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Schakelaar MY, Kemperman H, Schoneveld AH, Hoefer IE, Tiel Groenestege WM. Analysis of C-reactive protein from finger stick dried blood spot to predict high risk of cardiovascular disease. Sci Rep 2023; 13:2515. [PMID: 36781868 PMCID: PMC9923659 DOI: 10.1038/s41598-023-27522-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023] Open
Abstract
C-reactive protein (CRP) is an acute-phase protein involved in inflammation. Furthermore, CRP is an important biomarker used in diagnostics to predict risk of cardiovascular disease (CVD) in addition to monitoring bacterial and viral infections. To measure plasma CRP, venipuncture is still necessitated and has to be performed by trained phlebotomists. As a solution, dried blood spots (DBS) are used for minimally invasive at-home sampling of blood and can be send to diagnostic laboratories by regular mail. In this study, we included 53 patients that presented to the outpatient clinic of the University Medical Center Utrecht. Capillary finger stick was used to spot blood on a filter paper card and allowed to dry. After extraction of DBS, CRP was analyzed on an automated high-throughput chemistry analyzer. Additional validation steps regarding stability, effect of hematocrit, precision, and limits of blank and quantitation were conducted according to corresponding Clinical and Laboratory Standards Institute standards. An excellent regression analysis of R2 (95% confidence interval) = 0.986 (0.982-0.989) was found. This enabled correct classification for high CVD risk of all 25 cases with sensitivity (95% CI) of 1.00 (1.00-1.00) and specificity (95% CI) of 0.96 (0.89-1.03) and correct diagnosis of inflammation of 12/13 cases with sensitivity (95% CI) of 0.92 (0.77-1.07) and specificity (95% CI) of 1.00 (1.00-1.00). Furthermore, CRP was found to be stable for 31 days and observed hematocrit variation amongst patients was clinically acceptable. CRP from DBS can be accurately measured on an automated high-throughput chemistry analyzer and used to diagnose inflammation and classify high CVD risk. This method enables individuals to engage in at-home sampling of blood on DBS for (tele)diagnostics, screening programs, patient follow-up, and medication management.
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Affiliation(s)
- Michael Y Schakelaar
- Central Diagnostic Laboratory, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Hans Kemperman
- Central Diagnostic Laboratory, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Arjan H Schoneveld
- Central Diagnostic Laboratory, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Imo E Hoefer
- Central Diagnostic Laboratory, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wouter M Tiel Groenestege
- Central Diagnostic Laboratory, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Pang Y, Li Y, Zhang Y, Wang H, Lang J, Han L, Liu H, Xiong X, Gu L, Wu X. Effects of inflammation and oxidative stress on postoperative delirium in cardiac surgery. Front Cardiovasc Med 2022; 9:1049600. [PMID: 36505383 PMCID: PMC9731159 DOI: 10.3389/fcvm.2022.1049600] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022] Open
Abstract
The past decade has witnessed unprecedented medical progress, which has translated into cardiac surgery being increasingly common and safe. However, complications such as postoperative delirium remain a major concern. Although the pathophysiological changes of delirium after cardiac surgery remain poorly understood, it is widely thought that inflammation and oxidative stress may be potential triggers of delirium. The development of delirium following cardiac surgery is associated with perioperative risk factors. Multiple interventions are being explored to prevent and treat delirium. Therefore, research on the potential role of biomarkers in delirium as well as identification of perioperative risk factors and pharmacological interventions are necessary to mitigate the development of delirium.
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Affiliation(s)
- Yi Pang
- Bengbu Medical College, Bengbu, Anhui, China
| | - Yuntao Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yonggang Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongfa Wang
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Junhui Lang
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Liang Han
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - He Liu
- Department of Anesthesiology, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou Central Hospital, Huzhou, China
| | - Xiaoxing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lijuan Gu
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaomin Wu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,*Correspondence: Xiaomin Wu,
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Bilevich OA, Ovsyannikov NV, Usacheva EV, Kulikova OM. Conventional and optional cardiovascular risk factors in predicting outcome in hemodialysis patients. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To evaluate the frequency and effects on prognosis of conventional and optional cardiovascular risk (CVR) factors in hemodialysis patients.Material and methods. The study included 82 patients receiving hemodialysis. Clinical examination was carried out. We also assesed heart rate variability and pulse wave velocity by photoplethysmography. To identify significant prognostic factors and determine the range of their values, the decision tree method was used.Results. In hemodialysis patients, the prevalence of hypertension and overweight was higher than in the general population — 100% vs 33,8% and 51,2% vs 29,7%, respectively; the smoking prevalence was comparable — 25,6% vs 25,7%; the prevalence of hypercholesterolemia was lower than in the general population — 45,1% vs 57,6%. Optional CVR factors in hemodialysis patients were as follows: level of pulse pressure, duration of hypertension, hemoglobin level, pulse wave velocity, standard deviation normal to normal (SDNN), left ventricular ejection fraction. Based on a combination of significant CVR factors, 5 rules for predicting a favorable or unfavorable outcome in hemodialysis patients were identified.Conclusion. The use of proposed rules allows to develop novel measures and improve current ones aimed at modifying CVR factors and increasing the survival of hemodialysis patients.
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Muga MA, Owili PO, Hsu CY, Chao JCJ. Association of lifestyle factors with blood lipids and inflammation in adults aged 40 years and above: a population-based cross-sectional study in Taiwan. BMC Public Health 2019; 19:1346. [PMID: 31640644 PMCID: PMC6805612 DOI: 10.1186/s12889-019-7686-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/25/2019] [Indexed: 12/22/2022] Open
Abstract
Background Lifestyle factors were associated with an increased risk of cardiovascular disease (CVD) occurrence. We explored the associations between lifestyle factors and CVD risk factors, and assessed the interactive effects of lifestyle factors on CVD risk factors. Methods A cross-sectional data of 114,082 (57,680 men and 56,402 women) middle-aged adults and elderly in Taiwan were collected from 2001 to 2010. Logistic regression analysis was used to assess the associations between lifestyle factors and CVD risk factors. The relative excess risk due to interaction (RERI) and the attributable proportion due to interaction were used to explore the interactive effect of lifestyle factors on CVD risk factors. Results The interaction between alcohol consumption and smoking exhibited an excess risk of high triglycerides (RERI = 0.21; 95% CI: 0.14–0.29), and that of alcohol consumption and physical activity had an excess risk of high LDL-cholesterol (RERI = 0.11; 95% CI: 0.06–0.16) and high blood glucose (RERI = 0.05; 95% CI: 0.01–0.11). Alcohol consumption and vegetable-rich diet (intake of high vegetables with no or low meat) had an excess risk of high LDL-cholesterol and low HDL-cholesterol, but a reduced risk of high triglycerides (RERI = − 0.10; 95% CI: − 0.17 – -0.04). Smoking and physical activity had an increased risk of high blood glucose and a reduced risk of low HDL-cholesterol. Smoking and vegetable-rich diet reduced the risk of high triglycerides (RERI = − 0.11; 95% CI: − 0.18 – − 0.04), high blood glucose (RERI = − 0.14; 95% CI: − 0.21 – − 0.07) and low HDL-cholesterol (RERI = − 0.10; 95% CI: − 0.19 – -0.01). Conclusions The interaction between smoking, alcohol consumption, physical activity and diet were associated with lipid profile and blood glucose, hence there was an interaction between these lifestyle factors in an additive scale. Public health promotion should therefore consider multifaceted promotional activities that are likely to make a positive impact on the health status of the Taiwanese population.
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Affiliation(s)
- Miriam Adoyo Muga
- Department of Human Nutrition and Dietetics, School of Medicine and Health Sciences, Kabarak University, Kabarak, Nakuru, Kenya
| | - Patrick Opiyo Owili
- Department of Public Health, School of Health Sciences, University of Eastern Africa, Baraton, Eldoret, Kenya.,Master Programs in Public Health and Global Health, School of Health Sciences, University of Eastern Africa, Baraton, Eldoret, Kenya
| | - Chien-Yeh Hsu
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jane C-J Chao
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan. .,School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan. .,Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Badimon L, Peña E, Arderiu G, Padró T, Slevin M, Vilahur G, Chiva-Blanch G. C-Reactive Protein in Atherothrombosis and Angiogenesis. Front Immunol 2018; 9:430. [PMID: 29552019 PMCID: PMC5840191 DOI: 10.3389/fimmu.2018.00430] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/16/2018] [Indexed: 12/11/2022] Open
Abstract
C-reactive protein (CRP) is a short pentraxin mainly found as a pentamer in the circulation, or as non-soluble monomers CRP (mCRP) in tissues, exerting different functions. This review is focused on discussing the role of CRP in cardiovascular disease, including recent advances on the implication of CRP and its forms specifically on the pathogenesis of atherothrombosis and angiogenesis. Besides its role in the humoral innate immune response, CRP contributes to cardiovascular disease progression by recognizing and binding multiple intrinsic ligands. mCRP is not present in the healthy vessel wall but it becomes detectable in the early stages of atherogenesis and accumulates during the progression of atherosclerosis. CRP inhibits endothelial nitric oxide production and contributes to plaque instability by increasing endothelial cell adhesion molecules expression, by promoting monocyte recruitment into the atheromatous plaque and by enzymatically binding to modified low-density lipoprotein. CRP also contributes to thrombosis, but depending on its form it elicits different actions. Pentameric CRP has no involvement in thrombogenesis, whereas mCRP induces platelet activation and thrombus growth. In addition, mCRP has apparently contradictory pro-angiogenic and anti-angiogenic effects determining tissue remodeling in the atherosclerotic plaque and in infarcted tissues. Overall, CRP contributes to cardiovascular disease by several mechanisms that deserve an in-depth analysis.
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Affiliation(s)
- Lina Badimon
- Cardiovascular Science Institute - ICCC, IIB-Sant Pau, Hospital de Sant Pau, Barcelona, Spain.,CiberCV, Institute Carlos III, Madrid, Spain
| | - Esther Peña
- Cardiovascular Science Institute - ICCC, IIB-Sant Pau, Hospital de Sant Pau, Barcelona, Spain.,CiberCV, Institute Carlos III, Madrid, Spain
| | - Gemma Arderiu
- Cardiovascular Science Institute - ICCC, IIB-Sant Pau, Hospital de Sant Pau, Barcelona, Spain
| | - Teresa Padró
- Cardiovascular Science Institute - ICCC, IIB-Sant Pau, Hospital de Sant Pau, Barcelona, Spain.,CiberCV, Institute Carlos III, Madrid, Spain
| | - Mark Slevin
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - Gemma Vilahur
- Cardiovascular Science Institute - ICCC, IIB-Sant Pau, Hospital de Sant Pau, Barcelona, Spain.,CiberCV, Institute Carlos III, Madrid, Spain
| | - Gemma Chiva-Blanch
- Cardiovascular Science Institute - ICCC, IIB-Sant Pau, Hospital de Sant Pau, Barcelona, Spain
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Lu L, Sun R, Liu M, Zheng Y, Zhang P. The Inflammatory Heart Diseases: Causes, Symptoms, and Treatments. Cell Biochem Biophys 2017; 72:851-5. [PMID: 25682012 DOI: 10.1007/s12013-015-0550-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The inflammation of the heart muscles, such as myocarditis, the membrane sac which surrounds the heart called as pericarditis, and the inner lining of the heart or the myocardium, heart muscle as endocarditis are known as the inflammatory heart diseases. Inflammation of heart is caused by known infectious agents, viruses, bacteria, fungi or parasites, and by toxic materials from the environment, water, food, air, toxic gases, smoke, and pollution, or by an unknown origin. Myocarditis is induced by infection of heart muscle by virus like sarcoidosis and immune diseases. The symptoms include chest pain, angina, pain in heart muscle, and shortness of breath, edema, swelling of feet or ankles, and fatigue. The ECG, X-ray, and MRI can diagnose the disease; blood test and rise in enzymes levels provide abnormality in heart function. The treatment includes use of antibiotics for inflammation of heart muscle and medications. The ultrasound imaging indicates further damage to the heart muscle. In severe cases of infection heart failure can occur so long-term medications are necessary to control inflammation. The various biomarkers are reported for the inflammatory heart diseases. The causes, symptoms and treatments of inflammatory heart diseases are described.
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Affiliation(s)
- Lei Lu
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - RongRong Sun
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Min Liu
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Yi Zheng
- Graduate School, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu, China
| | - Peiying Zhang
- Department of Cardiology, Xuzhou Central Hospital, Affiliated Xuzhou Hospital, Medical School of Southeast University, Xuzhou Clinical Medical College of Nanjing University of Chinese Medicine, 199# South Jiefang Road, Xuzhou, 221009, Jiangsu, China.
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7
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Terre L. Building a Footbridge From Research to Practice in Cardiovascular Risk Reduction. Am J Lifestyle Med 2016. [DOI: 10.1177/1559827606297036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As Rippe, Angelopoulos, and Zukley noted in their State-of-the-Art Review, empirically supported lifestyle modification strategies offer numerous advantages over other modalities for reducing cardiovascular risks. Yet, despite compelling evidence for their implementation, the translation of lifestyle interventions from research to practice has been challenging. Their review prompts discussion of several especially thorny barriers including the persistent tensions between (1) research and practice, (2) main effects and mediators, (3) single and multifactor approaches to risk management, and (4) primary care and communitybased systems of health delivery.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri–Kansas City, 4825 Troost Building, Suite 215, Kansas City, MO 64110-2499
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8
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Metabolic Syndrome and Framingham Risk Score: Observation from Screening of Low-Income Semi-Urban African Women. MEDICINES 2016; 3:medicines3020015. [PMID: 28930125 PMCID: PMC5456224 DOI: 10.3390/medicines3020015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 05/25/2016] [Accepted: 06/01/2016] [Indexed: 11/17/2022]
Abstract
Background: The heightened cardiovascular risk associated with metabolic syndrome (MetS) has been documented by several researchers. The Framingham risk score (FRS) provides a simple and efficient method for identifying individuals at cardiovascular risk. The objective was to describe the prevalence of MetS and its association with FRS in predicting cardiovascular disease among a cohort of semi-urban women; Method: Clinical and laboratory parameters were evaluated among 189 healthy women. The International Diabetes Federation definition was used to diagnose metabolic syndrome. FRS was calculated for each participant; Result: About two thirds of the participant make less than $US 90 per month. The mean systolic blood pressure was 131.80 ± 30. Eighty (42.3%) participants were overweight with a mean waist circumference of 91.64 ± 11.19 cm. MetS was present in 46 (24.3%). Individuals with MetS were more likely to have increased FRS, p = 0.012. One hundred and eighty seven (98.9%) were in the low risk category according to FRS. There was a significant difference in the mean FRS between participants with and without MetS (13.52 versus 10.29 p = 0.025); Conclusion: Prevalence of MetS in this study was comparable to the global rate, despite a low economic status. Individuals with MetS were more likely to have cardiovascular disease than persons without MetS, thus emphasizing the need for risk stratification and prompt management.
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Ngo AD, Roberts CL, Chen JS, Figtree G. Delivery of a Small-For-Gestational-Age Infant and Risk of Maternal Cardiovascular Disease – A Population-Based Record Linkage Study. Heart Lung Circ 2015; 24:696-704. [DOI: 10.1016/j.hlc.2015.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/19/2014] [Accepted: 01/04/2015] [Indexed: 02/02/2023]
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Wang H, Zhang W, Wan J, Liu W, Yu B, Jin Q, Guan M. Microchip-based human serum atherogenic lipoprotein profile analysis. Anal Biochem 2014; 467:75-83. [DOI: 10.1016/j.ab.2014.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/24/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
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Kandula NR, Kanaya AM, Liu K, Lee JY, Herrington D, Hulley SB, Persell SD, Lloyd-Jones DM, Huffman MD. Association of 10-year and lifetime predicted cardiovascular disease risk with subclinical atherosclerosis in South Asians: findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. J Am Heart Assoc 2014; 3:e001117. [PMID: 25277669 PMCID: PMC4323809 DOI: 10.1161/jaha.114.001117] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Ten‐year and lifetime cardiovascular risk assessment algorithms have been adopted into atherosclerotic cardiovascular disease (ASCVD) prevention guidelines, but these prediction models are not based on South Asian populations and may underestimate the risk in Indians, Pakistanis, Bangladeshis, Nepali, and Sri Lankans in the United States. Little is known about ASCVD risk prediction and intermediate endpoints such as subclinical atherosclerosis in US individuals of South Asian ancestry. Methods and Results South Asians (n=893) from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study who were 40 to 79 years and free of ASCVD were included. Ten‐year ASCVD predicted risk was calculated using the 2013 Pooled Cohort Equations. Lifetime predicted risk was based on risk factor burden. Baseline levels of subclinical atherosclerosis (coronary artery calcium [CAC] and carotid intima media thickness [CIMT]) were compared across 10‐year and lifetime risk strata: (1) high (≥7.5%) 10‐year and low (<7.5%) 10‐year risk; (2) high (≥39%) lifetime and low (<39%) lifetime risk. South Asian men and women with high 10‐year predicted risk had a significantly greater CAC burden than those with low 10‐year risk. South Asians with high lifetime predicted risk had a significantly increased odds for CAC higher than 0 (odds ratio: men 1.97; 95% CI, 1.2 to 3.2; women 3.14; 95% CI, 1.5, 6.6). Associations between risk strata and CIMT were also present. Conclusion This study is the first to provide evidence that contemporary ASCVD risk assessment algorithms derived from non‐Hispanic white and African‐American samples can successfully identify substantial differences in atherosclerotic burden in US South Asians.
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Affiliation(s)
- Namratha R Kandula
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
| | - Alka M Kanaya
- University of California, San Francisco, CA (A.M.K., S.B.H.)
| | - Kiang Liu
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
| | - Ji Young Lee
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
| | | | | | - Stephen D Persell
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
| | - Donald M Lloyd-Jones
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
| | - Mark D Huffman
- Northwestern University, Chicago, IL (N.R.K., K.L., J.Y.L., S.D.P., D.M.L.J., M.D.H.)
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Staniak HL, Salgado Filho W, Miname MH, Benseñor IM, Lotufo PA, Sharovsky R, Rochitte CE, Bittencourt MS, Santos RD. Association between postprandial triglycerides and coronary artery disease detected by coronary computed tomography angiography. Atherosclerosis 2014; 233:381-386. [PMID: 24530767 DOI: 10.1016/j.atherosclerosis.2013.12.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/12/2013] [Accepted: 12/03/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Studies have demonstrated the association of severe anatomical coronary artery disease (CAD) with postprandial triglycerides (TG) concentrations. Nevertheless the relationship between less severe atherosclerosis plaque burden and postprandial TG is less established. OBJECTIVE to study the relationship between postprandial TG and CAD detected by coronary computed tomographic angiography (CTA). MATERIAL AND METHODS 130 patients who underwent an oral fat tolerance test were enrolled (85 with CAD detected by CTA and 45 without). Postprandial lipemia was studied by measuring TG from T0h to T6h with 2-h intervals, and analyzed the TG change over time using a longitudinal multivariable linear mixed effects model with the log normal of the TG as the primary outcome. RESULTS The majority of individuals with CAD had non-obstructive disease (63.3%) Patients with CAD had a slower clearance of postprandial TG change from 4 h to 6 h (p<0.05) compared to patients without CAD. These results remained significant after adjustment for fasting TG and glucose, age, gender, body mass index, and waist circumference. However, those differences did not reach statistical significance after adjustment for fasting HDL-C. CONCLUSION Patients with mild (<25% lumen obstruction) and moderate CAD (25-50% lumen obstruction) detected by coronary CTA had an impaired postprandial metabolism, with a delayed TG clearance, when compared to individuals with no CAD. This difference was partially explained by the lower HDL-C. Thus, though postprandial TG may contribute to the development of CAD, this association is partially related to low HDL-C.
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Affiliation(s)
- Henrique L Staniak
- Hospital Universitário, University of São Paulo, São Paulo, Brazil; Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Wilson Salgado Filho
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Márcio H Miname
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | | | - Paulo A Lotufo
- Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | | | - Carlos E Rochitte
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | | | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
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Kisten Y, Govender P, Naidoo NG, Gihwala D, Isaacs F. Duplex ultrasound: A diagnostic tool for carotid stenosis management in type 2 diabetes mellitus. Afr J Prim Health Care Fam Med 2013. [PMCID: PMC4709501 DOI: 10.4102/phcfm.v5i1.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Diabetic patients are at increased risk of developing cardiac events and stroke, and prevention of diabetes mellitus is therefore desirable. Marked geographical and ethnic variation in the prevalence of diabetes caused by urbanisation, demographic and epidemiological transitions has rendered this one of the major non-communicable diseases in South Africa. Duplex ultrasound (DUS) plays an important role in primary health care in early detection of carotid atherosclerotic disease and the degree of carotid stenosis present. It is a reliable, cost-effective and non-invasive diagnostic tool. The purpose of this study was to determine the role of ultrasound in carotid stenosis management in type 2 diabetes mellitus (T2DM).Objectives: To determine the prevalence of carotid stenosis in a selected T2DM population using DUS and to correlate these findings with other predisposing atherosclerotic risk factors.Methods: The study setting was at an academic hospital in the Western Cape using carotid DUS reports of 103 diabetic subjects ≥ 35 years old. Predisposing risk factors were correlated with degree of carotid stenosis present. Data were analysed using the Fischer exact test, Chisquare and Student t-test.Results: Carotid DUS reports of 63 out of 103 T2DM patients revealed no evidence of a carotid stenosis, thereby lowering the risk profile. Forty patients were identified as having carotidstenosis; 22 symptomatic patients had a > 70% carotid stenosis which warranted surgicalintervention. A greater prevalence of stenosis in the Caucasian group, in both the male (p =0.0411) and female (p = 0.0458) cohorts, was noted. The overall trend suggested a relationship between T2DM and lifestyle, and a statistically significant relationship (p = 0.0063) between smoking and carotid stenosis was observed.Conclusion: T2DM and predisposing atherosclerotic risk factors significantly increased thepossibility of carotid stenosis development.
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Affiliation(s)
- Yogan Kisten
- Department of Radiography, Cape Peninsula University of Technology, South Africa
| | - Pravesen Govender
- Department of Radiography, Cape Peninsula University of Technology, South Africa
| | - Nadraj G. Naidoo
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Dhiro Gihwala
- Faculty of Health & Wellness Sciences, Cape Peninsula University of Technology, South Africa
| | - Ferial Isaacs
- Department of Radiography, Cape Peninsula University of Technology, South Africa
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Reichenpfader U, Thaler K, Richter A, Thieda P, Gartlehner G. Klinische Ergebnisse, gesundheitsbezogene Lebensqualität und Kosten-Effektivität eines 6-monatigen Programms zur Lebensstilmodifikation bei Personen mit erhöhtem kardioväskularen Risiko in Niederösterreich. Wien Med Wochenschr 2012; 162:321-9. [DOI: 10.1007/s10354-012-0135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 01/03/2012] [Indexed: 11/28/2022]
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15
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Affiliation(s)
- Daniela Lucini
- Centro di ricerca Terapia Neurovegetativa e Medicina dell'esercizio, Dipartimento Scienze Cliniche, Università degli Studi di Milano, Italy.
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Jeemon P, Prabhakaran D, Huffman MD, Ramakrishnan L, Goenka S, Thankappan KR, Mohan V, Joshi PP, Mohan BVM, Ahmed F, Ramanathan M, Ahuja R, Chaturvedi V, Lloyd-Jones DM, Reddy KS. Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results). BMJ Open 2011; 1:e000068. [PMID: 22021747 PMCID: PMC3191418 DOI: 10.1136/bmjopen-2011-000068] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/25/2011] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date. METHODS The authors estimated short-term and lifetime predicted CVD risk among 10,054 disease-free, adult Indians in the 20-69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (≥ 10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups. RESULTS The mean age (SD) of the study population (men=63%) was 40.8 ± 10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively. CONCLUSION Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.
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Affiliation(s)
- Panniyammakal Jeemon
- Centre for Chronic Disease Control, New Delhi, India
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Public Health Foundation of India, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, India
- Center of Excellence, Center for Cardio-metabolic Risk Reduction in South Asia, New Delhi, India
| | - Mark D Huffman
- Centre for Chronic Disease Control, New Delhi, India
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | - K R Thankappan
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala
| | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - B V M Mohan
- Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, India
| | - F Ahmed
- KPC Medical College, Jadavpur, Kolkata, India
| | | | - R Ahuja
- King George Medical College, Lucknow, India
| | | | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Kaminikado K, Ikeda R, Idegami K, Nagatani N, Vestergaard MC, Saito M, Tamiya E. A rapid gel electrophoretic chip for serum cholesterol determination. Analyst 2011; 136:1826-30. [DOI: 10.1039/c0an00992j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
In the United States heart disease causes more than one-third of all deaths and most of these occur in women, not men, although women and health care professionals alike continue to view death from heart disease as a threat primarily to middle-aged men. The disparity between genders in the incidence of cardiovascular disease (CVD) may be the result of significant differences in both cardiovascular risk factors and presentation between men and women. This article reviews recent data regarding unique sex-specific characteristics of both risk for, and presentation of, CVD in women.
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Affiliation(s)
- L Veronica Lee
- Clinical Research and Development, Lantheus Medical Imaging, North Billerica, MA 01821, USA
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Vaccarino V, Badimon L, Corti R, de Wit C, Dorobantu M, Hall A, Koller A, Marzilli M, Pries A, Bugiardini R. Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors? Position paper from the working group on coronary pathophysiology and microcirculation of the European Society of Cardiology. Cardiovasc Res 2010; 90:9-17. [PMID: 21159671 DOI: 10.1093/cvr/cvq394] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women, and knowledge of the clinical consequences of atherosclerosis and CVD in women has grown tremendously over the past 20 years. Research efforts have increased and many reports on various aspects of ischaemic heart disease (IHD) in women have been published highlighting sex differences in pathophysiology, presentation, and treatment of IHD. Data, however, remain limited. A description of the state of the science, with recognition of the shortcomings of current data, is necessary to guide future research and move the field forward. In this report, we identify gaps in existing literature and make recommendations for future research. Women largely share similar cardiovascular risk factors for IHD with men; however, women with suspected or confirmed IHD have less coronary atherosclerosis than men, even though they are older and have more cardiovascular risk factors than men. Coronary endothelial dysfunction and microvascular disease have been proposed as important determinants in the aetiology and prognosis of IHD in women, but research is limited on whether sex differences in these mechanisms truly exist. Differences in the epidemiology of IHD between women and men remain largely unexplained, as we are still unable to explain why women are protected towards IHD until older age compared with men. Eventually, a better understanding of these processes and mechanisms may improve the prevention and the clinical management of IHD in women.
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Affiliation(s)
- Viola Vaccarino
- Emory University Rollins School of Public Health and School of Medicine, Atlanta, GA, USA
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Abstract
The rates of cardiovascular disease (CVD) have decreased significantly for men over the past few decades, but similar reductions have not occurred in women. Consequently, CVD remains the leading killer of women in the United States. Men usually develop heart disease earlier than women, but women develop heart disease more rapidly once menopause has occurred. A review of risk factors that are common between men and women demonstrates some notable sex-dependent differences. Many of these changes appear related to the hormonal changes that occur in menopause, such as the development of hypertension, changes in lipid concentrations, and central adiposity. In addition, diabetes is a more significant risk factor for CVD in women than men. Sociologic and physiologic factors need to be considered in treatment of risk factors, such as smoking, lack of exercise, obesity, and depression. Prevention is known to significantly reduce CVD risk, but new goals are being established for women as the sex-dependent differences have become apparent.
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Context and cardiovascular risk modification in two regions of Ontario, Canada: a photo elicitation study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:2481-99. [PMID: 19826558 PMCID: PMC2760424 DOI: 10.3390/ijerph6092481] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 09/14/2009] [Indexed: 11/17/2022]
Abstract
Cardiovascular diseases, which include coronary heart diseases (CHD), remain the leading cause of death in Canada and other industrialized countries. This qualitative study used photo-elicitation, focus groups and in-depth interviews to understand health behaviour change from the perspectives of 38 people who were aware of their high risk for CHD and had received information about cardiovascular risk modification while participating in a larger intervention study. Participants were drawn from two selected regions: Sudbury and District (northern Ontario) and the Greater Toronto Area (southern Ontario). Analysis drew on concepts of place and space to capture the complex interplay between geographic location, sociodemographic position, and people's efforts to understand and modify their risk for CHD. Three major sites of difference and ambiguity emerged: 1) place and access to health resources; 2) time and food culture; and 3) itineraries or travels through multiple locations. All participants reported difficulties in learning and adhering to new lifestyle patterns, but access to supportive health resources was different in the two regions. Even within regions, subgroups experienced different patterns of constraint and advantage. In each region, "fast" food and traditional foods were entrenched within different temporal and social meanings. Finally, different and shifting strategies for risk modification were required at various points during daily and seasonal travels through neighbourhoods, to workplaces, or on vacation. Thus health education for CHD risk modification should be place-specific and tailored to the needs and resources of specific communities.
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Agrinier N, Cournot M, Ferrières J. [Dyslipidemia in women after 50: age, menopause or both?]. Ann Cardiol Angeiol (Paris) 2009; 58:159-164. [PMID: 18980752 DOI: 10.1016/j.ancard.2008.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 09/07/2008] [Indexed: 05/27/2023]
Abstract
A high prevalence of cardiovascular risk factors is reported in postmenopausal women. The objective of this review was to determine whether the effect of the menopause on lipid profile remained after adjusting for age in middle age women. The results of 10 cross sectional studies and nine longitudinal studies added evidence of a worsening effect of the menopause on total cholesterol, LDL cholesterol and triglyceride plasmatic levels. This effect remained after adjustment for age. Menopausal estrogenic deficiency could be an explanation for those results, even if the hormonal replacement therapy effect on the lipid profile remains unclear.
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Affiliation(s)
- N Agrinier
- Epidémiologie et Evaluation Cliniques, CHU de Nancy, Nancy, France.
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Central blood pressure and hypertension: role in cardiovascular risk assessment. Clin Sci (Lond) 2009; 116:273-82. [DOI: 10.1042/cs20080072] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although the differences between central and peripheral BP (blood pressure) have been known for decades, the consequences of decision-making based on peripheral rather than central BP have only recently been recognized. The influence of cyclic stretch (owing to cyclic changes in BP) on the aortic wall in atherosclerosis has been documented at every stage of its development. Apart from mediating atherosclerosis progression and plaque instability, the pulsatile component of BP is the main mechanism leading to plaque rupture and, consequently, to acute coronary syndromes and other vascular complications. The principal goal of the present review is to evaluate the role of central BP measurements, principally systolic and pulse pressure, for cardiovascular risk assessment. Recent findings suggest that the pulsatile component of BP (when represented by central pulse pressure or central pulsatility) is one of the most important factors determining event-free survival. Results of several prospective studies (using both invasive and non-invasive measurements of central BP) indicate not only an independent predictive value of central pulse pressure, but also its advantage over brachial pressure. Recent evidence suggests that some antihypertensive drugs can influence central BP more consistently when compared with peripheral BP. This is especially true for agents acting on the renin–angiotensin system. Nevertheless, large prospective studies aiming at the comparison of the predictive value of peripheral and central BP in the general population, as well as studies comparing the effectiveness of hypertension management based on peripheral compared with central BP measurements, are needed before algorithms based on central BP can be recommended for clinical practice.
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Yamasaki K, Kurimura M, Kasai T, Sagara M, Kodama T, Inoue K. Determination of physiological plasma pentraxin 3 (PTX3) levels in healthy populations. Clin Chem Lab Med 2009; 47:471-7. [DOI: 10.1515/cclm.2009.110] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Rodondi N, Bovet P, Hayoz D, Cornuz J. The Impact of CAROtid plaque Screening on Smoking (CAROSS) cessation and control of other cardiovascular risk factors: Rationale and design of a randomized controlled trial. Contemp Clin Trials 2008; 29:767-73. [DOI: 10.1016/j.cct.2008.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 03/03/2008] [Accepted: 03/03/2008] [Indexed: 11/16/2022]
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Cugnetto ML, Saab PG, Llabre MM, Goldberg R, McCalla JR, Schneiderman N. Lifestyle factors, body mass index, and lipid profile in adolescents. J Pediatr Psychol 2008; 33:761-71. [PMID: 18024982 PMCID: PMC2734117 DOI: 10.1093/jpepsy/jsm108] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 09/19/2007] [Accepted: 10/14/2007] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE AND METHODS A model specifying body mass index (BMI) as mediating the relationship between lifestyle factors (aerobic fitness determined by peak oxygen consumption; physical activity by 7-day physical activity recall; diet by 24 hr dietary recall), and lipid profile were tested in a sample of 205 adolescents (73% boys), who were on average at risk of overweight, aerobically unfit, and from ethnic minority groups. RESULTS In this well-fitting model, consuming a diet low in fat and cholesterol, and being aerobically fit predicted lower BMI, which together resulted in increases in high-density lipoprotein cholesterol and decreases in triglycerides and low-density lipoprotein cholesterol. Being physically active, predicted greater aerobic fitness. CONCLUSIONS In addition to furthering understanding of the interrelationships among predisposing, major, and conditional coronary heart disease risk factors in adolescents, these data suggest that improving diet and aerobic fitness will reduce BMI and result in a better lipid profile.
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Affiliation(s)
| | - Patrice G. Saab
- Department of Psychology and Department of Medicine, University of Miami
| | - Maria M. Llabre
- Department of Psychology and Department of Medicine, University of Miami
| | - Ronald Goldberg
- Department of Psychology and Department of Medicine, University of Miami
| | - Judith R. McCalla
- Department of Psychology and Department of Medicine, University of Miami
| | - Neil Schneiderman
- Department of Psychology and Department of Medicine, University of Miami
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Prevalence and predictors of metabolic syndrome among HIV-infected and HIV-uninfected women in the Women's Interagency HIV Study. J Acquir Immune Defic Syndr 2008; 48:272-80. [PMID: 18545157 DOI: 10.1097/qai.0b013e31817af461] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To assess the prevalence of metabolic syndrome (MetSynd) among participants of the Women's Interagency HIV Study and to describe the association of MetSynd with HIV infection, antiretroviral therapies, and sociodemographic factors. METHODS Prevalence of MetSynd, defined by updated Adult Treatment Panel III guidelines, was assessed among 2393 (1725 seropositive and 668 seronegative) participants from the Women's Interagency HIV Study seen between October 2000 and October 2004. RESULTS HIV-1 infection was independently associated with MetSynd [33% vs 22%, P<0.0001 in HIV-seropositive compared with HIV-seronegative women; adjusted odds ratio (OR) 1.79 (95% confidence interval 1.48, 2.16)]. HIV-infected women had higher mean triglyceride (154 vs 101 mg/dL, P<0.0001) and lower mean high-density lipoprotein cholesterol levels (46 vs 55 mg/dL, P<0.0001). Most notable factors associated with higher prevalence of MetSynd among HIV-infected women included older age (OR=1.38 per 5 year increase, P<0.0001); higher body mass index; current smoking; HIV-1 RNA (OR=1.36, P=0.019, for >50,000 vs <80 copies/mL); and use of stavudine (OR=1.28, P=0.009). Nevirapine use was protective (OR=0.75, P=0.016). There was no significant association of MetSynd with ritonavir-boosted protease inhibitors (OR=1.15, P=0.134). CONCLUSIONS MetSynd is more prevalent in HIV-seropositive than HIV-seronegative women. This increased prevalence was due to dyslipidemias rather than higher blood pressure, glucose, or waist circumference.
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Abstract
OBJECTIVES To test the hypothesis that more supportive/less negative parenting is associated with lower resting blood pressure and heart rates in children and to determine whether parent and/or child gender and developmental stage moderate the relations in question. DESIGN Longitudinal data on 835 children/families who participated in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were analysed. Children (one per family) were followed from age 1 month to 11 years. METHODS Data were collected from children and their families via interviews, observations of parent-child interaction and physical health assessments. RESULTS Correlations show that more supportive and less negative parenting prior to kindergarten entry (approximately 5 years) are associated with lower heart rates and blood pressure in children of primary school grades 4-6 (approximately 9 to 11 years), especially in the case of fathering, sons and parenting during the pre-school years. CONCLUSIONS Such findings raise the prospect that interventions to enhance parenting, especially the early fathering of sons, may have beneficial effects on children's cardiovascular functioning. The inability to discount genetic mediation of parenting effects makes it clear that behaviour-genetic and/or experimental research is needed to document cause and effect relations.
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Affiliation(s)
- B G Bell
- Institute for the Study of Children, Families and Social Issues, Birkbeck University of London, London, UK
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Young JJ, Phillips HR, Marso SP, Granada JF, McPherson JA, Waksman R, Steinhubl SR, Schwartz RS, Stone GW. Vulnerable plaque intervention: State of the art. Catheter Cardiovasc Interv 2008; 71:367-74. [DOI: 10.1002/ccd.21354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wang CX, Shuaib A. Critical role of microvasculature basal lamina in ischemic brain injury. Prog Neurobiol 2007; 83:140-8. [PMID: 17868971 DOI: 10.1016/j.pneurobio.2007.07.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 06/05/2007] [Accepted: 07/26/2007] [Indexed: 11/19/2022]
Abstract
Cerebral vascular system can be divided into two categories: the macrovessels and microvessels. The microvessels consist of arterioles, capillaries and venules. There are three basic components in the microvasculature: endothelial cells, basal lamina and end-feet of astrocytes. The basal lamina is situated between the endothelial cells and the end-feet of astrocytes, and connects these two layers together. Damage to the basal lamina causes the dismantlement of microvascular wall structures, which in turn results in increase of microvascular permeability, hemorrhagic transformation, brain edema and compromise of the microcirculation. The present article reviews microvascular changes during ischemic brain injury, with emphasis on basal lamina damage.
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Affiliation(s)
- Chen Xu Wang
- Stroke Research Laboratory, University of Alberta, Edmonton, Canada.
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Eigenbrodt ML, Sukhija R, Rose KM, Tracy RE, Couper DJ, Evans GW, Bursac Z, Mehta JL. Common carotid artery wall thickness and external diameter as predictors of prevalent and incident cardiac events in a large population study. Cardiovasc Ultrasound 2007; 5:11. [PMID: 17349039 PMCID: PMC1831763 DOI: 10.1186/1476-7120-5-11] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 03/09/2007] [Indexed: 01/08/2023] Open
Abstract
Background Arterial diameters enlarge in response to wall thickening, plaques, and many atherosclerotic risk factors. We hypothesized that right common carotid artery (RCCA) diameter would be independently associated with cardiac disease and improve risk discrimination. Methods In a middle-aged, biracial population (baseline n = 11225), we examined associations between 1 standard deviation increments of baseline RCCA diameter with prevalent myocardial infarction (MI) and incident cardiac events (MI or cardiac death) using logistic regression and Cox proportional hazards models, respectively. Areas under the receiver operator characteristic curve (AUC) were used to estimate model discrimination. Results MI was present in 451 (4%) participants at baseline (1987–89), and incident cardiac events occurred among 646 (6%) others through 1999. Adjusting for IMT, RCCA diameter was associated with prevalent MI (female OR = 2.0, 95%CI = 1.61–2.49; male OR = 1.16, 95% CI = 1.04–1.30) and incident cardiac events (female HR = 1.75, 95% CI = 1.51–2.02; male HR = 1.27, 95% CI = 1.15–1.40). Associations were attenuated but persisted after adjustment for risk factors (not including IMT) (prevalent MI: female OR = 1.73, 95% CI = 1.40–2.14; male OR = 1.14, 95% CI = 1.02–1.28, and incident cardiac events: female HR = 1.26, 95% CI = 1.08–1.48; male HR = 1.19, 95% CI = 1.08–1.32). After additional adjustment for IMT, diameter was associated with incident cardiac events in women (HR = 1.18, 95% CI = 1.00–1.40) and men (HR = 1.17, 95% CI = 1.06–1.29), and with prevalent MI only in women (OR = 1.73; 95% CI = 1.37–2.17). In women, when adjustment was limited, diameter models had larger AUC than other models. Conclusion RCCA diameter is an important correlate of cardiac events, independent of IMT, but adds little to overall risk discrimination after risk factor adjustment.
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Affiliation(s)
- Marsha L Eigenbrodt
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rishi Sukhija
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kathryn M Rose
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Richard E Tracy
- Department of Pathology, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - David J Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, NC, USA
| | - Gregory W Evans
- Department of Biostatistical Sciences, Division of Public Health Sciences and Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Zoran Bursac
- Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jawahar L Mehta
- Department of Internal Medicine, Division of Cardiovascular Medicine, and Departments of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Ryan KE, McCance DR, Powell L, McMahon R, Trimble ER. Fenofibrate and pioglitazone improve endothelial function and reduce arterial stiffness in obese glucose tolerant men. Atherosclerosis 2006; 194:e123-30. [PMID: 17145061 DOI: 10.1016/j.atherosclerosis.2006.11.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 11/01/2006] [Accepted: 11/02/2006] [Indexed: 11/22/2022]
Abstract
Obesity is a low grade inflammatory state associated with premature cardiovascular morbidity and mortality. Along with traditional risk factors the measurement of endothelial function, insulin resistance, inflammation and arterial stiffness may contribute to the assessment of cardiovascular risk. We conducted a randomised placebo controlled trial to assess the effects of 12 weeks treatment with a PPAR alpha agonist (fenofibrate) and a PPAR gamma agonist (pioglitazone) on these parameters in obese glucose tolerant men. Arterial stiffness was measured using augmentation index and pulse wave velocity (PWV). E-selectin, VCAM-1 and ICAM-1 were used as markers of endothelial function. Insulin sensitivity improved with pioglitazone treatment (p=0.001) and, in keeping with this, adiponectin increased by 85.2% (p<0.001). Pro-inflammatory cytokine levels (TNFalpha, IL-6 and IL-1 beta) fell with both treatments (p<0.01 for TNFalpha and IL-1 beta, p<0.001 for IL-6). VCAM-1 and ICAM-1 were reduced with both treatments (p<0.001 for VCAM-1, p<0.05 for ICAM-1) and E-selectin improved with pioglitazone treatment (p=0.05). Both treatments resulted in a fall in augmentation index. PWV fell by 17.4% with fenofibrate treatment (p<0.001) and 16.3% with pioglitazone treatment (p<0.001). Pioglitazone and fenofibrate treatment of obese, glucose tolerant men reduces inflammation, improves markers of endothelial function and reduces arterial stiffness. These results suggest that treatment with PPAR agonists has potential to reduce the incidence of premature cardiovascular disease associated with obesity.
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Lloyd-Jones DM. Short-term versus long-term risk for coronary artery disease: implications for lipid guidelines. Curr Opin Lipidol 2006; 17:619-25. [PMID: 17095905 DOI: 10.1097/mol.0b013e3280108740] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The aim of this article is to describe recent advances in our understanding of lifetime risks for cardiovascular disease and their implications for lipid guidelines. RECENT FINDINGS Recent studies have indicated that, among younger and middle-aged adults, there is a large subset with low 10-year risk but high lifetime risk for cardiovascular disease. Individuals with high lifetime risks can be identified on the basis of single adverse risk factors or on the basis of overall risk factor burden. For example, using the ATP-III online risk estimator, a 45-year-old obese, nonsmoking, nondiabetic man with total cholesterol of 200 mg/dl, HDL-cholesterol of 40 mg/dl, and untreated systolic blood pressure of 135 mmHg has an estimated 10-year risk for hard coronary heart disease of 3%. In contrast, recent data indicate that his predicted remaining lifetime risk for cardiovascular disease is 50% and his predicted median survival is over 10 years shorter than a man at the same age with optimal risk factors. SUMMARY Lifetime risk estimation for cardiovascular disease may be an important adjunct to short-term (10-year) risk estimation that may help identify more treatment-eligible individuals at risk for cardiovascular disease, improve risk communication, motivate changes in lifestyle and behaviors, and promote adherence to therapy.
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Affiliation(s)
- Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ilinois 60611, USA.
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Ko M, Kim MT, Nam JJ. Assessing risk factors of coronary heart disease and its risk prediction among Korean adults: The 2001 Korea National Health and Nutrition Examination Survey. Int J Cardiol 2006; 110:184-90. [PMID: 16412525 DOI: 10.1016/j.ijcard.2005.07.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Revised: 07/13/2005] [Accepted: 07/24/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND An in-depth assessment of coronary heart disease (CHD) risk factors in Koreans was conducted to develop effective risk reduction strategies for this population. METHOD Based on 2001 Korea National Health and Examination Survey, a cross-sectional survey, this paper presents the prevalence of major CHD risk factors and estimates future risk by applying the Framingham model and CHD risk factor guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP) to 4639 Koreans aged 20 to 79 years. RESULT Our findings indicate that CHD is a major health threat to Koreans. Among these factors, low high-density lipoprotein cholesterol (HDL-C) was seen in 35.1% of men and 17.8% of women; both had a low rate of controlled high blood pressure (men 13.7%, women 23.6%), and age-adjusted current smoking was especially high (61.6%) in men. The 10-year CHD risk averaged 11.1% in men and 5.5% in women based on Framingham model, and 7.4% and 1.4% based on NCEP guidelines. About 9.1% of men and 2.6% of women were "high-risk," (>20%) based on the Framingham model, and 4.7% and 0.7%, respectively, on the NCEP guideline. Diabetes was the most prevalent risk factor among high-risk individuals and total cholesterol in men and low HDL-C in women was fairly high regardless of prediction method. CONCLUSION These findings suggest that current coronary heart health of Koreans is nearly comparable to that of western developed countries. Developing and implementing effective population-based intervention strategies focusing on diabetes is warranted to lower the CHD risk for Koreans.
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Affiliation(s)
- Minjung Ko
- Division of Epidemiology, School of Public Health, Seoul National University, Chongno-gu, Korea.
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Affiliation(s)
- Patrick E McBride
- University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI 53705, USA.
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Radziszewska B, Hart RG, Wolf PA, D'Agostino RB, Cutler JA. Clinical Research in Primary Stroke Prevention: Needs, Opportunities, and Challenges. Neuroepidemiology 2005; 25:91-104. [PMID: 15956806 DOI: 10.1159/000086342] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Most ( approximately 70%) of strokes are first-ever strokes, and hence to substantially reduce the neurological burden, primary prevention is crucial. Here, highlights of the National Institute of Neurological Disorders and Stroke workshop "Stroke Risk Assessment and Future Stroke Primary Prevention Trials" held January 12-13, 2004 are summarized. The Workshop discussions focused on stroke risk assessment; the high-risk vs. population-based approaches to primary prevention; desirable characteristics of candidate treatments and potential novel treatments, such as the 'polypill'; subclinical disease as risk assessment tool and as surrogate outcome, and methodological issues in stroke primary prevention trials. The importance of assessing cognitive decline as an important consequence of covert and overt vascular injury of the brain was emphasized. The scientific or logistic barriers to stroke primary prevention trials are challenging, but are not insurmountable.
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Affiliation(s)
- Barbara Radziszewska
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, 6001 Executive Boulevard, Bethesda, MD 20892, USA.
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Armani A, Becker RC. The biology, utilization, and attenuation of C-reactive protein in cardiovascular disease: part II. Am Heart J 2005; 149:977-83. [PMID: 15976778 DOI: 10.1016/j.ahj.2004.12.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Carroll S, Dudfield M. What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome. Sports Med 2004; 34:371-418. [PMID: 15157122 DOI: 10.2165/00007256-200434060-00004] [Citation(s) in RCA: 205] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the epidemic of type 2 diabetes mellitus and to reduce the increased risk of cardiovascular disease and all-cause mortality. Insulin resistance/hyperinsulinaemia are consistently linked with a clustering of multiple clinical and subclinical metabolic risk factors. It is now widely recognised that obesity (especially abdominal fat accumulation), hyperglycaemia, dyslipidaemia and hypertension are common metabolic traits that, concurrently, constitute the distinctive insulin resistance or metabolic syndrome. Cross-sectional and prospective data provide an emerging picture of associations of both physical activity habits and cardiorespiratory fitness with the metabolic syndrome. The metabolic syndrome, is a disorder that requires aggressive multi-factorial intervention. Recent treatment guidelines have emphasised the clinical utility of diagnosis and an important treatment role for 'therapeutic lifestyle change', incorporating moderate physical activity. Several previous narrative reviews have considered exercise training as an effective treatment for insulin resistance and other components of the syndrome. However, the evidence cited has been less consistent for exercise training effects on several metabolic syndrome variables, unless combined with appropriate dietary modifications to achieve weight loss. Recently published randomised controlled trial data concerning the effects of exercise training on separate metabolic syndrome traits are evaluated within this review. Novel systematic review and meta-analysis evidence is presented indicating that supervised, long-term, moderate to moderately vigorous intensity exercise training, in the absence of therapeutic weight loss, improves the dyslipidaemic profile by raising high density lipoprotein-cholesterol and lowering triglycerides in overweight and obese adults with characteristics of the metabolic syndrome. Lifestyle interventions, including exercise and dietary-induced weight loss may improve insulin resistance and glucose tolerance in obesity states and are highly effective in preventing or delaying the onset of type 2 diabetes in individuals with impaired glucose regulation. Randomised controlled trial evidence also indicates that exercise training decreases blood pressure in overweight/obese individuals with high normal blood pressure and hypertension. These evidence-based findings continue to support recommendations that supervised or partially supervised exercise training is an important initial adjunctive step in the treatment of individuals with the metabolic syndrome. Exercise training should be considered an essential part of 'therapeutic lifestyle change' and may concurrently improve insulin resistance and the entire cluster of metabolic risk factors.
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Affiliation(s)
- Sean Carroll
- School of Leisure and Sports Studies, Beckett Park Campus, Leeds Metropolitan University, Leeds, UK
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Aranceta J, Pérez Rodrigo C, Foz Sala M, Mantilla T, Serra Majem L, Moreno B, Monereo S, Millán J. Tablas de evaluación del riesgo coronario adaptadas a la población española. Estudio DORICA. Med Clin (Barc) 2004; 123:686-91. [PMID: 15563815 DOI: 10.1016/s0025-7753(04)75331-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Independent risk factors (smoking, hypertension, hypercholesterolemia and diabetes mellitus) are direct causes of coronary heart disease and are common in the population. Considering all independent factors together seems to be more appropriate to estimate the global risk of coronary heart disease. The objective of this paper was to estimate the global risk of coronary heart disease based on the Framingham function, adapted to the prevalence of risk factors in Spain. SUBJECTS AND METHOD The prevalence of risk factors in the Spanish population was estimated based on pooled analysis of regional cross-sectional random population surveys. Prevalence estimates and incidence rate of coronary events were replaced in the Framingham equation accordingly. Risk probability for 10 years was estimated and risk tables were designed using a gradual color coding system according to an increasing risk. RESULTS The estimated attributable fraction (AF) for hypertension in the Spanish population was 26.7% for men and 22.9% women; that for hypercholesterolemia was 15.7% and 12.7% for men and women, respectively. Smoking was identified in the third position of the ranking order for males (AF 13.13%) and fourth for the female group (AF 3.71%). The prevalence of obesity was 13.2% for men and 17.5% for women. AF for obesity among men was 4% and it was 5% for women. CONCLUSIONS An adaptation of the Framingham equation according to the prevalence of independent risk factors and incidence of coronary events in the Spanish population is useful to build instruments to estimate the 10-year global risk of coronary heart disease while a specific function based on a well-designed cohort study in not available in Spain.
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Affiliation(s)
- Javier Aranceta
- Unidad de Nutrición Comunitaria, Servicio Municipal de Salud Pública, Bilbao, Vizcaya, Spain.
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Abstract
Atherosclerosis is a very complex disease. Although it is thought that hyperlipidemia, dyslipidemia, and other conditions such as high blood pressure are mainly responsible for the development of atherosclerosis, many other factors such as endothelial dysfunction and inflammation play a significant role in its pathology. The clinicians should be aware of all the contributing factors to optimize the therapy for atherosclerosis. A combination of lifestyle modification, nutritional measures, and pharmacological intervention with statins or fibrates would achieve good results if the treatment of atherosclerosis were pursued vigorously. In the presence of hypertension, the use of angiotensin-converting enzyme inhibitors and calcium channel blockers would be more appropriate.
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Genest J, Frohlich J, Steiner G. Effect of fenofibrate-mediated increase in plasma homocysteine on the progression of coronary artery disease in type 2 diabetes mellitus. Am J Cardiol 2004; 93:848-53. [PMID: 15050487 DOI: 10.1016/j.amjcard.2003.12.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2002] [Revised: 12/04/2003] [Accepted: 12/04/2003] [Indexed: 10/26/2022]
Abstract
The Diabetes Atherosclerosis Intervention Study (DAIS) examined the effects of fenofibrate or placebo on the progression of coronary artery disease (CAD) in 418 type 2 diabetic subjects with dyslipidemia. Fenofibrate use was associated with a 6% increase in high-density lipoprotein cholesterol, a 28% decrease in triglycerides, a 5% decrease in low-density lipoprotein cholesterol, and a 55% increase in plasma homocysteine (tHcy). The purpose of the present study was to determine whether this increase in tHcy in the fenofibrate group was associated with CAD progression or with clinical events. The increase in tHcy with fenofibrate (n = 207) was not related to changes in factors known to modulate tHcy levels (serum levels of Vitamin B(12), folate, or renal function). CAD was quantified by angiography at baseline and after a minimum of 3 years of therapy with fenofibrate or placebo. The primary end point was change in mean segment diameter (MSD), minimal lumen diameter, and percent stenosis. Baseline tHcy level was correlated with percent diameter stenosis (r = 0.111, p = 0.028). Baseline, but not end-of-study elevated tHcy levels, decreased the beneficial effect of fenofibrate. Unexpectedly, the final tHcy levels correlated negatively with CAD progression (r = -0.111, p = 0.031) in the overall group. In the fenofibrate group, there was no significant correlation between tHcy and minimal lumen diameter (r = -0.135, p = 0.069), or percent stenosis. An increase in tHcy levels was not correlated with adverse clinical events in the fenofibrate group. This analysis of the the DAIS reveals that the fenofibrate-mediated increase in tHcy levels does not attenuate the beneficial effects of fenofibrate on CAD progression or clinical events.
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Affiliation(s)
- Jacques Genest
- Cardiology Division, McGill University Health Center, Healthy Heart Program, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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Sheridan S, Pignone M, Mulrow C. Framingham-based tools to calculate the global risk of coronary heart disease: a systematic review of tools for clinicians. J Gen Intern Med 2003; 18:1039-52. [PMID: 14687264 PMCID: PMC1494957 DOI: 10.1111/j.1525-1497.2003.30107.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the features of available Framingham-based risk calculation tools and review their accuracy and feasibility in clinical practice. DATA SOURCES medline, 1966-April 2003, and the google search engine on the Internet. TOOL AND STUDY SELECTION: We included risk calculation tools that used the Framingham risk equations to generate a global coronary heart disease (CHD) risk. To determine tool accuracy, we reviewed all articles that compared the performance of various Framingham-based risk tools to that of the continuous Framingham risk equations. To determine the feasibility of tool use in clinical practice, we reviewed articles on the availability of the risk factor information required for risk calculation, subjective preference for 1 risk calculator over another, or subjective ease of use. DATA EXTRACTION Two reviewers independently reviewed the results of the literature search, all websites, and abstracted all articles for relevant information. DATA SYNTHESIS Multiple CHD risk calculation tools are available, including risk charts and computerized calculators for personal digital assistants, personal computers, and web-based use. Most are easy to use and available without cost. They require information on age, smoking status, blood pressure, total and HDL cholesterol, and the presence or absence of diabetes. Compared to the full Framingham equations, accuracy for identifying patients at increased risk was generally quite high. Data on the feasibility of tool use was limited. CONCLUSIONS Several easy-to-use tools are available for estimating patients' CHD risk. Use of such tools could facilitate better decision making about interventions for primary prevention of CHD, but further research about their actual effect on clinical practice and patient outcomes is required.
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Affiliation(s)
- Stacey Sheridan
- Division of General Internal Medicine, University of North Carolina, Chapel Hill, NC 27599-7110, USA.
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Maas R, Böger RH. Old and new cardiovascular risk factors: from unresolved issues to new opportunities. ATHEROSCLEROSIS SUPP 2003; 4:5-17. [PMID: 14664897 DOI: 10.1016/s1567-5688(03)00028-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
With the aim of identifying areas that may deserve some further thinking the present review deliberately points out controversial issues in cardiovascular research and risk assessment. In the first part of the review general aspects are addressed regarding the evaluation of risk factors. A first point of concern is the frequent practice of combining different vascular events and effects in different vascular beds into a single endpoint. Furthermore, verification of vascular events in clinical reality may be surprisingly inaccurate. Problems in risk assessment also arise from overlapping properties (shared pathophysiological pathways) of traditional risk factors like hypertension, obesity and diabetes. In the second part of the review unresolved issues concerning selected established and emerging risk factors are discussed. The difficulty of establishing causality in cardiovascular disease is addressed, using modification of LDL cholesterol and accumulating evidence for pleiotropic effects of the LDL cholesterol-lowering statins as an example. As an alternative or supplement to the notion of LDL-related cardiovascular risk it is proposed to distinguish between statin-sensitive and statin-insensitive cardiovascular risk. Finally the future prospects of selected new and emerging risk factors like CRP, homocysteine, asymmetrical dimethylarginine (ADMA), oxLDL, and isoprostanes are evaluated. In summary, imprecise terminology and varying definitions of "cardiovascular risk" may lead to a considerable blurring of our current risk estimates, which may also explain some presently controversial issues. With several new risk factors and substantial changes in lifestyle and treatment patterns on the horizon major changes in the hierarchy of risk factors may be inevitable.
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Affiliation(s)
- Renke Maas
- Institut für Experimentelle und Klinische Pharmakologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Alcocer L. Statins for Everybody? New Evidence on the Efficacy and Safety of the Inhibitors of HMG Co-A Reductase. Am J Ther 2003; 10:423-8. [PMID: 14624280 DOI: 10.1097/00045391-200311000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Classically, the statins are the first choice drugs when treating dyslipidemias, especially in patients with hypercholesterolemia alone or accompanied by hypertriglyceridemia. The recent evidence of the effectiveness, safety and impact comes from hard endpoints, as demonstrated in 6 trials which included more than 40,000 subjects. The statins are being recommended for the treatment of a large number of patients with overt coronary heart disease, regardless of serum cholesterol levels, in patients with acute phases of coronary syndromes, and in patients without apparent coronary heart disease with moderate risk and average serum cholesterol and LDL cholesterol levels. These drugs are also being prescribed to patients with high-risk medical conditions that are "equivalent to coronary heart disease," like diabetes, lower limb atherosclerosis, or vascular cerebral disease, independent of the basal serum cholesterol levels or LDL cholesterol ranging from normal to high. Despite all the evidence collected as to the efficacy and safety of these drugs, the statins are not sufficiently used in daily practice, probably due to the ignorance of new concepts and the doubts related to the safety that may be cleared by careful analysis of 6 major studies with these drugs.
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Affiliation(s)
- Luis Alcocer
- México City General Hospital and National Autonomous University of México, México City, Mexico.
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Abstract
Although low-density lipoprotein cholesterol (LDL-C) remains the primary target for coronary heart disease (CHD) prevention in the latest guidelines of the National Cholesterol Education Program, many individuals who have CHD do not have substantially elevated LDL-C but have derangement of other lipid fractions, most commonly low levels of high-density lipoprotein cholesterol (HDL-C). In the guidelines, HDL-C is important in risk stratification in primary prevention, influencing the need for and intensity of treatment of LDL-C, and both HDL-C and triglyceride are defined as risk factors for the metabolic syndrome, a secondary target of therapy. Triglyceride level also determines in which individuals non-HDL-C should be a secondary target of therapy. Risk assessment that takes into account the entire lipid profile will identify more high-risk individuals than evaluating LDL-C alone. Some epidemiologic data suggest that instead of measuring the cholesterol in LDL or HDL, measuring their respective apolipoproteins, apolipoprotein (apo) B-100 and apo A-I, may improve CHD risk assessment, and in some observational and interventional studies, ratios of lipids and/or apolipoproteins have been better predictors of CHD risk than levels of any one lipid fraction. Trials of lipid-modifying therapy also suggest that apolipoproteins and ratios may provide improved targets for therapy beyond LDL-C, but optimal values have not been established. Because lipid-modifying therapy affects multiple components of the lipid profile, the effect on all lipid parameters should be considered when selecting the most appropriate agent. Therapies with beneficial effects across the lipid profile would be expected to improve CHD risk reduction.
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Affiliation(s)
- Christie M Ballantyne
- Section of Atherosclerosis, Department of Medicine, Baylor College of Medicine, Houston, Tex 77030, USA.
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Pasternak RC, Abrams J, Greenland P, Smaha LA, Wilson PWF, Houston-Miller N. 34th Bethesda Conference: Task force #1--Identification of coronary heart disease risk: is there a detection gap? J Am Coll Cardiol 2003; 41:1863-74. [PMID: 12798553 DOI: 10.1016/s0735-1097(03)00358-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Richard C Pasternak
- Preventive Cardiology and Cardiac Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2620, USA
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Marks BA, Heller T. Bridging the equity gap: health promotion for adults with intellectual and developmental disabilities. Nurs Clin North Am 2003; 38:205-28. [PMID: 12914305 DOI: 10.1016/s0029-6465(02)00049-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health is influenced by political, economic, social, cultural, environmental, behavioral and biological conditions--either positively or negatively. Health promotion aims to make these factors more favorable through health advocacy. Advocating for physical, mental, and social health requires that individuals with I/DD have opportunities to identify and realize their aspirations, develop the capacity to satisfy their needs, and possess the ability to adapt and/or cope with the environment. Because health is both an individual and a social responsibility, effective health promotion strategies must incorporate linkages between health and development, particularly for vulnerable and disadvantaged groups where deprivation in health and economic resources exist simultaneously and reinforce each other [6]. Incorporating health and development at the core of health promotion activities addresses issues of poverty, poor health, and unemployment, while accounting for social, cultural and economic differences. Health promotion enables people with I/DD to achieve their health goals by ensuring equal opportunities and resources. This includes having supportive environments, access to information, and life skills and opportunities to make healthy choices. People cannot achieve their health goals unless they can control health determinants. Health promotion efforts require coordinated action from all interested groups (e.g., government entities, health and other social and economic sectors, nongovernmental and voluntary organizations, local authorities, industry and media), including individuals, families and communities. Community-based health promotion emphasizes community participation, along with empowerment of community members to address inequities and increase control over their health [3]. Individual satisfaction and participation are critical components in community coalitions that are providing health promotion programs. Moreover, community leadership, shared decision-making, linkages with other organizations, and organizational climate can predict satisfaction, participation, and planning. Health becomes a resource for everyday life when individuals with I/DD are empowered and can participate in health promotion activities that are based in their community.
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Affiliation(s)
- Beth A Marks
- Department of Disability and Human Development (DHD), University of Illinois at Chicago (UIC), 1640 West Roosevelt Road, Chicago, IL 60608, USA.
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Abstract
The interplay of genetic and environmental factors places first-degree relatives of individuals with premature coronary heart disease at greater risk of developing the disease than the general population. Disease processes, such as dyslipidemia, hypertension, and glucose and insulin metabolism, and lifestyle habits, such as eating and exercise patterns, as well as socioeconomic status aggregate in families with coronary heart disease. The degree of risk associated with a family history varies with the degree of relationship and the age at onset of disease. All individuals with a family history of premature heart disease should have a thorough coronary risk assessment performed, which can be initiated in an office visit. Absolute risk for coronary heart disease determination will predict the intensity of preventive interventions. This article reviews the components of risk determination and primary prevention in individuals with a strong family history of coronary heart disease.
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Affiliation(s)
- Lora A Burke
- University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, USA.
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50
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Abstract
The enormous toll that coronary heart disease takes on our population merits serious consideration of all possible approaches toward early detection and prevention. It is pedestrian to the knowledgeable epidemiologist to state that coronary disease will kill more than twice as many women this year than will breast cancer. Coronary disease kills men at an even greater rate. If we had an effective preventive strategy involving early screening for one disease, why not find and apply a similar strategy for the other? Its vocal proponents have touted the coronary computed tomographic scan for calcification as the mammogram of the heart. However, unlike the breast mammogram, there are no studies showing that those tested fare any better than those who forego testing, in other words, that the test actually improves prognosis. Furthermore, the results regarding the prognostic value of computed tomographic screening are far from completely conclusive and will not be until the ongoing Multi-Ethnic Study of Atherosclerosis (MESA) trial (available at: http://140.142.220.3/mesa/) is completed.
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Affiliation(s)
- Robert Detrano
- Harbor-UCLA Medical Center Research and Education Institute, Torrance, CA 90502, USA
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