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Nusselder WJ, Long D, Waterlander WE, Stronks K, Boshuizen HC. Estimating the contribution of overweight and obesity to ethnic inequalities in cardio-metabolic diseases in the Netherlands: a simulation study. Public Health 2024; 232:45-51. [PMID: 38733960 DOI: 10.1016/j.puhe.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES Overweight and obesity (OWOB) starts in childhood, influences adult cardiovascular risk, and is not equally distributed across ethnic groups. It is unclear which effects can be expected from reductions in OWOB across the life course on inequalities in cardio-metabolic diseases in a multi-ethnic population. This study aims to estimate the effects of three scenarios of changes in OWOB (the Normal-Weight-for-All scenario, the No-Ethnic-Difference-over-the-Life-Course scenario, the and No-Ethnic-Differences-in-Childhood scenario). STUDY DESIGN A simulation study. METHODS We combine data from multiple data sources and use the Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA) model to estimate the effects of three scenarios on the cumulative incidence of diabetes mellitus, ischaemic heart disease (IHD) and stroke between 18 and 70 years in the five largest ethnic groups in the Netherlands. RESULTS In the scenario where all individuals have normal weight, the cumulative incidence decreased in all ethnic minority groups for all diseases, with largest decreases among South-Asian Surinamese, where the reduction of diabetes incidence exceeded 50%. In the scenario where the prevalence of OWOB in each ethnic-minority group was reduced to the current level among the Dutch-origin population, ethnic inequalities in cardio-metabolic diseases were substantially reduced, particularly when lowered prevalence of OWOB persisted across the lifespan. Reductions were the largest for diabetes and for the Asian Surinamese population. CONCLUSIONS A substantial part of the well-known ethnic inequalities in incidence of diabetes, IHD, and stroke can be attributed to OWOB. Interventions aimed at reducing OWOB have clear potential to reduce the health inequalities in these outcomes, especially for diabetes, in particular when they have an impact across the lifespan.
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Affiliation(s)
- W J Nusselder
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - D Long
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - W E Waterlander
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - K Stronks
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - H C Boshuizen
- Department Statistics, Data Science and Mathematical Modelling, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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2
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Agyemang C, van der Linden EL, Chilunga F, van den Born BJH. International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe. J Am Heart Assoc 2024; 13:e030228. [PMID: 38686900 DOI: 10.1161/jaha.123.030228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/26/2023] [Indexed: 05/02/2024]
Abstract
Europe and North America are the 2 largest recipients of international migrants from low-resource regions in the world. Here, large differences in cardiovascular disease (CVD) morbidity and death exist between migrants and the host populations. This review discusses the CVD burden and its most important contributors among the largest migrant groups in Europe and North America as well as the consequences of migration to high-income countries on CVD diagnosis and therapy. The available evidence indicates that migrants in Europe and North America generally have a higher CVD risk compared with the host populations. Cardiometabolic, behavioral, and psychosocial factors are important contributors to their increased CVD risk. However, despite these common denominators, there are important ethnic differences in the propensity to develop CVD that relate to pre- and postmigration factors, such as socioeconomic status, cultural factors, lifestyle, psychosocial stress, access to health care and health care usage. Some of these pre- and postmigration environmental factors may interact with genetic (epigenetics) and microbial factors, which further influence their CVD risk. The limited number of prospective cohorts and clinical trials in migrant populations remains an important culprit for better understanding pathophysiological mechanism driving health differences and for developing ethnic-specific CVD risk prediction and care. Only by improved understanding of the complex interaction among human biology, migration-related factors, and sociocultural determinants of health influencing CVD risk will we be able to mitigate these differences and truly make inclusive personalized treatment possible.
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Affiliation(s)
- Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Eva L van der Linden
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
- Department of Vascular Medicine, Amsterdam UMC University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
| | - Felix Chilunga
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam UMC University of Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
- Department of Vascular Medicine, Amsterdam UMC University of Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam The Netherlands
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3
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Akhtar N, Kate M, Kamran S, Joseph S, Morgan D, Uy R, Babu B, Shanti S, Shuaib A. Short-term functional outcomes of patients with acute intracerebral hemorrhage in the native and expatriate population. Front Neurol 2024; 15:1384985. [PMID: 38756212 PMCID: PMC11097684 DOI: 10.3389/fneur.2024.1384985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives Functional outcomes in patients with intracerebral hemorrhage (ICH) have not been well characterized in the Middle East and North Africa Region. We report the 30 and 90-day clinical outcomes in the native and expatriate of Qatar with ICH. Methods We evaluated the Glasgow Coma Scale (GCS), NIHSS, and imaging in the Qatar Stroke Registry (2013-22). The outcome measures were a modified Rankin Scale (mRS) at 90 days and mortality at 30 and 90 days. Unfavorable outcome was defined as mRS of 4-6. We performed non-parametric ROC analyses to measure the concordance index (C-index) to assess the goodness-of-fit of ICH score for predicting 30 day and 90-day mortality and functional outcome. Results 1,660 patients (median age of 49 (41.5-58) years; male 83.1%, expatriates 77.5%) with ICH, including supratentorial deep in 65.2%, cortical in 16.2%, infratentorial 16% and primary intraventricular in 2.5% were studied. The median baseline ICH volume was 7.5 (3.2-15.8) ml. An unfavorable outcome was seen in 673 (40.5%) patients at 90 days. The unfavorable 90-day outcome (mRS 4-6) was 49.2% in the native population vs. 44.4% in Africans, 39.0% in South Asian, 35.3% in Far Eastern, and 7.7% in Caucasians, p < 0.001. Mortality at 30 days and 90 days was 10.4 and 15.1%. Increasing age [OR (95% CI), 1.02 (1.00-1.03)], lower GCS [0.77 (0.73-0.80)], prior use of antiplatelet medications [1.82 (1.19-2.08)], higher ICH volume [1.03 (1.02-1.04)], and presence of any intraventricular hemorrhage [1.57(1.19-2.08)], were associated with unfavorable outcome. Conclusion In this relatively younger ICH cohort more than 75% were expatriates. The ICH volume, 90-day unfavorable outcome and mortality was lower in the expatriates compared to the local Arab population, likely related to the younger age and smaller size of the hemorrhages. Prognostic scoring systems may have to be modified in this population to avoid early withdrawal of care.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mahesh Kate
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ryan Uy
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Blessy Babu
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Shobhna Shanti
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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4
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Frydenlund J, Valentin JB, Norredam M, Frost L, Riahi S, Kragholm KH, Bøggild H, Lip GYH, Johnsen SP. Oral anticoagulation therapy initiation in patients with atrial fibrillation in relation to world region of origin: a register-based nationwide study. Open Heart 2024; 11:e002544. [PMID: 38553012 PMCID: PMC10982797 DOI: 10.1136/openhrt-2023-002544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia and results in a high risk of stroke. The number of immigrants is increasing globally, but little is known about potential differences in AF care across migrant populations. AIM To investigate if initiation of oral anticoagulation therapy (OAC) differs for patients with incident AF in relation to country of origin. METHODS A nationwide register-based study covering 1999-2017. AF was defined as a first-time diagnosis of AF and a high risk of stroke. Stroke risk was defined according to guidelines from the European Society of Cardiology (ESC). Poisson regression adjusted for sex, age, socioeconomic position and comorbidity was made to compute incidence rate ratios (IRR) for initiation of OAC. RESULTS The AF population included 254 586 individuals of Danish origin, 6673 of Western origin and 3757 of non-Western origin. Overall, OAC was initiated within -30/+90 days relative to the AF diagnosis in 50.3% of individuals of Danish origin initiated OAC, 49.6% of Western origin and 44.5% of non-Western origin. Immigrants from non-Western countries had significantly lower adjusted IRR of initiating OAC according to all ESC guidelines compared with patients of Danish origin. The adjusted IRRs ranged from 0.73 (95% CI: 0.66 to 0.80) following the launch of the 2010 ESC guideline to 0.89 (95% CI: 0.82 to 0.97) following the launch of the 2001 ESC guideline. CONCLUSION Patients with AF with a high risk of stroke of non-Western origin have persistently experienced a lower chance of initiating OAC compared with patients of Danish origin during the last decades.
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Affiliation(s)
| | | | - Marie Norredam
- Section of Health Services Research Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre University Hospital Copenhagen, Copenhagen, Denmark
| | - Lars Frost
- University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Henrik Bøggild
- Public Health and Epidemiology Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
- Liverpool Heart & Chest Hospital, Liverpool, UK
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Rhein J, Charbonnier G, Nacher M, Gaudron M, Moulin T, Rochemont DR, Cottier JP, Montagnac C, Sabbah N, de Toffol B. Prospective observational study of stroke in Cayenne, Tours and Besançon: The BECATOUR study. Rev Neurol (Paris) 2023; 179:975-982. [PMID: 37487805 DOI: 10.1016/j.neurol.2023.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/13/2022] [Accepted: 02/25/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Stroke is a major public health issue. Its epidemiology is still poorly known in French Guiana. METHOD We conducted a prospective observational study including 100 consecutive patients hospitalized for stroke in Cayenne (in French Guiana), and Tours and Besançon (in metropolitan France). We compared their age, medical history, cardiovascular risk factors, pre-admission Rankin score, Glasgow and NIHSS scores, usual treatments, acute phase management, type of stroke, duration of hospitalization, mechanism of stroke according to TOAST classification, NIHSS and Rankin scores at discharge, discharge treatments, and mode of discharge. RESULTS In French Guiana, the average age of patients was 7years lower (62 y), patients were more frequently affected by hypertension (75%) and diabetes (31%). Lacunar strokes were overrepresented (16.1%), and infarctions of cardioembolic origin were underrepresented (12%). NIHSS entry and Glasgow scores were similar between French Guiana and mainland France. Acute management was different: thrombolysis rate (9.3%) was 3 to 4 times lower, thrombectomy was not available. Fewer patients were transferred to rehabilitation centers and more patients were transferred to home hospitalization. DISCUSSION In Tours and Besançon, patients eligible for thrombectomy were overrepresented. This bias explains the overrepresentation of more severe infarctions and probably the overrepresentation of strokes of cardioembolic origin. Infarctions of undetermined origin were more numerous in French Guiana because patients were often discharged from hospital with an incomplete cardiological workup. CONCLUSION Despite some caveats, the profile of patients admitted for stroke in French Guiana is different from mainland France. The establishment of a stroke unit and an information campaign on the symptoms of stroke would allow better management.
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Affiliation(s)
- J Rhein
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - G Charbonnier
- Neurology Department, University Hospital Centre Besançon, 25000 Besançon, France
| | - M Nacher
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - M Gaudron
- Neurology Department, CHU Bretonneau, 37044 Tours cedex, France
| | - T Moulin
- Neurology Department, University Hospital Centre Besançon, 25000 Besançon, France
| | - D R Rochemont
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - J-P Cottier
- Neuroradiology Department, CHU Bretonneau, 37044 Tours cedex, France
| | - C Montagnac
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - N Sabbah
- Endocrinology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - B de Toffol
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana.
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6
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Vriend EMC, Wever BE, Bouwmeester TA, Agyemang C, Franco OH, Galenkamp H, Moll van Charante EP, Zwinderman AH, Collard D, van den Born BJH. Ethnic differences in blood pressure levels over time: the HELIUS study. Eur J Prev Cardiol 2023; 30:978-985. [PMID: 36971109 DOI: 10.1093/eurjpc/zwad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 06/18/2023]
Abstract
AIMS Hypertension is an important global health burden with major differences in prevalence among ethnic minorities compared with host populations. Longitudinal research on ethnic differences in blood pressure (BP) levels provides the opportunity to assess the efficacy of strategies aimed at mitigating gaps in hypertension control. In this study, we assessed the change in BP levels over time in a multi-ethnic population-based cohort in Amsterdam, the Netherlands. METHODS AND RESULTS We used baseline and follow-up data from HELIUS to assess differences in BP over time between participants of Dutch, South Asian Surinamese, African Surinamese, Ghanaian, Moroccan, and Turkish descent. Baseline data were collected between 2011 and 2015 and follow-up data between 2019 and 2021. The main outcome was ethnic differences in systolic BP (SBP) over time determined by linear mixed models adjusted for age, sex, and use of antihypertensive medication. We included 22 109 participants at baseline, from which 10 170 participants had complete follow-up data. The mean follow-up time was 6.3 (1.1) years. Compared with the Dutch population, the mean SBP increased significantly more from baseline to follow-up in Ghanaians [1.78 mmHg, 95% confidence interval (CI) 0.77-2.79], Moroccans (2.06 mmHg, 95% CI 1.23-2.90), and the Turkish population (1.30 mmHg, 95% CI 0.38-2.22). Systolic blood pressure differences were in part explained by differences in body mass index (BMI). No differences in SBP trajectory were present between the Dutch and Surinamese population. CONCLUSION Our findings indicate a further increase of ethnic differences in SBP among Ghanaian, Moroccan, and Turkish populations compared with the Dutch reference population that are in part attributable to differences in BMI.
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Affiliation(s)
- Esther M C Vriend
- Department of Internal Medicine, Section of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
| | - Britt E Wever
- Department of Internal Medicine, Section of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
| | - Thomas A Bouwmeester
- Department of Internal Medicine, Section of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
| | - Oscar H Franco
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
- Health Behaviours and Chronic Diseases, Amsterdam Public Health Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
| | - Eric P Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
| | - Aeilko H Zwinderman
- Department of Epidemiology, Biostatistics & Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
| | - Didier Collard
- Department of Internal Medicine, Section of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
| | - Bert-Jan H van den Born
- Department of Internal Medicine, Section of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam Zuidoost, The Netherlands
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7
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Agyemang C, van der Linden EL, Antwi-Berko D, Nkansah Darko S, Twumasi-Ankrah S, Meeks K, van den Born BJH, Henneman P, Owusu-Dabo E, Beune E. Cohort profile: Research on Obesity and Diabetes among African Migrants in Europe and Africa Prospective (RODAM-Pros) cohort study. BMJ Open 2022; 12:e067906. [PMID: 36521887 PMCID: PMC9756160 DOI: 10.1136/bmjopen-2022-067906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The Research on Obesity and Diabetes among African Migrants (RODAM) prospective (RODAM-Pros) cohort study was established to identify key changes in environmental exposures and epigenetic modifications driving the high burden of cardiovascular disease (CVD) risk among sub-Saharan African migrants. PARTICIPANTS All the participants in the RODAM cross-sectional study that completed the baseline assessment (n=5114) were eligible for the follow-up of which 2165 participants (n=638 from rural-Ghana, n=608 from urban-Ghana, and n=919 Ghanaian migrants in Amsterdam, the Netherlands) were included in the RODAM-Pros cohort study. Additionally, we included a subsample of European-Dutch (n=2098) to enable a comparison to be made between Ghanaian migrants living in the Netherlands and the European-Dutch host population. FINDINGS TO DATE Follow-up data have been collected on demographics, socioeconomic status, medical history, psychosocial environment, lifestyle factors, nutrition, anthropometrics, blood pressure, fasting blood, urine and stool samples. Biochemical analyses included glucose metabolism, lipid profile, electrolytes and renal function, liver metabolism and inflammation. In a subsample, we assessed DNA methylation patterns using Infinium 850K DNA Methylation BeadChip. Baseline results indicated that migrants have higher prevalence of CVD risk factors than non-migrants. Epigenome-wide association studies suggest important differences in DNA methylation between migrants and non-migrants. The follow-up study will shed further light on key-specific environmental exposures and epigenetic modifications contributing to the high burden of CVD risk among sub-Saharan African migrants. FUTURE PLANS Follow-up is planned at 5-year intervals, baseline completed in 2015 and first follow-up completed in 2021.
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Affiliation(s)
- Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Eva L van der Linden
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Daniel Antwi-Berko
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Samuel Nkansah Darko
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Sampson Twumasi-Ankrah
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Karlijn Meeks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Peter Henneman
- Department of Human Genetics, Genome Diagnostics laboratory Amsterdam, Reproduction & Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Erik Beune
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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8
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Bouwmeester TA, van de Velde L, Galenkamp H, Postema PG, Westerhof BE, van den Born BJH, Collard D. Association between the reflection magnitude and blood pressure in a multiethnic cohort: the Healthy Life in an Urban Setting study. J Hypertens 2022; 40:2263-2270. [PMID: 35950966 PMCID: PMC9553245 DOI: 10.1097/hjh.0000000000003256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022]
Abstract
AIMS Reflection magnitude (RM), the ratio of the amplitudes of the backward and forward central arterial pressure waves, has been shown to predict cardiovascular events. However, the association with blood pressure (BP) and hypertension is unclear. METHODS We assessed RM in 10 195 individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin aged between 18 and 70 years (54.2% female) participating in the Healthy Life in an Urban Setting study. To determine RM, central arterial pressure and flow were reconstructed from finger BP. Hypertension was defined based on office-BP and medication. Associations with BP, hypertension, and hypertensive organ damage were assessed using linear regression models with correction for relevant covariates. RESULTS Mean RM was 62.5% (standard deviation [SD] 8.0) in men and 63.8% (SD 8.1) in women. RM was lowest in Dutch and highest in South-Asian and African participants. RM increased linearly with 1.35 (95% confidence interval [CI] 1.23-1.46) for every 10 mmHg increase in systolic BP from 120 mmHg onwards, while the relation with diastolic BP was nonlinear. RM was 2.40 (95% CI 2.04-2.76) higher in hypertensive men and 3.82 (95% CI 3.46-4.19) higher in hypertensive women compared to normotensive men and women. In hypertensive men and women with ECG-based left ventricular hypertrophy or albuminuria RM was 1.64 (95% CI 1.09-2.20) and 0.94 (95% CI 0.37-1.52) higher compared to hypertensive participants without hypertensive organ damage. CONCLUSION RM is associated with BP, hypertension and hypertensive organ damage, and may in part explain disparities in hypertension associated cardiovascular risk.
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Affiliation(s)
- Thomas A. Bouwmeester
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
| | - Lennart van de Velde
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
- Faculty of Science and Technology, Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam
| | - Pieter G. Postema
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences
| | - Berend E. Westerhof
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam
| | - Didier Collard
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
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9
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Bouwmeester TA, van de Velde L, Galenkamp H, Postema PG, Westerhof BE, van den Born BJH, Collard D. Association between the reflection magnitude and blood pressure in a multiethnic cohort: the Healthy Life in an Urban Setting study. J Hypertens 2022; 40:2263-2270. [DOI: https:/doi.org/10.1097%2fhjh.0000000000003256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Aims:
Reflection magnitude (RM), the ratio of the amplitudes of the backward and forward central arterial pressure waves, has been shown to predict cardiovascular events. However, the association with blood pressure (BP) and hypertension is unclear.
Methods:
We assessed RM in 10 195 individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin aged between 18 and 70 years (54.2% female) participating in the Healthy Life in an Urban Setting study. To determine RM, central arterial pressure and flow were reconstructed from finger BP. Hypertension was defined based on office-BP and medication. Associations with BP, hypertension, and hypertensive organ damage were assessed using linear regression models with correction for relevant covariates.
Results:
Mean RM was 62.5% (standard deviation [SD] 8.0) in men and 63.8% (SD 8.1) in women. RM was lowest in Dutch and highest in South-Asian and African participants. RM increased linearly with 1.35 (95% confidence interval [CI] 1.23–1.46) for every 10 mmHg increase in systolic BP from 120 mmHg onwards, while the relation with diastolic BP was nonlinear. RM was 2.40 (95% CI 2.04–2.76) higher in hypertensive men and 3.82 (95% CI 3.46–4.19) higher in hypertensive women compared to normotensive men and women. In hypertensive men and women with ECG-based left ventricular hypertrophy or albuminuria RM was 1.64 (95% CI 1.09–2.20) and 0.94 (95% CI 0.37–1.52) higher compared to hypertensive participants without hypertensive organ damage.
Conclusion:
RM is associated with BP, hypertension and hypertensive organ damage, and may in part explain disparities in hypertension associated cardiovascular risk.
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Affiliation(s)
- Thomas A. Bouwmeester
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
| | - Lennart van de Velde
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
- Faculty of Science and Technology, Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam
| | - Pieter G. Postema
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences
| | - Berend E. Westerhof
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam
| | - Didier Collard
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
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10
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Mkoma GF, Johnsen SP, Iversen HK, Andersen G, Norredam M. Immigration status and utilization of secondary preventive treatment after ischemic stroke. Eur Stroke J 2022; 7:402-412. [PMID: 36478760 PMCID: PMC9720847 DOI: 10.1177/23969873221111870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The objective of the study was to assess use and persistence of secondary preventive treatment after ischemic stroke comparing immigrants and Danish-born residents. Patients and methods: A cohort of patients discharged with ischemic stroke (IS) diagnosis ( n = 106,224) by immigration status was identified from the Danish Stroke Registry between 2005 and 2018. We investigated use (claiming at least one prescription in 180 days post-discharge according to information from the Register of Medicinal Products Statistics) and persistence of treatment within 180 days thereafter using multivariable logistic regression and Fine and Gray models. Results: Overall, 82,078 Danish-born residents (80.6%) and 3589 (80.7%) immigrants with IS used at least one of the recommended preventive medications post-discharge. Immigrants had lower odds of use of anticoagulants and angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB) (odds ratio (OR), 0.66; 95% confidence interval (CI), 0.53–0.82 and OR, 0.87; 95% CI, 0.75–0.98, respectively) but had higher odds of use of beta-blockers (OR, 1.25; 95% CI, 1.02–1.53) than Danish-born residents after adjustment for age at stroke, sex, sociodemographic factors, duration of residence, stroke severity, and comorbidities. The odds were most evident among immigrants originating from non-Western countries. Persistence of medication use did not differ between immigrants and Danish-born residents after adjustment for sociodemographic factors and comorbidities. Conclusion: Modest disparities in use of standard guideline recommended secondary preventive medications were observed when comparing immigrants and Danish-born residents with ischemic stroke. Furthermore, no differences in persistence of medication therapy were observed.
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Affiliation(s)
- George F Mkoma
- Danish Research Center for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helle K Iversen
- Stroke Center Rigshospitalet, Department of Neurology, University of Copenhagen, Copenhagen, Denmark
| | - Grethe Andersen
- Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Marie Norredam
- Danish Research Center for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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11
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Hypertension determinants among Ghanaians differ according to location of residence. J Hypertens 2022; 40:1010-1018. [DOI: 10.1097/hjh.0000000000003108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Bolijn R, Sieben CHAM, Kunst AE, Blom M, Tan HL, van Valkengoed IGM. Sex differences in incidence of out-of-hospital cardiac arrest across ethnic and socioeconomic groups: A population-based cohort study in the Netherlands. Int J Cardiol 2021; 343:156-161. [PMID: 34509532 DOI: 10.1016/j.ijcard.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Insight into the occurrence of out-of-hospital cardiac arrest (OHCA) within general populations may help to target prevention strategies. Case registries suggest that there may be substantial differences in emergency medical service (EMS)-attended OHCA incidence between men and women, but relative sex differences across ethnic groups and socioeconomic (SES) groups have not been studied. We investigated sex differences in OHCA incidence, overall and across these subgroups. METHODS We performed a retrospective population-based cohort study, combining individual-level data on ethnicity and income (as SES measure) from Statistics Netherlands of all men and women aged ≥25 years living in one study region in the Netherlands on 01-01-2009 (n = 1,688,285) with prospectively collected EMS-attended OHCA cases (n = 5676) from the ARREST registry until 31-12-2015. We calculated age-standardised incidence rates of OHCA. Sex differences were assessed with Cox proportional hazards regression analyses, adjusted for age, ethnicity and income, in the overall population, and across ethnic and SES groups. RESULTS The age-standardised incidence rate of OHCA was lower in women than in men (30.9 versus 87.3 per 100,000 person-years), corresponding with a hazard ratio (HR) of 0.33 (95% confidence interval [CI] 0.31-0.35). These sex differences in hazard for OHCA existed in all income quintiles (HR range: 0.30-0.35) and ethnic groups (HR range: 0.19-0.40), except among Moroccans (HR 0.89, 95% CI 0.51-1.57). CONCLUSION Women have a substantial, yet lower OHCA incidence rate than men. The magnitude of these sex differences did not vary across social strata.
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Affiliation(s)
- Renee Bolijn
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Cenne H A M Sieben
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anton E Kunst
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marieke Blom
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hanno L Tan
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Irene G M van Valkengoed
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
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13
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Mkoma GF, Johnsen SP, Iversen HK, Andersen G, Norredam M. Incidence of stroke, transient ischaemic attack and determinants of poststroke mortality among immigrants in Denmark, 2004‒2018: a population-based cohort study. BMJ Open 2021; 11:e049347. [PMID: 34675015 PMCID: PMC8532551 DOI: 10.1136/bmjopen-2021-049347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Using recent registry data, we aimed to quantify the incidence of stroke and transient ischaemic attack (TIA) and to examine factors influencing the risk of poststroke mortality among immigrants compared with Danish-born individuals. DESIGN Population-based cohort study between 2004 and 2018. We estimated age-standardised incidence rate ratios (IRR) of stroke, stroke types and TIA for each ethnic group using Danish-born individuals as the reference by direct method of standardisation. We calculated the risk of poststroke mortality using Cox proportional hazard regression. SETTING The study was conducted using Danish nationwide registers. PARTICIPANTS All cases of first-ever stroke and TIA by country of origin (n=132 936) were included. RESULTS Overall, Western immigrants (IRR=2.25; 95% CI 2.20 to 2.31) and non-Western immigrants (IRR=1.37; 95% CI 1.30 to 1.44) had a higher risk of stroke than Danish-born individuals. The risk of TIA was higher in Western immigrants (IRR=2.08; 95% CI 1.93 to 2.23) followed by non-Western immigrants (IRR=1.45; 95% CI 1.27 to 1.63) than in Danish-born individuals. All-cause 1-year mortality hazard was higher but not significantly different in non-Western men (adjusted HR=1.38; 95% CI 0.92 to 2.08) compared with Danish-born men and additional adjustment for comorbidities reduced the HR to 0.85 (0.51 to 1.40) among ischaemic stroke cases. Among intracerebral haemorrhage cases, the adjusted mortality hazard was decreased in Western men (from HR of 1.76; 95% CI 1.09 to 2.85 to HR of 1.30; 95% CI 0.80 to 2.11) compared with Danish-born men after adjustment for stroke severity. Immigrants with ≤15 years of residence had a lower poststroke mortality hazard than Danish-born individuals after additional adjustment for sociodemographic factors (HR=0.36; 95% CI 0.14 to 0.91). CONCLUSIONS The age-standardised risk of stroke and TIA was significantly higher among the majority of immigrants than Danish-born individuals. Interventions that reduce the burden of comorbidities, improve acute stroke care and target sociodemographic factors may address the higher risk of poststroke mortality among immigrants.
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Affiliation(s)
- George Frederick Mkoma
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Søren Paaske Johnsen
- Danish Centre for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helle Klingenberg Iversen
- Stroke Centre Rigshospitalet, Department of Neurology, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Grethe Andersen
- Danish Stroke Centre, Department of Neurology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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14
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Perini W, van Valkengoed IGM, Snijder MB, Peters RJG, Kunst AE. The contribution of obesity to the population burden of high metabolic cardiovascular risk among different ethnic groups. The HELIUS study. Eur J Public Health 2021; 30:322-327. [PMID: 32053154 DOI: 10.1093/eurpub/ckz190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The burden of cardiovascular risk is distributed unequally between ethnic groups. It is uncertain to what extent this is attributable to ethnic differences in general and abdominal obesity. Therefore, we studied the contribution of general and abdominal obesity to metabolic cardiovascular risk among different ethnic groups. METHODS We used data of 21 411 participants of Dutch, South-Asian Surinamese, African-Surinamese, Ghanaian, Turkish or Moroccan origin in Healthy Life in an Urban Setting (Amsterdam, the Netherlands). Obesity was defined using body-mass-index (general) or waist-to-height-ratio (abdominal). High metabolic risk was defined as having at least two of the following: triglycerides ≥1.7 mmol/l, fasting glucose ≥5.6 mmol/l, blood pressure ≥130 mmHg systolic and/or ≥85 mmHg diastolic and high-density lipoprotein cholesterol <1.03 mmol/l (men) or <1.29 mmol/l (women). RESULTS Among ethnic minority men, age-adjusted prevalence rates of high metabolic risk ranged from 32 to 59% vs. 33% among Dutch men. Contributions of general obesity to high metabolic risk ranged from 7.1 to 17.8%, vs. 10.1% among Dutch men, whereas contributions of abdominal obesity ranged from 52.1 to 92.3%, vs. 53.9% among Dutch men. Among ethnic minority women, age-adjusted prevalence rates of high metabolic risk ranged from 24 to 35% vs. 12% among Dutch women. Contributions of general obesity ranged from 14.6 to 41.8%, vs. 20% among Dutch women, whereas contributions of abdominal obesity ranged from 68.0 to 92.8%, vs. 72.1% among Dutch women. CONCLUSIONS Obesity, especially abdominal obesity, contributes significantly to the prevalence of high metabolic cardiovascular risk. Results suggest that this contribution varies substantially between ethnic groups, which helps explain ethnic differences in cardiovascular risk.
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Affiliation(s)
- Wilco Perini
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene G M van Valkengoed
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marieke B Snijder
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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15
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Armengol GD, Hayfron-Benjamin CF, van den Born BJH, Galenkamp H, Agyemang C. Microvascular and macrovascular complications in type 2 diabetes in a multi-ethnic population based in Amsterdam. The HELIUS study. Prim Care Diabetes 2021; 15:528-534. [PMID: 33676869 DOI: 10.1016/j.pcd.2021.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess ethnic differences in diabetes-related microvascular and macrovascular complication rates in a multi-ethnic population in the Netherlands. STUDY, DESIGN AND SETTING Data from the HELIUS study comprising of 165 Dutch, 591 South-Asian Surinamese, 494 African Surinamese, 272 Ghanaian, 368 Turkish, and 444 Moroccan participants with diabetes were analyzed. Logistic regression was used to assess ethnic differences in microvascular (nephropathy) and macrovascular (coronary heart disease (CHD), peripheral artery disease (PAD) and stroke) complications, with adjustments for age, sex, education, and the conventional risk factors. RESULTS In an age-sex adjusted model, ethnic minorities had higher odds of nephropathy than Dutch except for Ghanaians and African Surinamese. The difference remained statistically significant in South-Asian Surinamese (odds ratio: 2.29; 95% CI, 1.09-4.80), but not in the Turkish (1.01; 0.43-2.38) and Moroccan (1.56; 0.68-3.53) participants. The odds of CHD was higher in all ethnic minorities than in Dutch, with the odds ratios ranging from 2.73 (1.09-6.84) in Ghanaians to 6.65 (2.77-15.90) in Turkish in the fully-adjusted model. There were no ethnic differences in the odds of PAD and stroke. CONCLUSIONS The findings suggest ethnic inequalities in macrovascular and microvascular complications in diabetes, with nephropathy and CHD being the most common complications affecting ethnic minorities.
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Affiliation(s)
- Gina Domínguez Armengol
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Charles F Hayfron-Benjamin
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Department of Physiology, University of Ghana Medical School, Ghana.
| | - Bert-Jan H van den Born
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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16
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Tse WC, Grey C, Harwood M, Jackson R, Kerr A, Mehta S, Poppe K, Pylypchuk R, Wells S, Selak V. Risk of major bleeding by ethnicity and socioeconomic deprivation among 488,107 people in primary care: a cohort study. BMC Cardiovasc Disord 2021; 21:206. [PMID: 33892644 PMCID: PMC8063422 DOI: 10.1186/s12872-021-01993-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Antithrombotic medications (antiplatelets and anticoagulants) reduce the risk of cardiovascular disease (CVD), but with the disadvantage of increasing bleeding risk. Ethnicity and socioeconomic deprivation are independent predictors of major bleeds among patients without CVD, but it is unclear whether they are also predictors of major bleeds among patients with CVD or atrial fibrillation (AF) after adjustment for clinical variables. Methods Prospective cohort study of 488,107 people in New Zealand Primary Care (including 64,420 Māori, the indigenous people of New Zealand) aged 30–79 years who had their CVD risk assessed between 2007 and 2016. Participants were divided into three mutually exclusive subgroups: (1) AF with or without CVD (n = 15,212), (2) CVD and no AF (n = 43,790), (3) no CVD or AF (n = 429,105). Adjusted hazards ratios (adjHRs) were estimated from Cox proportional hazards models predicting major bleeding risk for each of the three subgroups to determine whether ethnicity and socioeconomic deprivation are independent predictors of major bleeds in different cardiovascular risk groups. Results In all three subgroups (AF, CVD, no CVD/AF), Māori (adjHR 1.63 [1.39–1.91], 1.24 [1.09–1.42], 1.57 [95% CI 1.45–1.70], respectively), Pacific people (adjHR 1.90 [1.58–2.28], 1.30 [1.12–1.51], 1.62 [95% CI 1.49–1.75], respectively) and Chinese people (adjHR 1.53 [1.08–2.16], 1.15 [0.90–1.47], 1.13 [95% CI 1.01–1.26], respectively) were at increased risk of a major bleed compared to Europeans, although for Chinese people the effect did not reach statistical significance in the CVD subgroup. Compared to Europeans, Māori and Pacific peoples were generally at increased risk of all bleed types (gastrointestinal, intracranial and other bleeds). An increased risk of intracranial bleeds was observed among Chinese and Other Asian people and, in the CVD and no CVD/AF subgroups, among Indian people. Increasing socioeconomic deprivation was also associated with increased risk of a major bleed in all three subgroups (adjHR 1.07 [1.02–1.12], 1.07 [1.03–1.10], 1.10 [95% CI 1.08–1.12], respectively, for each increase in socioeconomic deprivation quintile). Conclusion Ethnicity and socioeconomic status should be considered in bleeding risk assessments to guide the use of antithrombotic medication for the management of AF and CVD. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01993-9.
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Affiliation(s)
- Wai Chung Tse
- School of Medicine, Monash University, Clayton, Australia
| | - Corina Grey
- Section of Epidemiology and Biostatistics, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Matire Harwood
- General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Andrew Kerr
- Section of Epidemiology and Biostatistics, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Middlemore Hospital, Auckland, New Zealand
| | - Suneela Mehta
- Section of Epidemiology and Biostatistics, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Katrina Poppe
- Section of Epidemiology and Biostatistics, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Romana Pylypchuk
- Section of Epidemiology and Biostatistics, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Sue Wells
- Section of Epidemiology and Biostatistics, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Vanessa Selak
- Section of Epidemiology and Biostatistics, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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17
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van der Linden EL, Couwenhoven BN, Beune EJ, Daams JG, van den Born BJH, Agyemang C. Hypertension awareness, treatment and control among ethnic minority populations in Europe: a systematic review and meta-analysis. J Hypertens 2021; 39:202-213. [PMID: 32925300 PMCID: PMC7810417 DOI: 10.1097/hjh.0000000000002651] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Ethnic minority populations (EMPs) are disproportionally affected by hypertension-mediated complications compared with European host populations (EHPs), which might be due to disparities in hypertension awareness, treatment and control. We conducted a systematic review and meta-analysis to compare awareness, treatment and control rates among EMPs with EHPs. METHODS MEDLINE, EMBASE and Web of Science were searched from inception to 29 January 2020. Critical appraisal was performed according to methods of Hoy et al. Pooled odds ratios with corresponding 95% confidence intervals were calculated for these rates, stratified by ethnic group, using either random or fixed effect meta-analysis based on I2-statistics. Study was registered in PROSPRO (CRD42020107897). RESULTS A total of 3532 records were screened of which 16 were included in the analysis with data on 26 800 EMP and 57 000 EHP individuals. Compared with EHPs, African origin populations were more likely to be aware (odds ratio 1.26, 95% confidence interval 1.02-1.56) and treated (1.49, 1.18-1.88) for hypertension, but were less likely to have their blood pressure controlled (0.56, 0.40-0.78), whereas South Asian populations were more likely to be aware (1.15, 1.02-1.30), but had similar treatment and control rates. In Moroccan populations, hypertension awareness (0.79, 0.62-1.00) and treatment levels (0.77, 0.60-0.97) were lower compared with EHPs, while in Turkish populations awareness was lower (0.81, 0.65-1.00). CONCLUSION Levels of hypertension awareness, treatment and control differ between EMPs and EHPs. Effort should be made to improve these suboptimal rates in EMPs, aiming to reduce ethnic inequalities in hypertension-mediated complications.
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Affiliation(s)
- Eva L. van der Linden
- Department of Public Health, Amsterdam Public Health Research Institute
- Department of Internal and Vascular Medicine, Amsterdam Cardiovascular Sciences
| | | | - Erik J.A.J. Beune
- Department of Internal and Vascular Medicine, Amsterdam Cardiovascular Sciences
| | - Joost G. Daams
- Medical Library AMC, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Department of Public Health, Amsterdam Public Health Research Institute
- Department of Internal and Vascular Medicine, Amsterdam Cardiovascular Sciences
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute
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18
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Bolijn R, Schalkers I, Tan HL, Kunst AE, van Valkengoed IGM. Patient perspectives on priorities for research on conventional and sex- and gender-related cardiovascular risk factors. Neth Heart J 2020; 28:656-661. [PMID: 33025404 PMCID: PMC7683649 DOI: 10.1007/s12471-020-01497-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background Recently, cardiovascular disease (CVD) research has focused on sex- and gender-related cardiovascular risk factors, in addition to conventional risk factors. This raises the question which factors are perceived by the target group (patients with CVD) as priorities for further research. Methods We carried out a survey to study priority setting for more research into conventional and sex- and gender-related risk factors according to 980 men and women with CVD or those at increased risk of CVD in the Netherlands. Data on conventional and sex- and gender-related risk factors were descriptively analysed, stratified by gender group. Results The most frequently prioritised conventional factors according to men were heritability, overweight and unhealthy diet, while women most frequently listed stress, heritability and hypertension. The most frequently prioritised sex- and gender-related risk factors were depression or depressive feelings, migraine and having many caretaking responsibilities (men), and pregnancy complications, contraceptive pill use and early age at menopause (women). New research on sex- and gender-related risk factors was perceived roughly as relevant as that on conventional factors by men (mean 7.4 and 8.3 on a 1–10 scale, respectively) and women (8.2 and 8.6, respectively). Ethnic and gender minority groups placed more emphasis on risk factors related to sociocultural aspects (gender) than the majority group. Conclusion Men and women with CVD or those at increased risk of CVD perceived new research on conventional and sex- and gender-related risk factors as a priority. These findings may guide researchers and funders in further prioritising new CVD research. Electronic supplementary material The online version of this article (10.1007/s12471-020-01497-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Bolijn
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Center, AMC/University of Amsterdam, Amsterdam, The Netherlands.
| | | | - H L Tan
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, AMC/University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - A E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Center, AMC/University of Amsterdam, Amsterdam, The Netherlands
| | - I G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Center, AMC/University of Amsterdam, Amsterdam, The Netherlands
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19
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Krishnamurthi RV, Barker-Collo S, Barber PA, Tippett LJ, Dalrymple-Alford JC, Tunnage B, Mahon S, Parmar PG, Moylan M, Feigin VL. Community Knowledge and Awareness of Stroke in New Zealand. J Stroke Cerebrovasc Dis 2019; 29:104589. [PMID: 31879136 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104589] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Community knowledge and stroke awareness is crucial for primary prevention of stroke and timely access to stroke treatments including acute reperfusion therapies. We conducted a national telephone survey to quantify the level of community stroke awareness. METHODS A random sample of 400 adults in New Zealand (NZ), stratified by the 4 main ethnic groups, was surveyed. Eligible participants answered stroke awareness questions using both unprompted (open-ended) and prompted questions (using a list). Proportional odds logistic regression models were used to identify factors associated with stroke awareness. RESULTS Only 1.5% of participants named stroke as a major cause of death. The stroke signs and symptoms most frequently identified from a list were sudden speech difficulty (94%) and sudden 1-sided weakness (92%). Without prompting, 78% of participants correctly identified at least 1 risk factor, 62% identified at least 2, and 35% identified 3 or more. When prompted with the list, scores increased 10-fold compared with unprompted responses. Ethnic disparities were observed, with Pacific peoples having the lowest level of awareness among the 4 ethnic groups. Higher education level, higher income, and personal experience of stroke were predictive of greater awareness (P ≤ .05). CONCLUSIONS Stroke was not recognized as a major cause of death. Although identification of stroke risk factors was high with prompting, awareness was low without prompting, particularly among those with lower education and income. Nationwide, culturally tailored public awareness campaigns are necessary to improve knowledge of stroke risk factors, recognition of stroke in the community and appropriate actions to take in cases of suspected stroke.
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Affiliation(s)
- Rita V Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | | | - Peter Alan Barber
- Centre for Brain Research, University of Auckland, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Lynette J Tippett
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - John C Dalrymple-Alford
- Department of Psychology, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Bronwyn Tunnage
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; Department of Paramedicine, Auckland University of Technology, Auckland, New Zealand
| | - Susan Mahon
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Priyakumari G Parmar
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Melanie Moylan
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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20
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The impact of ethnic/racial status on access to care and outcomes after stroke: A narrative systematic review. JOURNAL OF VASCULAR NURSING 2019; 37:199-212. [DOI: 10.1016/j.jvn.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/20/2019] [Accepted: 07/02/2019] [Indexed: 01/01/2023]
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21
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Wu T, Liu C, Huang Y, Li S, Wang Y. Simultaneous screening and isolation of activated constituents from Puerariae Flos by ultrafiltration with liquid chromatography and mass spectrometry combined with high-speed counter-current chromatography. J Sep Sci 2019; 41:4458-4468. [PMID: 30444083 DOI: 10.1002/jssc.201800691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023]
Abstract
Puerariae Flos is the flower of Puerariae Radix, which is a common Chinese herb containing numerous isoflavones in all parts of the flower. Standard methods for screening and isolating isoflavones are typically labor intensive and time consuming. In this study, a new assay based on ultrafiltration with liquid chromatography and mass spectrometry was developed for the rapid screening and identification of ligands for α-glucosidase, xanthine oxidase and lactate dehydrogenase in the extract of Puerariae Flos. Three isoflavones were identified as α-glucosidase inhibitors, three isoflavones were identified as lactate dehydrogenase inhibitors, and no specific binding ligands were identified for xanthine oxidase in the extract. Subsequently, specific binding ligands, puerarin, genistin, and tectorigenin (purities were 90, 60, 99, and 91.73%, respectively), were separated by high-speed counter-current chromatography. The partition coefficient values of the target compounds and resolutions of peaks were employed as indicators and the solvent system and mobile phase flow rate were optimized for two-stage separation. An optimized two-phase solvent system comprised of ethyl acetate/ethanol/water (4:0.5:3, v/v/v) was successfully used to isolate the three compounds from Puerariae Flos. The monomer compounds isolated, collected, and purified by high-speed counter-current chromatography were analyzed by high-performance liquid chromatography, resulting in the isolation of three targeted compounds. The chemical structures of all three targeted compounds were individually identified by ultra high performance liquid chromatography with high-resolution mass spectrometry. The results demonstrate that ultrafiltration with liquid chromatography and mass spectrometry combined with high-speed counter-current chromatography is not only a powerful tool for screening and isolating α-glucosidase and lactate dehydrogenase inhibitors in complex samples, but also a useful platform for identifying bioactive compounds for preventing and treating diabetes and stroke.
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Affiliation(s)
- Tong Wu
- Central Laboratory, Changchun Normal University, Changchun, P. R. China
| | - Chunming Liu
- Central Laboratory, Changchun Normal University, Changchun, P. R. China
| | - Yu Huang
- Central Laboratory, Changchun Normal University, Changchun, P. R. China
| | - Sainan Li
- Central Laboratory, Changchun Normal University, Changchun, P. R. China
| | - Yueqi Wang
- Central Laboratory, Changchun Normal University, Changchun, P. R. China
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22
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Agyemang C, van den Born BJ. Non-communicable diseases in migrants: an expert review. J Travel Med 2019; 26:5139836. [PMID: 30346574 DOI: 10.1093/jtm/tay107] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Non-communicable diseases (NCDs) remain a major challenge in the 21st century. High-income countries (HICs) populations are ethnically and culturally diverse due to international migration. Evidence suggests that NCDs rates differ between migrants and the host populations in HICs. This paper presents a review of NCDs burden among migrant groups in HICs in Europe, North America and Australia with a major focus on cardiovascular diseases (CVDs), cancer and diabetes. METHODS We performed a narrative review consisting of scholarly papers published between 1960 until 2018. RESULTS CVD risk differs by country of origin, country of destination and duration of residence. For example, stroke is more common in sub-Sahara African and South-Asian migrants, but lower in North African and Chinese migrants. Chinese migrants, however, have a higher risk of haemorrhagic stroke despite the lower rate of overall stroke. Coronary heart disease (CHD) is more common in South-Asian migrants, but less common in sub-Saharan and north African migrants although the lower risk of CHD in these population is waning. Diabetes risk is higher in all migrants and migrants seem to develop diabetes at an earlier age than the host populations. Migrants in general have lower rates of overall cancer morbidity and mortality than the host populations in Europe. However, migrants have a higher infectious disease-related cancers than the host populations in Europe. In North America, the picture is more complex. Data from cross-national comparisons indicate that migration-related lifestyle changes associated with the lifestyle of the host population in the country of settlement may influence NCDs risk among migrants in a very significant way. CONCLUSION With exception of diabetes, which is consistently higher in all migrant groups than in the host populations, the burden of NCDs among migrants seems to depend on the migrant group, country of settlement and NCD type. This suggests that more work is needed to disentangle the key migration-related lifestyle changes and contextual factors that may be driving the differential risk of NCDs among migrants in order to assist prevention and clinical management of NCDs in these populations.
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Affiliation(s)
- Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, AZ Amsterdam, the Netherlands
| | - Bert-Jan van den Born
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, AZ Amsterdam, the Netherlands.,Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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23
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Deen L, Buddeke J, Vaartjes I, Bots ML, Norredam M, Agyemang C. Ethnic differences in cardiovascular morbidity and mortality among patients with breast cancer in the Netherlands: a register-based cohort study. BMJ Open 2018; 8:e021509. [PMID: 30121599 PMCID: PMC6104747 DOI: 10.1136/bmjopen-2018-021509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Cardiovascular disease (CVD) is of increasing concern among breast cancer survivors. However, evidence on ethnic differences in CVD among women with breast cancer is sparse. We assessed ethnic differences in cardiovascular morbidity and mortality among patients with breast cancer in the Netherlands. METHODS A nationwide register-based cohort study comprising all women with a first admission for breast cancer (n=127 714) between 1996 and 2010 in the Netherlands was conducted. Differences in CVD admission, CVD mortality and overall CVD event, which comprised a CVD admission and/or CVD mortality, between the largest ethnic minority groups (Surinamese, Moroccan, Turkish, Antillean and Indonesian) and the Dutch general population (henceforth, Dutch) were investigated using Cox proportional hazard models. RESULTS The incidence of cardiovascular outcomes varied by the ethnic group. The incidence of an overall cardiovascular event was significantly higher for women with breast cancer from Suriname (HR 1.46; 95% CI 1.29 to 1.64) and Turkey (HR 1.25; 95% CI 1.03 to 1.51), compared with Dutch women with breast cancer. In contrast, Indonesian women with breast cancer had a significantly lower risk (HR 0.88; 95% CI 0.81 to 0.96) of a cardiovascular event compared with Dutch women with breast cancer. The risk of a cardiovascular event did not differ between Moroccan and Dutch women with breast cancer, whereas for Antillean women the risk was not significantly higher. CONCLUSIONS Our findings suggest that Surinamese and Turkish women with breast cancer are disadvantaged in terms of cardiovascular outcomes compared with Dutch women with breast cancer. More work is needed to unravel the potential factors contributing to these differences.
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Affiliation(s)
- Laura Deen
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Josefien Buddeke
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie Norredam
- Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Eeftinck Schattenkerk DW, van Gorp J, Vogt L, Peters RJ, van den Born BJH. Isolated systolic hypertension of the young and its association with central blood pressure in a large multi-ethnic population. The HELIUS study. Eur J Prev Cardiol 2018; 25:1351-1359. [PMID: 29808754 PMCID: PMC6130124 DOI: 10.1177/2047487318777430] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Isolated systolic hypertension (ISH) of the young has been associated with both normal and increased cardiovascular risk, which has been attributed to differences in central systolic blood pressure and arterial stiffness. Methods We assessed the prevalence of ISH of the young and compared differences in central systolic blood pressure and arterial stiffness between ISH and other hypertensive phenotypes in a multi-ethnic population of 3744 subjects (44% men), aged <40 years, participating in the HELIUS study. Results The overall prevalence of ISH was 2.7% (5.2% in men and 1.0% in women) with the highest prevalence in individuals of African descent. Subjects with ISH had lower central systolic blood pressure and pulse wave velocity compared with those with isolated diastolic or systolic-diastolic hypertension, resembling central systolic blood pressure and pulse wave velocity values observed in subjects with high-normal blood pressure. In addition, they had a lower augmentation index and larger stroke volume compared with all other hypertensive phenotypes. In subjects with ISH, increased systolic blood pressure amplification was associated with male gender, Dutch origin, lower age, taller stature, lower augmentation index and larger stroke volume. Conclusion ISH of the young is a heterogeneous condition with average central systolic blood pressure values comparable to individuals with high-normal blood pressure. On an individual level ISH was associated with both normal and raised central systolic blood pressure. In subjects with ISH of the young, measurement of central systolic blood pressure may aid in discriminating high from low cardiovascular risk.
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Affiliation(s)
| | - Jacqueline van Gorp
- 1 Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Liffert Vogt
- 2 Department of Nephrology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ron Jg Peters
- 3 Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
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25
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Ethnic disparities in treatment rates for hypertension and dyslipidemia: an analysis by different treatment indications: the Healthy Life in an Urban Setting study. J Hypertens 2018; 36:1540-1547. [PMID: 29771737 DOI: 10.1097/hjh.0000000000001716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Studies have reported ethnic disparities in treatment rates for cardiovascular risk factors. These studies are generally based on treatment indications defined by individual cardiovascular risk factors (ICRF). However, according to most European guidelines, preventive treatment for these risk factors is recommended only among those with sufficient overall cardiovascular risk (OCR). OBJECTIVE To determine ethnic disparities in treatment rates for hypertension and dyslipidemia among those with an indication for treatment based on ICRF and OCR. METHODS Using data of the HELIUS study, we determined the occurrence of cardiovascular risk factors and treatment rates among 11 357 participants from six ethnic backgrounds living in Amsterdam. Via logistic regression analyses, we determined ethnic differences in blood pressure (BP)-lowering or lipid-lowering treatment rates among those needing treatment based on ICRF (BP >140 mmHg and LDL >2.5 mmol/l, respectively) and on OCR (estimated overall 10-year cardiovascular disease risk according to SCORE). RESULTS Relative to the Dutch, ethnic minority men showed higher treatment rates for hypertension and dyslipidemia, regardless of whether OCR of ICRF recommendations for treatment were used. Ethnic minority women showed similar treatment rates relative to the Dutch based on OCR, but higher treatment rates based on ICRF recommendations (e.g. odds ratios for antihypertensive treatment ranged from 0.93 to 1.75 and from 1.26 to 1.93, respectively). CONCLUSION Treatment rates for hypertension and dyslipidemia are not lower among ethnic minority groups relative to the Dutch. In some cases, they are even higher, but these differences may be overestimated whenever using ICRF as treatment indication.
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26
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Mingina T, Zhao M. Role of PARK7 and NDKA in stroke management: a review of PARK7 and NDKA as stroke biomarkers. Biomark Med 2018; 12:419-425. [PMID: 29697269 DOI: 10.2217/bmm-2018-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIM Biomarkers are molecules measured in plasma, serum or other body fluids to characterize a disease. PARK7 and NDKA roles in the management of stroke are still on study. Therefore, their potentials need to be developed in totality. The aim of this review is to demonstrate that PARK7 and NDKA could present more clinical important information as biomarkers for management of stroke disease. Main contents: Four main aspects of PARK7 and NDKA are exploited in this review. First, their diagnostic value is discussed in order to demonstrate their possible role as stroke diagnosis markers. Second, this article will exploit the correlation of both markers with time, by showing their dynamic changes in serum and plasma. Third, it describes the observed relationship of their levels with NIH Stroke Scale. The last aspect visits the possibility of their implementation in stroke therapy. CONCLUSION This article explores recent findings and proposes the potential roles that PARK7 and NDKA play in the management of acute stroke disease.
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Affiliation(s)
- Tulantched Mingina
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 11004, PR China
| | - Min Zhao
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang 11004, PR China
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27
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Ethnic disparities in estimated cardiovascular disease risk in Amsterdam, the Netherlands : The HELIUS study. Neth Heart J 2018; 26:252-262. [PMID: 29644501 PMCID: PMC5910313 DOI: 10.1007/s12471-018-1107-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Ethnic differences have been reported in cardiovascular disease (CVD) risk factors. It is still unclear which ethnic groups are most at risk for CVD when all traditional CVD risk factors are considered together as overall risk. Objectives To examine ethnic differences in overall estimated CVD risk and the risk factors that contribute to these differences. Design Using data of the multi-ethnic HELIUS study (HEalthy LIfe in an Urban Setting) from Amsterdam, we examined whether estimated CVD risk and risk factors among those eligible for CVD risk estimation differed between participants of Dutch, South Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin. Using the Systematic COronary Risk Evaluation (SCORE) algorithm, we estimated risk of fatal CVD and risk of fatal plus non-fatal CVD. These risks were compared between ethnic groups via age-adjusted linear regression analyses. Results The SCORE algorithm was applicable to 9,128 participants. Relative to the fatal CVD risk of participants of Dutch origin, South Asian Surinamese participants showed a higher fatal CVD risk, Ghanaian males a lower fatal CVD risk, and participants of other ethnic origins a similar fatal CVD risk. For fatal plus non-fatal CVD risk, African Surinamese and Turkish men also showed a higher risk. When diabetes was incorporated in the CVD risk algorithm, all but Ghanaian men showed a higher CVD risk relative to the participants of Dutch origin (betas ranging from 0.98–3.10%). The CVD risk factors that contribute the most to these ethnic differences varied between ethnic groups. Conclusion Ethnic minority groups are at a greater estimated risk of fatal plus non-fatal CVD relative to the group of native Dutch. Further research is necessary to determine whether this will translate to ethnic differences in CVD incidence and, if so, whether ethnic-specific CVD prevention strategies are warranted. Electronic supplementary material The online version of this article (10.1007/s12471-018-1107-3) contains supplementary material, which is available to authorized users.
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28
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Agyemang C, van de Vorst IE, Koek HL, Bots ML, Seixas A, Norredam M, Ikram U, Stronks K, Vaartjes I. Ethnic Variations in Prognosis of Patients with Dementia: A Prospective Nationwide Registry Linkage Study in The Netherlands. J Alzheimers Dis 2018; 56:205-213. [PMID: 27911320 PMCID: PMC10081934 DOI: 10.3233/jad-160897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Data on dementia prognosis among ethnic minority groups are limited in Europe. OBJECTIVE We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic minority groups and the ethnic Dutch population in the NetherlandsMethods: Nationwide prospective cohorts of first hospitalized dementia patients (N = 55,827) from January 1, 2000 to December 31, 2010 were constructed. Differences in short-term and long-term mortality and readmission risk following hospitalization or referral to the day clinic between ethnic minority groups (Surinamese, Turkish, Antilleans, Indonesians) and the ethnic Dutch population were investigated using Cox proportional hazard regression models with adjustment for age, sex, and comorbidities. RESULTS Age-sex-adjusted short-term and long-term risks of death following a first hospitalization with dementia were comparable between the ethnic minority groups and the ethnic Dutch. Age- and sex-adjusted risk of admission was higher only in Turkish compared with ethnic Dutch (HR 1.57, 95% CI,1.08-2.29). The difference between Turkish and the Dutch attenuated and was no longer statistically significant after further adjustment for comorbidities. There were no ethnic differences in short-term and long-term risk of death, and risk of readmission among day clinic patients. CONCLUSION Compared with Dutch patients with a comparable comorbidity rate, ethnic minority patients with dementia did not have a worse prognosis. Given the poor prognosis of dementia, timely and targeted advance care planning is essential, particularly in ethnic minority groups who are mired by cultural barriers and where uptake of advance care planning is known to be low.
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Affiliation(s)
- Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Irene E van de Vorst
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Huiberdina L Koek
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Azizi Seixas
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark.,Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Umar Ikram
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Krishnamurthi RV, Barker-Collo S, Parag V, Parmar P, Witt E, Jones A, Mahon S, Anderson CS, Barber PA, Feigin VL. Stroke Incidence by Major Pathological Type and Ischemic Subtypes in the Auckland Regional Community Stroke Studies: Changes Between 2002 and 2011. Stroke 2017; 49:3-10. [PMID: 29212738 DOI: 10.1161/strokeaha.117.019358] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Major pathological stroke types (ischemic stroke [IS], primary intracerebral hemorrhage [ICH], and subarachnoid hemorrhage) and IS subtypes, have differing risk factors, management, and prognosis. We report changes in major stroke types and IS subtypes incidence during 10 years using data from the ARCOS (Auckland Regional Community Stroke Study) III performed during 12 months in 2002 to 2003 and the fourth ARCOS study (ARCOS-IV) performed in 2011 to 2012. METHODS ARCOS-III and ARCOS-IV were population-based registers of all new strokes in the greater Auckland region (population aged >15 years, 1 119 192). Strokes were classified into major pathological types (IS, ICH, subarachnoid hemorrhage, and undetermined type). Crude annual age-, sex-, and ethnic-specific stroke incidence with 95% confidence intervals was calculated. ISs were subclassified using TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria into 5 etiologic groups. Rate ratios with 95% confidence intervals were calculated for differences in age-standardized rates between the 2 studies. RESULTS In ARCOS-IV, there were 1329 (81%) ISs, 211 (13%) ICHs, 79 (5%) subarachnoid hemorrhages, and 24 (1%) undetermined type strokes. The proportional distribution of IS subtypes was 29% cardioembolism, 21% small-vessel occlusion, 15% large-artery atherosclerosis, 5% other determined etiology, and 31% undetermined type. Between 2002 and 2011, age-standardized incidence decreased for subarachnoid hemorrhage (rate ratios, 0.73; 95% confidence intervals, 0.54-0.99) and undetermined type (rate ratios, 0.14; 95% confidence intervals, 0.09-0.22). Rates were stable for IS and ICH. Among IS subtypes, large-artery atherosclerosis and small-vessel occlusion rates increased significantly. The frequency of all risk factors increased in IS. Ethnic differences were observed for both stroke subtype rates and their risk factor frequencies. CONCLUSIONS A lack of change in IS and ICH incidence may reflect a trend toward increased incidence of younger strokes. Increased rates of large-artery atherosclerosis and small-vessel occlusion are associated with increased smoking and high blood pressure. Ethnic differences in the proportional distribution of pathological stroke subtypes suggest differential exposure and susceptibility to risk factors.
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Affiliation(s)
- Rita V Krishnamurthi
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Suzanne Barker-Collo
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Varsha Parag
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Priyakumari Parmar
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Emma Witt
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Amy Jones
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Susan Mahon
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Craig S Anderson
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - P Alan Barber
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Valery L Feigin
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.).
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Valerio L, Peters RJ, Zwinderman AH, Pinto-Sietsma SJ. Association of Family History With Cardiovascular Disease in Hypertensive Individuals in a Multiethnic Population. J Am Heart Assoc 2016; 5:JAHA.116.004260. [PMID: 28003252 PMCID: PMC5210427 DOI: 10.1161/jaha.116.004260] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension alone is a poor predictor of the individual risk of cardiovascular disease. Hereditary factors of which hypertension is merely a marker may explain why some hypertensive individuals appear more susceptible to cardiovascular disease, and why some ethnicities have more often seemingly hypertension-related cardiovascular disease than others. We hypothesize that, in hypertensive individuals, a positive family history of cardiovascular disease identifies a high-risk subpopulation. METHODS AND RESULTS Healthy Life in Urban Settings (HELIUS) is a cohort study among participants of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan origin aged 70 years and younger. In participants with hypertension (n=6467), we used logistic regression to assess the association of family history of cardiovascular disease with prevalent stroke and nonstroke cardiovascular disease, adjusting for sex, age, education, and smoking. To detect ethnic differences, we tested for interaction between family history and ethnicity and stratified the analysis by ethnicity. A positive family history was associated with a higher prevalence of nonstroke cardiovascular disease (odds ratio [OR], 2.05; 95% CI, 1.65-2.54) and stroke (OR, 1.62; 95% CI, 1.19-2.20). The strongest association of family history with nonstroke cardiovascular disease was found among the Dutch (OR, 2.47; 95% CI, 1.37-4.44) and with stroke among the African Surinamese (OR, 2.17; 95% CI, 1.32-3.57). The interaction between family history and African Surinamese origin for stroke was statistically significant. CONCLUSIONS In multiethnic populations of hypertensive patients, a positive family history of cardiovascular disease may be used clinically to identify individuals at high risk for nonstroke cardiovascular disease regardless of ethnic origin and African Surinamese individuals at high risk for stroke.
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Affiliation(s)
- Luca Valerio
- Department of Public Health, University of Amsterdam Academic Medical Center, Amsterdam, the Netherlands.,Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, the Netherlands
| | - Ron J Peters
- Department of Cardiology, University of Amsterdam Academic Medical Center, Amsterdam, the Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, University of Amsterdam Academic Medical Center, Amsterdam, the Netherlands
| | - Sara-Joan Pinto-Sietsma
- Department of Vascular Medicine, University of Amsterdam Academic Medical Center, Amsterdam, the Netherlands .,Department of Clinical Epidemiology and Biostatistics, University of Amsterdam Academic Medical Center, Amsterdam, the Netherlands
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Li S, Li S, Tang Y, Liu C, Chen L, Zhang Y. Ultrafiltration-LC-MS combined with semi-preparative HPLC for the simultaneous screening and isolation of lactate dehydrogenase inhibitors fromBelamcanda chinensis. J Sep Sci 2016; 39:4533-4543. [DOI: 10.1002/jssc.201600703] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Senlin Li
- Central Laboratory; Changchun Normal University; Changchun China
| | - Sainan Li
- Central Laboratory; Changchun Normal University; Changchun China
| | - Ying Tang
- Central Laboratory; Changchun Normal University; Changchun China
| | - Chunming Liu
- Central Laboratory; Changchun Normal University; Changchun China
| | - Lina Chen
- Central Laboratory; Changchun Normal University; Changchun China
| | - Yuchi Zhang
- Central Laboratory; Changchun Normal University; Changchun China
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Faconti L, Silva MJ, Molaodi OR, Enayat ZE, Cassidy A, Karamanos A, Nanino E, Read UM, Dall P, Stansfield B, Harding S, Cruickshank KJ. Can arterial wave augmentation in young adults help account for variability of cardiovascular risk in different British ethnic groups? J Hypertens 2016; 34:2220-6. [PMID: 27490950 PMCID: PMC5051531 DOI: 10.1097/hjh.0000000000001066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/08/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Traditional cardiovascular risk factors do not fully account for ethnic differences in cardiovascular disease. We tested if arterial function indices, particularly augmentation index (AIx), and their determinants from childhood could underlie such ethnic variability among young British adults in the 'DASH' longitudinal study. METHODS DASH, at http://dash.sphsu.mrc.ac.uk/, includes representative samples of six main British ethnic groups. Pulse wave velocity (PWV) and AIx were recorded using the Arteriograph device at ages 21-23 years in a subsample (n = 666); psychosocial, anthropometric, and blood pressure (BP) measures were collected then and in two previous surveys at ages 11-13 years and 14-16 years. For n = 334, physical activity was measured over 5 days (ActivPal). RESULTS Unadjusted values and regression models for PWVs were similar or lower in ethnic minority than in White UK young adults, whereas AIx was higher - Caribbean (14.9, 95% confidence interval 12.3-17.0%), West African (15.3, 12.9-17.7%), Indian (15.1, 13.0-17.2%), and Pakistani/Bangladeshi (15.7, 13.7-17.7%), compared with White UK (11.9, 10.2-13.6%). In multivariate models, adjusted for sex, central SBP, height, and heart rate, Indian and Pakistani/Bangladeshi young adults had higher AIx (β = 3.35, 4.20, respectively, P < 0.01) than White UK with a similar trend for West Africans and Caribbeans but not statistically significant. Unlike PWV, physical activity, psychosocial or deprivation measures were not associated with AIx, with borderline associations from brachial BP but no other childhood variables. CONCLUSION Early adult AIx, but not arterial stiffness, may be a useful tool for testing components of excess cardiovascular risk in some ethnic minority groups.
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Affiliation(s)
- Luca Faconti
- Diabetes & Nutritional Sciences Division, King's College London; Cardiovascular and Social Epidemiology Groups, London
| | - Maria J. Silva
- Diabetes & Nutritional Sciences Division, King's College London; Cardiovascular and Social Epidemiology Groups, London
| | | | - Zinat E. Enayat
- Diabetes & Nutritional Sciences Division, King's College London; Cardiovascular and Social Epidemiology Groups, London
| | - Aidan Cassidy
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow
| | - Alexis Karamanos
- Diabetes & Nutritional Sciences Division, King's College London; Cardiovascular and Social Epidemiology Groups, London
| | - Elisa Nanino
- Diabetes & Nutritional Sciences Division, King's College London; Cardiovascular and Social Epidemiology Groups, London
| | - Ursula M. Read
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow
| | - Philippa Dall
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Ben Stansfield
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Seeromanie Harding
- Diabetes & Nutritional Sciences Division, King's College London; Cardiovascular and Social Epidemiology Groups, London
| | - Kennedy J. Cruickshank
- Diabetes & Nutritional Sciences Division, King's College London; Cardiovascular and Social Epidemiology Groups, London
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Guo Y, Wang H, Tao T, Tian Y, Wang Y, Chen Y, Lip GYH. Determinants and Time Trends for Ischaemic and Haemorrhagic Stroke in a Large Chinese Population. PLoS One 2016; 11:e0163171. [PMID: 27685332 PMCID: PMC5042494 DOI: 10.1371/journal.pone.0163171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/02/2016] [Indexed: 11/19/2022] Open
Abstract
Background The clinical epidemiology of stroke has been widely investigated in Caucasian populations, but the changes over time in the proportion of ischaemic to haemorrhagic strokes is less clear, especially in the Chinese population. Aims Our objective was to study the determinants and time trends for ischaemic and haemorrhagic stroke, in relation to age, in a large Chinese population cohort. Methods Using a medical insurance database in the southwest of China from 2001 to 2012, time trends in age-adjusted ischaemic and haemorrhagic stroke incidence and the contributing risk factors associated with age were investigated. Results Among 425,901 individuals without prior stroke (52.4% male, median age 54), the rate of ischaemic stroke (per 1000 patient-years) decreased between 2002–2007, then remained broadly similar between 2008–2012. The rate of haemorrhagic stroke showed a similar trend, being approximately 1.3–1.9 from 2008–2012. Compared to patients age<65, ischaemic and haemorrhagic stroke incidences (rate, 95% confidential interval, CI) were higher in the elderly population (age <65 versus age ≥65: ischaemic: 3.64, 3.33–4.00, vs 14.33, 14.01–14.60; haemorrhagic: 1.09, 1.00–1.10 vs 2.52,2.40–2.70, respectively, both p<0.001). There were no significant differences in haemorrhagic stroke rates between the elderly and the very elderly population. Ischaemic and haemorrhagic stroke shared similar risk factors (age, hypertension, coronary artery disease (CAD), vascular disease, and diabetes mellitus) (all p<0.05). In subjects age<75 years, CAD (7.17, 4.14–12.37) and diabetes mellitus (3.27, 2.42–4.42) contributed most to the developing of haemorrhagic stroke (all p<0.001). Amongst the very elderly, vascular disease (2.24, 1.49–3.37) was an additional major risk factor for haemorrhagic stroke, together with CAD and diabetes mellitus (all p<0.001). Conclusion In this large Chinese cohort, there was an increased risk of ischaemic stroke compared to haemorrhagic stroke with ageing. CAD, vascular disease, diabetes mellitus, and hypertension were major contributors to the development of hemorrhagic stroke in the very elderly Chinese population.
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Affiliation(s)
- Yutao Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hao Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Tao Tao
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yingchun Tian
- Department of Gerontology, Second People’s Hospital, Kunming, Yunnan Province, China
| | - Yutang Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
- * E-mail: (YC); (GYHL)
| | - Gregory Y. H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
- * E-mail: (YC); (GYHL)
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Xiong Y, Wang XM, Zhong M, Li ZQ, Wang Z, Tian ZF, Zheng K, Tan XX. Alterations of caveolin-1 expression in a mouse model of delayed cerebral vasospasm following subarachnoid hemorrhage. Exp Ther Med 2016; 12:1993-2002. [PMID: 27703494 PMCID: PMC5038886 DOI: 10.3892/etm.2016.3568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/13/2016] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to evaluate the expression levels of caveolin-1 in the basilar artery following delayed cerebral vasospasm (DCVS) in a rat model of subarachnoid hemorrhage (SAH), in order to investigate the association between caveolin-1 and DCVS, and its potential as a treatment for DCVS of SAH. A total of 150 Sprague Dawley rats were randomly allocated into blank, saline and SAH groups. The SAH and saline groups were subdivided into days 3, 5, 7 and 14 following the establishment of the model. The murine model of SAH was established by double injection of autologous arterial blood into the cisterna magana and DCVS was detected using Bederson neurological severity scores. Hematoxylin and eosin (HE) staining was used to observe the inner perimeter of the basilar artery pipe and variations in the thickness of the basilar artery wall. Alterations in the levels of caveolin-1 protein in the basilar artery were measured using immunofluorescence and western blot analysis; whereas alterations in the mRNA expression levels of caveolin-1 were detected by reverse transcription-quantitative polymerase chain reaction. In the present study, 15 mice succumbed to SAH-induced DCVS in the day 3 (n=3), 5 (n=5) and 7 (n=2) groups. No mortality was observed in the blank control and saline groups during the process of observation in the SAH group, All mice in the SAH groups exhibited Bederson neurological severity scores ≥1; whereas no neurological impairment was detected in the blank and normal saline groups, demonstrating the success of the model. HE staining was used to assess vasospasm and the results demonstrated that the inner perimeter of the basal artery pipe decreased at day 3 in the SAH group; whereas values peaked in the day 7 group. The thickness of the basal artery wall significantly increased (P<0.05), as compared with the blank and saline groups, in which no significant alterations in the wall thickness and the inner perimeter of the basal artery pipe were detected. As detected by immunofluorescence and western blot analysis, the expression levels of caveolin-1 protein significantly decreased in the day 7 of SAH group, as compared with the blank and saline groups (P<0.01), in which no significant alterations were detected. Caveolin-1 mRNA expression levels significantly increased at the day 7 in the SAH group, as compared with the blank and the saline groups (P<0.01), as detected by RT-qPCR. Furthermore, significant differences were detected at day 14 in the SAH group, as compared with the blank and the saline groups (P>0.05), in which no significant alterations were detected. Therefore, the results of the present study demonstrated that caveolin-1 protein was downregulated in the basilar artery of a rat modeling SAH, which may be associated with DCVS. This suggested that caveolin-1 may be a potential target for the treatment of DCVS.
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Affiliation(s)
- Ye Xiong
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, P.R. China
| | - Xue-Min Wang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, P.R. China
| | - Ming Zhong
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, P.R. China
| | - Ze-Qun Li
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, P.R. China
| | - Zhi Wang
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, P.R. China
| | - Zuo-Fu Tian
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, P.R. China
| | - Kuang Zheng
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, P.R. China
| | - Xian-Xi Tan
- Department of Neurosurgery, First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, P.R. China
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Ethnic Differences in Arterial Wave Reflection Are Mostly Explained by Differences in Body Height - Cross-Sectional Analysis of the HELIUS Study. PLoS One 2016; 11:e0160243. [PMID: 27472397 PMCID: PMC4966932 DOI: 10.1371/journal.pone.0160243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/15/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Differences in arterial wave reflection and central blood pressure (BP) have been associated with cardiovascular disease (CVD) in various populations and may contribute to ethnic differences in CVD. Whether ethnic differences in wave reflection and central BP can be explained by conventional risk factors for CVD or may result from physiological differences remains undetermined. METHODS We examined ethnic differences in augmentation index (AIx) and central systolic BP and their determinants in a large multi-ethnic cohort study in Amsterdam, the Netherlands. A total of 8812 (46% male) participants aged 18-70 years of Dutch, South-Asian Surinamese, African Surinamese and Ghanaian origin were included. AIx and central BP were measured in duplicate using the Arteriograph system. RESULTS AIx and central systolic BP were significantly higher in South-Asian Surinamese (35±17%, 126±22 mmHg), African Surinamese (33±17%, 129±23 mmHg) and Ghanaian (33±16%, 135±24 mmHg) as compared with Dutch (27±17%, 118±20 mmHg, all p<0.001). Correction for cardiovascular risk factors only slightly reduced the difference in AIx, whereas correction for body height attenuated age and gender corrected ethnic differences in AIx the most. Differences in central systolic BP were primarily determined by differences in AIx for South-Asian Surinamese and by differences in peripheral systolic BP for subjects of African origin. CONCLUSIONS Substantial differences in AIx and central BP exist across different ethnic groups that cannot be explained by differences in conventional risk factors for CVD. These findings may explain part of the underestimation of cardiovascular risk observed in populations of African and South-Asian descent.
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Fedeli U, Pigato M, Avossa F, Ferroni E, Nardetto L, Giometto B, Saugo M. Large variations in stroke hospitalization rates across immigrant groups in Italy. J Neurol 2015; 263:449-54. [DOI: 10.1007/s00415-015-7995-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 11/24/2022]
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Relationship between short sleep duration and cardiovascular risk factors in a multi-ethnic cohort – the helius study. Sleep Med 2015; 16:1482-8. [DOI: 10.1016/j.sleep.2015.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/16/2015] [Accepted: 08/19/2015] [Indexed: 01/03/2023]
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