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Heuchan GN, Lally PJ, Beeken RJ, Fisher A, Conway RE. Perception of a need to change weight in individuals living with and beyond breast, prostate and colorectal cancer: a cross-sectional survey. J Cancer Surviv 2024; 18:844-853. [PMID: 36701100 PMCID: PMC11081928 DOI: 10.1007/s11764-023-01333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/05/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE People living with and beyond cancer (LWBC) are advised to achieve a body mass index (BMI) within the healthy range (≥ 18.5 and < 25). Not perceiving a need for weight change may be a barrier to achieving a healthy weight. This study aimed to explore factors associated with perceived need for weight change among people LWBC. METHODS Adults diagnosed with breast, prostate, or colorectal cancer were recruited through National Health Service sites in Essex and London. Participants (N = 5835) completed the 'Health and Lifestyle After Cancer' survey, which included a question on perceived need to change weight. Associations between perceived need for weight change and BMI, and perceived need for weight change and health and demographic variables, were analyzed using chi-square tests and logistic regression, respectively. RESULTS The proportion of participants perceiving a need to lose weight differed according to BMI category: healthy weight (23%), overweight (64%), obese (85%) (P < 0.001). Having overweight or obesity but not perceiving a need to lose weight was associated with being older, male, non-white, not married or cohabiting, and having cancer that had spread, no formal qualifications, no comorbidities, and having received chemotherapy. CONCLUSIONS Perceived need to lose weight is prevalent among people LWBC with obesity and overweight. This group may be interested in weight management support. Demographic and health factors were associated with having obesity or overweight but not perceiving a need to lose weight. IMPLICATIONS FOR CANCER SURVIVORS Weight loss interventions for people LWBC are needed. A subset of people LWBC with overweight and obesity may need additional information or motivators to engage with weight management.
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Affiliation(s)
- Gabriella N Heuchan
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Phillippa J Lally
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
- Department of Psychology, University of Surrey, Guildford, Surrey, GU2 7HX, UK
| | - Rebecca J Beeken
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK.
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK.
| | - Abigail Fisher
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Rana E Conway
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
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2
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Moura L, Chahal J, Fernandez-Llimos F, Alves da Costa F, Antoniou S. Empowering pharmacists working in primary care through a cardiovascular disease clinical management course: Impact on practice. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:102117. [PMID: 38824814 DOI: 10.1016/j.cptl.2024.102117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is currently the leading cause of mortality and morbidity worldwide. A competent healthcare workforce working in primary care delivering disease management services efficiently is the cornerstone of well performing health systems, impacting patient outcomes positively. The aim of this study was to evaluate the effectiveness of a training course to support pharmacists working in General Practitioner (GP) practices; and to evaluate its impact on practice. METHODS A before and after evaluation model was employed to assess the effectiveness of training resorting to a survey exploring self-confidence and knowledge on clinical management of three CVD topics: Atrial Fibrillation (AF), Hypertension and hyperlipidaemia. Before and after training data (immediate and retained after 6 months) were analysed at the Primary Care Network (PCN) and GP Practice level of the pharmacists who took part in the training sessions. Data were analysed in IBM SPSS v.29 resorting to paired samples t-test and Cohen's d for estimation of the effect size. Independent samples t-tests were performed for a sample group of PCNs and GP practices with and without training (comparator group). RESULTS An improvement with large effect size was observed in pharmacists' self-confidence and knowledge related to the hypertension topic, suggesting potential practical benefit. For the topics of AF and hyperlipidaemia, pharmacists' confidence also increased with a large effect size, but for knowledge, the effect size of the increase was medium or small. Data suggests that pharmacists' practice has improved in both groups after 6 months, which suggests that it was not a sole result of the training. CONCLUSIONS This study provide evidence that the course improved pharmacists' knowledge and self-confidence, likely to contribute to performance in their clinical practice. Patients' clinical benefit is expected from pharmacists' improved capacity to effectively engage in medicines optimisation.
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Affiliation(s)
- L Moura
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal.
| | - J Chahal
- Barts Heart Centre, Pharmacy department, St. Bartholomew's Hospital, KGV Building, West Smithfields, EC1A 7BE London, United Kingdom.
| | - F Fernandez-Llimos
- Applied Molecular Biosciences Unit, (UCIBIO-i4HB) Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal.
| | - F Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal.
| | - S Antoniou
- Barts Heart Centre, Pharmacy department, St. Bartholomew's Hospital, KGV Building, West Smithfields, EC1A 7BE London, United Kingdom.
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3
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Ali S, Ho CY, Yang CC, Chou SH, Chen ZY, Huang WC, Shih TC. Computational fluid dynamics modeling of coronary artery blood flow using OpenFOAM: Validation with the food and drug administration benchmark nozzle model. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024:XST230239. [PMID: 38788116 DOI: 10.3233/xst-230239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Cardiovascular disease (CVD), a global health concern, particularly coronary artery disease (CAD), poses a significant threat to well-being. Seeking safer and cost-effective diagnostic alternatives to invasive coronary angiography, noninvasive coronary computed tomography angiography (CCTA) gains prominence. This study employed OpenFOAM, an open-source Computational Fluid Dynamics (CFD) software, to analyze hemodynamic parameters in coronary arteries with serial stenoses. Patient-specific three-dimensional (3D) models from CCTA images offer insights into hemodynamic changes. OpenFOAM breaks away from traditional commercial software, validated against the FDA benchmark nozzle model for reliability. Applying this refined methodology to seventeen coronary arteries across nine patients, the study evaluates parameters like fractional flow reserve computed tomography simulation (FFRCTS), fluid velocity, and wall shear stress (WSS) over time. Findings include FFRCTS values exceeding 0.8 for grade 0 stenosis and falling below 0.5 for grade 5 stenosis. Central velocity remains nearly constant for grade 1 stenosis but increases 3.4-fold for grade 5 stenosis. This research innovates by utilizing OpenFOAM, departing from previous reliance on commercial software. Combining qualitative stenosis grading with quantitative FFRCTS and velocity measurements offers a more comprehensive assessment of coronary artery conditions. The study introduces 3D renderings of wall shear stress distribution across stenosis grades, providing an intuitive visualization of hemodynamic changes for valuable insights into coronary stenosis diagnosis.
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Affiliation(s)
- Sajid Ali
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chien-Yi Ho
- Department of Family Medicine, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chen-Chia Yang
- Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Szu-Hsien Chou
- Department of Radiology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Zhen-Ye Chen
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Wei-Chien Huang
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
- Center for Molecular Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
| | - Tzu-Ching Shih
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
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4
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Owen O, O’Carroll V. The effectiveness of cardiac telerehabilitation in comparison to centre-based cardiac rehabilitation programmes: A literature review. J Telemed Telecare 2024; 30:631-646. [PMID: 35369770 PMCID: PMC11027439 DOI: 10.1177/1357633x221085865] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/07/2022] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is an effective, yet under-utilised, form of secondary prevention in cardiac patients. Telemedicine is one method of overcoming barriers to accessing CR. Previous systematic reviews highlight variation in the effectiveness of telerehabilitation programmes and current literature lacks identification of which telemedicine interventions are most effective, despite differences in the results of primary studies. The objectives of this literature review were to: evaluate the effectiveness of cardiac telerehabilitation compared to centre-based programmes for managing cardiac risk factors, satisfaction and adherence in cardiac patients; identify the technologies used to deliver CR; identify the key components of effective interventions. METHODS A literature search was conducted using MEDLINE, EMBASE and Scopus. Randomised controlled trials (RCTs) involving an intervention group that received telerehabilitation and a control group that attended a CR centre were included. RESULTS Twelve RCTs met the inclusion criteria. There is evidence to suggest that telerehabilitation programmes have similar effectiveness to centre-based CR. Phones were the most commonly used technology. Most studies used a combination of technologies including personal computers and self-monitoring equipment. Phase III telerehabilitation programmes using self-monitoring, motivational feedback and education were more effective than centre-based CR for increasing physical activity and functional capacity. CONCLUSION Cardiac telerehabilitation is delivered by a range of technologies and has a similar effectiveness to centre-based programmes. While evidence suggests that additional health benefits are seen in patients who receive a telemedicine intervention in Phase III of CR, further evidence would be required to confidently draw this conclusion.
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Affiliation(s)
- Olivia Owen
- Olivia Owen, School of Medicine, University of St Andrews, St Andrews, KY16 9TF, Scotland.
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5
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Song WP, Bo XW, Dou HX, Fan Q, Wang H. Association between periodontal disease and coronary heart disease: A bibliometric analysis. Heliyon 2024; 10:e28325. [PMID: 38571655 PMCID: PMC10988017 DOI: 10.1016/j.heliyon.2024.e28325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
Background Periodontal disease and coronary heart disease are both prevalent diseases worldwide and cause patients physical and mental suffering and a global burden. Recent studies have suggested a link between periodontal disease and coronary heart disease, but there is less research in this field from the perspective of bibliometrics. Objective This study aimed to quantitatively analyze the literature on periodontal disease and coronary heart disease to summarize intellectual bases, research hotspots, and emerging trends and pave the way for future research. Methods The Science Citation Index Expanded database was used to retrieve study records on periodontal disease and coronary heart disease from 1993 to 2022. After manual screening, the data were used for cooperative network analysis (including countries/regions, institutions and authors), keyword analysis, and reference co-citation analysis by CiteSpace software. Microsoft Excel 2019 was applied for curve fitting of annual trend in publications and citations. Results A total of 580 studies were included in the analysis. The number of publications and citations in this field has shown an upward trend over the past 30 years. There was less direct collaboration among authors and institutions in this field but closer collaboration between countries. The United States was the country with the most published articles in this field (169/580, 29.14%). Based on the results of keyword analysis and literature co-citation analysis, C-reactive protein, oral flora, atherosclerosis, infection, and inflammation were previous research hotspots, while global burden and cardiovascular outcomes were considered emerging trends in this field. Conclusion Studies on periodontal disease and coronary heart disease, which have attracted the attention of an increasing number of researchers, have been successfully analyzed using bibliometrics and visualization techniques. This paper will help scholars better understand the dynamic evolution of periodontal disease and coronary heart disease and point out the direction for future research. Clinical significance This paper presents an overview between periodontal disease and coronary heart disease. Further exploration of the two diseases themselves and the potential causal relationship between the two is necessary and relevant, which may impact basic research, diagnosis, and treatment related to both diseases. This will aid the work of researchers and specialist doctors, and ultimately benefit patients with both diseases.
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Affiliation(s)
- Wen-peng Song
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| | - Xiao-wen Bo
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hui-xin Dou
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| | - Qian Fan
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hao Wang
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
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Hiam L, McKee M, Dorling D. Influenza: cause or excuse? An analysis of flu's influence on worsening mortality trends in England and Wales, 2010-19. Br Med Bull 2024; 149:72-89. [PMID: 38224198 PMCID: PMC10938544 DOI: 10.1093/bmb/ldad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND England and Wales experienced a stagnation of previously improving life expectancy during the 2010s. Public bodies cited influenza as an important cause. SOURCES OF DATA We used data from the Office for National Statistics to examine mortality attributed directly to influenza and to all influenza-like diseases for the total population of England and Wales 2010-19. Several combinations of ICD-10 codes were used to address the possibility of under-counting influenza deaths. AREAS OF AGREEMENT Deaths from influenza and influenza-like diseases declined between 2010 and 2019, while earlier improvements in mortality from all causes of death were stalling and, with some causes, worsening. Our findings support existing research showing that influenza is not an important cause of the stalling of mortality rates 2010-19. AREAS OF CONTROVERSY Influenza was accepted by many as an important cause of stalling life expectancy for much of the 2010s, while few in public office have accepted austerity as a key factor in the changes seen during that time. GROWING POINTS This adds to the mounting evidence that austerity damaged health prior to COVID-19 and left the population more vulnerable when it arrived. AREAS FOR DEVELOPING TIMELY RESEARCH Future research should explore why so many in public office were quick to attribute the change in trends in overall mortality in the UK in this period to influenza, and why many continue to do so through to 2023 and to deny the key role of austerity in harming population health.
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Affiliation(s)
- Lucinda Hiam
- University of Oxford, School of Geography and the Environment, South Parks Road, Oxford OX1 3QY, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Danny Dorling
- University of Oxford, School of Geography and the Environment, South Parks Road, Oxford OX1 3QY, UK
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7
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Abdullah N, Blin JA, Kamalul Arifin AS, Abd Jalal N, Ismail N, Mohd Yusof NA, Abdullah MS, Husin NF, Dauni A, Kamaruddin MA, Mohammed Nawi A, Ahmad N, Hassan MR, Jamal R. Cardiovascular risk prediction with cardio-ankle vascular index in the malaysian cohort study. Curr Probl Cardiol 2024; 49:102192. [PMID: 37952789 DOI: 10.1016/j.cpcardiol.2023.102192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
The cardio-ankle vascular index (CAVI) is an important parameter assessing arterial function. It reflects arterial stiffness from the origin of the aorta to the ankle, and the algorithm is blood pressure independent. Recent data have suggested that a high CAVI score can predict future cardiovascular disease (CVD) events; however, to date, no study has been done in Malaysia. We conducted a prospective study on 2,168 The Malaysian Cohort (TMC) CVD-free participants (971 men and 1,197 women; mean age 51.64 ± 8.38 years old) recruited from November 2011 to March 2012. This participants were followed-up until the emergence of CVD incidence and mortality (endpoint between May to September 2019; duration of 7.5 years). Eligible participants were assessed based on CAVI baseline measurement which categorised them into low (CAVI <9.0) and high (CAVI ≥ 9.0) scores. The CVD events in the group with high CAVI (6.5 %) were significantly higher than in the low CAVI (2.6 %) group (p < 0.05). CAVI with cut-off point ≥ 9.0 was a significant independent predictor for CVD event even after adjustment for male, ethnicity, age, and intermediate atherogenic index of plasma (AIP). Those who have higher CAVI have 78 % significantly higher risk of developing CVD compared to those with the low CAVI (adjusted OR [95 % CI] = 1.78 [1.04 - 3.05], p =0.035). In addition, the participants with higher CAVI have significantly lower survival probability than those who have lower CAVI values. Thus, this study indicated that the CAVI can predict CVD event independently among the TMC participants.
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Affiliation(s)
| | - Joan Anak Blin
- UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur 56000, Malaysia.
| | | | - Nazihah Abd Jalal
- UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur 56000, Malaysia.
| | - Norliza Ismail
- UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur 56000, Malaysia.
| | | | | | - Nurul Faeizah Husin
- UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur 56000, Malaysia.
| | - Andri Dauni
- UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur 56000, Malaysia.
| | | | - Azmawati Mohammed Nawi
- Department of Public Health Medicine, Faculty of Medicine, UKM, Kuala Lumpur 56000, Malaysia.
| | - Norfazilah Ahmad
- Department of Public Health Medicine, Faculty of Medicine, UKM, Kuala Lumpur 56000, Malaysia.
| | - Mohd Rohaizat Hassan
- Department of Public Health Medicine, Faculty of Medicine, UKM, Kuala Lumpur 56000, Malaysia.
| | - Rahman Jamal
- UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur 56000, Malaysia.
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Wu R, Williams C, Zhou J, Schlackow I, Emberson J, Reith C, Keech A, Robson J, Armitage J, Gray A, Simes J, Baigent C, Mihaylova B, Armitage J, Baigent C, Barnes E, Blackwell L, Collins R, Davies K, Emberson J, Fulcher J, Halls H, Herrington WG, Holland L, Keech A, Kirby A, Mihaylova B, O'Connell R, Preiss D, Reith C, Simes J, Wilson K, Blazing M, Braunwald E, Lemos JD, Murphy S, Pedersen TR, Pfeffer M, White H, Wiviott S, Clearfield M, Downs JR, Gotto A, Weis S, Fellström B, Holdaas H, Jardine A, Pedersen TR, Gordon D, Davis B, Furberg C, Grimm R, Pressel S, Probstfield JL, Rahman M, Simpson L, Koren M, Dahlöf B, Gupta A, Poulter N, Sever P, Wedel H, Knopp RH, Cobbe S, Fellström B, Holdaas H, Jardine A, Schmieder R, Zannad F, Betteridge DJ, Colhoun HM, Durrington PN, Fuller J, Hitman GA, Neil A, Braunwald E, Davis B, Hawkins CM, Moyé L, Pfeffer M, Sacks F, Kjekshus J, Wedel H, Wikstrand J, Wanner C, Krane V, Franzosi MG, Latini R, Lucci D, Maggioni A, Marchioli R, Nicolis EB, Tavazzi L, Tognoni G, Bosch J, Lonn E, Yusuf S, Armitage J, Bowman L, Collins R, Keech A, Landray M, Parish S, Peto R, Sleight P, Kastelein JJ, Pedersen TR, Glynn R, Gotto A, Kastelein JJ, Koenig W, MacFadyen J, Ridker PM, Keech A, MacMahon S, Marschner I, Tonkin A, Shaw J, Simes J, White H, Serruys PW, Knatterud G, Blauw GJ, Cobbe S, Ford I, Macfarlane P, Packard C, Sattar N, Shepherd J, Trompet S, Braunwald E, Cannon CP, Murphy S, Collins R, Armitage J, Bowman L, Bulbulia R, Haynes R, Parish S, Peto R, Sleight P, Amarenco P, Welch KM, Kjekshus J, Pedersen TR, Wilhelmsen L, Barter P, Gotto A, LaRosa J, Kastelein JJ, Shepherd J, Cobbe S, Ford I, Kean S, Macfarlane P, Packard C, Roberston M, Sattar N, Shepherd J, Young R, Arashi H, Clarke R, Flather M, Goto S, Goldbourt U, Hopewell J, Hovingh GK, Kitas G, Newman C, Sabatine MS, Schwartz GG, Smeeth L, Tobert J, Varigos J, Yamamguchi J. Long-term cardiovascular risks and the impact of statin treatment on socioeconomic inequalities: a microsimulation model. Br J Gen Pract 2024; 74:BJGP.2023.0198. [PMID: 38373851 PMCID: PMC10904120 DOI: 10.3399/bjgp.2023.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/19/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND UK cardiovascular disease (CVD) incidence and mortality have declined in recent decades but socioeconomic inequalities persist. AIM To present a new CVD model, and project health outcomes and the impact of guideline-recommended statin treatment across quintiles of socioeconomic deprivation in the UK. DESIGN AND SETTING A lifetime microsimulation model was developed using 117 896 participants in 16 statin trials, 501 854 UK Biobank (UKB) participants, and quality-of-life data from national health surveys. METHOD A CVD microsimulation model was developed using risk equations for myocardial infarction, stroke, coronary revascularisation, cancer, and vascular and non-vascular death, estimated using trial data. The authors calibrated and further developed this model in the UKB cohort, including further characteristics and a diabetes risk equation, and validated the model in UKB and Whitehall II cohorts. The model was used to predict CVD incidence, life expectancy, quality-adjusted life years (QALYs), and the impact of UK guideline-recommended statin treatment across socioeconomic deprivation quintiles. RESULTS Age, sex, socioeconomic deprivation, smoking, hypertension, diabetes, and cardiovascular events were key CVD risk determinants. Model-predicted event rates corresponded well to observed rates across participant categories. The model projected strong gradients in remaining life expectancy, with 4-5-year (5-8 QALYs) gaps between the least and most socioeconomically deprived quintiles. Guideline-recommended statin treatment was projected to increase QALYs, with larger gains in quintiles of higher deprivation. CONCLUSION The study demonstrated the potential of guideline-recommended statin treatment to reduce socioeconomic inequalities. This CVD model is a novel resource for individualised long-term projections of health outcomes of CVD treatments.
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Affiliation(s)
- Runguo Wu
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Claire Williams
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Junwen Zhou
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iryna Schlackow
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan Emberson
- Nuffield Department of Population Health and Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Christina Reith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anthony Keech
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - John Robson
- Clinical Effectiveness Group, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jane Armitage
- Nuffield Department of Population Health and Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John Simes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Colin Baigent
- Nuffield Department of Population Health and Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London; associate professor and senior health economist, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Hailu KT, Salib K, Savithri Nandeesha S, Kasagga A, Hawrami C, Ricci E, Hamid P. The Effect of Fasting on Cardiovascular Diseases: A Systematic Review. Cureus 2024; 16:e53221. [PMID: 38425626 PMCID: PMC10902743 DOI: 10.7759/cureus.53221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Among the leading causes of morbidity, disability, and death worldwide are cardiovascular diseases (CVDs). Their risk factors usually include a variety of factors associated with cardiometabolic disorders. Many public health organizations prioritize the prevention of CVDs and encourage people to maintain a healthy lifestyle. It has been shown that fasting and a healthy diet can promote weight loss and improve cardiometabolic health in various animal species. We want to know the impact of fasting on CVDs. The topic is examined in this systematic review. We looked through a wide range of online sources, including PubMed, Cochrane Library, and Google Scholar, to find randomized controlled trials (RCTs) that looked into the connection between CVDs and fasting. We included human research that has been published in English in peer-reviewed publications in the last five years, and then we screened by the title, abstract, and full-text accessibility. We picked the final 10 articles for quality assessment using Cochrane Collaboration's tool for risk-of-bias assessment of RCTs. The findings suggest that fasting is beneficial in lowering the cardiovascular risk of a population. This result holds for all types of fasting used as an intervention in the clinical trials we reviewed. The result is pronounced when fasting regimens are combined with a regular exercise routine. More comprehensive data will come from larger-scale clinical trials and case-control studies, and a thorough examination of all the potential health impacts of fasting is warranted.
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Affiliation(s)
- Kirubel T Hailu
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Afet Speciality Clinic, Addis Ababa, ETH
| | - Korlos Salib
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Alousious Kasagga
- Pathology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chnoor Hawrami
- Pediatric Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Erica Ricci
- Anesthesiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Lababidi H, Salerno PRVO, Wass SY, Shafiabadi Hasani N, Bourges-Sevenier B, Al-Kindi S. The Global Burden of premature cardiovascular disease, 1990-2019. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200212. [PMID: 37876911 PMCID: PMC10590819 DOI: 10.1016/j.ijcrp.2023.200212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 10/26/2023]
Abstract
Aims Premature cardiovascular disease (pCVD) definition varies in literature, with age cut-offs ranging from 50-65 years. While there is some literature available on pCVD in North America, comprehensive data on its global burden is still lacking which hinders the development of efficient strategies for early detection and prevention. In this study we aimed to investigate the global trends in pCVD related morbidity and mortality from 1990 to 2019. Methods The 1990-2019 Global Burden of Disease (GBD) database was utilized to examine global trends in cardiovascular disease-related total mortality, mortality rates, and Disability-Adjusted Life Years (DALYs) within individuals aged 15-49 years. The findings were further analyzed based on factors such as age, sex, and Socio-Demographic Index (SDI). Results From 1990 to 2019, the number of global annual pCVD deaths increased by 25%, from 992,067 (95% UI 1,042,261 - 946,383) to 1,241,484 (95% UI 1,339,193 -1,146,252). The rate of associated mortality decreased by 13%. Metabolic conditions were the most significant risk factors for pCVD mortality. Ischemic heart disease and stroke are the leading causes of death across all age groups. pCVD mortality presented progressive widening between high and low SDI regions. Additionally, sex-specific disparities in CVD mortality were significantly greater in the premature age group as compared to all-age groups. Conclusion pCVD is an increasingly significant global cause of morbidity and mortality that disproportionately affects males and individuals living in less privileged regions. Furthermore, ischemic heart disease and stroke were identified as the main drivers of pCVD global burden.
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Affiliation(s)
- Hossam Lababidi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Pedro RVO. Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sojin Youn Wass
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Neda Shafiabadi Hasani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brendan Bourges-Sevenier
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sadeer Al-Kindi
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
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Boos CJ, Haling U, Schofield S, Cullinan P, Bull AMJ, Fear NT, Bennett AN. Relationship between combat-related traumatic injury and its severity to predicted cardiovascular disease risk: ADVANCE cohort study. BMC Cardiovasc Disord 2023; 23:581. [PMID: 38012542 PMCID: PMC10680223 DOI: 10.1186/s12872-023-03605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND This study investigated the relationship between combat-related traumatic injury (CRTI) and its severity and predicted cardiovascular disease (CVD) risk. MATERIAL AND METHODS This was an analysis of comparative 10-year predicted CVD risk (myocardial infarction, stroke or CVD-death) using the QRISK®3 scoring-system among adults recruited into the Armed Services Trauma Rehabilitation Outcome (ADVANCE) cohort study. Participants with CRTI were compared to uninjured servicemen frequency-matched by age, sex, rank, deployment (Afghanistan 2003-2014) and role. Injury severity was quantified using the New Injury Severity Score (NISS). RESULTS One thousand one hundred forty four adult combat veterans were recruited, consisting of 579 injured (161 amputees) and 565 uninjured men of similar age ethnicity and time from deployment/injury. Significant mental illness (8.5% vs 4.4%; p = 0.006) and erectile dysfunction (11.6% vs 5.8%; p < 0.001) was more common, body mass index (28.1 ± 3.9 vs 27.4 ± 3.4 kg/m2; p = 0.001) higher and systolic blood pressure variability (median [IQR]) (1.7 [1.2-3.0] vs 2.1 [1.2-3.5] mmHg; p = 0.008) lower among the injured versus uninjured respectively. The relative risk (RR) of predicted CVD (versus the population expected risk) was higher (RR:1.67 [IQR 1.16-2.48]) among the injured amputees versus the injured non-amputees (RR:1.60 [1.13-2.43]) and uninjured groups (RR:1.52 [1.12-2.34]; overall p = 0.015). After adjustment for confounders CRTI, worsening injury severity (higher NISS, blast and traumatic amputation) were independently associated with QRISK®3 scores. CONCLUSION CRTI and its worsening severity were independently associated with increased predicted 10-year CVD risk.
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Affiliation(s)
- Christopher J Boos
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Near Loughborough, LE12 5QW, Nottinghamshire, UK.
- The Academic Department of Military Mental Health, King's College London, London, SE5 9RJ, UK.
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BH1 3LT, UK.
- Department of Cardiology, University Hospitals Dorset, Poole Hospital, Longfleet Rd, Poole, BH15 2JB, Dorset, UK.
| | - Usamah Haling
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - Susie Schofield
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - Paul Cullinan
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| | - Nicola T Fear
- The Academic Department of Military Mental Health, King's College London, London, SE5 9RJ, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Near Loughborough, LE12 5QW, Nottinghamshire, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
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Maghoul A, Khonsari NM, Asadi S, Abdar ZE, Ejtahed HS, Qorbani M. Dietary carbohydrate quality index and cardio-metabolic risk factors. INT J VITAM NUTR RES 2023. [PMID: 38009678 DOI: 10.1024/0300-9831/a000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Introduction: Improving the quality of diet is known as one of the practical ways to reduce cardio-metabolic risk factors (CMRFs). The carbohydrate quality index (CQI) is a relatively new index to evaluate diet quality. It is calculated based on the ratio of solid carbohydrates to total carbohydrates, dietary fibre intake, glycemic index and the ratio of whole grains to total grains. This systematic review and meta-analysis was designed to investigate the association between dietary CQI and CMRFs. Methods: In this systematic review, some international databases, including Scopus, PubMed, EMBASE, Web of Science, and Google Scholar up to July 2022, were searched according to appropriate keywords. All observational studies with an English full text assessing the association between the dietary CQI and CMRFs were included. Two researchers independently extracted the data and assessed the quality of the articles with the Newcastle-Ottawa Scale. Random/fixed-effect meta-analysis was used to pool standardized mean difference (SMD) as an effect size. Results: 11 studies with a total of 63962 subjects were found to be eligible and included in the qualitative synthesis; only BMI, WC and metabolic syndrome reached the threshold of 3 reports with the same effect size and thus only 5 were included in the meta-analysis. The main finding of the included studies was that there were inverse associations between CQI and CMRFs, mainly obesity, glucose metabolism indices, and blood pressure. In the five studies included in the random effect meta-analysis, the association between CQI and body mass index (SMD: 0.45, 95%CI: -0.12, 1.01), waist circumference (SMD: -0.09, 95%CI: -0.34, 0.15) and metabolic syndrome (SMD: 0.63, 95%CI: -0.01, 1.28) was not statistically significant. Conclusion: Although the qualitative findings support the positive association of CQI with CMRFs, the evidence is insufficient to conclude robust findings. Further observational and interventional studies are needed to clearly elucidate this association.
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Affiliation(s)
- Arman Maghoul
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Sasan Asadi
- Department of Community Medicine, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan Province, Iran
| | - Zahra Esmaeili Abdar
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Wojtasińska A, Kućmierz J, Tokarek J, Dybiec J, Rodzeń A, Młynarska E, Rysz J, Franczyk B. New Insights into Cardiovascular Diseases Treatment Based on Molecular Targets. Int J Mol Sci 2023; 24:16735. [PMID: 38069058 PMCID: PMC10706703 DOI: 10.3390/ijms242316735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Cardiovascular diseases (CVDs) which consist of ischemic heart disease, stroke, heart failure, peripheral arterial disease, and several other cardiac and vascular conditions are one of the most common causes of death worldwide and often co-occur with diabetes mellitus and lipid disorders which worsens the prognosis and becomes a therapeutic challenge. Due to the increasing number of patients with CVDs, we need to search for new risk factors and pathophysiological changes to create new strategies for preventing, diagnosing, and treating not only CVDs but also comorbidities like diabetes mellitus and lipid disorders. As increasing amount of patients suffering from CVDs, there are many therapies which focus on new molecular targets like proprotein convertase subtilisin/kexin type 9 (PCSK9), angiopoietin-like protein 3, ATP-citrate lyase, or new technologies such as siRNA in treatment of dyslipidemia or sodium-glucose co-transporter-2 and glucagon-like peptide-1 in treatment of diabetes mellitus. Both SGLT-2 inhibitors and GLP-1 receptor agonists are used in the treatment of diabetes, however, they proved to have a beneficial effect in CVDs as well. Moreover, a significant amount of evidence has shown that exosomes seem to be associated with myocardial ischaemia and that exosome levels correlate with the severity of myocardial injury. In our work, we would like to focus on the above mechanisms. The knowledge of them allows for the appearance of new strategies of treatment among patients with CVDs.
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Affiliation(s)
- Armanda Wojtasińska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Joanna Kućmierz
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Julita Tokarek
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jill Dybiec
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Anna Rodzeń
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
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Weight N, Moledina S, Rashid M, Chew N, Castelletti S, Buchanan GL, Salinger S, Gale CP, Mamas MA. Temporal analysis of non-ST segment elevation-acute coronary syndrome (NSTEACS) outcomes in 'young' patients under the age of fifty: A nationwide cohort study. Int J Cardiol 2023; 391:131294. [PMID: 37625485 DOI: 10.1016/j.ijcard.2023.131294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/25/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The characteristics and risk factor profile of young patients presenting with non-ST segment elevation acute coronary syndrome (NSTEACS) and how they may have changed over time is not well reported. METHODS We identified 26,708 NSTEACS patients aged under 50 presenting to United Kingdom (UK) hospitals between 2010 and 2017 from Myocardial Ischaemia National Audit Project (MINAP). We calculated incidence of NSTEACS per 100,000 UK population, using Office of National Statistics (ONS) population estimates, prevalence of comorbidities, ethnicity, and in-hospital mortality. We formed biennial groups to enable comparison, 2010-2011, 2012-2013, 2014-2015 and 2016-2017. RESULTS The incidence of NSTEACS per 100,000 population showed minimal change between 2010 and 2017 (2010: 5.4 per 100,000 and 2017; 4.9 per 100,000). Rates of smoking (2010-11; 58% and 2016-17; 53%), and family history of coronary artery disease (CAD) (2010-11; 51% and 2016-17; 44%) fell, but the proportion of patients from an ethnic minority background (2010-11; 12% and 2016-17; 20%), with diabetes mellitus (DM) (2010-11; 14%, and 2016-17; 18%) and female patients (2010-11; 22% and 2016-17; 24%) increased over the study period. Mortality from NSTEACS remained unchanged (2010-11; 1% and 2016-17; 1%). CONCLUSIONS The incidence of NSTEACS in patients aged under fifty has not reduced despite reduction in prevalence of risk factors such as smoking hypercholesterolaemia in those admitted to UK hospitals. Despite improved rates of early invasive coronary angiography and percutaneous coronary intervention in 'young' NSTEACS patients, in-hospital mortality remains unchanged.
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Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Nicholas Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Silvia Castelletti
- Cardiology Department, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, (Italy)
| | - Gill Louise Buchanan
- Cardiology Department, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Sonja Salinger
- Clinic for Cardiovascular Diseases, Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK.
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15
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Zinchuk M, Kustov G, Popova S, Mishin I, Voinova N, Gersamija A, Yakovlev A, Guekht A. Functions of nonsuicidal self-injurious behavior in Russian patients with suicidal ideation. Front Public Health 2023; 11:1270944. [PMID: 38026411 PMCID: PMC10660280 DOI: 10.3389/fpubh.2023.1270944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Nonsuicidal self-injurious behavior (NSSI) is an important risk factor for future suicide attempts. Previous research has identified a number of motivations for engaging in NSSI. The aim of the present study was to translate the Inventory of Statements About Self-Injury (ISAS) into Russian and then to evaluate its psychometric properties in a sample of patients with non-psychotic mental disorders and suicidal ideation (SI). Other aims were to determine the prevalence of specific NSSI functions in this population and to assess the relationship between different NSSI functions and clinical and psychological parameters. Participants and methods The study was conducted at the largest center for non-psychotic mental disorders in Moscow. All admitted patients with both NSSI and SI completed the Russian version of the ISAS-II, underwent the Self-Injurious Thoughts and Behaviors Interview, and completed the Personality Inventory for DSM-5 and ICD-11 Brief Form Plus-Modified, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Results A total of 614 patients were included in the study. 543 (88.4%) patients were assigned female at birth with a mean age of 24.86 (7.86) years. Factor analysis supported a two-factor structure (Intrapersonal and Interpersonal) of the Russian version of the ISAS-II, but in contrast to the original study, the "Marking distress" function loaded more strongly on the Interpersonal factor. In people with non-psychotic mental disorders and SI, Interpersonal functions of NSSI are associated with more severe depressive symptoms (r = 0.34), 12 months history of NSSI (r = 0.30), higher number of NSSI methods (r = 0.41), likelihood of future NSSI (r = 0.35) and psychoticism (r = 0.32). Conclusion The Russian version of the ISAS-II is a valid and reliable instrument for assessing NSSI functions in a population at high risk for suicide attempts. Interpersonal functions are associated with a number of unpleasant clinical and psychological features.
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Affiliation(s)
- Mikhail Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Georgii Kustov
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Sofya Popova
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Ilya Mishin
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Nadezhda Voinova
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Anna Gersamija
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Alexander Yakovlev
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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16
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Janssen H, Ford K, Gascoyne B, Hill R, Roberts M, Bellis MA, Azam S. Cold indoor temperatures and their association with health and well-being: a systematic literature review. Public Health 2023; 224:185-194. [PMID: 37820536 DOI: 10.1016/j.puhe.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The study aimed to identify, appraise and update evidence on the association between cold temperatures (i.e. <18°C) within homes (i.e. dwellings) and health and well-being outcomes. STUDY DESIGN This study was a systematic review. METHODS Seven databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, APA PsycInfo, Applied Social Sciences Index and Abstracts, Coronavirus Research Database) were searched for studies published between 2014 and 2022, which explored the association between cold indoor temperatures and health and well-being outcomes. Studies were limited to those conducted in temperate and colder climates due to the increased risk of morbidity and mortality during winter in those climatic zones. Studies were independently quality assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS Of 1209 studies, 20 were included for review. Study outcomes included cardiovascular (blood pressure, electrocardiogram abnormalities, blood platelet count), respiratory (chronic obstructive pulmonary disease symptoms, respiratory viral infection), sleep, physical performance and general health. Seventeen studies found exposure to cold indoor temperatures was associated with negative effects on health outcomes studied. Older individuals and those with chronic health problems were found to be more vulnerable to negative health outcomes. CONCLUSION Evidence suggests that indoor temperatures <18°C are associated with negative health effects. However, the evidence is insufficient to allow clear conclusions regarding outcomes from specific temperature thresholds for different population groups. Significant gaps in the current evidence base are identified, including research on the impacts of cold indoor temperatures on mental health and well-being, studies involving young children, and the long-term health effects of cold indoor temperatures.
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Affiliation(s)
- H Janssen
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK.
| | - K Ford
- College of Human Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - B Gascoyne
- London Metropolitan University, London, N7 8DB, UK
| | - R Hill
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, CF10 4BZ, UK
| | - M Roberts
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, CF10 4BZ, UK
| | - M A Bellis
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK; Faculty of Health, Liverpool John Moores University, L2 2ER, UK
| | - S Azam
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, CF10 4BZ, UK
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Leontsinis I, Farmakis D, Avramidis D, Andrikou E, Valatsou A, Gartzonikas E, Doundoulakis I, Zarifis I, Karpouzis I, Kafkala K, Kouvelas N, Kourek C, Koufou E, Kochiadakis G, Kifnidis K, Liori S, Manolis G, Marketou M, Moschos N, Bampatsias D, Bibis G, Bonou M, Naka A, Davlouros P, Ntalakouras I, Papakonstantinou PΕ, Pappa E, Patsilinakos S, Plaitis A, Sideris A, Sideris S, Skoularigis J, Stamatelopoulos K, Stefanou G, Tziakas D, Chatzieleftheriou C, Chrysochoou C, Filippatos G, Tsioufis C. Cardiorenal multimorbidity in hospitalized cardiology patients: The Hellenic Cardiorenal Morbidity Snapshot (HECMOS) study. Hellenic J Cardiol 2023; 74:8-17. [PMID: 37146905 DOI: 10.1016/j.hjc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 05/07/2023] Open
Abstract
PURPOSE Cardiovascular disease is commonly accompanied by renal dysfunction. Multimorbidity in hospitalized patients impacts unfavorably on prognosis and hospital stay. We aimed to illustrate the contemporary burden of cardiorenal morbidity across inpatient cardiology care in Greece. METHODS The Hellenic Cardiorenal Morbidity Snapshot (HECMOS) used an electronic platform to collect demographic and clinically relevant information about all patients hospitalized on March 3, 2022, in Greece. The participating institutions covered all levels of inpatient cardiology care and most of the country's territories to collect a real-world, nation representative sample. RESULTS A total of 923 patients (men 68.4%, median age 73 ± 14.8 years) were admitted to 55 different cardiology departments. 57.7% of the participants were aged >70 years. Hypertension was highly prevalent and present in 66% of the cases. History of chronic HF, diabetes mellitus, atrial fibrillation, and chronic kidney disease was present in 38%, 31.8%, 30%, and 26%, respectively. Furthermore, 64.1% of the sample exhibited at least one of these 4 entities. Accordingly, a combination of ≥2 of these morbid conditions was recorded in 38.7%, of ≥3 in 18.2%, whereas 4.3% of the sample combined all 4 in their medical history. The most common combination was the coexistence of heart failure-atrial fibrillation accounting for 20.6% of the sample. Nine of 10 nonelectively admitted patients were hospitalized due to acute HF (39.9%), acute coronary syndrome (33.5%), or tachyarrhythmias (13.2%). CONCLUSION HECMOS participants carried a remarkable burden of cardio-reno-metabolic disease. HF in conjunction with atrial fibrillation was found to be the most prevalent combination among the studied cardiorenal nexus of morbidities in the whole study population.
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Affiliation(s)
- Ioannis Leontsinis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | | | | | - Eirini Andrikou
- Cardiology Department, Konstantopoulio General Hospital, Athens, Greece
| | - Angeliki Valatsou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Elias Gartzonikas
- University Cardiology Clinic, University of Ioannina, Ioannina, Greece
| | - Ioannis Doundoulakis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Ioannis Zarifis
- Cardiology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | | | - Nikos Kouvelas
- Cardiology Dpt, 251 Hellenic Airforce General Hospital, Athens, Greece
| | - Christos Kourek
- Cardiology Dpt, 417 Veterans Army Hospital (NIMTS), Athens, Greece
| | - Eleni Koufou
- Cardiology Department, Patras University Hospital, Rio, Greece
| | - George Kochiadakis
- Department of Cardiology, Heraklion University Hospital, Iraklio, Crete, Greece
| | | | - Sotiria Liori
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Manolis
- Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece
| | - Maria Marketou
- Department of Cardiology, Heraklion University Hospital, Iraklio, Crete, Greece
| | | | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - George Bibis
- Cardiology Dpt, General Hospital of Argos, Greece
| | - Maria Bonou
- Cardiology Department, Laiko General Hospital, Athens, Greece
| | - Aikaterini Naka
- University Cardiology Clinic, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Ntalakouras
- Department of Cardiology, Heraklion University Hospital, Iraklio, Crete, Greece
| | | | - Evgenia Pappa
- Department of Cardiology, General Hospital "G. Hatzikosta", Ioannina, Greece
| | | | | | - Antonios Sideris
- Second Cardiology Department, Evangelismos Hospital, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Dimitrios Tziakas
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Christina Chrysochoou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece.
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Davies IG. Exploring high-protein diets in the context of cardiac rehabilitation. Proc Nutr Soc 2023:1-12. [PMID: 37877360 DOI: 10.1017/s0029665123004779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
The review aims to explore the potential benefit and risk of high-protein diets (HPD) regarding the comorbidity of sarcopoenia and CVD in the setting of cardiac rehabilitation (CR). CR is standard care for individuals who have experienced a cardiac event, but the current practice of predominantly aerobic exercise, a lower-fat diet and weight loss poorly addresses the issue of sarcopoenia. HPD, especially when combined with resistance exercise (RE), may be valuable adjuncts to current CR practice and benefit both muscle and cardiovascular health. Meta-analyses and randomised controlled trials of HPD and CVD risk show beneficial but variable effects regarding weight loss, the lipid profile, insulin resistance and lean body mass in those living with or high risk of CVD. Meta-analyses of prospective cohort studies on hard CVD endpoints favour lower- and plant-protein diets over higher animal protein, but the evidence is inconsistent. HPD augment the strength and muscle gaining benefits of RE in older populations, but there are no published data in those living with CVD providing promising opportunities for CR research. HPD raise concern regarding renal and bone health, the microbiome, branched chain amino acids and environmental sustainability and findings suggest that plant-based HPD may confer ecological and overall health advantages compared to animal-based HPD. However, incorporating RE with HPD might alleviate certain health risks. In conclusion, a largely plant-based HPD is deemed favourable for CR when combined with RE, but further research regarding efficacy and safety in CR populations is needed.
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Affiliation(s)
- Ian G Davies
- Research Institute of Sports and Exercise Sciences, Student Life Building, Liverpool John Moores University, Copperas Hill, Liverpool L3 5LJ, UK
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19
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Sakalaki M, Pivodic A, Svärdsudd K, Hansson PO, Fu M. Cumulative incidence and risk factors of myocardial infarction during 20 years of follow-up: comparing two cohorts of middle-aged men born 30 years apart. Clin Res Cardiol 2023:10.1007/s00392-023-02308-y. [PMID: 37755468 DOI: 10.1007/s00392-023-02308-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To study cumulative incidence and predictors of myocardial infarction (MI) in two random general population samples consisting of middle-aged Swedish men born 30 years apart. METHOD Results from the "Study of Men Born In 1913" and the "Study of Men Born In 1943", two longitudinal cohort studies performed in the same geographic area and using the same methodology were compared. Both cohorts were followed prospectively from 50 to 70 years of age. MI was defined as first myocardial infarction, fatal or non-fatal. RESULTS Men born in 1943 had a 34% lower cumulative risk of first MI [HR 0.66 (0.50-0.88), p = 0.0051] during follow-up as compared to men born in 1913. Interaction analysis showed that hypertension had a significantly higher impact on risk of MI in cohort 1943 than in cohort 1913 [HR 2.33 (95% CI 1.41-3.83)] and [HR 1.10 (0.74-1.62)], p = 0.0009 respectively. The population attributable risk for hypertension was 2.5-fold higher in the cohort of men born in 1943 as compared to men born in 1913, and diabetes mellitus and sedentary lifestyle attributed more to MI risk in cohort 1943 than in cohort 1913. On the contrary, smoking and total cholesterol have less attributable risk to MI in cohort 1943 than in cohort 1913. CONCLUSION Despite declining incident MI and improved cardiovascular prevention in general, hypertension remains an increasingly important attributable risk factor to MI together with diabetes mellitus and sedentary lifestyle over time.
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Affiliation(s)
- Maria Sakalaki
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.
- Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Region Västra Götaland, Gothenburg, Sweden.
| | - Aldina Pivodic
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- APNC Sweden, Gothenburg, Sweden
| | - Kurt Svärdsudd
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Region Västra Götaland, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Region Västra Götaland, Gothenburg, Sweden
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20
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Choi HJ, LeBlanc M, Moger TA, Valberg M, Page CM, Aamodt G, Næss Ø. Geographical variation in cardiovascular disease mortality in Norway: The role of life course socioeconomic position and parental health. Health Place 2023; 83:103095. [PMID: 37659155 DOI: 10.1016/j.healthplace.2023.103095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 09/04/2023]
Abstract
Despite substantial geographical variation in cardiovascular (CVD) mortality within countries, little is known about whether this variation can be explained by individuals' life course socioeconomic position (SEP) or differences in family history of premature CVD deaths. Cox proportional hazards models were used to investigate the association between the county of residence at ages 50-59 and CVD death in Norwegians born between 1940 and 1959 and survived to at least age 60, using national data. Individual life course SEP and family history of premature CVD death reduced the geographical variation in CVD mortality across Norwegian counties, but some significant differences remained. Furthermore, CVD risk varied by residents' migration histories between two counties with distinct CVD and socioeconomic profiles.
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Affiliation(s)
- Hye Jung Choi
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Marissa LeBlanc
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Tron Anders Moger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Valberg
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Christian M Page
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Mathematics, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Geir Aamodt
- Department of Public Health Science, LANDSAM, Norwegian University of Life Science, Ås, Norway
| | - Øyvind Næss
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Norwegian Institute of Public Health, Oslo, Norway
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21
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Chen J, Wu K, Cao W, Shao J, Huang M. Association between monocyte to high-density lipoprotein cholesterol ratio and multi-vessel coronary artery disease: a cross-sectional study. Lipids Health Dis 2023; 22:121. [PMID: 37553680 PMCID: PMC10408165 DOI: 10.1186/s12944-023-01897-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Patients with multi-vessel coronary artery disease (MV-CAD) have poorer clinical outcomes than those with single-vessel coronary artery disease (SV-CAD). Solid evidence underlines that high-density lipoprotein cholesterol (HDL-C) plays a protective role and monocyte plays a negative role in coronary artery disease (CAD). However, the monocyte to high-density lipoprotein ratio (MHR) has not been studied in relation to MV-CAD. METHODS In this study, 640 patients underwent coronary angiography, of whom 225 had severe coronary artery disease. Then divide the above two groups of patients into three groups based on the MHR tertiles, respectively. Logistic regression and subgroup analysis were carried out to estimate the association between MHR and MV-CAD. The receiver operating characteristic (ROC) curve analysis was constructed by combining classic CAD risk factors with MHR in response to MV-CAD. In addition, the mediating effect of MHR between smoking and MV-CAD in suspected CAD Patients was analyzed. RESULTS Among the three MHR groups, a statistically discrepant was observed in the number of patients with CAD, Severe-CAD and MV-CAD (PCAD < 0.001; PSevere-CAD < 0.001; PMV-CAD = 0.001) in suspected CAD patients. Furthermore, the number of patients with MV-CAD (P < 0.001) was different in Severe-CAD patients among three MHR groups. Non-CAD and CAD patients showed statistically discrepant in MHR levels (P < 0.001), and this difference also was observed between SV-CAD and MV-CAD patients (P < 0.001). In the analysis of suspected CAD patients, a significantly positive relationship was found between MHR and CAD, Severe-CAD, and MV-CAD (P for trend < 0.001). The effect of MHR on MV-CAD was consistent across all subgroups, with no significant randomized factor-by-subgroup interaction (P-interaction = 0.17-0.89). ROC analysis showed that the model constructed with MHR and classic influencing factors of CAD was superior to the model constructed solely based on classic influencing factors of CAD (0.742 vs.0.682, P = 0.002). In the analysis of Severe-CAD patients, patients with higher MHR levels had a higher risk of MV-CAD [OR (95%CI): 2.90 (1.49, 5.62), P for trend = 0.002] compared to patients with lower MHR. The trends persisted after adjusting for demographic (P for trend = 0.004) and classic influencing factors of CAD (P for trend = 0.009). All subgroup factors for patients with MV-CAD had no interaction with MHR (P-interaction = 0.15-0.86). ROC analysis showed that the model combining MHR and classic influencing factors of CAD was superior to the one including only the classic influencing factors of CAD (0.716 vs.0.650, P = 0.046). Assuming that MHR played a mediating effect between smoking and MV-CAD in suspected CAD patients. The results indicated that MHR played a partial mediating effect of 0.48 (P < 0.001). CONCLUSION A higher MHR was mainly associated with multi-vessel coronary artery disease and MHR partially mediated the association between smoking and MV-CAD.
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Affiliation(s)
- Jiaqi Chen
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Yongzhong Street, Wenzhou, 325000, Zhejiang, China
| | - Kangxiang Wu
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Yongzhong Street, Wenzhou, 325000, Zhejiang, China
| | - Wanchun Cao
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Yongzhong Street, Wenzhou, 325000, Zhejiang, China
| | - Jianan Shao
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Yongzhong Street, Wenzhou, 325000, Zhejiang, China
| | - Mingyuan Huang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Yongzhong Street, Wenzhou, 325000, Zhejiang, China.
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22
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Ting KH, Lu YT, Hsin CH, Lee CY, Huang JY, Yang SF, Hsieh MH. Correlation between coronary heart disease severity and subsequent chronic rhinosinusitis severity: A retrospective cohort study. Int J Med Sci 2023; 20:1240-1246. [PMID: 37575269 PMCID: PMC10416719 DOI: 10.7150/ijms.86601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Coronary heart disease (CHD) is associated with the development of several diseases. This retrospective population-based cohort study investigated the association between CHD severity and subsequent chronic rhinosinusitis (CRS) of varying severity. We used data from Taiwan's National Health Insurance Research Database. CHD was categorized as severe if treated using a coronary artery bypass graft (CABG) and as mild if treated with percutaneous coronary intervention (PCI). The primary outcome of this study was the development of CRS or severe CRS treated using functional endoscopic sinus surgery. Cox proportional hazards regression was used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CRS and severe CRS in different patient groups. We included 31,784 patients who received PCI surgery (the CHD-PCI group) and 15,892 patients who received CABG surgery (the CHD-CABG group). A total of 813 and 482 episodes of CRS occurred in the CHD-PCI and CHD-CABG groups, respectively, and 45 and 16 severe CRS events occurred in the CHD-PCI and CHD-CABG groups, respectively. Our multivariable analysis demonstrated that the incidence of CRS in the CHD-CABG group was significantly higher than that in the CHD-PCI group (aHR: 1.196, 95% CI: 1.064-1.280, P = 0.0402), but the two groups had similar incidence rates of severe CRS (aHR: 0.795, 95% CI: 0.456-1.388, P = 0.5534). Subgroup analyses revealed that the association between CHD severity and CRS development was more significant among men (P = 0.0016). In conclusion, we determined that severe CHD treated with CABG was associated with a higher incidence of subsequent CRS, and this association was more prominent among men.
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Affiliation(s)
- Ke-Hsin Ting
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Yunlin Branch, Yunlin, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yen-Ting Lu
- Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Otolaryngology, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Chung-Han Hsin
- Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Ophthalmology, Nobel Eye Institute, Taipei, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ming-Hong Hsieh
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan
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23
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Mamouei M, Fisher T, Rao S, Li Y, Salimi-Khorshidi G, Rahimi K. A comparative study of model-centric and data-centric approaches in the development of cardiovascular disease risk prediction models in the UK Biobank. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:337-346. [PMID: 37538143 PMCID: PMC10393888 DOI: 10.1093/ehjdh/ztad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/01/2023] [Indexed: 08/05/2023]
Abstract
Aims A diverse set of factors influence cardiovascular diseases (CVDs), but a systematic investigation of the interplay between these determinants and the contribution of each to CVD incidence prediction is largely missing from the literature. In this study, we leverage one of the most comprehensive biobanks worldwide, the UK Biobank, to investigate the contribution of different risk factor categories to more accurate incidence predictions in the overall population, by sex, different age groups, and ethnicity. Methods and results The investigated categories include the history of medical events, behavioural factors, socioeconomic factors, environmental factors, and measurements. We included data from a cohort of 405 257 participants aged 37-73 years and trained various machine learning and deep learning models on different subsets of risk factors to predict CVD incidence. Each of the models was trained on the complete set of predictors and subsets where each category was excluded. The results were benchmarked against QRISK3. The findings highlight that (i) leveraging a more comprehensive medical history substantially improves model performance. Relative to QRISK3, the best performing models improved the discrimination by 3.78% and improved precision by 1.80%. (ii) Both model- and data-centric approaches are necessary to improve predictive performance. The benefits of using a comprehensive history of diseases were far more pronounced when a neural sequence model, BEHRT, was used. This highlights the importance of the temporality of medical events that existing clinical risk models fail to capture. (iii) Besides the history of diseases, socioeconomic factors and measurements had small but significant independent contributions to the predictive performance. Conclusion These findings emphasize the need for considering broad determinants and novel modelling approaches to enhance CVD incidence prediction.
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Affiliation(s)
- Mohammad Mamouei
- Corresponding author. Tel: +44 1865 617200, Fax: +44 1865 617202,
| | - Thomas Fisher
- Deep Medicine, Oxford Martin School, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Nuffield Department of Women’s and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK
| | - Shishir Rao
- Deep Medicine, Oxford Martin School, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Nuffield Department of Women’s and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK
| | - Yikuan Li
- Deep Medicine, Oxford Martin School, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Nuffield Department of Women’s and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK
| | - Ghomalreza Salimi-Khorshidi
- Deep Medicine, Oxford Martin School, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Nuffield Department of Women’s and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK
| | - Kazem Rahimi
- Deep Medicine, Oxford Martin School, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Nuffield Department of Women’s and Reproductive Health, Medical Science Division, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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24
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Hesse K, Egred M, Zaman A, Alkhalil M, Farag M. Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in Complex Coronary Artery Disease: Long-term Clinical Outcomes from a High-volume Center. Heart Views 2023; 24:141-147. [PMID: 37584024 PMCID: PMC10424755 DOI: 10.4103/heartviews.heartviews_116_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/11/2023] [Indexed: 08/17/2023] Open
Abstract
Background Clinical equipoise between a percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) in the treatment of complex coronary artery disease (CAD), including unprotected left main coronary artery (LMCA) and/or three-vessel disease (3VD), remains debatable. Methods A retrospective analysis of an unselected cohort undergoing contemporary PCI versus CABG at a large center in 2015. Patients who received nonemergent treatment of unprotected LMCA and/or 3VD were included. The primary study endpoint was all-cause mortality at 5 years. Secondary endpoints included a composite of all-cause mortality, spontaneous myocardial infarction (MI), or ischemia-driven repeat revascularization at 30 days and 1 year. Results Four hundred and thirty patients met the inclusion criteria, 225 had PCI, and 205 had CABG. PCI patients were older with frequent LMCA involvement and higher EuroSCORE yet they had a fourfold shorter in-hospital stay compared to CABG patients. At 5 years, there was no significant difference in the primary endpoint between CABG and PCI (adjusted Hazard ratios 0.68, 95% confidence interval: 0.38-1.22, P = 0.19). Likewise, there was no significant difference in the incidence of the secondary composite endpoint or its components at 30 days or 1 year. A propensity score-matched analysis in 220 patients revealed similar outcomes. Conclusions In real-world long-term contemporary data, survival after PCI was comparable to CABG at 5 years in patients with unprotected LMCA and/or 3VD. At 1 year, the incidence of spontaneous MI and ischemia-driven repeat revascularization did not differ between the two cohorts. The mode of revascularization in these complex patients should be guided by the heart team.
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Affiliation(s)
- Kerrick Hesse
- Department of Cardiothoracic, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Mohaned Egred
- Department of Cardiothoracic, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Azfar Zaman
- Department of Cardiothoracic, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Mohammad Alkhalil
- Department of Cardiothoracic, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Mohamed Farag
- Department of Cardiothoracic, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
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25
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Freitas D, Alner S, Demetrescu C, Antonacci G, Proudlove N. Time to be more efficient: reducing wasted transthoracic echocardiography (TTE) diagnostic appointment slots at Guy's and St Thomas' NHS Trust. BMJ Open Qual 2023; 12:e002317. [PMID: 37460255 DOI: 10.1136/bmjoq-2023-002317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
Transthoracic echocardiography (TTE) is one of the most requested non-invasive cardiac imaging diagnostic modalities available in the National Health Service (NHS). There is persistently high demand, but nationally, activity has lagged, producing increasing numbers of breaches of the 6-week waiting time target. This delays patients' diagnosis and treatment.Patients attend hospital for TTE either as a clinic-linked or a standalone appointment. In this quality improvement project, we identified that the clinic-linked slots were a major source of wasted capacity due to both unbooked slots and a high rate of patients not attending their appointments (DNA).DNA is a complex issue, aggravated in our trust by many IT systems, complex clinic-booking pathways and restricted patient communication channels. We parked changing these processes, pending an imminent, unifying IT development programme. We focused instead on unused clinic-linked appointments, with the goal of reducing these from 18% (~31 of ~175 allocated each week) to 5% by the end of the 14 week project period.In close collaboration with service stakeholders, we identified that the primary root causes were related to the clinic-linked TTE booking pathway. The change idea was a 7-day rule: after reminders at 9 and 8 days prior to the clinic date, any appointment slots still unbooked by cardiology sub-specialities for patients attending clinic-linked appointments at 7 days, would be used for booking standalone TTE patients.We refined this process over two plan-do-study-act (PDSA) cycles, reducing unused (wasted) appointment slots, allocated initially to clinic-linked patients, to a sustained level of 5.1%, meaning we could now perform approximately 21 additional TTE tests weekly; we have materially increased activity without increasing capacity.This contributed to a significant reduction in 6-week TTE waiting-time breaches. Over the project, this went from 378 (30%, February 2022) to 71 (8%, September 2022) and latest data show 28 (4%, February 2023).
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Affiliation(s)
- Dario Freitas
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sam Alner
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Camelia Demetrescu
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Grazia Antonacci
- Department of Primary Care and Public Health, NIHR ARC Northwest London, Imperial College London, London, UK
- Centre for Health Economics and Policy Innovation (CHEPI), Imperial College Business School, Imperial College London, London, UK
| | - Nathan Proudlove
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
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26
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Kang W, Malvaso A. Mental Health in Coronary Heart Disease (CHD) Patients: Findings from the UK Household Longitudinal Study (UKHLS). Healthcare (Basel) 2023; 11:healthcare11101364. [PMID: 37239650 DOI: 10.3390/healthcare11101364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES Mental health conditions in patients with coronary heart disease (CHD) are closely related to clinical outcomes. Thus, this study's goal is to investigate how CHD affects general and specific aspects of mental health. METHODS We analyzed data from Wave 10 Understanding Society: the UK Household Longitudinal Study (UKHLS), which were collected between 2018 and 2019. After removing people who had missing data, there were 450 participants who indicated that they have CHD, and 6138 age- and sex-matched healthy participants indicated that they were not clinically diagnosed with CHD. RESULTS The main findings were that participants with CHD had more mental health problems, as shown by the GHQ-12 summary score (t (449) = 6.00, p < 0.001, 95% C.I. [0.20, 0.40], Cohen's d = 0.30), social dysfunction and anhedonia, (t (449) = 5.79, p < 0.001, 95% C.I. [0.20, 0.40], Cohen's d = 0.30), depression and anxiety (t (449) = 5.04, p < 0.001, 95% C.I. [0.15, 0.33], Cohen's d = 0.24), and loss of confidence (t (449) = 4.46, p < 0.001, 95% C.I. [0.11, 0.30], Cohen's d = 0.21). CONCLUSION This study implies that GHQ-12 is a valid assessment of mental health problems in CHD patients, and there is a need to consider how different aspects of mental health are affected by CHD rather than solely focusing on depression or anxiety problems alone in patients with CHD.
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Affiliation(s)
- Weixi Kang
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, London SW7 2BX, UK
| | - Antonio Malvaso
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
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27
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Thorlu-Bangura Z, Poole L, Sood H, Khan N, Stevenson F, Khunti K, Gill P, Sajid M, Hanif W, Bhala N, Modha S, Patel K, Blandford A, Banerjee A, Ramasawmy M. Digital health, cardiometabolic disease and ethnicity: an analysis of United Kingdom government policies from 2010 to 2022. J Public Health Policy 2023:10.1057/s41271-023-00410-z. [PMID: 37085565 PMCID: PMC10120476 DOI: 10.1057/s41271-023-00410-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 04/23/2023]
Abstract
Recent health policies in the United Kingdom (UK) and internationally have focussed on digitisation of healthcare. We examined UK policies for evidence of government action addressing health inequalities and digital health, using cardiometabolic disease as an exemplar. Using a systematic search methodology, we identified 87 relevant policy documents published between 2010 and 2022. We found increasing emphasis on digital health, including for prevention, diagnosis and management of cardiometabolic disease. Several policies also focused on tackling health inequalities and improving digital access. The COVID-19 pandemic amplified inequalities. No policies addressed ethnic inequalities in digital health for cardiometabolic disease, despite high prevalence in minority ethnic communities. Our findings suggest that creating opportunities for digital inclusion and reduce longer-term health inequalities, will require future policies to focus on: the heterogeneity of ethnic groups; cross-sectoral disadvantages which contribute to disease burden and digital accessibility; and disease-specific interventions which lend themselves to culturally tailored solutions.
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Affiliation(s)
| | - Lydia Poole
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, Surrey, UK
| | | | - Nushrat Khan
- Institute of Health Informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
| | - Fiona Stevenson
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Madiha Sajid
- Patient and Public Involvement Representative, DISC Study, London, UK
| | - Wasim Hanif
- Department of Diabetes, University Hospital Birmingham, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Edgbaston, Birmingham, UK
| | - Shivali Modha
- Patient and Public Involvement Representative, DISC Study, London, UK
| | - Kiran Patel
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Amitava Banerjee
- Institute of Health Informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
| | - Mel Ramasawmy
- Institute of Health Informatics, UCL, 222 Euston Road, London, NW1 2DA, UK.
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Pohl J, Heintze C, Herrmann WJ. Patients' and GPs' duties and responsibilities in long-term care after myocardial infarction: a qualitative study of patients' perspectives. Fam Pract 2023; 40:98-104. [PMID: 35770486 DOI: 10.1093/fampra/cmac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cardiovascular disease is one of the main causes of death in Europe and around the world. Effective and individualized long-term treatment of patients with chronic diseases such as cardiovascular disease and myocardial infarction reduces mortality and the risk of recurrence and prevents secondary disease. However, there is little data on patients' views. OBJECTIVE To examine patients' perspectives on long-term care after myocardial infarction. METHODS A qualitative interview study with patients after myocardial infarction in Berlin and Brandenburg, Germany. Fifteen episodic interviews were conducted, transcribed, coded, and analyzed using framework analysis. RESULTS Participants consistently emphasized major functions fulfilled by general practitioners: monitoring, advice, diagnosis, referral, coordination. Furthermore, other functions such as empathy and feeling emotionally valued. Major patient roles emerged such as information sharing, lifestyle change, and coping. Responsibility toward doctors was expressed in terms of active participation in describing their symptoms, following the doctor's directions, and sharing in decision-making. Self-responsibility in participants showed 2 contrasting approaches. On the one hand, a passive attitude (acceptance, helplessness), and on the other, active resistance and taking action. CONCLUSION The study underlines the importance of communication and awareness of the patient's perspective. General practitioners must address patients' aims and fears, encourage their initiative, and focus on empathy and education.
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Affiliation(s)
- Jonathan Pohl
- Institute of General Practice and Family Medicine, Charité Universitätsmedizin Berlin, Germany
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité Universitätsmedizin Berlin, Germany
| | - Wolfram J Herrmann
- Institute of General Practice and Family Medicine, Charité Universitätsmedizin Berlin, Germany
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Makkar K, Sharma YP, Batta A, Hatwal J, Panda PK. Role of fibrinogen, albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome. World J Cardiol 2023; 15:13-22. [PMID: 36714367 PMCID: PMC9850671 DOI: 10.4330/wjc.v15.i1.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/08/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic unmasked the huge deficit in healthcare resources worldwide. It highlighted the need for efficient risk stratification in management of cardiovascular emergencies.
AIM To study the applicability of the old, available and affordable nonconventional biomarkers: albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome (ACS).
METHODS In this prospective, observational study, 166 consecutive patients with ACS were enrolled. Fibrinogen, albumin and their ratio were determined from serum. Patients with underlying chronic liver disease, active malignancy, autoimmune disease, active COVID-19 infection and undergoing thrombolysis were excluded.
RESULTS Mean age of the population was 60.5 ± 1.5 years, 74.1% being males. ST elevation myocardial infarction (STEMI) was most common presentation of ACS seen in 57% patients. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % [area under the receiver operating characteristic curves (AUROC) = 0.8, P = 0.001] to predict ≤ thrombolysis in myocardial infarction (TIMI) 1 flow in culprit artery in STEMI patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity (AUROC = 0.715, P = 0.006).
CONCLUSION Novel biomarkers, with their high cost, lack of availability and long turn over time are impractical for real-world use. Identifying ≤ TIMI 1 flow in the culprit artery has significant impact of management and outcome. Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.
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Affiliation(s)
- Kunaal Makkar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Yash Paul Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
| | - Juniali Hatwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Prashant Kumar Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Patel M, Uthman O. Impact of quality of life in developing cardiovascular disease later in life: Graphical chain model of the English Longitudinal Study of Ageing (ELSA). Arch Gerontol Geriatr 2023; 104:104820. [PMID: 36108360 DOI: 10.1016/j.archger.2022.104820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of this paper is to demonstrate how graphical chain models can be used to model how cardiovascular disease affected quality of life in later life over the course of 17 years of data. METHODS Waves 1-9 of the English Longitudinal Study of Ageing was used to investigate how quality of life changed over each wave using the CASP-19 questionnaire, and whether having experienced a cardiovascular event had an effect on quality of life. RESULTS A total of 12,099 participants were included in the study. Participants had a mean age of 64.2 years, the majority of which were over 50 years old. Older people are more likely to have cardiac events. A one-unit rise in CES-D 8-item score was related with a 14% increased risk of CVD at Wave 1. Those with an O-level, A-level, or degree (or equivalent) had lower CVD risks than those with no education. Women had half the CVD risk of men. Living alone reduced the risk of a CVD-event by 15%. Moderate and vigorous exercise lowered cardiac event risk compared to no exercise. Current or ex-smokers have a 30% higher risk of CVD than non-smokers. Cardiovascular event was significantly associated with quality of life at waves 1 and 2 only. DISCUSSION Events related to cardiovascular disease only affected quality of life in later life up to 4 years. Factors such as age, depression, perceived position on social ladder, and high levels of physical activity affected quality of life throughout the majority of waves.
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Affiliation(s)
- Mubarak Patel
- Warwick Evidence, Warwick Medical School (WMS), University of Warwick, Coventry CV47AL, UK.
| | - Olalekan Uthman
- Warwick Evidence, Warwick Medical School (WMS), University of Warwick, Coventry CV47AL, UK.
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Zhao SQ, Zhao LP, Xu XP, You H. Individual-Level Health Care Costs Attributable to Noncommunicable Diseases: A Longitudinal Study Based on the Older Adults in China. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231214469. [PMID: 38044620 PMCID: PMC10697053 DOI: 10.1177/00469580231214469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023]
Abstract
Noncommunicable chronic diseases among the elderly population represent a significant economic burden in China. However, previous disease-related health cost studies lacked representation of older adults and comparability of the burden of multiple chronic diseases. The objective of this study was to determine the fraction of health care costs attributable to the 6 most prevalent chronic diseases and comorbidities in the sample of older adults. This study employed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with 3 waves in 2011, 2014, and 2018, and included 18 349 observations in total. Outpatient costs, inpatient costs, and total health care costs were included in this study. Based on a 2-part random effects model, the effect of chronic disease on health service utilization was first explored by constructing a dummy variable for whether or not to utilize health care, followed by estimation of attributable costs in the population with health care utilization. Among the older adults in the sample, hypertension, heart disease, cataracts, arthritis, stroke or Cerebrovascular disease (CVD) and chronic lung disease are the 6 most prevalent chronic conditions. The costs attributable to the 6 chronic diseases mentioned above were 36.00% of outpatient costs, 55.92% of inpatient costs, and 45.05% of total health care costs for older adults. Of these, heart disease, stroke or CVD, and chronic lung disease accounted for 22.11%, 13.24%, and 10.56% of total health care costs, respectively. Moreover, the proportion of health care costs attributable to chronic diseases was higher for older adults who were male, lived in urban areas, and had a lower level of education. The proportion of health care costs attributable to chronic diseases is substantial among older adults in China. Health care costs associated with chronic diseases can be decreased with well-targeted interventions and comprehensive access to health services.
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Affiliation(s)
| | | | | | - Hua You
- Nanjing Medical University, Nanjing, China
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Zheng F, Xie W, Li C, Gao D, Liang J. Prediction abilities of SCORE2 risk algorithms for incident dementia and all-cause mortality: results from the UK Biobank cohort study. J Gerontol A Biol Sci Med Sci 2022; 78:704-710. [PMID: 36512643 DOI: 10.1093/gerona/glac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Whether the updated Systematic COronary Risk Evaluation (SCORE2) risk algorithm is suitable for the prediction of incident dementia and all-cause mortality and whether its discrimination abilities for these outcomes are higher than those of the SCORE and Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) risk algorithms are unclear. METHODS The present study included 429,033 participants (mean age: 57.1±8.1 years; male: 46.2%; white: 94.1%) free of dementia from the UK Biobank at baseline, with a median follow-up of 12.8 years. Cox regression models were adopted to investigate the longitudinal relationships of SCORE2 risk categories with outcomes, and receiver operating characteristic curve analyses were used to compare the discrimination abilities of the three algorithms. RESULTS During 5,376,778 person-years of follow-up, 6477 all-cause dementia, 2726 Alzheimer's disease (AD), 1439 vascular disease (VD), and 31,981 all-cause deaths were identified. We found that higher SCORE2 risk was associated with higher risks of all-cause dementia, AD, VD, and all-cause mortality. The C-indices of SCORE2 risk for discriminating incident all-cause dementia, AD, VD, and all-cause death were 0.750 (95% CI: 0.745 to 0.755), 0.750 (95% CI: 0.743 to 0.757), 0.800 (95% CI: 0.791 to 0.809), and 0.721 (95% CI: 0.718 to 0.724), respectively, which were significantly improved in comparison to those of the SCORE and CAIDE risk algorithms. CONCLUSION The SCORE2 risk algorithm is applicable in predicting incident all-cause dementia, AD, VD and all-cause mortality in European populations, and its discrimination abilities for dementia and death are significantly higher than those of the SCORE and CAIDE risk algorithms. Further validations in other populations are warranted.
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Affiliation(s)
- Fanfan Zheng
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Darui Gao
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Jie Liang
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Mistry H, Enderby J, Court R, Al-Khudairy L, Nduka C, Melendez-Torres GJ, Taylor-Phillips S, Clarke A, Uthman OA. Determining optimal strategies for primary prevention of cardiovascular disease: systematic review of cost-effectiveness analyses in the United Kingdom. Health Technol Assess 2022:10.3310/QOVK6659. [PMID: 36562488 PMCID: PMC10068585 DOI: 10.3310/qovk6659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The aim of the study was to guide researchers and commissioners of cardiovascular disease preventative services towards possible cost-effective interventions by reviewing published economic analyses of interventions for the primary prevention of cardiovascular disease, conducted for or within the UK NHS. METHODS In January 2021, electronic searches of MEDLINE and Embase were carried out to find economic evaluations of cardiovascular disease preventative services. We included fully published economic evaluations (including economic models) conducted alongside randomised controlled trials of any form of intervention that was aimed at the primary prevention of cardiovascular disease, including, but not limited to, drugs, diet, physical activity and public health. Full systematic review methods were used with predetermined inclusion/exclusion criteria, data extraction and formal quality appraisal [using the Consolidated Health Economic Evaluation Reporting Standards checklist and the framework for the quality assessment of decision analytic modelling by Philips et al. (Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004;8(36)]. RESULTS Of 4351 non-duplicate citations, eight articles met the review's inclusion criteria. The eight articles focused on health promotion (n = 3), lipid-lowering medicine (n = 4) and blood pressure-lowering medication (n = 1). The majority of the populations in each study had at least one risk factor for cardiovascular disease or were at high risk of cardiovascular disease. For the primary prevention of cardiovascular disease, all strategies were cost-effective at a threshold of £25,000 per quality-adjusted life-year, except increasing motivational interviewing in addition to other behaviour change strategies. Where the cost per quality-adjusted life-year gained was reported, interventions varied from dominant (i.e. less expensive and more effective than the comparator intervention) to £55,000 per quality-adjusted life-year gained. FUTURE WORK AND LIMITATIONS We found few health economic analyses of interventions for primary cardiovascular disease prevention conducted within the last decade. Future economic assessments should be undertaken and presented in accordance with best practices so that future reviews may make clear recommendations to improve health policy. CONCLUSIONS It is difficult to establish direct comparisons or draw firm conclusions because of the uncertainty and heterogeneity among studies. However, interventions conducted for or within the UK NHS were likely to be cost-effective in people at increased risk of cardiovascular disease when compared with usual care or no intervention. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in Health Technology Assessment. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hema Mistry
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jodie Enderby
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Chidozie Nduka
- Warwick Medical School, University of Warwick, Coventry, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Aileen Clarke
- Warwick Medical School, University of Warwick, Coventry, UK
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Ulloque-Badaracco JR, Hernandez-Bustamante EA, Alarcon-Braga EA, Mosquera-Rojas MD, Campos-Aspajo A, Salazar-Valdivia FE, Valdez-Cornejo VA, Benites-Zapata VA, Herrera-Añazco P, Valenzuela-Rodríguez G, Hernandez AV. Atherogenic index of plasma and coronary artery disease: A systematic review. Open Med (Wars) 2022; 17:1915-1926. [PMID: 36561845 PMCID: PMC9730543 DOI: 10.1515/med-2022-0590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 10/06/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022] Open
Abstract
Various studies suggest that the atherogenic index of plasma (AIP) is associated with the risk of coronary artery disease (CAD) in different clinical scenarios. This review aimed to synthesize evidence of the association between AIP values and CAD. A literature search was carried out on four databases, namely, PubMed, Scopus, Web of Science, and Ovid-Medline. A handsearch was performed on preprint repositories (MedRxiv and Research Square). The effect measurements were expressed as odds ratios (OR) with their corresponding 95% confidence intervals (CI). For the quantitative synthesis, we employed a random-effects model. We analyzed 14 articles (with 40,902 participants) from seven different countries. The quantitative analysis revealed that an increase in one unit of AIP was associated with higher odds of developing CAD (OR 2.11; 95% CI 1.65-2.69; P < 0.001; I 2 = 98%). We conducted subgroup analyses of Chinese (OR 1.89; 95% CI 1.40-2.56; P < 0.001) and non-Chinese studies (OR 2.51; 95% CI 1.42-4.42; P < 0.001). The sensitivity analysis by risk of bias continued to demonstrate an association, and the heterogeneity remained unchanged (OR 1.75; 95% CI 1.33-2.31; P < 0.001; I 2 = 98%). Higher AIP values were associated with higher odds of developing CAD.
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Affiliation(s)
- Juan R. Ulloque-Badaracco
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú,Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Enrique A. Hernandez-Bustamante
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Perú,Grupo Peruano de Investigación Epidemiológica, Unidad Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - Esteban A. Alarcon-Braga
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú,Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Melany D. Mosquera-Rojas
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú,Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Alvaro Campos-Aspajo
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú,Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Farley E. Salazar-Valdivia
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú,Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Valeria A. Valdez-Cornejo
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú,Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Vicente A. Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Avenida La Fontana #750 La Molina, Lima, Perú
| | - Percy Herrera-Añazco
- Facultad de Ciencias de la Salud, Universidad Privada del Norte, Trujillo, Perú,Instituto de Evaluación de Tecnologías en Salud e Investigación – IETSI, EsSalud, Lima, Peru
| | - Germán Valenzuela-Rodríguez
- Clínica Delgado, Servicio de Medicina Interna y Cardiología, Lima, Perú,Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Perú
| | - Adrian V. Hernandez
- Unidad de Revisiones Sistemáticas y Meta- análisis, Guías de Práctica Clínica y Evaluaciones de Tecnología Sanitaria, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú,Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, United States of America
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Xie CX, Robson J, Williams C, Carvalho C, Rison S, Raisi-Estabragh Z. Dual antithrombotic therapy and gastroprotection in atrial fibrillation: an observational primary care study. BJGP Open 2022; 6:BJGPO.2022.0048. [PMID: 36028299 PMCID: PMC9904777 DOI: 10.3399/bjgpo.2022.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/06/2022] [Accepted: 05/06/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Patients with both atrial fibrillation (AF) and cardiovascular disease (CVD) may receive dual antithrombotic therapy (DAT) with both an anticoagulant and ≥1 antiplatelet agents. Avoiding prolonged duration of DAT and use of gastroprotective therapies reduces bleeding risk. AIM To describe the extent and duration of DAT and use of gastroprotection in a primary care cohort of patients with AF. DESIGN & SETTING Observational study in 1.2 million people registered with GPs across four east London clinical commissioning groups (CCGs), covering prescribing from January 2020-June 2021. METHOD In patients with AF, factors associated with DAT prescription, prolonged DAT prescription (>12 months), and gastroprotective prescription were characterised using logistic regression. RESULTS There were 8881 patients with AF, of whom 4.7% (n = 416) were on DAT. Of these, 65.9% (n = 274) were prescribed DAT for >12 months and 84.4% (n = 351) were prescribed concomitant gastroprotection. Independent of all other factors, females with AF were less likely to receive DAT than males (odds ratio [OR] 0.61, 95% confidence interval [CI] = 0.49 to 0.77). Similarly, older (aged ≥75 years) individuals (OR 0.79, 95% CI = 0.63 to 0.98) were less likely to receive DAT than younger patients. Among those with AF on DAT, pre-existing CVD (OR 3.33, 95% CI = 1.71 to 6.47) and South Asian ethnicity (OR 2.70, 95% CI = 1.15 to 6.32) were associated with increased gastroprotection prescriptions. Gastroprotection prescription (OR 1.80, 95% CI = 1.01 to 3.22) was associated with prolonged DAT prescription. CONCLUSION Almost two-thirds of patients with AF on DAT were prescribed prolonged durations of therapy. Prescription of gastroprotection therapies was suboptimal in one in six patients. Treatment decisions varied by sex, age, ethnic group, and comorbidity. Duration of DAT and gastroprotection in patients with AF requires improvement.
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Affiliation(s)
- Charis Xuan Xie
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John Robson
- North East London Integrated Care System, Unex Tower, London, UK
| | - Crystal Williams
- North East London Integrated Care System, Unex Tower, London, UK
| | - Chris Carvalho
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- North East London Integrated Care System, Unex Tower, London, UK
| | - Stuart Rison
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- North East London Integrated Care System, Unex Tower, London, UK
| | - Zahra Raisi-Estabragh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, National Institute for Health and Care Research Barts Biomedical Research Centre, Queen Mary University London, London, UK
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SIAFARIKAS CHRISTOS, LIATIS STAVROS, KAPELIOS CHRISTOS, SKOULOUDI MARINA, BONOU MARIA, BARBETSEAS JOHN. Inadequate management of cardiovascular risk factors prior to admission for an acute coronary event. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E598-E603. [PMID: 36891008 PMCID: PMC9986978 DOI: 10.15167/2421-4248/jpmh2022.63.4.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/12/2022] [Indexed: 03/10/2023]
Abstract
Objectives Optimal regulation of modifiable risk factors has been proposed as the standard of care both for primary and secondary prevention of cardiovascular disease (CVD). The aim of this study was to assess primary and secondary cardiovascular risk management received before admission for an acute coronary event. Methods Data were analyzed for 185 consecutive hospitalized patients with a diagnosis of acute coronary syndrome (ACS) in the Cardiology department of a University hospital during an annual period (1/7/2019 until 30/6/2020). The study population was divided into two groups, the primary and secondary prevention subgroups, according to previous medical history of cardiovascular disease (CVD). Results The mean age of the participants was 65.5 ±12.2 years and most patients were male (81.6%). Previous CVD was present in 51 patients (27.9%). Fifty-seven patients (30.8%) had a history of diabetes mellitus (DM) and 97 (52.4%) had a history of dyslipidemia. Hypertension was present in 101 (54.6%) patients. In the secondary prevention group, the LDL-C was on target in only 33.3% of the patients, while 20% patients did not use statins. The use of antiplatelet/anticoagulant agents was 94.5%. Among patients with diabetes, only 20% had been using a GLP-1 receptor agonist or/and an SGLT-2 inhibitor, while the HbA1c was on target in 47.8%. Twenty-five percent of the patients were active smokers. In the primary prevention group, the use of statins was overall low (25.8%) but more frequent in patients with diabetes and those without diabetes at very high-risk for CVD (47.1% and 32.1% respectively). The LDL-C was on target in less than 23.1% of the patients. The use of antiplatelet/anticoagulant agents was low (20.1%), but higher in those with diabetes (52.9%). In the diabetic group, HbA1c was on target in 61.8%. Active smoking was practiced by 46.3% of the patients. Conclusions Our data show that in a substantial proportion of patients presenting with ACS, previous CVD prevention, both primary and secondary, fails to meet the current recommendations provided by scientific societies.
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Affiliation(s)
- CHRISTOS SIAFARIKAS
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527, Athens, Greece
- Correspondence: Siafarikas Christos, First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Agiou Thoma 17, 11527, Athens. Tel.: +306944604258 - E-mail:
| | - STAVROS LIATIS
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527, Athens, Greece
| | - CHRISTOS KAPELIOS
- Department of Cardiology, Laiko General Hospital, 11527 Athens, Greece
| | - MARINA SKOULOUDI
- Department of Cardiology, Laiko General Hospital, 11527 Athens, Greece
| | - MARIA BONOU
- Department of Cardiology, Laiko General Hospital, 11527 Athens, Greece
| | - JOHN BARBETSEAS
- Department of Cardiology, Laiko General Hospital, 11527 Athens, Greece
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Are South African Wild Foods the Answer to Rising Rates of Cardiovascular Disease? DIVERSITY 2022. [DOI: 10.3390/d14121014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The rising burden of cardiovascular disease in South Africa gives impetus to managerial changes, particularly to the available foods in the market. Since there are many economically disadvantaged groups in urban societies who are at the forefront of the CVD burden, initiatives to make healthier foods available should focus on affordability in conjunction with improved phytochemical diversity to incentivize change. The modern obesogenic diet is deficient in phytochemicals that are protective against the metabolic products of sugar metabolism, i.e., inflammation, reactive oxygen species and mitochondrial fatigue, whereas traditional southern African food species have high phytochemical diversity and are also higher in soluble dietary fibres that modulate the release of sugars from starches, nurture the microbiome and produce digestive artefacts that are prophylactic against cardiovascular disease. The examples of indigenous southern African food species with high horticultural potential that can be harvested sustainably to feed a large market of consumers include: Aloe marlothii, Acanthosicyos horridus, Adansonia digitata, Aloe ferox, Amaranthus hybridus, Annesorhiza nuda, Aponogeton distachyos, Bulbine frutescens, Carpobrotus edulis, Citrullus lanatus, Dioscorea bulbifera, Dovyalis caffra, Eleusine coracana, Lagenaria siceraria, Mentha longifolia, Momordica balsamina, Pelargonium crispum, Pelargonium sidoides, Pennisetum glaucum, Plectranthus esculentus, Schinziophyton rautanenii, Sclerocarya birrea, Solenostemon rotundifolius, Talinum caffrum, Tylosema esculentum, Vigna unguiculata and Vigna subterranea. The current review explains the importance of phytochemical diversity in the human diet, it gives a lucid explanation of phytochemical groups and links the phytochemical profiles of these indigenous southern African foods to their protective effects against cardiovascular disease.
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Franco C, Sciatti E, Favero G, Bonomini F, Vizzardi E, Rezzani R. Essential Hypertension and Oxidative Stress: Novel Future Perspectives. Int J Mol Sci 2022; 23:ijms232214489. [PMID: 36430967 PMCID: PMC9692622 DOI: 10.3390/ijms232214489] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Among cardiovascular diseases, hypertension is one of the main risk factors predisposing to fatal complications. Oxidative stress and chronic inflammation have been identified as potentially responsible for the development of endothelial damage and vascular stiffness, two of the primum movens of hypertension and cardiovascular diseases. Based on these data, we conducted an open-label randomized study, first, to evaluate the endothelial damage and vascular stiffness in hypertense patients; second, to test the effect of supplementation with a physiological antioxidant (melatonin 1 mg/day for 1 year) in patients with essential hypertension vs. hypertensive controls. Twenty-three patients of either gender were enrolled and randomized 1:1 in two groups (control and supplemented group). The plasmatic total antioxidant capacity (as a marker of oxidative stress), blood pressure, arterial stiffness, and peripheral endothelial function were evaluated at the beginning of the study and after 1 year in both groups. Our results showed that arterial stiffness improved significantly (p = 0.022) in supplemented patients. The endothelial function increased too, even if not significantly (p = 0.688), after 1 year of melatonin administration. Moreover, the supplemented group showed a significative reduction in TAC levels (p = 0.041) correlated with the improvement of arterial stiffness. These data suggest that melatonin may play an important role in reducing the serum levels of TAC and, consequently, in improving arterial stiffness.
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Affiliation(s)
- Caterina Franco
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Edoardo Sciatti
- Cardiology Unit 1, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Gaia Favero
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Francesca Bonomini
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
- Interdepartmental University Center of Research “Adaption and Regeneration of Tissues and Organs-(ARTO)”, University of Brescia, 25123 Brescia, Italy
- Italian Society of Orofacial Pain (SISDO), 25123 Brescia, Italy
| | - Enrico Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
- Correspondence: (E.V.); (R.R.)
| | - Rita Rezzani
- Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
- Interdepartmental University Center of Research “Adaption and Regeneration of Tissues and Organs-(ARTO)”, University of Brescia, 25123 Brescia, Italy
- Italian Society of Orofacial Pain (SISDO), 25123 Brescia, Italy
- Correspondence: (E.V.); (R.R.)
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Mordi I, Trucco E. The eyes as a window to the heart: looking beyond the horizon. Br J Ophthalmol 2022; 106:1627-1628. [PMID: 36195458 DOI: 10.1136/bjo-2022-322517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ify Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
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Ramírez J, van Duijvenboden S, Young WJ, Tinker A, Lambiase PD, Orini M, Munroe PB. Prediction of Coronary Artery Disease and Major Adverse Cardiovascular Events Using Clinical and Genetic Risk Scores for Cardiovascular Risk Factors. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2022; 15:e003441. [PMID: 35861959 PMCID: PMC9584057 DOI: 10.1161/circgen.121.003441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) and major adverse cardiovascular events (MACE) are the leading causes of death in the general population, but risk stratification remains suboptimal. CAD genetic risk scores (GRSs) predict risk independently from clinical tools, like QRISK3. We assessed the added value of GRSs for a variety of cardiovascular traits (CV GRSs) for predicting CAD and MACE and tested their early-life screening potential by comparing against the CAD GRS only. METHODS We used data from 379 581 participants in the UK Biobank without known cardiovascular conditions (follow-up, 11.3 years; 3.3% CAD cases and 5.2% MACE cases). In a training subset (50%) we built 3 scores: QRISK3; QRISK3 and an established CAD GRS; and QRISK3, the CAD GRS and the CV GRSs. In an independent subset (50%), we evaluated each score's performance using the concordance index, odds ratio and net reclassification index. We then repeated the analyses without considering QRISK3. RESULTS For CAD, the combination of QRISK3 and the CAD GRS had a better performance than QRISK3 alone (concordance index, 0.766 versus 0.753; odds ratio, 5.47 versus 4.82; net reclassification index, 7.7%). Adding the CV GRSs did not significantly improve risk stratification. When only looking at genetic information, the combination of CV GRSs and the CAD GRS had a better performance than the CAD GRS alone (concordance index, 0.637 versus 0.625; odds ratio, 2.17 versus 2.07; net reclassification index, 3.3%). Similar results were obtained for MACE. CONCLUSIONS In individuals without known cardiovascular disease, the inclusion of CV GRSs to a clinical tool and an established CAD GRS does not improve CAD or MACE risk stratification. However, their combination only with the CAD GRS increases prediction performance indicating potential use in early-life screening before the advanced development of conventional cardiovascular risk factors.
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Affiliation(s)
- Julia Ramírez
- Clinical Pharmacology and Precision Medicine Deparment, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (J.R., S.v.D., W.J.Y., A.T., P.B.M.).,Electronic Engineering and Communications Department, Aragon Institute of Engineering Research, University of Zaragoza, Spain and CIBER's Bioengineering, Biomaterials and Nanomedicine, Spain. (J.R.)
| | - Stefan van Duijvenboden
- Clinical Pharmacology and Precision Medicine Deparment, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (J.R., S.v.D., W.J.Y., A.T., P.B.M.).,Institute of Cardiovascular Science, University College London, London, United Kingdom (S.v.D., P.D.L., M.O.)
| | - William J Young
- Clinical Pharmacology and Precision Medicine Deparment, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (J.R., S.v.D., W.J.Y., A.T., P.B.M.).,Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (W.J.Y., P.D.L., M.O.)
| | - Andrew Tinker
- Clinical Pharmacology and Precision Medicine Deparment, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (J.R., S.v.D., W.J.Y., A.T., P.B.M.).,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (A.T., P.B.M.)
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, London, United Kingdom (S.v.D., P.D.L., M.O.).,Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (W.J.Y., P.D.L., M.O.)
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, United Kingdom (S.v.D., P.D.L., M.O.).,Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (W.J.Y., P.D.L., M.O.)
| | - Patricia B Munroe
- Clinical Pharmacology and Precision Medicine Deparment, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (J.R., S.v.D., W.J.Y., A.T., P.B.M.).,NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (A.T., P.B.M.)
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Pineda‐Moncusí M, El‐Hussein L, Delmestri A, Cooper C, Moayyeri A, Libanati C, Toth E, Prieto‐Alhambra D, Khalid S. Estimating the Incidence and Key Risk Factors of Cardiovascular Disease in Patients at High Risk of Imminent Fracture Using Routinely Collected Real-World Data From the UK. J Bone Miner Res 2022; 37:1986-1996. [PMID: 35818312 PMCID: PMC9826104 DOI: 10.1002/jbmr.4648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/31/2022] [Accepted: 07/07/2022] [Indexed: 01/11/2023]
Abstract
The objective of this work was to estimate the incidence rate of cardiovascular disease (CVD) events (myocardial infarction, stroke, or CVD death) at 1 year among three cohorts of patients at high risk of fracture (osteoporosis, previous fracture, and anti-osteoporosis medication) and to identify the key risk factors of CVD events in these three cohorts. To do so, this prospective cohort study used data from the Clinical Practice Research Datalink, a primary care database from United Kingdom. Major adverse cardiovascular events (MACE, a composite outcome for the occurrence of either myocardial infarction [MI], stroke, or CVD death) were identified in patients aged 50 years or older at high or imminent fracture risk identified in three different cohorts (not mutually exclusive): recently diagnosed with osteoporosis (OST, n = 65,295), incident fragility fracture (IFX, n = 67,065), and starting oral bisphosphonates (OBP, n = 145,959). About 1.90%, 4.39%, and 2.38% of the participants in OST, IFX, and OBP cohorts, respectively, experienced MACE events. IFX was the cohort with the higher risk: MACE incidence rates (cases/1000 person-years) were 19.63 (18.54-20.73) in OST, 52.64 (50.7-54.5) in IFX, and 26.26 (25.41-27.12) in OBP cohorts. Risk of MACE events at 1 year was predicted in the three cohorts. Models using a set of general, CVD, and fracture candidates selected by lasso regression had a good discrimination (≥70%) and internal validity and generally outperformed the models using only the CVD risk factors of general population listed in QRISK tool. Main risk factors common in all MACE models were sex, age, smoking, alcohol, atrial fibrillation, antihypertensive medication, prior MI/stroke, established CVD, glomerular filtration rate, systolic blood pressure, cholesterol levels, and number of concomitant medicines. Identified key risk factors highlight the differences of patients at high risk of fracture versus general population. Proposed models could improve prediction of CVD events in patients with osteoporosis in primary care settings. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Marta Pineda‐Moncusí
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic CentreUniversity of OxfordOxfordUK
| | - Leena El‐Hussein
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic CentreUniversity of OxfordOxfordUK
| | - Antonella Delmestri
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic CentreUniversity of OxfordOxfordUK
| | - Cyrus Cooper
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic CentreUniversity of OxfordOxfordUK
- MRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton General HospitalSouthamptonUK
| | | | | | | | - Daniel Prieto‐Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic CentreUniversity of OxfordOxfordUK
- MRC Lifecourse Epidemiology UnitUniversity of Southampton, Southampton General HospitalSouthamptonUK
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJ Gol)CIBERFESBarcelonaSpain
- Universitat Autònoma de BarcelonaBellaterra (Cerdanyola del Vallès)Cerdanyola del VallèsSpain
| | - Sara Khalid
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic CentreUniversity of OxfordOxfordUK
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Vasan RS, Song RJ, van den Heuvel ER. Temporal Trends in Incidence of Premature Cardiovascular Disease Over the Past 7 Decades: The Framingham Heart Study. J Am Heart Assoc 2022; 11:e026497. [PMID: 36172970 DOI: 10.1161/jaha.122.026497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Premature onset of cardiovascular disease (CVD) imposes a significant societal burden and challenges prevention efforts. Methods and Results Trends in the incidence of premature CVD (before age 55, 60, or 65 years, separate analysis for each threshold) were evaluated in 14 464 Framingham Heart Study participants over 7 decades of observation (1950-2019). The change in the incidence of premature CVD (per decade) in men and women was assessed using overdispersed Poisson regression (accounting for cohort effects), adjusting for age at entry and age at onset of premature CVD within each decade. CVD was defined as a composite of fatal or nonfatal coronary heart disease, stroke or transient ischemic attack, peripheral vascular disease, and heart failure. There were 2223 first CVD events (832 in women) before age 65 years during 282 481 person-years of observations (154 587 in women) between 1950 and 2019. The age-adjusted CVD incidence before age 65 years decreased from 14.8 per 1000 person-years (1950-1959) to 4.69 per 1000 person-years (2010-2019) in men and from 7.23 per 1000 person-years (1950-1959) to 1.73 per 1000 person-years (2010-2019) in women. In adjusted analyses, the incidence of premature CVD decreased per decade in men (18.4% [95% CI, 12.0%-24.0%], for onset before age 55 years; 19.5% [95% CI, 12.0%-27.0%], for onset before age 60 years; 21.3% [95% CI, 16.0%-27.0%], for onset before age 65 years) and women (15.1% [95% CI, 7.0%-22.0%], for onset before age 55 years; 14.0% [95% CI, 6.0%-22.0%], for onset before age 60 years; 18.2% [95% CI, 12.0%-24.0%], for onset before age 65 years). The decline in premature CVD was accompanied by a reduction in smoking and increased use of lipid-lowering treatments across the decades. Incidence of premature coronary heart disease decreased, whereas the contribution of stroke to premature CVD burden increased over time. Conclusions The incidence of premature CVD has decreased among White adults in the Framingham cohort over the past 70 years; the residual burden of premature stroke warrants further study. Additional studies of trends in premature CVD in more racially and geographically diverse populations are warranted to elucidate the generalizability of these findings.
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Affiliation(s)
- Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology Boston University School of Medicine Boston MA.,Framingham Heart Study Framingham MA.,Department of Epidemiology Boston University School of Public Health Boston MA.,University of Texas School of Public Health San Antonio TX
| | - Rebecca J Song
- Department of Epidemiology Boston University School of Public Health Boston MA
| | - Edwin R van den Heuvel
- Section of Preventive Medicine and Epidemiology Boston University School of Medicine Boston MA.,Department of Biostatistics Boston University School of Public Health Boston MA.,Department of Mathematics and Computer Science Eindhoven University of Technology Eindhoven the Netherlands
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Jolliffe DA, Holt H, Greenig M, Talaei M, Perdek N, Pfeffer P, Vivaldi G, Maltby S, Symons J, Barlow NL, Normandale A, Garcha R, Richter AG, Faustini SE, Orton C, Ford D, Lyons RA, Davies GA, Kee F, Griffiths CJ, Norrie J, Sheikh A, Shaheen SO, Relton C, Martineau AR. Effect of a test-and-treat approach to vitamin D supplementation on risk of all cause acute respiratory tract infection and covid-19: phase 3 randomised controlled trial (CORONAVIT). BMJ 2022; 378:e071230. [PMID: 36215226 PMCID: PMC9449358 DOI: 10.1136/bmj-2022-071230] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the effect of population level implementation of a test-and-treat approach to correction of suboptimal vitamin D status (25-hydroxyvitamin D (25(OH)D) <75 nmol/L) on risk of all cause acute respiratory tract infection and covid 19. DESIGN Phase 3 open label randomised controlled trial. SETTING United Kingdom. PARTICIPANTS 6200 people aged ≥16 years who were not taking vitamin D supplements at baseline. INTERVENTIONS Offer of a postal finger prick test of blood 25(OH)D concentration with provision of a six month supply of lower dose vitamin D (800 IU/day, n=1550) or higher dose vitamin D (3200 IU/day, n=1550) to those with blood 25(OH)D concentration <75 nmol/L, compared with no offer of testing or supplementation (n=3100). Follow-up was for six months. MAIN OUTCOME MEASURES The primary outcome was the proportion of participants with at least one swab test or doctor confirmed acute respiratory tract infection of any cause. A secondary outcome was the proportion of participants with swab test confirmed covid-19. Logistic regression was used to calculate odds ratios and associated 95% confidence intervals. The primary analysis was conducted by intention to treat. RESULTS Of 3100 participants offered a vitamin D test, 2958 (95.4%) accepted and 2674 (86.3%) had 25(OH)D concentrations <75 nmol/L and received vitamin D supplements (n=1328 lower dose, n=1346 higher dose). Compared with 136/2949 (4.6%) participants in the no offer group, at least one acute respiratory tract infection of any cause occurred in 87/1515 (5.7%) in the lower dose group (odds ratio 1.26, 95% confidence interval 0.96 to 1.66) and 76/1515 (5.0%) in the higher dose group (1.09, 0.82 to 1.46). Compared with 78/2949 (2.6%) participants in the no offer group, 55/1515 (3.6%) developed covid-19 in the lower dose group (1.39, 0.98 to 1.97) and 45/1515 (3.0%) in the higher dose group (1.13, 0.78 to 1.63). CONCLUSIONS Among people aged 16 years and older with a high baseline prevalence of suboptimal vitamin D status, implementation of a population level test-and-treat approach to vitamin D supplementation was not associated with a reduction in risk of all cause acute respiratory tract infection or covid-19. TRIAL REGISTRATION ClinicalTrials.gov NCT04579640.
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Affiliation(s)
- David A Jolliffe
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Hayley Holt
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
| | - Matthew Greenig
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Mohammad Talaei
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Natalia Perdek
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Paul Pfeffer
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Giulia Vivaldi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Sheena Maltby
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | | | - Nicola L Barlow
- Clinical Biochemistry Department, Black Country Pathology Services, City Hospital, Birmingham, UK
| | - Alexa Normandale
- Clinical Biochemistry Department, Black Country Pathology Services, City Hospital, Birmingham, UK
| | - Rajvinder Garcha
- Clinical Biochemistry Department, Black Country Pathology Services, City Hospital, Birmingham, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Christopher Orton
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
| | - David Ford
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
| | - Gwyneth A Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
- Health Data Research UK BREATHE Hub, Swansea University, Swansea, UK
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
| | - Frank Kee
- Centre for Public Health (NI), Queen's University Belfast, Belfast, UK
| | - Christopher J Griffiths
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
- Health Data Research UK BREATHE Hub, Queen Mary University of London, London, UK
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Data Research UK BREATHE Hub, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Data Research UK BREATHE Hub, University of Edinburgh, Edinburgh, UK
| | - Seif O Shaheen
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Clare Relton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Adrian R Martineau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
- Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK
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Chambergo-Michilot D, Atamari-Anahui N, Segura-Saldaña P, Brañez-Condorena A, Alva-Diaz C, Espinoza-Alva D. Trends and geographical variation in mortality from coronary disease in Peru. PLoS One 2022; 17:e0273949. [PMID: 36067204 PMCID: PMC9447875 DOI: 10.1371/journal.pone.0273949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background Coronary disease (CD) is the main cause of mortality worldwide. Data about trends and geographical variation in CD mortality is available in some American countries. This information varies among countries since CD risk factors frequencies vary. Objective To describe the trend and geographical variation of coronary disease (CD) mortality in Peru, 2005–2017. Methods Analysis of secondary data of the Peruvian Ministry of Health’s registry of deaths. We analyzed CD mortality. We described the absolute and relative frequency of deaths and age-standardized mortality rate (ASMR) by natural regions, departments, age, sex, and year. We also described the change of ASMR between two periods (2005–2010 vs. 2011–2017). Results There were 64,721 CD deaths between 2005 and 2017 (4.12% among all deaths). The absolute frequency of CD deaths was 5,665 and 6,565 in 2005 and 2017, respectively. CD mortality was more frequent in men and older adults. The ASMR varied among natural regions, being higher in the Coast (19.61 per 100,000 inhabitants). The change between the two periods revealed that almost all departments reduced their ASMRs, except for Callao, Lambayeque, and Madre de Dios. Conclusion CD mortality has increased in Peru. Mortality was higher in men and older adults, and it varied among departments. More political efforts are needed to reduce these trends.
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Affiliation(s)
- Diego Chambergo-Michilot
- CHANGE Research Working Group, Facultad de Ciencias de la Salud, Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Perú
- Department of Cardiology Research, Torres de Salud National Research Center, Lima, Peru
| | - Noé Atamari-Anahui
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Perú
- * E-mail:
| | - Pedro Segura-Saldaña
- Department of Cardiology Research, Torres de Salud National Research Center, Lima, Peru
- Ingeniería Biomédica, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Ana Brañez-Condorena
- ADIECS Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Carlos Alva-Diaz
- Universidad Señor de Sipán, Chiclayo, Perú
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Perú
| | - Daniel Espinoza-Alva
- Servicio de Cardiología Clínica, Instituto Nacional Cardiovascular-INCOR, EsSalud, Lima, Perú
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Scott Reid P, Neville E, Cater F, Mullis R, Mant J, Duschinsky R. Accounts of preventative coping: an interview study of stroke survivors on general practice registers. BMJ Open 2022; 12:e058441. [PMID: 36691146 PMCID: PMC9445822 DOI: 10.1136/bmjopen-2021-058441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 06/20/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Preventative coping is an underexplored aspect of coping behaviour. Specifically, coping is a key concern in stroke survivor accounts, but this has yet to be investigated with reference to secondary prevention. DESIGN Secondary analysis of a qualitative data set comprising semistructured interviews of 22 stroke survivors recruited from five general practices in the East of England. The topic guide included exploration of advice and support given by their doctor on medication and lifestyle. The interviews were coded using thematic analysis. RESULTS The accounts emphasised individual responsibility. Two key themes were identified, which foregrounded the role of self-concept for coping: (a) striving to be 'good', (b) appeal to ideas of 'personality'. In the former, preventative behaviour was depicted in moralistic terms, with the doctor as an adjudicator. In the latter, participants attributed their coping behaviour to their personality, which might help or hinder these efforts. CONCLUSIONS We highlight that coping was characterised by survivors as something enacted by the individual self, and consider how constructions of self may impact preventative coping efforts.
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Affiliation(s)
| | - Emma Neville
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Frances Cater
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Ricky Mullis
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, University of Cambridge, Cambridge, UK
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Xiao W, Wumaer A, Maimaitiwusiman Z, Liu J, Xuekelati S, Wang H. Heat maps of cardiovascular disease risk factor clustering among community-dwelling older people in Xinjiang: a cross-sectional study. BMJ Open 2022; 12:e058400. [PMID: 35981774 PMCID: PMC9394193 DOI: 10.1136/bmjopen-2021-058400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The clustering of multiple cardiovascular disease (CVD) risk factors (CRFs) increases the risk of CVD prevalence and mortality. Little is known about CRF clustering among community-dwelling older people in Xinjiang. The objective of this study was to explore the prevalence of CRF clustering in this population. DESIGN Cross-sectional study. SETTING Xinjiang, China. PARTICIPANTS Multilevel random sampling was used to survey individuals aged ≥60 in six regions of Xinjiang. In total, 87 000 participants volunteered, with a response rate of 96.67%; 702 participants with incomplete data were excluded and data from 86 298 participants were analysed. OUTCOME MEASURES The prevalence of smoking, hypertension, diabetes, dyslipidaemia and overweight/obesity was 9.4%, 52.1%, 16.8%, 28.6% and 62.7%, respectively. The prevalence of CRF clusters among people of different ages, regions and ethnic groups differed significantly. The 85.7% of the participants presented at least one CRFs and 55.9% of the participants presented clustering of CRFs. The proportion of CRF clusters tended to be higher in men, 60-69-year-old group, northern Xinjiang and the Kazakh population. After adjusting for age and sex, logistic regression analysis revealed that men, 60-69-year-old group, northern Xinjiang and the Kazakh population were more likely to have clustering of CRFs, compared with their counterparts. CONCLUSIONS The prevalence of CRFs in the older Xinjiang population is high and their clustering differs by sex, age, region and ethnicity. CRF prevention and management should be active in this population, and strategies to reduce CVD risk based on sex, age, ethnic group and region are warranted.
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Affiliation(s)
- Wenwen Xiao
- Second Department of Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Aishanjiang Wumaer
- Second Department of Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Zhuoya Maimaitiwusiman
- Second Department of Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Jinling Liu
- Second Department of Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Saiyare Xuekelati
- Second Department of Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Hongmei Wang
- Second Department of Cadre Health Care Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
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McMonagle C, Brown D, Reeve R, Mancy R. Trends in the diversity of mortality causes and age-standardised mortality rates among subpopulations within Scotland, 2001-2019. SSM Popul Health 2022; 19:101192. [PMID: 36039349 PMCID: PMC9418986 DOI: 10.1016/j.ssmph.2022.101192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 02/09/2023] Open
Abstract
Previous research has demonstrated increasing diversity in causes of mortality among high-income nations in recent decades, associated with improvements in health and increasing life expectancies. Health outcomes are known to vary widely between communities within these countries and inequalities between sexes and other subpopulations are key in understanding the health of populations. Despite this, little is known about variation in the diversity of mortality causes between these subpopulations. Diversification in mortality causes indicates an increase in the pool of potential causes of mortality an individual is likely to face. This poses challenges for the public health and medical sectors by increasing diagnostic uncertainty and broadening the range of causes to be addressed by public health and medical interventions. Here we examine trends over time in the diversity in causes of mortality in Scotland by sex and area-level deprivation, also examining deaths among those younger than 75 years and those 75 years and older separately. We find that diversity in causes of mortality has increased across subpopulations; that it has risen more quickly in men than women; that the rate of increase has been similar across age categories; and that there is no clear ranking in the trends by deprivation quintile, despite slower improvements in mortality rates among the most deprived. Increasing diversity in mortality causes suggests that a greater public health focus on reducing death rates from a broader range of causes is likely to be required, and this may be especially important for men who face a faster rate of diversification.
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Affiliation(s)
- Ciaran McMonagle
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, G3 7HR, UK,Boyd Orr Centre for Population and Ecosystem Health, University of Glasgow, Glasgow, UK,Corresponding author. MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, G3 7HR, UK.
| | - Denise Brown
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, G3 7HR, UK
| | - Richard Reeve
- Boyd Orr Centre for Population and Ecosystem Health, University of Glasgow, Glasgow, UK,School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Rebecca Mancy
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, G3 7HR, UK,School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
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Liu X, Zhang D, Wu X, Tu J, Gong C, Li Y, Cui W, Chen J, Lu S. Urinary metals as influencing factors of coronary heart disease among a population in Guangzhou, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 241:113746. [PMID: 35689886 DOI: 10.1016/j.ecoenv.2022.113746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
The cardiovascular system is highly sensitive to toxic metal exposure and trace element dysregulation. However, previous findings relating to metal exposure and coronary heart disease (CHD) have partially been conflicting and difficult to exhibit the combined effect of metal mixtures. This case-control study investigated urinary concentrations of ten metal/metalloids among clinically-diagnosed CHD patients and healthy adults during May to December 2021 in Guangzhou, China. We found that cadmium (Cd) status in urine from CHD patients was remarkably higher than its reference, while chromium (Cr), nickel (Ni), copper (Cu) and selenium (Se) concentrations were lower (p < 0.05). Spearman correlation analysis showed that urinary arsenic (As) and Se were highly correlated (rs=0.830, p < 0.001), indicating their similar sources. Principal component analysis (PCA) exhibited denser distribution of Cd-Sn in cases than in controls. Logistic regression analysis exhibited significant associations between urinary Cd (adjusted OR: 1.965, 95% CI: 1.222-3.162), Se (0.787, 95% CI: 0.695-0.893), Ni (0.493, 95% CI: 0.265-0.916) and CHD risk. Quantile g-computation showed negative joint effect of metal mixtures on CHD (adjusted OR: 0.383, 95% CI: 0.159-0.932) (p < 0.05), suggesting the need for supplementing essential trace elements. The negative partial effect was primarily attributed to Se and Ni, while positive partial effect was mainly due to tin (Sn) and Cd. Nevertheless, we also found a quantile increase of Cd-Sn level was negatively correlated with 8.26% (95% CI: 3.44-13.08%) decrease of high-density lipoprotein cholesterol (p < 0.001), and 71.2% of the joint effect attributed to Cd. Based on random forest, Se, Cd and Ni were found to be the dominant influencing factors of CHD. The role of Ni in CHD is yet to be uncovered, while excessive Cd exposure and low Se status among CHD patients need to be mitigated.
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Affiliation(s)
- Xiang Liu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Duo Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou 510275, China
| | - Xiaoling Wu
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou 510275, China
| | - Jiazichao Tu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Caiping Gong
- Department of Clinical Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yanmin Li
- Department of Physical Examination Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wenhao Cui
- Department of Clinical Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
| | - Shaoyou Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou 510275, China.
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Abdi M, Esmaeili Gouvarchin Ghaleh H, Ranjbar R. Lactobacilli and Bifidobacterium as anti-atherosclerotic agents. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2022; 25:934-946. [PMID: 36159325 PMCID: PMC9464336 DOI: 10.22038/ijbms.2022.63860.14073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/04/2022] [Indexed: 11/06/2022]
Abstract
Atherosclerosis is the thickening or hardening of the arteries which is caused by a buildup of atheromatous plaque in the inner lining of an artery. Hypercholesterolemia, inflammation, oxidative stress, and trimethylamine N-oxide (TMAO) are important risk factors for atherosclerosis. Therefore, this study aimed to review the anti-atherosclerotic effects of Lactobacilli and Bifidobacterium via improving lipid profile and reducing the effects of oxidative stress, inflammation, and TMAO. To prepare the present review, several databases such as Scopus, PubMed, and Google Scholar were searched, and relevant articles from 1990 until 2022 were selected and reviewed. The present review showed that Lactobacilli and Bifidobacterium reduce the risk of atherosclerosis in both in vitro and in vivo studies by breaking down or altering cholesterol metabolism with the help of their by-products and by reducing inflammation and oxidative stress and TMAO. Consumption of Lactobacilli and Bifidobacterium can be useful in prevention of atherosclerosis.
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Affiliation(s)
- Milad Abdi
- Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Reza Ranjbar
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran,Corresponding author: Reza Ranjbar. Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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50
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Hernandez-Hernandez ME, Zee RYL, Pulido-Perez P, Torres-Rasgado E, Romero JR. The Effects of Biological Sex and Cardiovascular Disease on COVID-19 Mortality. Am J Physiol Heart Circ Physiol 2022; 323:H397-H402. [PMID: 35867708 PMCID: PMC9359635 DOI: 10.1152/ajpheart.00295.2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiovascular disease (CVD) is a common comorbidity observed in patients with COVID-19 that is associated with increased severity and mortality. However, the effects of biological sex on CVD associated mortality in COVID-19 patients is poorly established particularly among Hispanic/Latin Americans. We examined the association of preexisting CVD with COVID-19 mortality in hospitalized Latin American men and women. This multicenter study included hospitalized Mexican patients with a positive diagnosis of COVID-19. The main outcome was in-hospital mortality. Multivariable regression analyses were used to calculate the adjusted odd ratios with 95% confidence interval for mortality in women and men. Of 81,400 patients with a positive diagnosis for SARS-CoV-2 infection, 28,929 (35.54%) hospitalized patients were evaluated. Of these, the 35.41% (10,243) were women. In-hospital death was higher in men than in women. In relation to CVD between the sexes, women had a higher incidence of CVD than men (4.69% vs 3.93%. P=0.0023). The adjusted logistic regression analyses showed that CVD was significantly associated with COVID-19 mortality in women but not men. We then stratified by sex according to age <52 and ≥52 years old. Similar significant association was also found in pre-specified analysis in women ≥52 years old but not in men of similar age. We conclude that CVD's effect on mortality among COVID-19 hospitalized patients is dependent on biological sex and age in this Latin American cohort. These results suggest that therapeutic strategies for Latin American women with CVD and COVID-19 should include particular attention to their cardiovascular health.
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Affiliation(s)
- Maria Elena Hernandez-Hernandez
- Doctorate in Biological Science, Autonomous University of Tlaxcala, Puebla, Mexico.,Faculty of Medicine, Autonomous University of Puebla, Puebla, Puebla, Mexico
| | - Robert Y L Zee
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Department of Pediatric Dentistry, Tufts University School of Dental Medicine, Boston, MA, United States
| | | | | | - Jose R Romero
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, United States
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