men and 359 women) were enrolled from January 2000 to October 2015. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated, and a multivariate analysis was conducted.After adjusting for age, alcohol consumption, smoking status, family history of gastric cancer or esophageal cancer, and serum total cholesterol level, a BMI ranging from 27.5 to 29.9 was significantly related to an increased risk of gastric high-grade dysplasia in both men (adjusted OR = 1.87, 95% CI = 1.24-2.81) and women (adjusted OR = 2.72, 95% CI = 1.44-5.16). The 2 highest BMI categories (27.5-29.9 and ≥30.0) were identified as risk factors for gastric cardia high-grade dysplasia in both men (BMI = 27.5-29.9: adjusted OR = 1.78, 95% CI = 1.02-3.10; BMI ≥ 30.0: adjusted OR = 2.54, 95% CI = 1.27-5.08) and women (BMI = 27.5-29.9: adjusted OR = 2.88, 95% CI = 1.27-6.55; BMI ≥ 30.0: adjusted OR = 2.77, 95% CI = 1.36-5.64), whereas only a BMI ranging from 27.5 to 29.9 was a risk factor for gastric noncardia high-grade dysplasia in both men (adjusted OR = 1.98, 95% CI = 1.25-3.14) and women (adjusted OR = 2.88, 95% CI = 1.43-5.81). In addition, higher serum total cholesterol was associated with an increased risk of gastric noncardia high-grade dysplasia (adjusted OR = 1.83, 95% CI = 1.25-2.69) in women.Increased BMI was associated with an increased risk of gastric high-grade dysplasia in both men and women, and higher serum total cholesterol increased the risk of gastric noncardia high-grade dysplasia in women.
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Affiliation(s)
- Ya-Kai Huang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Wei-Ming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhi-Qiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yu-Qin Liu
- Cell Culture Center, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jian-Chun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Correspondence: Jian-Chun Yu, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China (e-mail: )
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Perera R, McFadden E, McLellan J, Lung T, Clarke P, Pérez T, Fanshawe T, Dalton A, Farmer A, Glasziou P, Takahashi O, Stevens J, Irwig L, Hirst J, Stevens S, Leslie A, Ohde S, Deshpande G, Urayama K, Shine B, Stevens R. Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling. Health Technol Assess 2016; 19:1-401, vii-viii. [PMID: 26680162 DOI: 10.3310/hta191000] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Various lipid measurements in monitoring/screening programmes can be used, alone or in cardiovascular risk scores, to guide treatment for prevention of cardiovascular disease (CVD). Because some changes in lipids are due to variability rather than true change, the value of lipid-monitoring strategies needs evaluation. OBJECTIVE To determine clinical value and cost-effectiveness of different monitoring intervals and different lipid measures for primary and secondary prevention of CVD. DATA SOURCES We searched databases and clinical trials registers from 2007 (including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Clinical Trials Register, the Current Controlled Trials register, and the Cumulative Index to Nursing and Allied Health Literature) to update and extend previous systematic reviews. Patient-level data from the Clinical Practice Research Datalink and St Luke's Hospital, Japan, were used in statistical modelling. Utilities and health-care costs were drawn from the literature. METHODS In two meta-analyses, we used prospective studies to examine associations of lipids with CVD and mortality, and randomised controlled trials to estimate lipid-lowering effects of atorvastatin doses. Patient-level data were used to estimate progression and variability of lipid measurements over time, and hence to model lipid-monitoring strategies. Results are expressed as rates of true-/false-positive and true-/false-negative tests for high lipid or high CVD risk. We estimated incremental costs per quality-adjusted life-year. RESULTS A total of 115 publications reported strength of association between different lipid measures and CVD events in 138 data sets. The summary adjusted hazard ratio per standard deviation of total cholesterol (TC) to high-density lipoprotein (HDL) cholesterol ratio was 1.25 (95% confidence interval 1.15 to 1.35) for CVD in a primary prevention population but heterogeneity was high (I(2) = 98%); similar results were observed for non-HDL cholesterol, apolipoprotein B and other ratio measures. Associations were smaller for other single lipid measures. Across 10 trials, low-dose atorvastatin (10 and 20 mg) effects ranged from a TC reduction of 0.92 mmol/l to 2.07 mmol/l, and low-density lipoprotein reduction of between 0.88 mmol/l and 1.86 mmol/l. Effects of 40 mg and 80 mg were reported by one trial each. For primary prevention, over a 3-year period, we estimate annual monitoring would unnecessarily treat 9 per 1000 more men (28 vs. 19 per 1000) and 5 per 1000 more women (17 vs. 12 per 1000) than monitoring every 3 years. However, annual monitoring would also undertreat 9 per 1000 fewer men (7 vs. 16 per 1000) and 4 per 1000 fewer women (7 vs. 11 per 1000) than monitoring at 3-year intervals. For secondary prevention, over a 3-year period, annual monitoring would increase unnecessary treatment changes by 66 per 1000 men and 31 per 1000 women, and decrease undertreatment by 29 per 1000 men and 28 per 1000 men, compared with monitoring every 3 years. In cost-effectiveness, strategies with increased screening/monitoring dominate. Exploratory analyses found that any unknown harms of statins would need utility decrements as large as 0.08 (men) to 0.11 (women) per statin user to reverse this finding in primary prevention. LIMITATION Heterogeneity in meta-analyses. CONCLUSIONS While acknowledging known and potential unknown harms of statins, we find that more frequent monitoring strategies are cost-effective compared with others. Regular lipid monitoring in those with and without CVD is likely to be beneficial to patients and to the health service. Future research should include trials of the benefits and harms of atorvastatin 40 and 80 mg, large-scale surveillance of statin safety, and investigation of the effect of monitoring on medication adherence. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003727. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rafael Perera
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emily McFadden
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie McLellan
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tom Lung
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Philip Clarke
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Teresa Pérez
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas Fanshawe
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Dalton
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Farmer
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Osamu Takahashi
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | | | - Les Irwig
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Jennifer Hirst
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Stevens
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Asuka Leslie
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Sachiko Ohde
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Gautam Deshpande
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Kevin Urayama
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Brian Shine
- Oxford University Hospitals Trust, Oxford, UK
| | - Richard Stevens
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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22
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Hong YF, Kim H, Kim HS, Park WJ, Kim JY, Chung DK. Lactobacillus acidophilus K301 Inhibits Atherogenesis via Induction of 24 (S), 25-Epoxycholesterol-Mediated ABCA1 and ABCG1 Production and Cholesterol Efflux in Macrophages. PLoS One 2016; 11:e0154302. [PMID: 27120199 PMCID: PMC4847857 DOI: 10.1371/journal.pone.0154302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 04/11/2016] [Indexed: 12/30/2022] Open
Abstract
Lactobacillus acidophilus species are well-known probiotics with the beneficial activity of regulating cholesterol levels. In this study, we showed that L. acidophilus K301 reduced the level of cholesterol through reverse transport in macrophages. L. acidophilus K301 upregulated the mRNA and protein levels of genes such as ATP-binding cassette A1 (ABCA1) and ATP-binding cassette G1 (ABCG1) under the control of liver X receptor (LXR), resulting in increased apoA-I-dependent cholesterol efflux in phorbol 12-myristate 13-acetate (PMA)-differentiated THP-1 cells. L. acidophilus K301 induced both ABCA1 and ABCG1 through the endogenous LXR agonist 24(S), 25-epoxcycholesterol, which is synthesized by intracellular cholesterol synthetic pathways. In vivo studies using L. acidophilus K301-treated ApoE-/- mice showed reduced accumulation of lipoproteins in the arterial lumen. The inhibitory effects of L. acidophilus K301 on accumulation of lipoprotein in atherosclerotic plaques were mediated by the induction of squalene reductase (SQLE) and oxidosqualene cyclase (OSC) and resulted in ABCA1-mediated cholesterol efflux. Taken together, our findings revealed that Lactobacillus acidophilus K301 regulates the expression of genes related to cholesterol reverse transport via the induction of endogenous LXR agonist, suggesting the therapeutic potential of Lactobacillus acidophilus K301 as an anti-atherosclerotic agent.
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Affiliation(s)
- Yi-Fan Hong
- Graduate School of Biotechnology and Institute of Life Science and Resources, Kyung Hee University, Yongin, 446–701, Republic of Korea
- Skin Biotechnology Center, Kyung Hee University, Yongin, 446–701, Republic of Korea
| | - Hangeun Kim
- Graduate School of Biotechnology and Institute of Life Science and Resources, Kyung Hee University, Yongin, 446–701, Republic of Korea
- Skin Biotechnology Center, Kyung Hee University, Yongin, 446–701, Republic of Korea
| | - Hye Sun Kim
- Graduate School of Biotechnology and Institute of Life Science and Resources, Kyung Hee University, Yongin, 446–701, Republic of Korea
| | - Woo Jung Park
- Graduate School of Biotechnology and Institute of Life Science and Resources, Kyung Hee University, Yongin, 446–701, Republic of Korea
| | - Joo-Yun Kim
- Graduate School of Biotechnology and Institute of Life Science and Resources, Kyung Hee University, Yongin, 446–701, Republic of Korea
- * E-mail: (JYK); (DKC)
| | - Dae Kyun Chung
- Graduate School of Biotechnology and Institute of Life Science and Resources, Kyung Hee University, Yongin, 446–701, Republic of Korea
- Skin Biotechnology Center, Kyung Hee University, Yongin, 446–701, Republic of Korea
- RNA Inc., #308 Life Sceince Building, Kyung Hee University Global Campus, Yongin, 446–701, Republic of Korea
- * E-mail: (JYK); (DKC)
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23
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Naito R, Miyauchi K, Konishi H, Tsuboi S, Ogita M, Dohi T, Kasai T, Tamura H, Okazaki S, Isoda K, Daida H. Appropriate Level of Low-Density Lipoprotein Cholesterol for Secondary Prevention of Coronary Artery Disease. J Atheroscler Thromb 2015; 23:413-21. [PMID: 26558399 DOI: 10.5551/jat.32284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Current Japanese guidelines state the target level of low-density lipoprotein cholesterol (LDL-C) of <100mg/dL for secondary prevention of coronary artery disease (CAD). However, this level was set considering the results of trials mainly conducted in Western countries. In addition, the effect of achieving target LDL-C on secondary prevention is unknown. METHODS We examined the effects of achieving target LDL-C on clinical outcomes. Patients who underwent percutaneous coronary intervention at Juntendo University Hospital (Tokyo, Japan) from 2004 to 2010 and received follow-up coronary angiography (CAG) were analyzed. The study population was divided into two groups based on the follow-up LDL-C. The incidence of major adverse cardiovascular events within 3 years after the follow-up CAG was examined. RESULTS A total of 1321 consecutive patients were enrolled. Sixty-three percent of the patients achieved the target LDL-C. The rate of 3-year events was lower in the group that achieved the target LDL-C (achieved group). The adjusted relative risk reduction in the achieved group was 26% (p=0.02). In the sub-analysis among the four groups stratified by baseline LDL-C of 140 and follow-up LDL-C of 100, the adjusted hazard ratio for 3-year events was 1.84 (95% confidence interval; 1.10-3.24)in Group 3 (baseline <140, follow-up ≥100) and 2.05 (1.18-3.74) Group 4 (baseline ≥140, follow-up ≥100) [Group 2 (baseline ≥140, follow-up <100) as reference]. CONCLUSIONS Our data suggested that follow-up LDL-C <100mg/dL was appropriate for secondary prevention of CAD in Japanese population.
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Affiliation(s)
- Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
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24
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Mediators of the effect of body mass index on coronary heart disease: decomposing direct and indirect effects. Epidemiology 2015; 26:153-62. [PMID: 25643095 DOI: 10.1097/ede.0000000000000234] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of overweight and obesity is rising globally and together they constitute a major risk factor for coronary heart disease (CHD). Previous estimates of direct effects of high body mass index (BMI) on CHD did not consider an interaction between BMI and its mediators and did not include inflammatory biomarkers as potential mediators. METHODS We analyzed data from 9 prospective cohort studies with 58,322 participants and 9,459 CHD events and decomposed the total effects into natural direct and indirect effects using a 2-stage regression model. We examined overweight (BMI = 25 to <30 kg/m) separately. We pooled hazard ratios using random-effects models and calculated the percentages of excess relative risk mediated by blood pressure, cholesterol, glucose, fibrinogen and high-sensitive C-reactive protein. RESULTS There was no interaction between BMI and its mediators in the multiplicative scale (P < 0.05 for all). Blood pressure was the most important mediator. The percentage of excess relative risk of overweight (versus normal BMI, 20 to <25 kg/m) mediated was 28% for blood pressure, 10% for blood glucose, and 14% for cholesterol. The same percentages for obesity were 37% for blood pressure, 17% for blood glucose, and 6% for cholesterol. The percentage mediated through all three metabolic risk factors together was 47% (95% confidence interval = 33%-63%) for overweight and 52% (38%-68%) for obesity. Fibrinogen mediated 6% to 9% and high-sensitive C-reactive protein mediated 6% to 8% of the excess relative risk for overweight and obese participants. CONCLUSIONS Metabolic mediators explain about half of the adverse effects of high BMI on CHD. The role of inflammatory and prothrombotic biomarkers is much smaller than that of metabolic factors.
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Masudi S, Yavari P, Mehrabi Y, Azizi F, Khalili D, Hadaegh F. Underestimating the Effect of Lipids on Cardiovascular Events: Regression Dilution Bias in the Population-Based Cohort of Tehran Lipid and Glucose Study. Int J Endocrinol Metab 2015; 13:e27528. [PMID: 26587030 PMCID: PMC4648128 DOI: 10.5812/ijem.27528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/03/2015] [Accepted: 05/31/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Random errors in the measurement of risk factors lead to bias in the exposure-disease association. OBJECTIVES This study aimed to examine the extent of underestimation in the association of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG) with cardiovascular disease (CVDs) in the Tehran Lipid and Glucose Study. PATIENTS AND METHODS Of 6327 eligible people in the original cohort followed for about 10 years to detect CVD events, 3063 (1224 men and 1839 women) had replicate measurements for blood lipids. Two regression dilution ratios were calculated by nonparametric and parametric methods, using replicate data from reexaminations three and six years after baseline. Adjusted and unadjusted hazard ratios (HR) were corrected for regression dilution bias. RESULTS By parametric method, based on reexamination three years after baseline, the strength of real association of usual levels of TC, TG and HDL-C with cardiovascular disease, considering β coefficients of related models, were underestimated about 42%, 51% and 81% in men and 40%, 43% and 62% in women, respectively. Underestimations were relatively independent of age, sex and body mass index. Correction for regression dilution bias led to more than 60% increase in estimated HR for TC adjusted for confounders. CONCLUSIONS Using baseline measurements of lipids led to considerable underestimation in the association of these factors with CVD outcome in TLGS. The underestimation increased with time interval between baseline and follow-up measurements for TC and TG. TC had more attenuation on estimated HR due to stronger relation with CVD risk.
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Affiliation(s)
- Sima Masudi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Parvin Yavari
- Department of Health and Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Davood Khalili, Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. P O Box: 19395-4763. Tel: +98-2122432500, Fax: +98-2122416264, E-mail:
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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26
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Jo SY, Choi EA, Lee JJ, Chang HC. Characterization of starter kimchi fermented with Leuconostoc kimchii GJ2 and its cholesterol-lowering effects in rats fed a high-fat and high-cholesterol diet. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2015; 95:2750-2756. [PMID: 25425317 DOI: 10.1002/jsfa.7018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 11/06/2014] [Accepted: 11/20/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The hypocholesterolemic effects of lactic acid bacteria and kimchi have been demonstrated previously. However, the kimchi fermentation process still relies on naturally present microorganisms. To obtain functional kimchi with consistent quality, we validated the capacity of Leuconostoc kimchii GJ2 as a starter culture to control kimchi fermentation. Moreover, cholesterol-lowering effects of starter kimchi as a health-promoting product were explored. RESULTS Bacteriocin production by Lc. kimchii GJ2 was highly enhanced in the presence of 5% Lactobacillus sakei NJ1 cell fractions. When kimchi was fermented with bacteriocin-enhanced Lc. kimchii GJ2, Lc. kimchii GJ2 became overwhelmingly predominant (98.3%) at the end of fermentation and maintained its dominance (up to 82%) for 84 days. Growing as well as dead cells of Lc. kimchii GJ2 showed high cholesterol assimilation (in vitro). Rats were fed a high-fat and high-cholesterol diet supplemented with starter kimchi. The results showed that feeding of starter kimchi significantly reduced serum total cholesterol, triglyceride and low-density lipoprotein cholesterol levels. Additionally, atherogenic index, cardiac risk factor and triglyceride and total cholesterol levels in liver and epididymal adipose tissue decreased significantly in rats fed starter kimchi. CONCLUSION Kimchi fermented with Lc. kimchii GJ2 as a starter culture has efficient cholesterol-lowering effects.
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Affiliation(s)
- Se Yeon Jo
- Department of Food and Nutrition, and Kimchi Research Center, Chosun University, Gwangju 501-759, Republic of Korea
| | - Eun A Choi
- Department of Food and Nutrition, and Kimchi Research Center, Chosun University, Gwangju 501-759, Republic of Korea
| | - Jae Joon Lee
- Department of Food and Nutrition, and Kimchi Research Center, Chosun University, Gwangju 501-759, Republic of Korea
| | - Hae Choon Chang
- Department of Food and Nutrition, and Kimchi Research Center, Chosun University, Gwangju 501-759, Republic of Korea
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27
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Zavišić G, Ristić S, Petrièević S, Novaković Jovanović J, Radulović Ž, Janać Petković B, Strahinić I, Piperski V. Characterisation and preliminary lipid-lowering evaluation of Lactobacillus isolated from a traditional Serbian dairy product. Benef Microbes 2015; 6:119-28. [PMID: 24889894 DOI: 10.3920/bm2014.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We investigated the potential probiotic properties of indigenous lactic acid bacteria (LAB) isolated from Serbian homemade cheese. Seventeen LAB strains were isolated and characterised using standard protocols. One of the strains showed several probiotic properties: survival at low pH and in bile salts solution, antimicrobial activity, susceptibility to antibiotics and adhesion to hexodecane. DNA analysis identified the isolate as Lactobacillus casei, hereafter named L. casei 5s. The lipid lowering effect of L. casei 5s was evaluated in vivo using a hyperlipidemic rat model. Orally administered L. casei 5s significantly decreased the elevated total serum cholesterol and triglycerides, and attenuated macro vesicular steatosis in the liver. Moreover, L. casei 5s improved the intestinal microbial balance in favour of lactobacilli, while decreasing the number of Escherichia coli cells. The bacteria were re-isolated and identified from the surface of the intestinal mucosa and from the faecal samples of treated animals, indicating adhesiveness and colonisation ability. The results of an acute oral toxicity study in mice and the absence of translocation to other organs demonstrated the safety of the strain. In conclusion, L. casei 5s demonstrated promising probiotic potential and might be a good candidate for more detailed investigations.
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Affiliation(s)
- G Zavišić
- Galenika a.d., R×D Institute, Batajnièki drum bb, 11080 Belgrade, Serbia
| | - S Ristić
- Galenika a.d., R×D Institute, Batajnièki drum bb, 11080 Belgrade, Serbia
| | - S Petrièević
- Galenika a.d., R×D Institute, Batajnièki drum bb, 11080 Belgrade, Serbia
| | | | - Ž Radulović
- Galenika a.d., R×D Institute, Batajnièki drum bb, 11080 Belgrade, Serbia
| | - B Janać Petković
- Institute for Biological Research 'Siniša Stanković', University of Belgrade, Bulevar Despota Stefana 142, 11060 Belgrade, Serbia
| | - I Strahinić
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444a, 11010 Belgrade, Serbia
| | - V Piperski
- Galenika a.d., R×D Institute, Batajnièki drum bb, 11080 Belgrade, Serbia
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Xie Y, Zhang H, Liu H, Xiong L, Gao X, Jia H, Lian Z, Tong N, Han T. Hypocholesterolemic effects of Kluyveromyces marxianus M3 isolated from Tibetan mushrooms on diet-induced hypercholesterolemia in rat. Braz J Microbiol 2015; 46:389-95. [PMID: 26273253 PMCID: PMC4507530 DOI: 10.1590/s1517-838246220131278] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 09/14/2014] [Indexed: 01/25/2023] Open
Abstract
To investigate the effects of Kluyveromyces marxianus M3
isolated from Tibetan mushrooms on diet-induced hypercholesterolemia in rats,
female Wistar rats were fed a high-cholesterol diet (HCD) for 28 d to generate
hyperlipidemic models. Hyperlipidemic rats were assigned to four groups, which
were individually treated with three different dosages of K.
marxianus M3+HCD or physiological saline+HCD via oral gavage for 28
d. The total cholesterol (TC), triglycerides (TG), high-density lipoprotein
cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels in
the serum and liver of the rats were measured using commercially available
enzyme kits. In addition, the liver morphology was also examined using
hematoxylin and eosin staining and optical microscopy. According to our results,
the serum and liver TC, TG, LDL-C levels and atherogenic index (AI) were
significantly decreased in rats orally administered K.
marxianus M3 (p <0.01), and the HDL-C levels and anti
atherogenic index (AAI) were significantly increased (p <0.01) compared to
the control group. Moreover, K. marxianus M3 treatment also
reduced the build-up of lipid droplets in the liver and exhibited normal
hepatocytes, suggesting a protective effect of K. marxianus M3
in hyperlipidemic rats.
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Affiliation(s)
- Yuanhong Xie
- Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China, Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Hongxing Zhang
- Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China, Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Hui Liu
- Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China, Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Lixia Xiong
- Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China, Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Xiuzhi Gao
- Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China, Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Hui Jia
- Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China, Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
| | - Zhengxing Lian
- China Agriculture University, College of Animal Science & Technology, China Agricultural University, Beijing, China, College of Animal Science & Technology, China Agricultural University, Beijing, China
| | - Nengsheng Tong
- Beijing China Investment Corporation Clinical Laboratory, Beijing, China, Beijing China Investment Corporation Clinical Laboratory, Beijing, China
| | - Tao Han
- Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China, Beijing Laboratory of Food Quality and Safety, Faculty of Food Science and Engineering, Beijing University of Agriculture, Beijing, China
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Arcoraci V, Santoni L, Ferrara R, Furneri G, Cannata A, Sultana J, Moretti S, Di Luccio A, Tari DU, Pagliaro C, Corrao S, Tari M. Effect of an educational program in primary care: the case of lipid control in cardio-cerebrovascular prevention. Int J Immunopathol Pharmacol 2014; 27:351-63. [PMID: 25280026 DOI: 10.1177/039463201402700305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lowering blood cholesterol levels reduces the risk of coronary heart disease. However, the effect of interventions depends on the patients' adherence to treatment. Primary care plays an important role in the detection, treatment and monitoring of disease, therefore different educational programs (EP) have been implemented to improve disease management in general practice. The present study is aimed to assess whether a general practitioner auditing and feedback EP may improve dyslipidaemia management in a primary care setting and to evaluate patients' adherence to prescribed lipid-lowering treatment. The quality of cardiovascular and cerebrovascular disease prevention before and after the implementation of an EP offered to 25 general practitioners (GPs), was evaluated. Clinical and prescription data on patients receiving at least one lipid-lowering treatment was collected. To evaluate the quality of the healthcare service provided, clinical and biochemical outcomes, and drug-utilization, process indicators were set up. Adherence was evaluated before and after the EP as the "Medication Possession Ratio" (MPR). A correlation analysis was carried out to estimate the effect of the MPR in achieving pre-defined clinical end-points. Prescription data for lipid-lowering drugs was collected in a sample of 839 patients. While no differences in the achievement of blood lipid targets were observed, a slight but significant improvement of the MPR was registered after the EP (MPR >0.8=64.2% vs 60.6%, p=0.0426). Moreover, high levels of statin adherence were associated with the achievement of total blood cholesterol target (OR=3.3 for MPR >0.8 vs MPR <0.5, 95% CI:1.7-6.7) or LDL therapeutic goal (OR=3.3 for MPR >0.8 vs MPR <0.5, 95% CI:1.5-7.2). The EP partially improved the defined clinical targets; probably, a more patient-based approach could be more appropriate to achieve the defined target. Further studies are needed to identify how healthcare services can be improved.
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Affiliation(s)
- V Arcoraci
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Italy
| | - L Santoni
- Pfizer, Department of Outcome Research Roma, Italy
| | - R Ferrara
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Italy
| | - G Furneri
- Italian National Research Center on Aging (I.N.R.C.A.), Scientific Direction Ancona, Italy
| | - A Cannata
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Italy
| | - J Sultana
- Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Italy
| | - S Moretti
- "Caserta-1" Local Health Unit, Italy
| | | | - D U Tari
- "Caserta-1" Local Health Unit, Italy
| | | | - S Corrao
- Di.Bi.MIS, University of Palermo, Internal Medicine Division ARNAS Civico, Palermo, Italy
| | - M Tari
- "Caserta-1" Local Health Unit, Italy
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Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol 2014; 2:634-47. [PMID: 24842598 PMCID: PMC4572741 DOI: 10.1016/s2213-8587(14)70102-0] [Citation(s) in RCA: 524] [Impact Index Per Article: 52.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. METHODS We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. FINDINGS In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. INTERPRETATION The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. FUNDING UK Medical Research Council, US National Institutes of Health.
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Soran H, Schofield JD, Durrington PN. The importance of considering LDL cholesterol response as well as cardiovascular risk in deciding who can benefit from statin therapy. Curr Opin Lipidol 2014; 25:239-46. [PMID: 24978144 DOI: 10.1097/mol.0000000000000097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Guidelines seeking to deploy statin treatment rely heavily on the use of estimates of absolute cardiovascular disease (CVD) risk as an arbiter of who should receive statins. We question whether this is an effective strategy unless the LDL-cholesterol (LDL-C) response is also considered. RECENT FINDINGS Recently, meta-analyses of randomized clinical trials of statins have revealed that CVD risk decreases linearly by 22% for each 1 mmol/l reduction in LDL-C. Calculation of the number needed to treat with statins to prevent one CVD event using both the pretreatment absolute CVD risk and the LDL-C response that can be achieved is thus possible. Application of this evidence reveals that many people (including younger ones) with high LDL-C levels can benefit more than people currently receiving statin treatment solely on the basis of their absolute CVD risk, whereas others at higher CVD risk, but with lower LDL-C, will derive little benefit. This does not seem to have been adequately considered in recent clinical guidelines. SUMMARY A simple additional mathematical step in risk assessment to take account of the LDL-C response to statins and provide knowledge of number needed to treat would greatly improve individual management, cost-effectiveness and the population impact of statins.
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Affiliation(s)
- Handrean Soran
- aCardiovascular Research Group, School of Biomedicine, University of Manchester, bCardiovascular Trials Unit, University Department of Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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32
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Cholesterol-lowering effect of Lactobacillus plantarum NCU116 in a hyperlipidaemic rat model. J Funct Foods 2014. [DOI: 10.1016/j.jff.2014.03.031] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Szymczyk I, Wojtyna E, Lukas W, Kępa J, Pawlikowska T. How does gender influence the recognition of cardiovascular risk and adherence to self-care recommendations?: A study in Polish primary care. BMC FAMILY PRACTICE 2013; 14:165. [PMID: 24175983 PMCID: PMC3818445 DOI: 10.1186/1471-2296-14-165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 10/29/2013] [Indexed: 11/24/2022]
Abstract
Background Studies have shown a correlation between gender and an ability to change lifestyle to reduce the risk of disease. However, the results of these studies are ambiguous, especially where a healthy lifestyle is concerned. Additionally, health behaviors are strongly modified by culture and the environment. Psychological factors also substantially affect engagement with disease-related lifestyle interventions. This study aimed to examine whether there are differences between men and women in the frequency of health care behavior for the purpose of reducing cardiovascular risk (CVR), as well as cognitive appraisal of this type of risk. We also aimed to identify the psychological predictors of engaging in recommended behavior for reducing the risk of cardiovascular disease after providing information about this risk in men and women. Methods A total of 134 consecutive eligible patients in a family practice entered a longitudinal study. At initial consultation, the individual’s CVR and associated health burden was examined, and preventive measures were recommended by the physician. Self-care behavior, cognitive appraisal of risk, and coping styles were then assessed using psychological questionnaires. Six months after the initial data collection, the frequency of subjects’ self-care behavior was examined. Results We found an increase in health care behavior after providing information regarding the rate of CVR in both sexes; this increase was greater for women than for men. Women followed self-care guidelines more often than men, particularly for preventive measures and dietary advice. Women were more inclined to recognize their CVR as a challenge. Coping style, cognitive appraisal, age, level of health behaviors at baseline and CVR values accounted for 48% of the variance in adherence to self-care guidelines in women and it was 52% in men. In women, total risk of CVD values were most important, while in men, cognitive appraisal of harm/loss was most important. Conclusions Different predictors of acquisition of health behavior are encountered in men and women. Our results suggest that gender-adjusted motivation models influencing the recognition process need to be considered to optimize compliance in patients with CVR.
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Affiliation(s)
| | - Ewa Wojtyna
- Institute of Psychology, University of Silesia in Katowice, ul, Grażyńskiego 53, 40-126 Katowice, Poland.
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Cassagnol M, Ezzo D, Patel PN. New therapeutic alternatives for the management of dyslipidemia. J Pharm Pract 2013; 26:528-40. [PMID: 24142496 DOI: 10.1177/0897190013507582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Hypercholesterolemia affects over 34 million adults in the United States and is a major cause of coronary heart disease (CHD). Conventional therapies, such as statins, have demonstrated their ability to improve clinical end points and decrease morbidity and mortality in patients with CHD. Lomitapide (Juxtapid(®)), mipomersen (Kynamro(®)), and icosapent (Vascepa(®)) are 3 novel agents approved by the US Food and Drug Administration in the past 2 years, which offer new lipid-lowering treatment options with unique pharmacology.
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Affiliation(s)
- Manouchkathe Cassagnol
- St. John's University, College of Pharmacy and Health Sciences, Department of Clinical Pharmacy Practice, Queens, New York, USA and Long Island Jewish Medical Center, Department of Pharmacy, New Hyde Park, New York, USA
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Wormser D, White IR, Thompson SG, Wood AM. Within-person variability in calculated risk factors: comparing the aetiological association of adiposity ratios with risk of coronary heart disease. Int J Epidemiol 2013; 42:849-59. [PMID: 23918853 PMCID: PMC3733701 DOI: 10.1093/ije/dyt077] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Within-person variability in measured values of a risk factor can bias its association with disease. We investigated the extent of regression dilution bias in calculated variables and its implications for comparing the aetiological associations of risk factors. METHODS Using a numerical illustration and repeats from 42,300 individuals (12 cohorts), we estimated regression dilution ratios (RDRs) in calculated risk factors [body-mass index (BMI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)] and in their components (height, weight, waist circumference, and hip circumference), assuming the long-term average exposure to be of interest. Error-corrected hazard ratios (HRs) for risk of coronary heart disease (CHD) were compared across adiposity measures per standard-deviation (SD) change in: (i) baseline and (ii) error-corrected levels. RESULTS RDRs in calculated risk factors depend strongly on the RDRs, correlation, and comparative distributions of the components of these risk factors. For measures of adiposity, the RDR was lower for WHR [RDR: 0.72 (95% confidence interval 0.65-0.80)] than for either of its components [waist circumference: 0.87 (0.85-0.90); hip circumference: 0.90 (0.86-0.93) or for BMI: 0.96 (0.93-0.98) and WHtR: 0.87 (0.85-0.90)], predominantly because of the stronger correlation and more similar distributions observed between waist circumference and hip circumference than between height and weight or between waist circumference and height. Error-corrected HRs for BMI, waist circumference, WHR, and WHtR, were respectively 1.24, 1.30, 1.44, and 1.32 per SD change in baseline levels of these variables, and 1.24, 1.27, 1.35, and 1.30 per SD change in error-corrected levels. CONCLUSIONS The extent of within-person variability relative to between-person variability in calculated risk factors can be considerably larger (or smaller) than in its components. Aetiological associations of risk factors should be compared through the use of error-corrected HRs per SD change in error-corrected levels of these risk factors.
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Affiliation(s)
- David Wormser
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Hu X, Wang T, Li W, Jin F, Wang L. Effects of NS Lactobacillus strains on lipid metabolism of rats fed a high-cholesterol diet. Lipids Health Dis 2013; 12:67. [PMID: 23656797 PMCID: PMC3667092 DOI: 10.1186/1476-511x-12-67] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/07/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Elevated serum cholesterol level is generally considered to be a risk factor for the development of cardiovascular diseases which seriously threaten human health. The cholesterol-lowering effects of lactic acid bacteria have recently become an area of great interest and controversy for many researchers. In this study, we investigated the effects of two NS lactobacillus strains, Lactobacillus plantarum NS5 and Lactobacillus delbrueckii subsp. bulgaricus NS12, on lipid metabolism of rats fed a high cholesterol diet. METHODS Thirty-two SD rats were assigned to four groups and fed either a normal or a high-cholesterol diet. The NS lactobacillus treated groups received the high-cholesterol diet supplemented with Lactobacillus plantarum NS5 or Lactobacillus delbrueckii subsp. bulgaricus NS12 in drinking water. The rats were sacrificed after a 6-week feeding period. Body weights, visceral organ and fat weights, serum and liver cholesterol and lipid levels, intestinal microbiota and liver mRNA expression levels related to cholesterol metabolism were analyzed. Liver lipid deposition and adipocyte size were evaluated histologically. RESULTS Compared with rats fed a high cholesterol diet, serum total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B and free fatty acids levels were decreased and apolipoprotein A-I level was increased in NS5 or NS12 strain treated rats, and with no significant change in high-density lipoprotein cholesterol level. Liver cholesterol and triglyceride levels were also significantly decreased in NS lactobacillus strains treated groups. Meanwhile, the NS lactobacillus strains obviously alleviated hepatic injuries, decreased liver lipid deposition and reduced adipocyte size of high cholesterol diet fed rats. NS lactobacillus strains restored the changes in intestinal microbiota compositions, such as the increase in Bacteroides and the decrease in Clostridium. NS lactobacillus strains also regulated the mRNA expression levels of liver enzymes related to cholesterol metabolism, including the down regulation of acyl-CoA:cholesterol acyltransferase (ACAT) and the upregulation of cholesterol 7α-hydroxylase (CYP7A1). CONCLUSION This study suggested that the two NS lactobacillus strains may affect lipid metabolism and have cholesterol-lowering effects in rats fed a high cholesterol diet.
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Affiliation(s)
- Xu Hu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Huang Y, Wang X, Wang J, Wu F, Sui Y, Yang L, Wang Z. Lactobacillus plantarum strains as potential probiotic cultures with cholesterol-lowering activity. J Dairy Sci 2013; 96:2746-53. [PMID: 23498020 DOI: 10.3168/jds.2012-6123] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 12/19/2012] [Indexed: 11/19/2022]
Abstract
Elevated blood cholesterol is an important risk factor associated with atherosclerosis and coronary heart disease. The search for mediators that fine-tune cholesterol homeostasis has revealed lactic acid bacteria (LAB) to be potentially beneficial. The aim of the present study was to identify and characterize probiotic strains with bile salt hydrolase activity from kefir grains and evaluate their potential use as cholesterol-reducing probiotics in rats. Two isolates, Lp09 and Lp45, obtained from kefir grains were identified as Lactobacillus plantarum via molecular typing methods. Lactobacillus plantarum Lp09 and Lp45 exhibited excellent tolerance to low pH levels and high bile salt concentrations and showed potential bile salt hydrolase activity, bile salt deconjugation activity, and cholesterol coprecipitation ability. Additionally, the potential effect of Lb. plantarum Lp09 and Lp45 on plasma cholesterol levels was evaluated in Sprague-Dawley rats. Rats in 3 treatment groups were fed different experimental diets: a high-cholesterol diet, a high-cholesterol diet plus Lb. plantarum Lp09, or a high-cholesterol diet plus Lb. plantarum Lp45 for 4 wk. Total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels in serum as well as cholesterol and triglyceride levels in liver were significantly decreased in the LAB-treated rats compared with rats fed a high-cholesterol diet without LAB supplementation. Also, both fecal cholesterol and bile acid levels were significantly increased after LAB administration. No significant changes were detected in high-density lipoprotein cholesterol levels. These results suggest that the Lb. plantarum Lp09 and Lp45 strains present the potential to be explored as probiotic agents for the management of hypercholesterolemia.
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Affiliation(s)
- Ying Huang
- Central Research Laboratory, Second Hospital of Jilin University, Changchun 130041, People's Republic of China
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Banjoko IO, Adeyanju MM, Ademuyiwa O, Adebawo OO, Olalere RA, Kolawole MO, Adegbola IA, Adesanmi TA, Oladunjoye TO, Ogunnowo AA, Shorinola AA, Daropale O, Babatope EB, Osibogun AO, Ogunfowokan DT, Jentegbe TA, Apelehin TG, Ogunnowo O, Olokodana O, Fetuga FY, Omitola M, Okafor LA, Ebohon CL, Ita JO, Disu KA, Ogherebe O, Eriobu SU, Bakare AA. Hypolipidemic effects of lactic acid bacteria fermented cereal in rats. Lipids Health Dis 2012; 11:170. [PMID: 23231860 PMCID: PMC3548745 DOI: 10.1186/1476-511x-11-170] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 11/28/2012] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The objectives of the present study were to investigate the efficacy of the mixed culture of Lactobacillus acidophilus (DSM 20242), Bifidobacterium bifidum (DSM 20082) and Lactobacillus helveticus (CK60) in the fermentation of maize and the evaluation of the effect of the fermented meal on the lipid profile of rats. METHODS Rats were randomly assigned to 3 groups and each group placed on a Diet A (high fat diet into which a maize meal fermented with a mixed culture of Lb acidophilus (DSM 20242), B bifidum (DSM 20082) and Lb helveticus (CK 60) was incorporated), B (unfermented high fat diet) or C (commercial rat chow) respectively after the first group of 7 rats randomly selected were sacrificed to obtain the baseline data. Thereafter 7 rats each from the experimental and control groups were sacrificed weekly for 4 weeks and the plasma, erythrocytes, lipoproteins and organs of the rats were assessed for cholesterol, triglyceride and phospholipids. RESULTS Our results revealed that the mixed culture of Lb acidophilus (DSM 20242), B bifidum (DSM 20082) and Lb helveticus (CK 60) were able to grow and ferment maize meal into 'ogi' of acceptable flavour. In addition to plasma and hepatic hypercholesterolemia and hypertriglyceridemia, phospholipidosis in plasma, as well as cholesterogenesis, triglyceride constipation and phospholipidosis in extra-hepatic tissues characterized the consumption of unfermented hyperlipidemic diets. However, feeding the animals with the fermented maize diet reversed the dyslipidemia. CONCLUSION The findings of this study indicate that consumption of mixed culture lactic acid bacteria (Lb acidophilus (DSM 20242), Bifidobacterium bifidum (DSM 20082) and Lb helveticus (CK 60) fermented food results in the inhibition of fat absorption. It also inhibits the activity of HMG CoA reductase. This inhibition may be by feedback inhibition or repression of the transcription of the gene encoding the enzyme via activation of the sterol regulatory element binding protein (SREBP) transcription factor. It is also possible that consumption of fermented food enhances conversion of cholesterol to bile acids by activating cholesterol-7α-hydroxylase.
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Bruthans J, Cífková R, Lánská V, O'Flaherty M, Critchley JA, Holub J, Janský P, Zvárová J, Capewell S. Explaining the decline in coronary heart disease mortality in the Czech Republic between 1985 and 2007. Eur J Prev Cardiol 2012. [PMID: 23180867 DOI: 10.1177/2047487312469476] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) mortality has declined substantially in the Czech Republic over the last two decades. DESIGN The purpose of this study was to determine what proportion of this CHD mortality decline could be associated with temporal trends in major CHD risk factors and what proportion with advances in medical and surgical treatments. METHODS The validated IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of CHD management and risk factor trends in the Czech Republic in adults aged 25-74 years between 1985 and 2007. The main sources were official statistics, national quality of care registries, published trials and meta-analyses, and the Czech MONICA and Czech post-MONICA studies. RESULTS Between 1985 and 2007, age-adjusted CHD mortality rates in the Czech Republic decreased by 66.2% in men and 65.4% in women in the age group 25-74 years, representing 12,080 fewer CHD deaths in 2007. Changes in CHD risk factors explained approximately 52% of the total mortality decrease, and improvements in medical treatments approximately 43%. Increases in body mass index and in diabetes prevalence had a negative impact, increasing CHD mortality by approximately 1% and 5%, respectively. CONCLUSIONS More than half of the very substantial fall in CHD mortality in the Czech Republic between 1985 and 2007 was attributable to reduction in major cardiovascular risk factors. Improvement in treatments accounted for approximately 43% of the total mortality decrease. These findings emphasize the value of primary prevention and evidence-based medical treatment.
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Affiliation(s)
- Jan Bruthans
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic Department of Medicine II, Charles University Medical School, Pilsen, Czech Republic
| | - Renata Cífková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic Centre for Cardiovascular Prevention, Thomayer Hospital and Charles University Medical School I, Prague, Czech Republic Department of Medicine II, Charles University Medical School I, Prague, Czech Republic International Clinical Research Centre Brno, Czech Republic
| | - Věra Lánská
- Medical Statistics Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | - Jiří Holub
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Petr Janský
- Department of Cardiovascular Surgery, Charles University Medical School II and Motol University Hospital, Prague, Czech Republic
| | - Jana Zvárová
- Centre of Biomedical Informatics, Institute of Computer Science, Academy of Sciences of the Czech Republic, Prague, Czech Republic
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Manufacture of Cheddar cheese using probiotic Lactobacillus plantarum K25 and its cholesterol-lowering effects in a mice model. World J Microbiol Biotechnol 2012; 29:127-35. [DOI: 10.1007/s11274-012-1165-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/29/2012] [Indexed: 11/25/2022]
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Messina M, Messina V, Jenkins DJA. Can breast cancer patients use soyafoods to help reduce risk of CHD? Br J Nutr 2012; 108:810-9. [PMID: 22874526 DOI: 10.1017/s0007114512001900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Over the past 20 years, the popularity of soyafoods has increased in part because of research suggesting that these foods convey health benefits independent of their nutrient content. For example, in 1999, the US Food and Drug Administration approved a health-claim for soyafoods and CHD based on the hypocholesterolaemic effects of soya protein. However, soyafoods have become controversial in recent years because of concerns that their uniquely rich phyto-oestrogen (isoflavone) content may cause untoward effects in some individuals. Most notable in this regard is the concern that soyafoods are contraindicated for breast cancer patients and women at high risk of developing this disease. Furthermore, the hypocholesterolaemic effects of soya protein have been challenged. However, the results of recently published meta-analyses indicate that soya protein directly lowers circulating LDL-cholesterol levels by approximately 4 %. There is also intriguing evidence that soyafoods reduce CHD risk independent of their effects on lipid levels. In regard to the breast cancer controversy, recently published clinical and epidemiological data do not support observations in rodents that soyabean isoflavones increase breast cancer risk. In postmenopausal women, isoflavone exposure does not adversely affect breast tissue density or breast cell proliferation. Furthermore, both US and Chinese prospective epidemiological studies show that post-diagnosis soya consumption is associated with an improved prognosis. Therefore, soyafoods should be considered by women as healthy foods to include in diets aimed at reducing the risk of CHD regardless of their breast cancer status.
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Affiliation(s)
- Mark Messina
- School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA.
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Daou C, Zhang H. Oat Beta-Glucan: Its Role in Health Promotion and Prevention of Diseases. Compr Rev Food Sci Food Saf 2012. [DOI: 10.1111/j.1541-4337.2012.00189.x] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Sniderman AD, Lawler PR, Williams K, Thanassoulis G, de Graaf J, Furberg CD. The causal exposure model of vascular disease. Clin Sci (Lond) 2012; 122:369-73. [PMID: 22187965 PMCID: PMC3244267 DOI: 10.1042/cs20110449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 10/26/2011] [Accepted: 11/04/2011] [Indexed: 02/02/2023]
Abstract
Primary prevention of cardiovascular disease is governed at present by the risk factor model for cardiovascular events, a model which is widely accepted by physicians and professional associations, but which has important limitations: most critically, that effective treatment to reduce arterial damage is often delayed until the age at which cardiovascular events become common. This delay means that many of the early victims of vascular disease will not be identified in time. This delay also allows atherosclerosis to develop and progress unchecked within the arterial tree with the result that the absolute effectiveness of preventive therapy is limited by the time it is eventually initiated. The causal exposure model of vascular disease is an alternative to the risk factor model for cardiovascular events. Whereas the risk factor model aims to identify and treat those at markedly increased risk of vascular events within the next decade, the causal exposure model of vascular disease aims to prevent events by treating the causes of the disease when they are identified. In the risk factor model, age is an independent non-modifiable risk factor and the predictive power of age far outweighs that of the other risk factors. In the causal exposure model, age is the duration of time the arterial wall is exposed to the causes of atherosclerosis: apoB (apolipoprotein B) lipoproteins, hypertension, diabetes and smoking. Preventing the development of advanced atherosclerotic lesions by treating the causes of vascular disease is the simplest, surest and most effective way to prevent clinical events.
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Affiliation(s)
- Allan D Sniderman
- Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Montreal, QC, Canada.
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Carvajal-Zarrabal O, Barradas-Dermitz DM, Orta-Flores Z, Hayward-Jones PM, Nolasco-Hipólito C, Aguilar-Uscanga MG, Miranda-Medina A, Bujang KB. Hibiscus sabdariffa L., roselle calyx, from ethnobotany to pharmacology. J Exp Pharmacol 2012; 4:25-39. [PMID: 27186114 PMCID: PMC4863543 DOI: 10.2147/jep.s27974] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Using MEDLINE and SCOPUS databases, a review of the literature from the pioneering study of 1991 until 2010 was performed on the effects on biological models of Hibiscus sabdariffa L. roselle calyx, its extracts mainly in polar solvents, or pure components found in extracts, as well as their possible relationship to these effects. Three relevant effects on lipid metabolism, antihypertensive activity, and apoptosis were observed. Our chronological review of the studies mentioned in the literature provides another opportunity to see how humans compile scientific knowledge of a chemical structure-physiological activity relationship starting from an ethnobotanical-ethnopharmagognosy contribution. The chemical components that are the main active principles in the physiological activities of Hibiscus sabdariffa L. calyx are anthocyanins and polyphenols (protocatechuic acid and quercetin). Advances have also been made in the elucidation of action mechanisms. Additionally, it has become clear that the lack of standardization in terms of chemical components of the material arising from Hibiscus sabdariffa L. used in testing on biological models imposes limits on the possibility of carrying out comparative analyses between studies. Fortunately, more recent studies are overcoming this obstacle by reporting component concentrations of assumed active principles; however, complete analysis of the extract, if this is to be considered as a therapeutic agent, is not commonly reported in the aforesaid studies. If one of the eventual scenarios for Hibiscus sabdariffa L. calyx is as a therapeutic agent in communities with economic limitations, then studies of a pharmacological nature should guarantee the effectiveness, safety, and tolerability of this material, which is widely accepted to be associated with chemical complexity, thus making this knowledge necessary.
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Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TIL, Getz L. Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study. J Eval Clin Pract 2012; 18:159-68. [PMID: 21951982 PMCID: PMC3303886 DOI: 10.1111/j.1365-2753.2011.01767.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline. METHODS We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20-74, who participated in the Nord-Trøndelag Health Study (HUNT 2, 1995-1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total). RESULTS Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89-0.99 per 1.0 mmol L(-1) increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88-1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92-1.24) was not linear but seemed to follow a 'U-shaped' curve, with the highest mortality <5.0 and ≥7.0 mmol L(-1) . Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98-1.15) and in total (HR: 0.98; 95% CI: 0.93-1.03) followed a 'U-shaped' pattern. CONCLUSION Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.
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Affiliation(s)
- Halfdan Petursson
- Research Unit of General Practice, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Paynter NP, Crainiceanu CM, Sharrett AR, Chambless LE, Coresh J. Effect of correcting for long-term variation in major coronary heart disease risk factors: relative hazard estimation and risk prediction in the Atherosclerosis Risk in Communities Study. Ann Epidemiol 2012; 22:191-7. [PMID: 22221585 DOI: 10.1016/j.annepidem.2011.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 11/11/2011] [Accepted: 12/13/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the effect of correcting coronary heart disease (CHD) risk factors for long-term within-person variation on CHD risk. METHODS By using 5533 men and 7301 women from the Atherosclerosis Risk in Communities (ARIC) study, we compared models incorporating risk factors measured at a single visit and models incorporating additional measurements for systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol taken 3 years before baseline. RESULTS The largest change away from null was observed for systolic blood pressure, ie, hazard ratio (HR) 1.38 to 1.69 (+81%) in women and HR 1.26 to 1.41 (+56%) in men. HRs also decreased for age (-32% in women, -9% in men), race (-67% in women), the presence of diabetes (-13% in men and women), and medication use for hypertension (-27% in women, -26% in men) and cholesterol (-97% in women, HR 1.06-0.93 in men). The area under the ROC curve did not improve significantly in men or women, whereas reclassification was only significant in women (net reclassification improvement 5.4%, p = 0.016). CONCLUSIONS Modeling long-term variation in CHD risk factors had a substantial impact on HR estimates, with new effect estimates further from the null for some risk factors and closer for others including age and medication use, but only improved risk classification in women.
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Affiliation(s)
- Nina P Paynter
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
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Farzadfar F, Danaei G, Namdaritabar H, Rajaratnam JK, Marcus JR, Khosravi A, Alikhani S, Murray CJ, Ezzati M. National and subnational mortality effects of metabolic risk factors and smoking in Iran: a comparative risk assessment. Popul Health Metr 2011; 9:55. [PMID: 21989074 PMCID: PMC3229448 DOI: 10.1186/1478-7954-9-55] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 10/11/2011] [Indexed: 11/25/2022] Open
Abstract
Background Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC), and high body mass index (BMI) on mortality and life expectancy, nationally and subnationally, using representative data and comparable methods. Methods We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease-specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework. Results In 2005, high SBP was responsible for 41,000 (95% uncertainty interval: 38,000, 44,000) deaths in men and 39,000 (36,000, 42,000) deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years (2.6, 3.9) and 4.1 years (3.2, 4.9) in men and women, respectively; the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions. Discussion Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran. Interventions for other metabolic risk factors and smoking can also improve population health.
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Affiliation(s)
- Farshad Farzadfar
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK.
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Mochari-Greenberger H, Terry MB, Mosca L. Sex, age, and race/ethnicity do not modify the effectiveness of a diet intervention among family members of hospitalized cardiovascular disease patients. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:366-373. [PMID: 21906549 PMCID: PMC3172568 DOI: 10.1016/j.jneb.2011.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 12/22/2010] [Accepted: 01/22/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine whether effectiveness of a diet intervention for family members of cardiovascular disease patients varies by participant sex, race/ethnicity, or age because these characteristics have been associated with unique barriers to diet change. DESIGN Randomized controlled trial. SETTING AND PARTICIPANTS University medical center. Healthy adult family members of patients hospitalized with cardiovascular disease (n = 501; 66% women; 36% racial/ethnic minorities; mean age 48 years). INTERVENTION A special screening and educational intervention (SI) vs control intervention (CI) to reduce dietary saturated fat and cholesterol intake throughout 1 year. MAIN OUTCOME MEASURES Absolute change in MEDFICTS (meats, eggs, dairy, fried foods, fat in baked goods, convenience foods, fats added at the table and snacks) diet score, saturated fat, and dietary cholesterol in the SI vs CI from baseline to 1 year. ANALYSIS t tests stratified by sex, race/ethnicity, and age group; linear regression. Significance set at P < .05. RESULTS The SI was effective to improve MEDFICTS score independent of sex, race/ethnicity, and age group (β = -6.7; P < .001). There was no interaction between the SI and sex (β = .9; P = .84), race/ethnicity (β = -1.1; P = .81), or age group (β = -.6; P = .89) on change in MEDFICTS score or change in saturated fat or dietary cholesterol intake from baseline to 1 year. CONCLUSIONS AND IMPLICATIONS Results support the potential for a hospital-based screening and education program to improve diet in diverse populations of cardiovascular disease patient family members.
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Affiliation(s)
| | - Mary Beth Terry
- Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Lori Mosca
- Columbia University Medical Center, New York, NY 10032
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Shakur R, Sathasivam S, Yu C, Cheung I, Selvakumaran A, Anandarajah C, Shakur A, Kaler M, McElligott G. Optimizing secondary prevention: Statin prescribing across East and West London in accordance with NICE guidelines. JRSM SHORT REPORTS 2011; 2:63. [PMID: 21847445 PMCID: PMC3147237 DOI: 10.1258/shorts.2011.011027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives Statins are a well-known primary and secondary prevention drug for cardiovascular disease and NICE guidelines have been issued to identify key indicators for their use. An audit looking into statin prescribing for medical inpatients was carried out in two geographically distinct London hospitals. Design A prospective inpatient audit of medical prescription charts was performed. Blood results were reviewed for the inpatients during their admission to identify any contraindications for statin usage (rhabdomyolysis). The medical notes were also reviewed for patient refusal of statin therapy. Setting The study was carried out at two distinct hospitals in London. Whipps Cross University Hospital (WCUH) and Chelsea & Westminster Hospital (CWH) are located in East London and West London, respectively. Acute medical, surgical, obstetrics and gynaecology, paediatric and palliative wards were excluded. Participants A total of 309 inpatient medical notes and prescription chart data were collected from WCUH (n = 211) and CWH (n = 98). Main outcome measures High percentage of hospitalized patients are not prescribed statins despite clear clinical indications for their use. Regardless of geographical and socioeconomic factors between hospitals, statin prescribing remains suboptimal. Results The patient demographics in both hospitals were very similar; the mean age at WCUH was 78 ± 15 1SD while at CWH the mean age was 74 ± 15 1SD. The results showed that approximately one-third of patients (30% at WCUH and 33% at CWH) had at least one indication for statin therapy according to NICE guidelines and yet they were not prescribed a statin. Ten percent of patients at WCUH and 13% of patients at CWH had ischaemic heart disease (IHD) and yet were not prescribed statins. Conclusion Statin prescription is often overlooked in secondary care with patients being discharged without the appropriate assessment (NICE guidelines), which subsequently means repeat prescriptions are not provided by the GP. This study is the first to show that this problem is not due to resources or geography, but is inherent within the NHS system. Consequently, a revised prescription chart checking system has been suggested for pharmacists and junior doctors.
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Affiliation(s)
- Rameen Shakur
- Department of Medical Education, Barts and The London School of Medicine and Dentistry , London , UK
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Wright DFB, Pavan Kumar VV, Al-Sallami HS, Duffull SB. The Influence of Dosing Time, Variable Compliance and Circadian Low-Density Lipoprotein Production on the Effect of Simvastatin: Simulations from a Pharmacokinetic-Pharmacodynamic Model. Basic Clin Pharmacol Toxicol 2011; 109:494-8. [DOI: 10.1111/j.1742-7843.2011.00757.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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