1
|
Popescu AI, Rata AL, Barac S, Popescu R, Onofrei RR, Vlad C, Vlad D. Narrative Review of Biological Markers in Chronic Limb-Threatening Ischemia. Biomedicines 2024; 12:798. [PMID: 38672153 PMCID: PMC11047884 DOI: 10.3390/biomedicines12040798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI), the advanced stage of peripheral arterial disease, is diagnosed in the presence of ischemic rest pain, non-healing ulcers, or gangrene. Several studies have demonstrated that inflammation and endothelial dysfunction are some of the main substrates of CLTI. METHODS A narrative review was conducted and reported according to PRISMA guidelines. Three databases were searched-Web of Science, Medline, and EMBASE-for the studies assessing CLTI and the biological markers related to it. RESULTS We included 22 studies, and all the markers identified (C-reactive protein, D-dimers, fibrinogen, cytokines, IL-6, TNF-α, ICAM-1 (Intracellular Adhesion Molecule-1), VCAM-1 (Vascular Cell Adhesion Molecule-1), neutrophile-to-lymphocytes ratio (NLR), IL-8, Pentraxin-3, neutrophil gelatinase-associated lipocalin (NGAL), calprotectin, E-selectin, P-selectin, neopterin, High-Mobility Group Box-1 protein (HGMB-1), Osteoprotegerin (OPG) and Sortilin) were positively associated with advanced CLTI, with major limb or major cardiovascular events in these patients. CONCLUSIONS All the studied markers had increased values in patients with CLTI, especially when associated with diabetes mellitus, proving a very important association between diabetes and major limb or cardiovascular events in these patients. There is a need for more studies to validate these markers in terms of diagnosis or prognosis in CLTI patients and in trying to find new medical strategies that target inflammation or endothelial dysfunction in these patients.
Collapse
Affiliation(s)
- Alexandra Ioana Popescu
- Pharmacology Department, Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Andreea Luciana Rata
- Surgical Emergencies Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Sorin Barac
- Vascular Surgery Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Roxana Popescu
- Cell and Molecular Biology Department, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Roxana Ramona Onofrei
- Department of Rehabilitation, Physical Medicine and Rheumatology, Research Center for Assessment of Human Motion, Functionality and Disability, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Cristian Vlad
- Pharmacology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (D.V.)
| | - Daliborca Vlad
- Pharmacology Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.V.); (D.V.)
| |
Collapse
|
2
|
Stopic B, Medic-Brkic B, Savic-Vujovic K, Davidovic Z, Todorovic J, Dimkovic N. Biomarkers and Predictors of Adverse Cardiovascular Events in Different Stages of Chronic Kidney Disease. Dose Response 2022; 20:15593258221127568. [PMID: 36118679 PMCID: PMC9478703 DOI: 10.1177/15593258221127568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chronic kidney disease (CKD) is an important factor that contributes to the
increase of all-cause morbidity and mortality in the group of non-communicable
diseases, and it is also recognized as a strong and independent risk factor that
contributes to cardiovascular disease (CVD). CVDs are a consequence of the
action of a large number of risk factors among which are traditional and
non-traditional. These risk factors have been the subject of a large number of
studies which partially explained the unfavorable cardiovascular (CV) outcome of
CKD patients. Therefore, valid studies about clinical and biohumoral predictors
are of particular importance, especially in the early stages of renal disease,
that is, in patients with creatinine clearance below
60 ml/min/1.73 m2 when preventive measures are most effective.
Among potential predictors of adverse CV outcome are biomarkers of inflammation
(Interleukin-18—IL-18), oxidative stress (ischemia-modified albumin—IMA;
superoxide dismutase—SOD), acute kidney injury (kidney injury
molecule-1—KIM-1; neutrophil gelatinase–associated
lipocalin—NGAL), and microribonucleic acids (specific microRNA-133a). In this
review, we tried to confirm the relationship between risk factors of CKD and CVD
and newer, less frequently examined biomarkers with the occurrence of incidental
CV events in renal patients.
Collapse
Affiliation(s)
- Bojan Stopic
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Branislava Medic-Brkic
- Faculty of Medicine, Department of Pharmacology, University of Belgrade, Belgrade, Serbia
| | - Katarina Savic-Vujovic
- Faculty of Medicine, Department of Pharmacology, University of Belgrade, Belgrade, Serbia
| | - Zeljko Davidovic
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| | - Jovana Todorovic
- Faculty of Medicine, Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
| | - Nada Dimkovic
- Clinical Department for Nephrology, Zvezdara University Medical Center, Belgrade, Serbia
| |
Collapse
|
3
|
Scarale MG, Antonucci A, Cardellini M, Copetti M, Salvemini L, Menghini R, Mazza T, Casagrande V, Ferrazza G, Lamacchia O, De Cosmo S, Di Paola R, Federici M, Trischitta V, Menzaghi C. A Serum Resistin and Multicytokine Inflammatory Pathway Is Linked With and Helps Predict All-cause Death in Diabetes. J Clin Endocrinol Metab 2021; 106:e4350-e4359. [PMID: 34192323 DOI: 10.1210/clinem/dgab472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Type 2 diabetes (T2D) shows a high mortality rate, partly mediated by atherosclerotic plaque instability. Discovering novel biomarkers may help identify high-risk patients who would benefit from more aggressive and specific managements. We recently described a serum resistin and multicytokine inflammatory pathway (REMAP), including resistin, interleukin (IL)-1β, IL-6, IL-8, and TNF-α, that is associated with cardiovascular disease. OBJECTIVE We investigated whether REMAP is associated with and improves the prediction of mortality in T2D. METHODS A REMAP score was investigated in 3 cohorts comprising 1528 patients with T2D (409 incident deaths) and in 59 patients who underwent carotid endarterectomy (CEA; 24 deaths). Plaques were classified as unstable/stable according to the modified American Heart Association atherosclerosis classification. RESULTS REMAP was associated with all-cause mortality in each cohort and in all 1528 individuals (fully adjusted hazard ratio [HR] for 1 SD increase = 1.34, P < .001). In CEA patients, REMAP was associated with mortality (HR = 1.64, P = .04) and a modest change was observed when plaque stability was taken into account (HR = 1.58; P = .07). REMAP improved discrimination and reclassification measures of both Estimation of Mortality Risk in Type 2 Diabetic Patients and Risk Equations for Complications of Type 2 Diabetes, well-established prediction models of mortality in T2D (P < .05-< .001). CONCLUSION REMAP is independently associated with and improves predict all-cause mortality in T2D; it can therefore be used to identify high-risk individuals to be targeted with more aggressive management. Whether REMAP can also identify patients who are more responsive to IL-6 and IL-1β monoclonal antibodies that reduce cardiovascular burden and total mortality is an intriguing possibility to be tested.
Collapse
Affiliation(s)
- Maria Giovanna Scarale
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
| | - Alessandra Antonucci
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
| | - Marina Cardellini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
- Center for Atherosclerosis, Department of Medical Sciences, Policlinico Tor Vergata University, Rome 00133, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo 71013, Italy
| | - Lucia Salvemini
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
| | - Rossella Menghini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Tommaso Mazza
- Bioinformatics Unit, IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo 71013, Italy
| | - Viviana Casagrande
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Gianluigi Ferrazza
- Center for Atherosclerosis, Department of Medical Sciences, Policlinico Tor Vergata University, Rome 00133, Italy
| | - Olga Lamacchia
- Unit of Endocrinology and Diabetology, Department of Medical and Surgical Sciences, University of Foggia, Foggia 71100, Italy
| | - Salvatore De Cosmo
- Department of Clinical Sciences, Fondazione IRCCS "Casa Sollievo Della Sofferenza," San Giovanni Rotondo 71013, Italy
| | - Rosa Di Paola
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
- Center for Atherosclerosis, Department of Medical Sciences, Policlinico Tor Vergata University, Rome 00133, Italy
| | - Vincenzo Trischitta
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
- Department of Experimental Medicine, "Sapienza" University, Rome 00185, Italy
| | - Claudia Menzaghi
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
| |
Collapse
|
4
|
Hou HQ, Xiang XL, Pan YS, Zhang QH, Li H, Meng X, Wang YJ. Baseline or 90-day fibrinogen levels and long-term outcomes after ischemic stroke or TIA: Results from the China national stroke registry Ⅲ. Atherosclerosis 2021; 337:35-41. [PMID: 34757269 DOI: 10.1016/j.atherosclerosis.2021.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/14/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Elevated fibrinogen levels have been observed in patients with acute ischemic stroke, but the association of fibrinogen with stroke outcomes is still undefined. We aimed to assess the association between baseline or 90-day fibrinogen levels and long-term outcomes in patients with ischemic stroke or transient ischemic attack (TIA). METHODS Using data from the China National Stroke Registry Ⅲ, this substudy included 10 518 patients within 7 days (baseline) of onset and 6268 patients at 90 days of recovery. Multivariate Cox regression and logistic regression analyses were used to assess the associations of fibrinogen with poor functional outcome (modified Rankin Scale score 3-6), dependence (modified Rankin Scale score 3-5), all-cause death, and stroke recurrence at 1 year. RESULTS Fibrinogen levels at 90 days were higher than those at baseline (443.5 mg/dl versus 393.7 mg/dl; p < 0.001). A high baseline fibrinogen level was associated with poor functional outcome (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.35-1.97) and dependence (OR, 1.68; 95% CI, 1.36-2.09) after adjusting for all confounding risk factors. In contrast, further adjustment for high-sensitivity C-reactive protein attenuated the association between baseline fibrinogen level and all-cause death or stroke recurrence. Furthermore, a high 90-day fibrinogen level was also associated with poor functional outcome (OR, 1.46; 95% CI, 1.07-2.00) and dependence (OR, 1.43; 95% CI, 1.03-1.98) after adjusting for all confounding risk factors. CONCLUSIONS High baseline and 90-day fibrinogen levels were associated with outcomes in patients with ischemic stroke or TIA.
Collapse
Affiliation(s)
- Hui-Qing Hou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, China; Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiang-Long Xiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, China
| | - Yue-Song Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, China
| | - Qi-Hui Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Dongfang Hospital, Beijing Chinese Medical University, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, China
| | - Yong-Jun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, China.
| |
Collapse
|
5
|
Visit-to-visit variability of blood pressure and cardiovascular events among the working-age population in Japan: findings from the Japan Epidemiology Collaboration on Occupational Health Study. Hypertens Res 2021; 44:1017-1025. [PMID: 33990791 DOI: 10.1038/s41440-021-00654-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/25/2021] [Accepted: 03/02/2021] [Indexed: 02/03/2023]
Abstract
Increased visit-to-visit variability (VVV) of blood pressure, which is calculated based on several readings, has been suggested to be a significant predictor of cardiovascular events and mortality, independent of mean blood pressure. This study examined associations between the VVV of systolic blood pressure (SBP) measured annually and cardiovascular disease (CVD) events among 72,617 Japanese subjects. Data were obtained from the Japan Epidemiology Collaboration on Occupational Health Study, which is an ongoing epidemiological survey of workers in Japan. VVV was calculated as the coefficient of variation of SBP readings from 2008 to 2011; information on fatal and nonfatal CVD events was collected from registries of specific outcomes between April 2012 and March 2019. A Cox proportional hazards model was applied to investigate associations after adjusting for mean SBP between 2008 and 2011 and covariates. During the 7-year follow-up period, there were 63 CVD fatalities and 314 CVD events (combining fatal and nonfatal events). The results showed that a one-standard deviation increase in VVV was associated with a significant increase in the risk of CVD mortality (hazard ratio [HR] = 1.42; 95% confidence interval [CI] = 1.32-1.54); those in the highest tertile had a 3.20 times (95% CI = 1.26-8.17) higher risk of CVD mortality than those in the lowest tertile. We found less pronounced associations regarding CVD events (HR = 1.08, 95% CI = 1.02-1.15). In conclusion, VVV was significantly associated with CVD mortality in our Japanese working population.
Collapse
|
6
|
Denegri A, Boriani G. High Sensitivity C-reactive Protein (hsCRP) and its Implications in Cardiovascular Outcomes. Curr Pharm Des 2021; 27:263-275. [PMID: 32679014 DOI: 10.2174/1381612826666200717090334] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
Atherosclerosis and its fearsome complications represent the first cause of morbidity and mortality worldwide. Over the last two decades, several pieces of evidence have been accumulated, suggesting a central role of inflammation in atheroma development. High sensitivity C-reactive protein (hsCRP) is a well-established marker of cardiovascular (CV) disease; high levels of hsCRP have been associated with adverse CV outcome after acute coronary syndrome (ACS) and, despite some controversy, an active role for hsCRP in initiation and development of the atherosclerotic plaque has been also proposed. Randomized clinical trials focusing on hsCRP have been crucial in elucidating the anti-inflammatory effects of statin therapy. Thus, hsCRP has been progressively considered a real CV risk factor likewise to low-density lipoprotein cholesterol (LDL-C), expanding the concept of residual CV inflammatory risk. Subsequent research has been designed to investigate potential new targets of atherothrombotic protection. Despite the fact that the clinical usefulness of hsCRP is widely recognized, hsCRP may not represent the ideal target of specific anti-inflammatory therapies. Clinical investigations, therefore, have also focused on other inflammatory mediators, restricting hsCRP to an indicator rather than a therapeutic target. The aim of the present review is to provide an illustrative overview of the current knowledge of atherosclerosis and inflammation, highlighting the most representative clinical studies of lipid-lowering and antiinflammatory therapies focused on hsCRP in CV diseases.
Collapse
Affiliation(s)
- Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| |
Collapse
|
7
|
Gager GM, Biesinger B, Hofer F, Winter MP, Hengstenberg C, Jilma B, Eyileten C, Postula M, Lang IM, Siller-Matula JM. Interleukin-6 level is a powerful predictor of long-term cardiovascular mortality in patients with acute coronary syndrome. Vascul Pharmacol 2020; 135:106806. [PMID: 33035661 DOI: 10.1016/j.vph.2020.106806] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/23/2020] [Accepted: 10/03/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The interleukin-6 (IL-6) pathway has a crucial role in the pathogenesis of atherosclerosis, the main cause of cardiovascular diseases. We aimed to characterize the predictive value of inflammatory biomarkers on long-term cardiovascular mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS This prospective observational study included 322 consecutive patients with ACS undergoing PCI. Blood-derived biomarkers IL-6 and high-sensitivity C-reactive protein (hsCRP) were assessed at the time point of ACS. Patients were followed-up for 6 years. Long-term cardiovascular mortality was our primary endpoint. Adjusted Cox-regression analysis was used for prediction of events. RESULTS Elevated IL-6 values (≥3.3 pg/mL) emerged as an independent and the most powerful predictor for cardiovascular mortality: the ROC analysis showed that IL-6 was more accurate for cardiovascular mortality prediction as compared to hsCRP (IL-6: AUC = 0.72; 95%CI: 0.62-0.81; p = 0.009 vs hsCRP: AUC = 0.56; 95%CI: 0.41-0.72; p = 0.445). The positive predictive value of IL-6 for mortality was 9%, the negative predictive value 99%, sensitivity 94% and specificity 48%. The primary endpoint of long-term cardiovascular death occurred more frequently in patients with high vs low IL-6 (9.0% vs 0.5%, p = 0.001). The multivariate Cox regression analysis revealed that patients with high IL-6 (≥3.3 pg/mL) values were at 8.6-fold higher hazard to die than those with low IL-6 (<3.3 pg/mL) levels (adj. hazard ratio [HR] = 8.60, 95%CI: 1.07-69.32; p = 0.043). CONCLUSION In the setting of ACS, high IL-6 values are associated with substantial long-term cardiovascular mortality. Further, IL-6 performs as a superior predictor for cardiovascular death as compared to hsCRP.
Collapse
Affiliation(s)
- Gloria M Gager
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Biesinger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Felix Hofer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Max-Paul Winter
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
| | - Irene M Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Jolanta M Siller-Matula
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland.
| |
Collapse
|
8
|
Targeted anti-inflammatory therapy is a new insight for reducing cardiovascular events: A review from physiology to the clinic. Life Sci 2020; 253:117720. [PMID: 32360620 DOI: 10.1016/j.lfs.2020.117720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/30/2022]
Abstract
Despite considerable progressions, cardiovascular disease (CVD) is still one of the major causes of mortality around the world, indicates an important and unmet clinical need. Recently, extensive studies have been performed on the role of inflammatory factors as either a major or surrogate factor in the pathophysiology of CVD. Epidemiological observations suggest the theory of the role of inflammatory mediators in the development of cardiovascular events. This may support the idea that targeted anti-inflammatory therapies, on the background of traditional validated medical therapies, can play a significant role in prevention and even reduction of cardiovascular disorders. Many randomized controlled trials have shown that drugs commonly useful for primary and secondary prevention of CVD have an anti-inflammatory mechanism. Further, many anti-inflammatory drugs are being examined because of their potential to reduce the risk of cardiovascular problems. In this study, we review the process of inflammation in the development of cardiovascular events, both in vivo and clinical evidence in immunotherapy for CVD.
Collapse
|
9
|
Involvement of circulating inflammatory factors in prognosis and risk of cardiovascular disease. J Mol Cell Cardiol 2019; 132:110-119. [DOI: 10.1016/j.yjmcc.2019.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 12/11/2022]
|
10
|
Menezes AMB, Oliveira PD, Wehrmeister FC, Assunção MCF, Oliveira IO, Tovo-Rodrigues L, Ferreira GD, Gonçalves H. Association of modifiable risk factors and IL-6, CRP, and adiponectin: Findings from the 1993 Birth Cohort, Southern Brazil. PLoS One 2019; 14:e0216202. [PMID: 31071114 PMCID: PMC6508856 DOI: 10.1371/journal.pone.0216202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 04/16/2019] [Indexed: 12/12/2022] Open
Abstract
Background The literature on the relationship between lifestyle behaviors and inflammatory markers is scarce. Methods A birth cohort was followed since birth up to 22 years in Southern Brazil. Interleukin-6 (IL-6), C-reactive protein (CRP) and adiponectin were measured in nonfasting blood samples drawn at 18 and 22 years of age. Exposures including smoking, alcohol intake, physical inactivity and obesity, were collected at 15, 18 and 22 years. Cross sectional analyses were based on the number of follow-up visits with these exposures and the association with IL-6, CRP and adiponectin at 22 years old. We also carried out a longitudinal Generalized Least Squares (GLS) random-effects analysis with outcomes at 18 and at 22 years old. All analyses were adjusted for several covariates. Results The sample comprised 3,479 cohort members at 22 years. The presence of obesity at ≥ 2 follow-ups showed the highest mean values (SE) for IL-6 [2.45 (1.05)] and CRP [3.74 (1.11)] and the lowest mean value for adiponectin [8.60 (0.37)] (adjusted analyses, females) compared with other exposures; the highest mean of IL-6 [1.65 (1.05)] and CRP [1.78 (1.11)] and the lowest mean of adiponectin [9.98 (0.38)] were for the number of follow-ups with ≥2 exposures compared to those with no exposures at any follow-up (adjusted analyses, females). The longitudinal analysis showed an increase in obesity associated with IL-6 and CRP in both sexes and an inverse association with adiponectin in females; smoking (in males) was associated with IL-6 and CRP, harmful alcohol intake was associated with CRP in males, and increased in physical activity was inversely associated with CRP in men. Conclusion We concluded that obesity is the main exposure positively associated with IL-6 and CRP and inversely associated with adiponectin (mainly in females). Smoking is also associated with these markers in the longitudinal analysis (in males).
Collapse
Affiliation(s)
| | | | | | | | - Isabel O. Oliveira
- Federal University of Pelotas—Postgraduate Program in Epidemiology, Pelotas, Brazil
| | | | - Gustavo Dias Ferreira
- Federal University of Pelotas—Department of Physiology and Pharmacology, Pelotas, Brazil
| | - Helen Gonçalves
- Federal University of Pelotas—Postgraduate Program in Epidemiology, Pelotas, Brazil
| |
Collapse
|
11
|
Carrick D, Haig C, Maznyczka AM, Carberry J, Mangion K, Ahmed N, Yue May VT, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Davie A, Mahrous A, Mordi I, Ford I, Radjenovic A, Welsh P, Sattar N, Wetherall K, Oldroyd KG, Berry C. Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction. Hypertension 2019; 72:720-730. [PMID: 30012869 PMCID: PMC6080885 DOI: 10.1161/hypertensionaha.117.10786] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The rationale for our study was to investigate the pathophysiology of microvascular injury in patients with acute ST-segment-elevation myocardial infarction in relation to a history of hypertension. We undertook a cohort study using invasive and noninvasive measures of microvascular injury, cardiac magnetic resonance imaging at 2 days and 6 months, and assessed health outcomes in the longer term. Three hundred twenty-four patients with acute myocardial infarction (mean age, 59 [12] years; blood pressure, 135 [25] / 79 [14] mm Hg; 237 [73%] male, 105 [32%] with antecedent hypertension) were prospectively enrolled during emergency percutaneous coronary intervention. Compared with patients without antecedent hypertension, patients with hypertension were older (63 [12] years versus 57 [11] years; P<0.001) and a lower proportion were cigarette smokers (52 [50%] versus 144 [66%]; P=0.007). Coronary blood flow, microvascular resistance within the culprit artery, infarct pathologies, inflammation (C-reactive protein and interleukin-6) were not associated with hypertension. Compared with patients without antecedent hypertension, patients with hypertension had less improvement in left ventricular ejection fraction at 6 months from baseline (5.3 [8.2]% versus 7.4 [7.6]%; P=0.040). Antecedent hypertension was a multivariable associate of incident myocardial hemorrhage 2-day post-MI (1.81 [0.98-3.34]; P=0.059) and all-cause death or heart failure (n=47 events, n=24 with hypertension; 2.53 [1.28-4.98]; P=0.007) postdischarge (median follow-up 4 years). Severe progressive microvascular injury is implicated in the pathophysiology and prognosis of patients with a history of hypertension and acute myocardial infarction. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02072850.
Collapse
Affiliation(s)
- David Carrick
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Annette M Maznyczka
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Jaclyn Carberry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Kenneth Mangion
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Nadeem Ahmed
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Vannesa Teng Yue May
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Margaret McEntegart
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Mark C Petrie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ify Mordi
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Aleksandra Radjenovic
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Paul Welsh
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Naveed Sattar
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Keith G Oldroyd
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Colin Berry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| |
Collapse
|
12
|
Carrieri V, Jones AM. Inequality of opportunity in health: A decomposition-based approach. HEALTH ECONOMICS 2018; 27:1981-1995. [PMID: 30091293 DOI: 10.1002/hec.3814] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/25/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
This paper presents new decomposition-based approaches to measure inequality of opportunity in health that capture Roemer's distinction between circumstances and effort and are consistent with both compensation and reward principles. Our approach is fully nonparametric in the way that it handles differences in circumstances and provides decompositions of both a rank-dependent relative (the Gini coefficient) and a rank-independent absolute inequality index (the variance). The decompositions distinguish the contribution of effort from the direct and indirect (through effort) contribution of circumstances to the total inequality. Our approach is illustrated by an empirical application that uses objectively measured biomarkers as health outcomes and as proxies for relevant effort variables. Using data from the Health Survey for England from 2003 to 2012, we find that circumstances are the leading determinant of inequality in cholesterol, glycated haemoglobin, and in a combined ill-health index whereas effort plays a substantial role in explaining inequality in fibrinogen only.
Collapse
Affiliation(s)
- Vincenzo Carrieri
- Dipartimento di Scienze Economiche e Statistiche, Università di Salerno, Fisciano, Italy
- Health Econometrics and Data Group, University of York, York, UK
- RWI Research Network, Essen, Germany
| | - Andrew M Jones
- Department of Economics and Related Studies, University of York, York, UK
- Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
13
|
Colombo M, Looker HC, Farran B, Agakov F, Brosnan M, Welsh P, Sattar N, Livingstone S, Durrington PN, Betteridge D, McKeigue PM, Colhoun HM. Apolipoprotein CIII and N-terminal prohormone b-type natriuretic peptide as independent predictors for cardiovascular disease in type 2 diabetes. Atherosclerosis 2018; 274:182-190. [DOI: 10.1016/j.atherosclerosis.2018.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/12/2018] [Accepted: 05/09/2018] [Indexed: 12/24/2022]
|
14
|
Welsh C, Welsh P, Mark PB, Celis-Morales CA, Lewsey J, Gray SR, Lyall DM, Iliodromiti S, Gill JMR, Pell J, Jhund PS, Sattar N. Association of Total and Differential Leukocyte Counts With Cardiovascular Disease and Mortality in the UK Biobank. Arterioscler Thromb Vasc Biol 2018; 38:1415-1423. [PMID: 29699973 DOI: 10.1161/atvbaha.118.310945] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/09/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Elevated white blood cell count is associated with a higher risk of cardiovascular disease (CVD). We aimed to investigate whether specific leukocyte subpopulations, which may more closely indicate a specific inflammatory pathway, are specifically associated with CVD. APPROACH AND RESULTS Participants (478 259) from UK Biobank with data for white blood cell count were included. Death because of CVD (n=1377) and non-CVD causes (n=8987) occurred during median follow-up time of 7.0 years (interquartile range, 6.3-7.6). In Cox models, deciles of leukocyte counts (lymphocytes, monocytes, neutrophils, eosinophils, and basophils) were examined using the fifth decile as the referent group. Models were stratified by sex and adjusted for a range of classical risk factors. A sensitivity analysis excluded participants with baseline comorbidites and the first 2 years of follow-up. Men (hazard ratio [HR], 1.59; 95% confidence interval, 1.22-2.08) and women (HR, 2.15; 95% confidence interval, 1.38-3.35) in the highest decile of neutrophil count were at higher risk of CVD mortality and nonfatal CVD (men HR, 1.28; 95% confidence interval, 1.16-1.42 and women HR, 1.21; 95% confidence interval, 1.06-1.38). In the sensitivity analysis, the power to investigate CVD mortality was limited, but for both sexes combined, the linear HRs for a 1×109/L cell count increase in white blood cell count and neutrophils, respectively, was 1.05 (1.03-1.07) and 1.07 (1.04-1.11). CONCLUSIONS Among circulating leukocyte subpopulations, neutrophil count in men was most consistently associated with fatal and nonfatal CVD. Further studies of interventions that lower circulating neutrophils, such as canakinumab, are required to investigate causality.
Collapse
Affiliation(s)
- Claire Welsh
- From the Institute of Cardiovascular and Medical Sciences (P.W., C.W., P.B.M., C.A.C.-M., S.R.G., S.I., J.M.R.G., P.S.J., N.S.)
| | - Paul Welsh
- From the Institute of Cardiovascular and Medical Sciences (P.W., C.W., P.B.M., C.A.C.-M., S.R.G., S.I., J.M.R.G., P.S.J., N.S.)
| | - Patrick B Mark
- From the Institute of Cardiovascular and Medical Sciences (P.W., C.W., P.B.M., C.A.C.-M., S.R.G., S.I., J.M.R.G., P.S.J., N.S.)
| | - Carlos A Celis-Morales
- From the Institute of Cardiovascular and Medical Sciences (P.W., C.W., P.B.M., C.A.C.-M., S.R.G., S.I., J.M.R.G., P.S.J., N.S.)
| | - James Lewsey
- Institute of Health and Wellbeing (J.L., D.M.L., J.P.), University of Glasgow, Scotland
| | - Stuart R Gray
- From the Institute of Cardiovascular and Medical Sciences (P.W., C.W., P.B.M., C.A.C.-M., S.R.G., S.I., J.M.R.G., P.S.J., N.S.)
| | - Donald M Lyall
- Institute of Health and Wellbeing (J.L., D.M.L., J.P.), University of Glasgow, Scotland
| | - Stamatina Iliodromiti
- From the Institute of Cardiovascular and Medical Sciences (P.W., C.W., P.B.M., C.A.C.-M., S.R.G., S.I., J.M.R.G., P.S.J., N.S.)
| | - Jason M R Gill
- From the Institute of Cardiovascular and Medical Sciences (P.W., C.W., P.B.M., C.A.C.-M., S.R.G., S.I., J.M.R.G., P.S.J., N.S.)
| | - Jill Pell
- Institute of Health and Wellbeing (J.L., D.M.L., J.P.), University of Glasgow, Scotland
| | - Pardeep S Jhund
- From the Institute of Cardiovascular and Medical Sciences (P.W., C.W., P.B.M., C.A.C.-M., S.R.G., S.I., J.M.R.G., P.S.J., N.S.)
| | - Naveed Sattar
- From the Institute of Cardiovascular and Medical Sciences (P.W., C.W., P.B.M., C.A.C.-M., S.R.G., S.I., J.M.R.G., P.S.J., N.S.)
| |
Collapse
|
15
|
Menezes AMB, Oliveira PD, Wehrmeister FC, Gonçalves H, Assunção MCF, Tovo-Rodrigues L, Ferreira GD, Oliveira IO. Association between interleukin-6, C-reactive protein and adiponectin with adiposity: Findings from the 1993 pelotas (Brazil) birth cohort at 18 and 22 years. Cytokine 2018; 110:44-51. [PMID: 29704817 PMCID: PMC6109205 DOI: 10.1016/j.cyto.2018.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/29/2022]
Abstract
There is a positive association between IL and 6 and CRP with body adiposity. The analysis between adiponectin and adiposity shows an inverse association. These associations are both cross-sectional and prospective and cumulative. Women show higher mean IL-6, CRP and adiponectin when compared with men. The associations were found in a cohort at 18 and 22 years of age and in both sexes.
Background Most of the literature has shown a direct association between adiposity, interleukin-6 (IL-6) and C-reactive protein (CRP), and an inverse association with adiponectin. The aim of this paper was to assess the association of obesity measurements and IL-6, CRP and adiponectin. Methods We performed cross-sectional/longitudinal analysis in the 1993 Birth Cohort in Brazil. Associations between IL-6 (pg/mL), CRP (mg/L) and adiponectin (µg/Ml) with body mass index (BMI), waist circumference (WC), percentage total fat mass (FM) (BODPOD) and trunk FM (DXA) were verified. Four trajectory variables were generated: (a) highest tertile/obesity according to BMI in both follow-ups; (b) highest tertile/obesity only at 18 years; (c) highest tertile/obesity only at 22 years; (d) not in the highest tertile/not obese at both ages. Results We found a direct association for IL-6 and CRP and an inverse association for adiponectin with measures of adiposity. For instance, for females, the highest mean IL-6 and CRP, respectively, was for those who had been in the obese category at 18–22 years (2.49; 3.75), in the highest tertile of WC (2.11; 3.08), in the highest % of FM (1.56; 3.30 l), and in the highest tertile of trunk FM (2.07; 3.26) (p < 0.001 for all these results in the adjusted analysis). Adiponectin showed an inverse association for the above variables, with lower mean values for males than females. Conclusion There was a longitudinal and direct association between adiposity and IL-6 and CRP, and an inverse association with adiponectin at 22 years.
Collapse
Affiliation(s)
- Ana Maria Baptista Menezes
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Paula Duarte Oliveira
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Fernando César Wehrmeister
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Helen Gonçalves
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Maria Cecilia F Assunção
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Luciana Tovo-Rodrigues
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Gustavo Dias Ferreira
- Federal University of Pelotas, Department of Physiology and Pharmacology Campus Capão do Leão, s/n. Pelotas, RS. Zip code: 96010-900, Brazil.
| | - Isabel O Oliveira
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| |
Collapse
|
16
|
Parsons TJ, Sartini C, Welsh P, Sattar N, Ash S, Lennon LT, Wannamethee SG, Lee IM, Whincup PH, Jefferis BJ. Physical Activity, Sedentary Behavior, and Inflammatory and Hemostatic Markers in Men. Med Sci Sports Exerc 2017; 49:459-465. [PMID: 28222056 DOI: 10.1249/mss.0000000000001113] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE This study aimed to determine whether higher levels of physical activity (PA) and less sedentary behavior (SB) are associated with less inflammation, indicated by inflammatory and hemostatic biomarkers, in older men. METHODS A cross-sectional study of 1139 men, from the British Regional Heart Study (mean ± SD age = 78 ± 5 yr), and longitudinal analyses of 490 men with two PA measures 1 yr apart were used in this study. Single fasting venous blood samples were analyzed for several biomarkers. PA and SB were measured using ActiGraph GT3X accelerometers. Total time and time spent in bouts of moderate to vigorous PA (MVPA), light PA, and SB were derived. Linear regression analyses were used to investigate associations. RESULTS Cross-sectionally, higher total PA, daily steps, and MVPA were all associated with lower levels of interleukin 6 (IL-6), C-reactive protein (CRP), tissue plasminogen activator (tPA), von Willebrand factor (vWF), and D-dimer, whereas higher levels of SB were associated with higher levels of IL-6, CRP, and tPA. Each additional 10 min of MVPA was associated with a 3.2% lower IL-6 (95% confidence interval [CI] = -4.5% to -1.8%), 5.6% lower CRP (95% CI = -7.8 to -3.3), 2.2% lower tPA (95% CI = -3.0 to -1.4), 1.2% lower vWF (95% CI = -2.1 to -0.3), and 1.8% lower D-dimer (95% CI = -2.9 to -0.7), and for CRP, vWF, and D-dimer independently of SB. Associations between SB and IL-6 or tPA were independent of MVPA. Longer bouts of PA or SB were not more strongly associated with outcomes than shorter bouts. Longitudinal analyses were inconsistent with these findings, possibly because of power limitations. CONCLUSION Although PA (particularly MVPA) was generally associated with inflammatory and hemostatic biomarkers, we found no evidence that longer bouts were more important than shorter bouts.
Collapse
Affiliation(s)
- Tessa J Parsons
- 1UCL Department of Primary Care and Population Health, UCL Medical School, London, UNITED KINGDOM; 2UCL Physical Activity Research Group, London, UNITED KINGDOM; 3Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, Glasgow, UNITED KINGDOM; 4Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and 5Population Health Research Institute, St George's University of London, Cranmer Terrace, London, UNITED KINGDOM
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Gilotra TS, Geraci SA. C-Reactive Protein as an Independent Cardiovascular Risk Predictor in HIV+ Patients: A Focused Review of Published Studies. J Clin Med Res 2017; 9:891-899. [PMID: 29038665 PMCID: PMC5633088 DOI: 10.14740/jocmr3154w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/08/2017] [Indexed: 12/23/2022] Open
Abstract
Patients infected with the human immunodeficiency virus (HIV+) are living longer and at heightened risk for developing cardiovascular events (CVEs). Commonly used prediction tools appear to misrepresent their CVE risk to varying degrees and in varying directions. Inclusion of markers of cellular infection, chronic immune activation and/or systemic inflammation into risk models might provide better predictive accuracy. Observational studies assessing the relationship of high-sensitivity C-reactive protein (hs-CRP) to CVE in HIV+ patients have reported inconsistent findings. This review of published studies attempted to determine if the available evidence supports its potential use in new models for stable, treated HIV+ patients. We searched the PubMed database using keywords and combinations of “HIV” AND “cardiovascular risk” AND “CRP”. Papers presenting original analyses, associating hs-CRP concentration as an independent variable to hard cardiovascular outcomes (myocardial infarction and cardiovascular death), or to hard CVE as part of a composite endpoint, were included. Five observational studies met inclusion/exclusion criteria for review. Three papers identified an association between elevated hs-CRP and CVE, while two others failed to find any significant association. All reports were heterogeneous in terms of independent variables, controls, and designs. The larger and more rigorous studies, employing higher rates of confounder controls and more objective endpoints in their composites, showed positive associations. Though not conclusive, the preponderance of the evidence at this time supports CRP as a potentially valuable factor to be studied in prospective cardiovascular risk prediction investigations in HIV+ patients.
Collapse
Affiliation(s)
- Tarvinder S Gilotra
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Stephen A Geraci
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.,Division of Cardiology, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| |
Collapse
|
18
|
|
19
|
Carrieri V, Jones AM. The Income-Health Relationship 'Beyond the Mean': New Evidence from Biomarkers. HEALTH ECONOMICS 2017; 26:937-956. [PMID: 27416807 DOI: 10.1002/hec.3372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/04/2016] [Accepted: 05/19/2016] [Indexed: 06/06/2023]
Abstract
The relationship between income and health is one of the most explored topics in health economics but less is known about this relationship at different points of the health distribution. Analysis based solely on the mean may miss important information in other parts of the distribution. This is especially relevant when clinical concern is focused on the tail of the distribution and when evaluating the income gradient at different points of the distribution and decomposing income-related inequalities in health is of interest. We use the unconditional quantile regression approach to analyse the income gradient across the entire distribution of objectively measured blood-based biomarkers. We apply an Oaxaca-Blinder decomposition at various quantiles of the biomarker distributions to analyse gender differentials in biomarkers and to measure the contribution of income (and other covariates) to these differentials. Using data from the Health Survey for England, we find a non-linear relationship between income and health and a strong gradient with respect to income at the highest quantiles of the biomarker distributions. We find that there is heterogeneity in the association of health to income across genders, which accounts for a substantial percentage of the gender differentials in observed health. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Vincenzo Carrieri
- Università di Salerno, Fisciano (SA), Italy
- HEDG, University of York, York, UK
| | - Andrew M Jones
- University of York, York, UK
- Monash University, Clayton, VIC, Australia
- University of Bergen, Bergen, Norway
| |
Collapse
|
20
|
Chang SC, Glymour M, Cornelis M, Walter S, Rimm EB, Tchetgen Tchetgen E, Kawachi I, Kubzansky LD. Social Integration and Reduced Risk of Coronary Heart Disease in Women: The Role of Lifestyle Behaviors. Circ Res 2017; 120:1927-1937. [PMID: 28373350 PMCID: PMC5476459 DOI: 10.1161/circresaha.116.309443] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 03/15/2017] [Accepted: 03/30/2017] [Indexed: 02/06/2023]
Abstract
RATIONALE Higher social integration is associated with lower cardiovascular mortality; however, whether it is associated with incident coronary heart disease (CHD), especially in women, and whether associations differ by case fatality are unclear. OBJECTIVES This study sought to examine the associations between social integration and risk of incident CHD in a large female prospective cohort. METHODS AND RESULTS Seventy-six thousand three hundred and sixty-two women in the Nurses' Health Study, free of CHD and stroke at baseline (1992), were followed until 2014. Social integration was assessed by a simplified Berkman-Syme Social Network Index every 4 years. End points included nonfatal myocardial infarction and fatal CHD. Two thousand three hundred and seventy-two incident CHD events occurred throughout follow-up. Adjusting for demographic, health/medical risk factors, and depressive symptoms, being socially integrated was significantly associated with lower CHD risk, particularly fatal CHD. The most socially integrated women had a hazard ratio of 0.55 (95% confidence interval, 0.41-0.73) of developing fatal CHD compared with those least socially integrated (P for trend <0.0001). When additionally adjusting for lifestyle behaviors, findings for fatal CHD were maintained but attenuated (P for trend =0.02), whereas the significant associations no longer remained for nonfatal myocardial infarction. The inverse associations between social integration and nonfatal myocardial infarction risk were largely explained by health-promoting behaviors, particularly through differences in cigarette smoking; however, the association with fatal CHD risk remained after accounting for these behaviors and, thus, may involve more direct biological mechanisms. CONCLUSIONS Social integration is inversely associated with CHD incidence in women, but is largely explained by lifestyle/behavioral pathways.
Collapse
Affiliation(s)
- Shun-Chiao Chang
- From the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.-C.C., E.B.R.); Department of Social and Behavioral Sciences (S.-C.C., M.G., S.W., I.K., L.D.K.), Department of Nutrition (E.B.R.), Department of Biostatistics (E.T.T.), and Department of Epidemiology (E.B.R.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco (M.G., S.W.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.C.).
| | - Maria Glymour
- From the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.-C.C., E.B.R.); Department of Social and Behavioral Sciences (S.-C.C., M.G., S.W., I.K., L.D.K.), Department of Nutrition (E.B.R.), Department of Biostatistics (E.T.T.), and Department of Epidemiology (E.B.R.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco (M.G., S.W.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.C.)
| | - Marilyn Cornelis
- From the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.-C.C., E.B.R.); Department of Social and Behavioral Sciences (S.-C.C., M.G., S.W., I.K., L.D.K.), Department of Nutrition (E.B.R.), Department of Biostatistics (E.T.T.), and Department of Epidemiology (E.B.R.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco (M.G., S.W.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.C.)
| | - Stefan Walter
- From the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.-C.C., E.B.R.); Department of Social and Behavioral Sciences (S.-C.C., M.G., S.W., I.K., L.D.K.), Department of Nutrition (E.B.R.), Department of Biostatistics (E.T.T.), and Department of Epidemiology (E.B.R.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco (M.G., S.W.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.C.)
| | - Eric B Rimm
- From the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.-C.C., E.B.R.); Department of Social and Behavioral Sciences (S.-C.C., M.G., S.W., I.K., L.D.K.), Department of Nutrition (E.B.R.), Department of Biostatistics (E.T.T.), and Department of Epidemiology (E.B.R.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco (M.G., S.W.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.C.)
| | - Eric Tchetgen Tchetgen
- From the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.-C.C., E.B.R.); Department of Social and Behavioral Sciences (S.-C.C., M.G., S.W., I.K., L.D.K.), Department of Nutrition (E.B.R.), Department of Biostatistics (E.T.T.), and Department of Epidemiology (E.B.R.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco (M.G., S.W.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.C.)
| | - Ichiro Kawachi
- From the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.-C.C., E.B.R.); Department of Social and Behavioral Sciences (S.-C.C., M.G., S.W., I.K., L.D.K.), Department of Nutrition (E.B.R.), Department of Biostatistics (E.T.T.), and Department of Epidemiology (E.B.R.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco (M.G., S.W.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.C.)
| | - Laura D Kubzansky
- From the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.-C.C., E.B.R.); Department of Social and Behavioral Sciences (S.-C.C., M.G., S.W., I.K., L.D.K.), Department of Nutrition (E.B.R.), Department of Biostatistics (E.T.T.), and Department of Epidemiology (E.B.R.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology and Biostatistics, University of California, San Francisco (M.G., S.W.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.C.)
| |
Collapse
|
21
|
Park JK, Kim JY, Moon JY, Ahn EY, Lee EY, Lee EB, Cho KH, Song YW. Altered lipoproteins in patients with systemic lupus erythematosus are associated with augmented oxidative stress: a potential role in atherosclerosis. Arthritis Res Ther 2016; 18:306. [PMID: 28038677 PMCID: PMC5203709 DOI: 10.1186/s13075-016-1204-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/05/2016] [Indexed: 11/30/2022] Open
Abstract
Background To examine the structural and oxidative properties of lipoproteins from patients with systemic lupus erythematosus (SLE). Methods The lipid profiles of 35 SLE patients and 15 healthy controls (HCs) were compared. Oxidation status, susceptibility to oxidation, and structural integrity of low-density lipoprotein (LDL) were determined by measuring malondialdehyde (MDA), de novo formation of conjugated dienes in the presence of CuSO4, and mobility on gel electrophoresis, respectively. In vitro foam cell formation and the oxidative potential in zebrafish embryos were examined. Results LDL levels in SLE patients and HCs were similar (p = 0.277). LDL from SLE patients was more fragmented than that from HCs. In addition, LDL from SLE patients was more oxidized than LDL from HCs (p < 0.001) and more susceptible to de novo oxidation (p < 0.001) in vitro. THP-1 cells engulfed more LDL from SLE patients than LDL from HCs (p < 0.001). LDL from SLE patients, which was injected into zebrafish embryos, induced a higher degree of oxidation and a higher mortality than LDL from HCs (both p < 0.001). The survival of embryos treated with oxidized LDL was significantly better in the presence of HDL3 from HCs than that from SLE patients (all p < 0.001). Conclusions Lipoproteins from SLE patients exhibited greater oxidative potential, which might contribute to accelerated atherosclerosis in SLE. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1204-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jin Kyun Park
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.,Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Yong Kim
- Department of Medical Biotechnology, Yeungnam University, Gyeongsangbuk-Do, Republic of Korea
| | - Jin Young Moon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Young Ahn
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Hyun Cho
- Department of Medical Biotechnology, Yeungnam University, Gyeongsangbuk-Do, Republic of Korea
| | - Yeong Wook Song
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea. .,Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
22
|
Sartini C, Barry SJ, Whincup PH, Wannamethee SG, Lowe GDO, Jefferis BJ, Lennon L, Welsh P, Ford I, Sattar N, Morris RW. Relationship between outdoor temperature and cardiovascular disease risk factors in older people. Eur J Prev Cardiol 2016; 24:349-356. [PMID: 27899528 PMCID: PMC5301906 DOI: 10.1177/2047487316682119] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Previous studies demonstrated that lower outdoor temperatures increase the levels of established cardiovascular disease risk factors, such as blood pressure and lipids. Whether or not low temperatures increase novel cardiovascular disease risk factors levels is not well studied. The aim was to investigate associations of outdoor temperature with a comprehensive range of established and novel cardiovascular disease risk factors in two large Northern European studies of older adults, in whom cardiovascular disease risk is increased. Design and methods Data came from the British Regional Heart Study (4252 men aged 60-79 years) and the Prospective Study of Pravastatin in the Elderly at Risk (5804 men and women aged 70-82 years). Associations between outdoor temperature and cardiovascular disease risk factors were quantified in each study and then pooled using a random effects model. Results With a 5℃ lower mean temperature, total cholesterol was 0.04 mmol/l (95% confidence interval (CI) 0.02-0.07) higher, low density lipoprotein cholesterol was 0.02 mmol/l (95% CI 0.01-0.05) higher and SBP was 1.12 mm Hg (95% CI 0.60-1.64) higher. Among novel cardiovascular disease risk factors, C-reactive protein was 3.3% (95% CI 1.0-5.6%) higher, interleukin-6 was 2.7% (95% CI 1.1-4.3%) higher, and vitamin D was 11.2% (95% CI 1.0-20.4%) lower. Conclusions Lower outdoor temperature was associated with adverse effects on cholesterol, blood pressure, circulating inflammatory markers, and vitamin D in two older populations. Public health approaches to protect the elderly against low temperatures could help in reducing the levels of several cardiovascular disease risk factors.
Collapse
Affiliation(s)
- Claudio Sartini
- 1 Department of Primary Care and Population Health, University College London, UK
| | - Sarah Je Barry
- 2 Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences. Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Peter H Whincup
- 3 Population Health Research Institute, St George's University of London, UK
| | - S Goya Wannamethee
- 1 Department of Primary Care and Population Health, University College London, UK
| | - Gordon DO Lowe
- 4 Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Barbara J Jefferis
- 1 Department of Primary Care and Population Health, University College London, UK
| | - Lucy Lennon
- 1 Department of Primary Care and Population Health, University College London, UK
| | - Paul Welsh
- 2 Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences. Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Ian Ford
- 2 Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences. Robertson Centre for Biostatistics, University of Glasgow, UK
| | - Naveed Sattar
- 4 Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Richard W Morris
- 5 School of Social and Community Medicine, University of Bristol, UK
| |
Collapse
|
23
|
Helbig AK, Stöckl D, Heier M, Ladwig KH, Meisinger C. Symptoms of Insomnia and Sleep Duration and Their Association with Incident Strokes: Findings from the Population-Based MONICA/KORA Augsburg Cohort Study. PLoS One 2015; 10:e0134480. [PMID: 26230576 PMCID: PMC4521822 DOI: 10.1371/journal.pone.0134480] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/10/2015] [Indexed: 12/21/2022] Open
Abstract
Objective To examine the relationship between symptoms of insomnia and sleep duration and incident total (non-fatal plus fatal) strokes, non-fatal strokes, and fatal strokes in a large cohort of men and women from the general population in Germany. Methods In four population-based MONICA (monitoring trends and determinants in cardiovascular disease)/KORA (Cooperative Health Research in the Region of Augsburg) surveys conducted between 1984 and 2001, 17,604 men and women (aged 25 to 74 years) were asked about issues like sleep, health behavior, and medical history. In subsequent surveys and mortality follow-ups, incident stroke cases (cerebral hemorrhage, ischemic stroke, transient ischemic attack, unknown stroke type) were gathered prospectively until 2009. Sex-specific hazard ratios (HR) and their 95% confidence intervals (CI) were estimated using sequential Cox proportional hazards regression models. Results During a mean follow-up of 14 years, 917 strokes (710 non-fatal strokes and 207 fatal strokes) were observed. Trouble falling asleep and difficulty staying asleep were not significantly related to any incident stroke outcome in either sex in the multivariable models. Among men, the HR for the association between short (≤5 hours) and long (≥10 hours) daily sleep duration and total strokes were 1.44 (95% CI: 1.01–2.06) and 1.63 (95% CI: 1.16–2.29), after adjustment for basic confounding variables. As for non-fatal strokes and fatal strokes, in the analyses adjusted for age, survey, education, physical activity, alcohol consumption, smoking habits, body mass index, hypertension, diabetes, and dyslipidemia, the increased risks persisted, albeit somewhat attenuated, but no longer remained significant. Among women, in the multivariable analyses the quantity of sleep was also not related to any stroke outcome. Conclusion In the present study, symptoms of insomnia and exceptional sleep duration were not significantly predictive of incident total strokes, non-fatal strokes, and fatal strokes in either sex.
Collapse
Affiliation(s)
- A Katharina Helbig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Doris Stöckl
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| |
Collapse
|
24
|
Poortvliet RKE, Lloyd SM, Ford I, Sattar N, de Craen AJM, Wijsman LW, Mooijaart SP, Westendorp RGJ, Jukema JW, de Ruijter W, Gussekloo J, Stott DJ. Biological correlates of blood pressure variability in elderly at high risk of cardiovascular disease. Am J Hypertens 2015; 28:469-79. [PMID: 25298176 DOI: 10.1093/ajh/hpu181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Visit-to-visit variability in blood pressure is an independent predictor of cardiovascular disease. This study investigates biological correlates of intra-individual variability in blood pressure in older persons. METHODS Nested observational study within the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) among 3,794 male and female participants (range 70-82 years) with a history of, or risk factors for cardiovascular disease. Individual visit-to-visit variability in systolic and diastolic blood pressure and pulse pressure (expressed as 1 SD in mm Hg) was assessed using nine measurements over 2 years. Correlates of higher visit-to-visit variability were examined at baseline, including markers of inflammation, endothelial function, renal function and glucose homeostasis. RESULTS Over the first 2 years, the mean intra-individual variability (1 SD) was 14.4mm Hg for systolic blood pressure, 7.7mm Hg for diastolic blood pressure, and 12.6mm Hg for pulse pressure. After multivariate adjustment a higher level of interleukin-6 at baseline was consistently associated with higher intra-individual variability of blood pressure, including systolic, diastolic, and pulse pressure. Markers of endothelial function (Von Willebrand factor, tissue plasminogen activator), renal function (glomerular filtration rate) and glucose homeostasis (blood glucose, homeostatic model assessment index) were not or to a minor extent associated with blood pressure variability. CONCLUSION In an elderly population at risk of cardiovascular disease, inflammation (as evidenced by higher levels of interleukin-6) is associated with higher intra-individual variability in systolic, diastolic, and pulse pressure.
Collapse
Affiliation(s)
- Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands;
| | - Suzanne M Lloyd
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Liselotte W Wijsman
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands; Netherlands Consortium for Healthy Ageing, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands; Netherlands Consortium for Healthy Ageing, Leiden, The Netherlands; Institute for Evidence-Based Medicine in Old Age, Leiden, The Netherlands
| | | | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter de Ruijter
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - David J Stott
- Academic Section of Geriatric Medicine, University of Glasgow-Faculty of Medicine, Glasgow Royal Infirmary, Glasgow, UK
| |
Collapse
|
25
|
Brito V, Alcaraz A, Augustovski F, Pichón-Riviere A, García-Martí S, Bardach A, Ciapponi A, Lopez A, Comandé D. [High sensitivity C protein as an independent risk factor in people with and without history of cardiovascular disease]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:124-35. [PMID: 25700576 DOI: 10.1016/j.acmx.2014.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 11/02/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022] Open
Abstract
Among the new cardiovascular event (CVE) risk biomarkers, C-reactive protein detected using high sensitive techniques (hs-CRP) has been one of the most commonly evaluated. In this review, the available evidence on the usefulness of hs-CRP was explored as an independent risk event factor in subjects with no cardiovascular history and as prognosis in case of chronic or acute cardiovascular condition. An overview (revision of revisions) was carried out searching in the main bibliographic databases and in other general Internet search engines. During the first stage, systematic reviews, clinical practice guidelines, health technology assessments and coverage policies were found and, during the second stage primary studies published after the systematic review search dates were added. Seven hundred and seventy four quotes were found, including 36 papers assessing the role of hs-CRP in healthy populations or with cardiovascular history. High quality evidence was found pointing out hs-CRP, both as risk factor in the general population and as prognostic factor in those with CVE, in all the populations assessed. It was most useful in subjects with a history of CVE and intermediate risk of events at 10 years; where adding hs-CRP to the classical models for event risk estimation improves risk staging. There was no consensus on its clinical usefulness as a prognostic marker in subjects with chronic or acute disease.
Collapse
Affiliation(s)
- Viviana Brito
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.
| | - Andrea Alcaraz
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Federico Augustovski
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Andrés Pichón-Riviere
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Sebastián García-Martí
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Ariel Bardach
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Analía Lopez
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Daniel Comandé
- Departamento de Evaluaciones de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | |
Collapse
|
26
|
Greisenegger S, Segal HC, Burgess AI, Poole DL, Mehta Z, Rothwell PM. Biomarkers and mortality after transient ischemic attack and minor ischemic stroke: population-based study. Stroke 2015; 46:659-66. [PMID: 25649803 DOI: 10.1161/strokeaha.114.007624] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Premature death after transient ischemic attack or stroke is more often because of heart disease or cancer than stroke. Previous studies found blood biomarkers not usefully predictive of nonfatal stroke but possibly of all-cause death. This association might be explained by potentially treatable occult cardiac disease or cancer. We therefore aimed to validate the association of a panel of biomarkers with all-cause death, particularly cardiac death and cancer death, despite the absence of associations with risk of nonfatal vascular events. METHODS Fifteen biomarkers were measured in 929 consecutive patients in a population-based study (Oxford Vascular Study), recruited from 2002 and followed up to 2013. Associations were determined by Cox regression. Model discrimination was assessed by c-statistic and the integrated discrimination improvement. RESULTS During 5560 patient-years of follow-up, none of the biomarkers predicted risk of nonfatal vascular events. However, soluble tumor necrosis factor α receptor-1, von Willebrand factor, heart-type fatty-acid-binding protein, and N-terminal pro-B-type natriuretic peptide were independently predictive of all-cause death (n=361; adjusted hazard ratio per SD, 95% confidence interval: heart-type fatty-acid-binding protein: 1.31, 1.12-1.56, P=0.002; N-terminal pro-B-type natriuretic peptide: 1.34, 1.11-1.62, P=0.002; soluble tumor necrosis factor α receptor-1: 1.45, 1.26-1.66, P=0.02; von Willebrand factor: 1.19, 1.04-1.36, P=0.01). The independent contribution of the four biomarkers taken together added prognostic information and improved model discrimination (integrated discrimination improvement=0.028, P=0.0001). N-terminal pro-B-type natriuretic peptide was most predictive of vascular death (adjusted hazard ratio=1.80, 95% confidence interval, 1.34-2.41, P<0.0001), whereas heart-type fatty-acid-binding protein predicted cancer deaths (1.64, 1.26-2.12, P=0.0002). Associations were strongest in patients without known prior cardiac disease or cancer. CONCLUSIONS Several biomarkers predicted death of any cause after transient ischemic attack and minor stroke. N-terminal pro-B-type natriuretic peptide and heart-type fatty-acid-binding protein might improve patient selection for additional screening for occult cardiac disease or cancer, respectively. However, our results require validation in future studies.
Collapse
Affiliation(s)
- Stefan Greisenegger
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., P.M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.)
| | - Helen C Segal
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., P.M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.)
| | - Annette I Burgess
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., P.M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.)
| | - Debbie L Poole
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., P.M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.)
| | - Ziyah Mehta
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., P.M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.)
| | - Peter M Rothwell
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom (S.G., H.C.S., A.I.B., D.L.P., Z.M., P.M.R.); and Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.).
| |
Collapse
|
27
|
Loeffen R, Winckers K, Ford I, Jukema JW, Robertson M, Stott DJ, Spronk HM, ten Cate H, Lowe GD. Associations Between Thrombin Generation and the Risk of Cardiovascular Disease in Elderly Patients: Results From the PROSPER Study. J Gerontol A Biol Sci Med Sci 2014; 70:982-8. [PMID: 25540034 DOI: 10.1093/gerona/glu228] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 11/12/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hypercoagulability may be an important contributor to the pathophysiology of atherosclerosis and atherothrombosis. As thrombin fulfills a central role in coagulation and links to several cellular mechanisms involved in arterial disease, we hypothesized that thrombin generation is associated with cardiovascular events in elderly patients. METHODS We studied the relationship between plasma thrombin generation and incident coronary heart disease (CHD) and stroke in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). From this multicenter prospective cohort, 4,932 samples of subjects (70-82 years) with pre-existing vascular disease or risk factors were available for thrombin generation measurements. RESULTS Within the 3.2 years of follow-up incident stroke and CHD was observed in 227 and 545 subjects, respectively. Baseline thrombin generation was significantly decreased in subjects with incident stroke compared with subjects without: normalized peak height 71.1±40.8% versus 82.3±44.9%, p = .0002, and normalized endogenous thrombin potential 79.1±23.3% versus 87.0±24.8%, p < .0001 (mean and SDs). Thrombin generation was independently and inversely associated with stroke risk: hazard ratio 0.71 (95%CI: 0.60-0.85), 0.68 (95%CI: 0.58-0.79), for normalized peak height and normalized endogenous thrombin potential, respectively (all p < .001). In subjects with incident CHD, thrombin generation was comparable to subjects without a coronary event. Only an increased normalized peak height was significantly associated with incident CHD (hazard ratio 1.17 [95% CI: 1.06-1.28], p = .002). CONCLUSIONS We demonstrate that a delayed and decreased thrombin generation is a strong and independent predictor for stroke in elderly people at increased risk of vascular disease. However, no convincing consistent association could be demonstrated between thrombin generation and incident CHD.
Collapse
Affiliation(s)
- Rinske Loeffen
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Kristien Winckers
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ian Ford
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michele Robertson
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - David J Stott
- Faculty of Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Henri M Spronk
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hugo ten Cate
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gordon D Lowe
- Faculty of Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | | |
Collapse
|
28
|
Abstract
Autoimmune rheumatic diseases can affect the cardiac vasculature, valves, myocardium, pericardium, and conduction system, leading to a plethora of cardiovascular manifestations that can remain clinically silent or lead to substantial cardiovascular morbidity and mortality. Although the high risk of cardiovascular pathology in patients with autoimmune inflammatory rheumatological diseases is not owing to atherosclerosis alone, this particular condition contributes substantially to cardiovascular morbidity and mortality-the degree of coronary atherosclerosis observed in patients with rheumatic diseases can be as accelerated, diffuse, and extensive as in patients with diabetes mellitus. The high risk of atherosclerosis is not solely attributable to traditional cardiovascular risk factors: dysfunctional immune responses, a hallmark of patients with rheumatic disorders, are thought to cause chronic tissue-destructive inflammation. Prompt recognition of cardiovascular abnormalities is needed for timely and appropriate management, and aggressive control of traditional risk factors remains imperative in patients with rheumatic diseases. Moreover, therapies directed towards inflammatory process are crucial to reduce cardiovascular disease morbidity and mortality. In this Review, we examine the multiple cardiovascular manifestations in patients with rheumatological disorders, their underlying pathophysiology, and available management strategies, with particular emphasis on the vascular aspects of the emerging field of 'cardiorheumatology'.
Collapse
|
29
|
Welsh P, Preiss D, Lloyd SM, de Craen AJ, Jukema JW, Westendorp RG, Buckley BM, Kearney PM, Briggs A, Stott DJ, Ford I, Sattar N. Contrasting associations of insulin resistance with diabetes, cardiovascular disease and all-cause mortality in the elderly: PROSPER long-term follow-up. Diabetologia 2014; 57:2513-20. [PMID: 25264116 DOI: 10.1007/s00125-014-3383-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/29/2014] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS Insulin resistance is commonly proposed as a precursor to both type 2 diabetes and cardiovascular disease (CVD), yet few studies have directly compared insulin resistance with both outcomes simultaneously and determined whether associations with each outcome differ in strength or are comparable. We assessed the association of fasting insulin and HOMA-IR with incident CVD and diabetes in older people. METHODS In the long-term follow-up of the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) cohort, HOMA-IR measurement was available in 4,742 older people (70-82 years) without diabetes at baseline. Of these, 283 developed diabetes during the 3.2 year within-trial follow-up, while 1,943 all-cause deaths, 470 CHD deaths (identified from death records) and 590 fatal/non-fatal CVD events (identified from medical record linkage in the Scottish participants) occurred during an extended 8.6 years of total follow-up. Cause-specific Cox proportional-hazards models were fitted using multivariable models. RESULTS Higher HOMA-IR was associated with incident diabetes: HR 4.80 (95% CI 3.14, 7.33) comparing extreme thirds after adjustment for confounders. However, HOMA-IR in the top third was not associated with all-cause mortality, CHD mortality or fatal/non-fatal CVD: HR 1.02 (95% CI 0.90, 1.17), 1.03 (0.79, 1.36) and 0.94 (0.74, 1.20), respectively. Results were similar when fasting insulin was considered as an exposure. CONCLUSIONS/INTERPRETATION Our data support insulin resistance as a predictor of diabetes in later life but, perhaps surprisingly, suggest this pathway is of negligible importance to CVD outcomes in the elderly.
Collapse
Affiliation(s)
- Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK,
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
|
31
|
Nordell AD, McKenna M, Borges ÁH, Duprez D, Neuhaus J, Neaton JD. Severity of cardiovascular disease outcomes among patients with HIV is related to markers of inflammation and coagulation. J Am Heart Assoc 2014; 3:e000844. [PMID: 24870935 PMCID: PMC4309077 DOI: 10.1161/jaha.114.000844] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background In the general population, raised levels of inflammatory markers are stronger predictors of fatal than nonfatal cardiovascular disease (CVD) events. People with HIV have elevated levels of interleukin‐6 (IL‐6), high‐sensitivity C‐reactive protein (hsCRP), and D‐dimer; HIV‐induced activation of inflammatory and coagulation pathways may be responsible for their greater risk of CVD. Whether the enhanced inflammation and coagulation associated with HIV is associated with more fatal CVD events has not been investigated. Methods and Results Biomarkers were measured at baseline for 9764 patients with HIV and no history of CVD. Of these patients, we focus on the 288 that experienced either a fatal (n=74) or nonfatal (n=214) CVD event over a median of 5 years. Odds ratios (ORs) (fatal versus nonfatal CVD) (95% confidence intervals [CIs]) associated with a doubling of IL‐6, D‐dimer, hsCRP, and a 1‐unit increase in an IL‐6 and D‐dimer score, measured a median of 2.6 years before the event, were 1.39 (1.07 to 1.79), 1.40 (1.10 to 1.78), 1.09 (0.93 to 1.28), and 1.51 (1.15 to 1.97), respectively. Of the 214 patients with nonfatal CVD, 23 died during follow‐up. Hazard ratios (95% CI) for all‐cause mortality were 1.72 (1.28 to 2.31), 1.73 (1.27 to 2.36), 1.44 (1.15 to 1.80), and 1.88 (1.39 to 2.55), respectively, for IL‐6, D‐dimer, hsCRP, and the IL‐6 and D‐dimer score. Conclusions Higher IL‐6 and D‐dimer levels reflecting enhanced inflammation and coagulation associated with HIV are associated with a greater risk of fatal CVD and a greater risk of death after a nonfatal CVD event. Clinical Trial Registration URL: http://www.clinicaltrial.gov Unique identifier: SMART: NCT00027352, ESPRIT: NCT00004978, SILCAAT: NCT00013611.
Collapse
Affiliation(s)
- Anna D Nordell
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN (A.D.N., M.M.K., J.N., J.D.N.)
| | - Matthew McKenna
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN (A.D.N., M.M.K., J.N., J.D.N.)
| | - Álvaro H Borges
- Department of Infectious Diseases, Rigshospitalet and Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark (B.)
| | - Daniel Duprez
- Cardiovascular Division, University of Minnesota, Minneapolis, MN (D.D.)
| | - Jacqueline Neuhaus
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN (A.D.N., M.M.K., J.N., J.D.N.)
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN (A.D.N., M.M.K., J.N., J.D.N.)
| | | | | |
Collapse
|
32
|
Jefferis BJ, Whincup PH, Lennon LT, Papacosta O, Goya Wannamethee S. Physical activity in older men: longitudinal associations with inflammatory and hemostatic biomarkers, N-terminal pro-brain natriuretic peptide, and onset of coronary heart disease and mortality. J Am Geriatr Soc 2014; 62:599-606. [PMID: 24635212 PMCID: PMC4283726 DOI: 10.1111/jgs.12748] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine associations between habitual physical activity (PA) and changes in PA and onset of coronary heart disease (CHD) and the pathways linking PA to CHD. DESIGN British Regional Heart Study population-based cohort; men completed questionnaires in 1996 and 1998 to 2000, attended rescreen in 1998 to 2000, and were followed up to June 2010. SETTING Community. PARTICIPANTS Of 4,252 men recruited from primary care centers (77% of those invited and eligible) who were rescreened in 1998 to 2000, 3,320 were ambulatory and free from CHD, stroke, and heart failure and participated in the current study. MEASUREMENTS Usual PA (regular walking and cycling, recreational activity and sport). Outcome was first fatal or nonfatal myocardial infarction. RESULTS In 3,320 ambulatory men, 303 first and 184 fatal CHD events occurred during a median of 11 years of follow-up; 9% reported no usual PA, 23% occasional PA, and 68% light or more-intense PA. PA was inversely associated with novel risk markers C-reactive protein, D-dimer, von Willebrand Factor and N-terminal pro-brain natriuretic peptide (NT-proBNP). Compared with no usual PA, hazard ratios (HRs) for CHD events, adjusted for age and region, were 0.52 (95% confidence interval (CI) = 0.34-0.79) for occasional PA, 0.47 (95% CI = 0.30-0.74) for light PA, 0.51 (95% CI = 0.32-0.82) for moderate PA, and 0.44 (95% CI = 0.29-0.65) for moderately vigorous or vigorous PA (P for linear trend = .004). Adjustment for established and novel risk markers somewhat attenuated HRs and abolished linear trends. Compared with men who remained inactive, men who maintained at least light PA had an HR for CHD events of 0.73 (95% CI = 0.53-1.02) and men whose PA level increased had an HR of 0.86 (95% CI = 0.55-1.35). CONCLUSION Even light PA was associated with significantly lower risk of CHD events in healthy older men, partly through inflammatory and hemostatic mechanisms and cardiac function (NT-proBNP).
Collapse
Affiliation(s)
- Barbara J Jefferis
- Department of Primary Care and Population Health, University College London, London, UK; Population Health Domain Physical Activity Research Group, University College London, London, UK
| | | | | | | | | |
Collapse
|
33
|
Resting heart rate and incident heart failure and cardiovascular mortality in older adults: role of inflammation and endothelial dysfunction: the PROSPER study. Eur J Heart Fail 2014; 15:581-8. [DOI: 10.1093/eurjhf/hfs195] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
|
34
|
Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG. Sarcopenic obesity and risk of cardiovascular disease and mortality: a population-based cohort study of older men. J Am Geriatr Soc 2014; 62:253-60. [PMID: 24428349 PMCID: PMC4234002 DOI: 10.1111/jgs.12652] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives To examine associations between sarcopenia, obesity, and sarcopenic obesity and risk of cardiovascular disease (CVD) and all-cause mortality in older men. Design Prospective cohort study. Setting British Regional Heart Study. Participants Men aged 60–79 years (n = 4,252). Measurements Baseline waist circumference (WC) and midarm muscle circumference (MAMC) measurements were used to classify participants into four groups: sarcopenic, obese, sarcopenic obese, or optimal WC and MAMC. The cohort was followed for a mean of 11.3 years for CVD and all-cause mortality. Cox regression analyses assessed associations between sarcopenic obesity groups and all-cause mortality, CVD mortality, CVD events, and coronary heart disease (CHD) events. Results There were 1,314 deaths, 518 CVD deaths, 852 CVD events, and 458 CHD events during follow-up. All-cause mortality risk was significantly greater in sarcopenic (HR = 1.41, 95% CI = 1.22–1.63) and obese (HR = 1.21, 95% CI = 1.03–1.42) men than in the optimal reference group, with the highest risk in sarcopenic obese (HR = 1.72, 95% CI = 1.35–2.18), after adjustment for lifestyle characteristics. Risk of CVD mortality was significantly greater in sarcopenic and obese but not sarcopenic obese men. No association was seen between sarcopenic obesity groups and CHD or CVD events. Conclusion Sarcopenia and central adiposity were associated with greater cardiovascular mortality and all-cause mortality. Sarcopenic obese men had the highest risk of all-cause mortality but not CVD mortality. Efforts to promote healthy aging should focus on preventing obesity and maintaining muscle mass.
Collapse
Affiliation(s)
- Janice L Atkins
- Department of Primary Care and Population Health, University College London, London, UK
| | | | | | | | | | | |
Collapse
|
35
|
McInnes IB, Thompson L, Giles JT, Bathon JM, Salmon JE, Beaulieu AD, Codding CE, Carlson TH, Delles C, Lee JS, Sattar N. Effect of interleukin-6 receptor blockade on surrogates of vascular risk in rheumatoid arthritis: MEASURE, a randomised, placebo-controlled study. Ann Rheum Dis 2013; 74:694-702. [PMID: 24368514 PMCID: PMC4392313 DOI: 10.1136/annrheumdis-2013-204345] [Citation(s) in RCA: 207] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives The interleukin-6 receptor (IL-6R) blocker tocilizumab (TCZ) reduces inflammatory disease activity in rheumatoid arthritis (RA) but elevates lipid concentrations in some patients. We aimed to characterise the impact of IL-6R inhibition on established and novel risk factors in active RA. Methods Randomised, multicentre, two-part, phase III trial (24-week double-blind, 80-week open-label), MEASURE, evaluated lipid and lipoprotein levels, high-density lipoprotein (HDL) particle composition, markers of coagulation, thrombosis and vascular function by pulse wave velocity (PWV) in 132 patients with RA who received TCZ or placebo. Results Median total-cholesterol, low-density lipoprotein-cholesterol (LDL-C) and triglyceride levels increased in TCZ versus placebo recipients by week 12 (12.6% vs 1.7%, 28.1% vs 2.2%, 10.6% vs −1.9%, respectively; all p<0.01). There were no significant differences in mean small LDL, mean oxidised LDL or total HDL-C concentrations. However, HDL-associated serum amyloid A content decreased in TCZ recipients. TCZ also induced reductions (>30%) in secretory phospholipase A2-IIA, lipoprotein(a), fibrinogen and D-dimers and elevation of paraoxonase (all p<0.0001 vs placebo). The ApoB/ApoA1 ratio remained stable over time in both groups. PWV decreases were greater with placebo than TCZ at 12 weeks (adjusted mean difference 0.79 m/s (95% CI 0.22 to 1.35; p=0.0067)). Conclusions These data provide the first detailed evidence for the modulation of lipoprotein particles and other surrogates of vascular risk with IL-6R inhibition. When compared with placebo, TCZ induced elevations in LDL-C but altered HDL particles towards an anti-inflammatory composition and favourably modified most, but not all, measured vascular risk surrogates. The net effect of such changes for cardiovascular risk requires determination.
Collapse
Affiliation(s)
| | | | - Jon T Giles
- Columbia University, New York, New York, USA
| | | | - Jane E Salmon
- Hospital for Special Surgery-Weill Cornell Medical College, New York, New York, USA
| | - Andre D Beaulieu
- Centre Hospitalier de l'Université Laval, Quebec City, Quebec, Canada
| | | | | | | | | | | |
Collapse
|
36
|
Xiong XX, Gu LJ, Shen J, Kang XH, Zheng YY, Yue SB, Zhu SM. Probenecid protects against transient focal cerebral ischemic injury by inhibiting HMGB1 release and attenuating AQP4 expression in mice. Neurochem Res 2013; 39:216-24. [PMID: 24317635 DOI: 10.1007/s11064-013-1212-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/31/2013] [Accepted: 11/25/2013] [Indexed: 12/11/2022]
Abstract
Stroke results in inflammation, brain edema, and neuronal death. However, effective neuroprotectants are not available. Recent studies have shown that high mobility group box-1 (HMGB1), a proinflammatory cytokine, contributes to ischemic brain injury. Aquaporin 4 (AQP4), a water channel protein, is considered to play a pivotal role in ischemia-induced brain edema. More recently, studies have shown that pannexin 1 channels are involved in cerebral ischemic injury and the cellular inflammatory response. Here, we examined whether the pannexin 1 channel inhibitor probenecid could reduce focal ischemic brain injury by inhibiting cerebral inflammation and edema. Transient focal ischemia was induced in C57BL/6J mice by middle cerebral artery occlusion (MCAO) for 1 h. Infarct volume, neurological score and cerebral water content were evaluated 48 h after MCAO. Immunostaining, western blot analysis and ELISA were used to assess the effects of probenecid on the cellular inflammatory response, HMGB1 release and AQP4 expression. Administration of probenecid reduced infarct size, decreased cerebral water content, inhibited neuronal death, and reduced inflammation in the brain 48 h after stroke. In addition, HMGB1 release from neurons was significantly diminished and serum HMGB1 levels were substantially reduced following probenecid treatment. Moreover, AQP4 protein expression was downregulated in the cortical penumbra following post-stroke treatment with probenecid. These results suggest that probenecid, a powerful pannexin 1 channel inhibitor, protects against ischemic brain injury by inhibiting cerebral inflammation and edema.
Collapse
Affiliation(s)
- Xiao-Xing Xiong
- Department of Anesthesia, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | | | | | | | | | | | | |
Collapse
|
37
|
van Wijk DF, Boekholdt SM, Wareham NJ, Ahmadi-Abhari S, Kastelein JJP, Stroes ESG, Khaw KT. C-reactive protein, fatal and nonfatal coronary artery disease, stroke, and peripheral artery disease in the prospective EPIC-Norfolk cohort study. Arterioscler Thromb Vasc Biol 2013; 33:2888-94. [PMID: 24072695 DOI: 10.1161/atvbaha.113.301736] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Circulating levels of C-reactive protein (CRP) are associated with an increased risk of coronary artery disease (CAD), stroke, and peripheral artery disease (PAD). Observational and experimental evidence suggest that CRP might differentially predict fatal and nonfatal cardiovascular events. Here, we sought to determine the predictive value of CRP for fatal and nonfatal CAD, stroke, or PAD. APPROACH AND RESULTS CRP levels were measured in 18 450 apparently healthy participants in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort. Cox proportional hazards models were used to quantify the association between CRP levels and fatal and nonfatal CAD events, strokes, and PAD events. Bootstrapping was applied to test for significant differences between the risk of fatal and nonfatal events. During 208 485 person-years at risk, 2915 CAD events, 361 strokes, and 657 PAD events occurred. CRP was associated with fatal and nonfatal CAD events and nonfatal PAD events. When adding CRP to predictive risk models for fatal and nonfatal events corrected for known cardiovascular risk factors, the net reclassification index was 2.1% for fatal and 1.9% for nonfatal events. Multivariate adjusted hazard ratios for fatal CAD events (hazard ratio, 1.36; 95% confidence interval, 1.27-1.46) differed significantly (mean difference, 13%; 95% confidence interval, 5.1%-21.9%; P<0.001) from the multivariate adjusted hazard ratio for nonfatal CAD events (hazard ratio, 1.21; 95% confidence interval, 1.15-1.26). CONCLUSIONS In the EPIC-Norfolk cohort, CRP was associated with fatal and nonfatal CAD events, as well as nonfatal PAD events. Adding CRP to risk stratification models resulted in a small improvement in classification for both fatal and nonfatal events. Importantly, CRP was significantly more strongly associated with fatal CAD events than with nonfatal CAD events.
Collapse
Affiliation(s)
- Diederik F van Wijk
- From the Department of Vascular Medicine (D.F.v.W., J.J.P.K., E.S.G.S.) and Department of Cardiology (S.M.B.), Academic Medical Center, Amsterdam, The Netherlands; MRC Epidemiology Unit, Addenbrookes Hospital, Cambridge, United Kingdom (N.J.W.); and Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (S.A.-A., K.-T.K.)
| | | | | | | | | | | | | |
Collapse
|
38
|
Mooijaart SP, Sattar N, Trompet S, Lucke J, Stott DJ, Ford I, Jukema JW, Westendorp RGJ, de Craen AJM. Circulating interleukin-6 concentration and cognitive decline in old age: the PROSPER study. J Intern Med 2013; 274:77-85. [PMID: 23414490 DOI: 10.1111/joim.12052] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Inflammation is involved in the pathogenesis of cardiovascular disease and cognitive decline. Interleukin-6 (IL-6) has a role in cardiovascular disease, but the association of IL-6 concentration and the functional IL-6 -174 polymorphism with cognitive decline has not been demonstrated unequivocally. The objective of this study was to investigate the associations between both high concentration of IL-6 and the -174 promoter polymorphism, and increased cognitive decline in old age. METHODS Over 5000 participants of the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) with a mean age of 75 years and a history of cardiovascular disease or its risk factors were included in this study. We determined baseline concentrations of IL-6 and genotype of the IL-6 -174 polymorphism, of which the C allele was previously shown to be associated with higher circulating concentrations of IL-6. A cognitive test battery was administered at baseline and repeatedly during follow-up (mean 39 months). RESULTS In the cross-sectional analysis of 5653 participants, higher IL-6 concentration was associated with worse executive cognitive function (P < 0.001), independent of cardiovascular disease status and risk factors. No association was found between IL-6 concentration and memory function (P > 0.14). In the prospective analysis, higher IL-6 concentration was associated with an increased rate of cognitive decline in both executive function (P = 0.002) and memory function (P = 0.002), again independent of cardiovascular disease status and risk factors. Although not associated with IL-6 concentrations, the IL-6 -174 CC genotype was associated with worse performance on the Stroop test (P = 0.045). CONCLUSIONS Higher circulating levels of IL-6 were associated with worse cognitive function and steeper cognitive decline and provide preliminary genetic evidence for a potential causal association. The findings support the importance of the need for further investigation of the IL-6 pathway in cognitive decline.
Collapse
Affiliation(s)
- S P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Weikert C, Drogan D, di Giuseppe R, Fritsche A, Buijsse B, Nöthlings U, Willich SN, Berger K, Boeing H. Liver enzymes and stroke risk in middle-aged German adults. Atherosclerosis 2013; 228:508-14. [PMID: 23608248 DOI: 10.1016/j.atherosclerosis.2013.03.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 03/13/2013] [Accepted: 03/25/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the association between the liver enzymes γ-glutamyltransferase (GGT) and (alanine aminotransferase) ALT and risk of stroke, its subtypes including TIA as well as fatal and non-fatal events. METHODS A case-cohort study within the European Prospective Investigation into Cancer and Nutrition-Potsdam Study comprising 27548 middle-aged subjects was designed. GGT and ALT were measured in plasma of 353 individuals who developed a stroke and in 2110 individuals who remained free of cardiovascular events during a mean follow-up of 8.2 ± 2.2 years. Cox proportional-hazard models were applied to evaluate the association between liver enzymes and stroke risk. RESULTS After adjustment for established clinical and lifestyle factors, a 1 unit change in naturally logged GGT was related to a 1.20 (95%CI: 1.03-1.40) increased stroke risk. Risk estimates did not significantly differ between fatal (Relative Risk (RR) = 1.35, 95%CI: 1.14-1.61) and non-fatal events (RR = 1.15; 95%CI: 0.97-1.36). ALT was not associated with overall stroke risk (RR = 0.95; 95%CI: 0.71-1.26). However, in subtype analyses we observed in multivariable adjusted models a significant increased risk of hemorrhagic stroke (RR = 2.00; 95% CI: 1.01-3.96), but decreased risk of ischemic stroke (RR = 0.66; 95%CI: 0.44-0.998). CONCLUSIONS Our data provide further evidence for a link between GGT, but not ALT and overall stroke suggesting that these biomarkers are involved in different pathways of disease development. Further studies are needed to clarify the putative relationships between ALT and subtypes of stroke.
Collapse
Affiliation(s)
- Cornelia Weikert
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Welsh P, Doolin O, Willeit P, Packard C, Macfarlane P, Cobbe S, Gudnason V, Di Angelantonio E, Ford I, Sattar N. N-terminal pro-B-type natriuretic peptide and the prediction of primary cardiovascular events: results from 15-year follow-up of WOSCOPS. Eur Heart J 2013; 34:443-50. [PMID: 22942340 PMCID: PMC3566528 DOI: 10.1093/eurheartj/ehs239] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 07/04/2012] [Accepted: 07/18/2012] [Indexed: 12/20/2022] Open
Abstract
AIMS To test whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) was independently associated with, and improved the prediction of, cardiovascular disease (CVD) in a primary prevention cohort. METHODS AND RESULTS In the West of Scotland Coronary Prevention Study (WOSCOPS), a cohort of middle-aged men with hypercholesterolaemia at a moderate risk of CVD, we related the baseline NT-proBNP (geometric mean 28 pg/mL) in 4801 men to the risk of CVD over 15 years during which 1690 experienced CVD events. Taking into account the competing risk of non-CVD death, NT-proBNP was associated with an increased risk of all CVD [HR: 1.17 (95% CI: 1.11-1.23) per standard deviation increase in log NT-proBNP] after adjustment for classical and clinical cardiovascular risk factors plus C-reactive protein. N-terminal pro-B-type natriuretic peptide was more strongly related to the risk of fatal [HR: 1.34 (95% CI: 1.19-1.52)] than non-fatal CVD [HR: 1.17 (95% CI: 1.10-1.24)] (P= 0.022). The addition of NT-proBNP to traditional risk factors improved the C-index (+0.013; P < 0.001). The continuous net reclassification index improved with the addition of NT-proBNP by 19.8% (95% CI: 13.6-25.9%) compared with 9.8% (95% CI: 4.2-15.6%) with the addition of C-reactive protein. N-terminal pro-B-type natriuretic peptide correctly reclassified 14.7% of events, whereas C-reactive protein correctly reclassified 3.4% of events. Results were similar in the 4128 men without evidence of angina, nitrate prescription, minor ECG abnormalities, or prior cerebrovascular disease. CONCLUSION N-terminal pro-B-type natriuretic peptide predicts CVD events in men without clinical evidence of CHD, angina, or history of stroke, and appears related more strongly to the risk for fatal events. N-terminal pro-B-type natriuretic peptide also provides moderate risk discrimination, in excess of that provided by the measurement of C-reactive protein. Clinical trial registration WOSCOPS was carried out and completed prior to the requirement for clinical trial registration.
Collapse
Affiliation(s)
- Paul Welsh
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, GlasgowG12 8TAUK
| | - Orla Doolin
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Peter Willeit
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Chris Packard
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Peter Macfarlane
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Stuart Cobbe
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Vilmundur Gudnason
- University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | - Emanuele Di Angelantonio
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, GlasgowG12 8TAUK
| |
Collapse
|
41
|
Abstract
Cardiac and peripheral vascular biomarkers are increasingly becoming targets of both research and clinical practice. As of 2008, cardiovascular-related medical care accounts for greater than 20% of all the economic costs of illness in the United States. In the age of burgeoning financial pressures on the entire health care system, never has it been more important to try to understand who is at risk for cardiovascular disease in order to prevent new events. In this paper, we will discuss the cost of cardiovascular disease to society, clarify the definition of and need for biomarkers, offer an example of a current biomarker, namely high-sensitivity C-reactive protein, and finally examine the approval process for utilizing these in clinical practice.
Collapse
Affiliation(s)
- Jana E Montgomery
- Dartmouth-Hitchcock Medical Center, Division of Cardiology, Lebanon, NH 03756, USA.
| | | |
Collapse
|
42
|
Welsh P, Doolin O, McConnachie A, Boulton E, McNeil G, Macdonald H, Hardcastle A, Hart C, Upton M, Watt G, Sattar N. Circulating 25OHD, dietary vitamin D, PTH, and calcium associations with incident cardiovascular disease and mortality: the MIDSPAN Family Study. J Clin Endocrinol Metab 2012; 97:4578-87. [PMID: 23071162 DOI: 10.1210/jc.2012-2272] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Observational studies relating circulating 25-hydroxyvitamin D (25OHD) and dietary vitamin D intake to cardiovascular disease (CVD) have reported conflicting results. OBJECTIVE Our objective was to investigate the association of 25OHD, dietary vitamin D, PTH, and adjusted calcium with CVD and mortality in a Scottish cohort. DESIGN AND SETTING The MIDSPAN Family Study is a prospective study of 1040 men and 1298 women from the West of Scotland recruited in 1996 and followed up for a median 14.4 yr. PARTICIPANTS Locally resident adult offspring of a general population cohort were recruited from 1972-1976. MAIN OUTCOME MEASURES CVD events (n = 416) and all-cause mortality (n = 100) were evaluated. RESULTS 25OHD was measured using liquid chromatography-tandem mass spectrometry in available plasma (n = 2081). Median plasma 25OHD was 18.6 ng/ml, and median vitamin D intake was 3.2 μg/d (128 IU/d). Vitamin D deficiency (25OHD <15 ng/ml) was present in 689 participants (33.1%). There was no evidence that dietary vitamin D intake, PTH, or adjusted calcium were associated with CVD events or with mortality. Vitamin D deficiency was not associated with CVD (fully adjusted hazard ratio = 1.00; 95% confidence interval = 0.77-1.31). Results were similar after excluding patients who reported an activity-limiting longstanding illness at baseline (18.8%) and those taking any vitamin supplements (21.7%). However, there was some evidence vitamin D deficiency was associated with all-cause mortality (fully adjusted hazard ratio = 2.02; 95% confidence interval = 1.17-3.51). CONCLUSION Vitamin D deficiency was not associated with risk of CVD in this cohort with very low 25OHD. Future trials of vitamin D supplementation in middle-aged cohorts should be powered to detect differences in mortality outcomes as well as CVD.
Collapse
Affiliation(s)
- Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Early cardiac risk stratification in obese patients: the need of new simple diagnostic tools. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2012. [DOI: 10.1007/s12349-012-0107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
44
|
Miwa K, Tanaka M, Okazaki S, Furukado S, Sakaguchi M, Mochizuki H, Kitagawa K. Association between interleukin-6 levels and first-ever cerebrovascular events in patients with vascular risk factors. Arterioscler Thromb Vasc Biol 2012; 33:400-5. [PMID: 23175672 DOI: 10.1161/atvbaha.112.300350] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of this study was to examine the association of inflammatory markers with risk of first-ever cerebrovascular events (CVEs), while simultaneously evaluating subclinical vascular disease. METHODS AND RESULTS We enrolled 464 outpatients who had vascular risk factors without any preexisting cardiovascular disease. We examined the presence of silent lacunar infarction (SLI) by magnetic resonance imaging; carotid intima-media thickness by ultrasound; and measured high-sensitivity C-reactive protein, interleukin (IL)-6, and IL-18 at baseline, and assessed their associations with CVEs using Cox proportional hazards models of 4.8±2.6 years follow-up. We further calculated measures of reclassification and discrimination. In age- and sex-adjusted analysis, IL-6, but neither high-sensitivity C-reactive protein nor IL-18, was associated with CVEs. The association remained significant after adjustment for conventional risk factors, intima-media thickness, and SLI (hazard ratios: 1.80, per 1-SD increase in log IL-6, P=0.03). Compared with the patients with below median IL-6 without SLI, those with above median IL-6 and SLI had a higher risk of CVEs (hazard ratios: 4.14, P=0.0014). The combination of IL-6 and SLI resulted in the net reclassification improvement of 14.3% (P=0.04), and the integrated discrimination improvement gain of 2.1% (P=0.05). CONCLUSIONS IL-6 levels were independently associated with CVEs and could improve reclassification in those with SLI.
Collapse
Affiliation(s)
- Kaori Miwa
- Department of Neurology and Stroke Center, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | | | | | | | | |
Collapse
|
45
|
Chen Z, Qian Q, Tang C, Ding J, Feng Y, Ma G. Association of two variants in the interleukin-6 receptor gene and premature coronary heart disease in a Chinese Han population. Mol Biol Rep 2012; 40:1021-6. [PMID: 23073775 DOI: 10.1007/s11033-012-2143-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
Abstract
Two novel single nucleotide polymorphisms (SNPs; rs7529229 and rs2228145) in the interleukin-6 receptor (IL6R) gene have recently been associated with coronary heart disease (CHD) in a European population. We sought to replicate this finding and to investigate associations of these two SNPs with the severity and clinical phenotypes of premature CHD in a Chinese Han population. A total of 418 patients were studied, including 187 cases with coronary stenosis ≥50 % or acute myocardial infarction (males < 55 years and females < 65 years) and 231 controls without documented CHD. A ligase detection reaction was performed to detect rs7529229 and rs2228145. There were no differences between the controls and premature CHD groups in the frequencies for the three genotypes and alleles of rs7529229 and rs2228145 (all P > 0.05), nor did they differ between the two groups when grouped by gender (all P > 0.05). There were also no associations between these two SNPs and the severity of coronary lesions or clinical phenotypes of premature CHD (all P > 0.05). Our results do not support an association between rs7529229 or rs2228145 with premature CHD in the Chinese Han population. Further studies are warranted to elucidate the role of these two SNPs in the development of atherosclerosis and CHD.
Collapse
Affiliation(s)
- Zhong Chen
- Department of Cardiology, The Affiliated Zhongda Hospital and School of Medicine, Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, People's Republic of China.
| | | | | | | | | | | |
Collapse
|
46
|
de Jager SCA, Bongaerts BWC, Weber M, Kraaijeveld AO, Rousch M, Dimmeler S, van Dieijen-Visser MP, Cleutjens KBJM, Nelemans PJ, van Berkel TJC, Biessen EAL. Chemokines CCL3/MIP1α, CCL5/RANTES and CCL18/PARC are independent risk predictors of short-term mortality in patients with acute coronary syndromes. PLoS One 2012; 7:e45804. [PMID: 23029252 PMCID: PMC3448678 DOI: 10.1371/journal.pone.0045804] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 08/24/2012] [Indexed: 12/25/2022] Open
Abstract
Cytokines play an important role in ischemic injury and repair. However, little is known about their prognostic value in cardiovascular disease. The aim of this study was to investigate the prognostic importance of chemokines CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC for the risk of future cardiovascular events in patients with acute coronary syndromes (ACS). Baseline levels of CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC were determined in ACS patients from the Bad Nauheim ACS II registry (n = 609). During the following 200 days, patients were monitored for the occurrence of fatal and non-fatal cardiovascular events. Patients with CCL3/MIP1α, CCL5/RANTES and CCL18/PARC concentrations in the highest tertile were associated with an increased risk of a fatal event during follow-up (HR: 2.19, 95%CI: 1.04–4.61 for CCL3/MIP1α, HR: 3.45, 95%CI: 1.54–7.72 for CCL5/RANTES and HR: 3.14, 95%CI: 1.33–7.46 for CCL18/PARC). This risk was highest for patients with all three biomarkers concentrations in the upper tertile (HR: 2.52, 95%CI: 1.11–5.65). Together with known risk predictors of cardiovascular events, CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC combined improved the c-statistics from 0.74 to 0.81 (p = 0.007). In conclusion, CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC are independently associated with the risk of short-term mortality in ACS patients. Combining all three biomarkers further increased their prognostic value.
Collapse
Affiliation(s)
- Saskia C. A. de Jager
- Division of Biopharmaceutics, Leiden Amsterdam Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Brenda W. C. Bongaerts
- Department of Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Maastricht, The Netherlands
- * E-mail:
| | - Michael Weber
- Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | | | - Mat Rousch
- Department of Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Maastricht, The Netherlands
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Kitty B. J. M. Cleutjens
- Department of Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Maastricht, The Netherlands
| | - Patty J. Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Theo J. C. van Berkel
- Division of Biopharmaceutics, Leiden Amsterdam Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Erik A. L. Biessen
- Department of Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, Maastricht, The Netherlands
| |
Collapse
|
47
|
Kim KI, Oh SW, Ahn S, Heo NJ, Kim S, Chin HJ, Na KY, Chae DW, Kim CH, Kim S. CRP level and HDL cholesterol concentration jointly predict mortality in a Korean population. Am J Med 2012; 125:787-95.e4. [PMID: 22840665 DOI: 10.1016/j.amjmed.2012.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 02/03/2012] [Accepted: 02/29/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND C-reactive protein (CRP) and high-density lipoprotein (HDL) cholesterol are well-known cardiovascular predictors. However, the joint effect of these parameters on long-term mortality has not been established. METHODS We studied a total of 92,500 subjects older than 20 years who underwent routine health examination at the three health care centers affiliated with Seoul National University. High-sensitivity CRP and the lipid profile were obtained at baseline. Subjects were followed for a median of 45.5 months. Mortality data were obtained from the National Statistics Office of Korea. RESULTS There were 649 deaths (0.7%) during the follow-up. The leading cause of death was cancer. The subjects who died were significantly older, had a male predominance, and had increased levels of inflammatory markers. A significant mortality difference was identified according to the CRP and HDL cholesterol levels. Considering both parameters jointly, subjects with a CRP ≥1.4 mg/L (highest quartile) and HDL cholesterol <45 mg/dL (lowest quartile) were at the highest risk for all-cause mortality, even after adjusting for covariates (hazard ratio 2.29, 95% confidence interval, 1.83~2.87). After matching on the propensity score, 6304 subjects with a high CRP and low HDL cholesterol were at high risk of death (hazard ratio 2.52, 95% confidence interval, 1.59~4.01). Interestingly, the joint effect of CRP and HDL cholesterol was observed for cardiovascular as well as cancer-related mortality prediction. CONCLUSIONS Elevated CRP and low HDL cholesterol jointly contribute to the prediction of all-cause, cancer, and cardiovascular mortality in Koreans. The interactive relationship between them in mediating inflammatory processes might explain these results.
Collapse
Affiliation(s)
- Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Fava C, Montagnana M, Guidi GC, Melander O. From circulating biomarkers to genomics and imaging in the prediction of cardiovascular events in the general population. Ann Med 2012; 44:433-47. [PMID: 21623699 DOI: 10.3109/07853890.2011.582511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. In the last decades numerous markers have been considered and investigated for the prediction of CV events, but only a few of them resulted in improved global risk assessment beyond traditional risk factors when incorporated into coronary evaluation scores. Recent genetic studies have pointed out a few but consistent loci or genes which are independently associated with CV risk. The idea is fascinating that these genetic markers could lead to improved individual CV risk assessment and tailored pharmacological interventions. In this brief review we will not make a systematic review of all non-genetic and genetic markers of CV risk but we will try to make a brief overview of the most interesting ones with the aim to underline potential 'pros' and 'cons' of their implementation in clinical practice.
Collapse
Affiliation(s)
- Cristiano Fava
- Department of Clinical Sciences, Lund University, University Hospital of Malmö, Sweden
| | | | | | | |
Collapse
|
49
|
Barzilay JI, Howard AG, Evans GW, Fleg JL, Cohen RM, Booth GL, Kimel AR, Pedley CF, Cushman WC. Intensive blood pressure treatment does not improve cardiovascular outcomes in centrally obese hypertensive individuals with diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial. Diabetes Care 2012; 35:1401-5. [PMID: 22723577 PMCID: PMC3379577 DOI: 10.2337/dc11-1827] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial reported no differences in most cardiovascular disease (CVD) outcomes between intensive and standard blood pressure therapy in individuals with diabetes mellitus (DM) and hypertension. Many such individuals are centrally obese. Here we evaluate whether the trial outcomes varied by the level of central obesity. RESEARCH DESIGN AND METHODS The cohort included 4,687 people (47.7% women) with DM and hypertension. Mean age was 62.2, and mean follow-up was 4.7 years. Participants were randomly assigned to one of two blood pressure treatment strategies: intensive (systolic <120 mmHg) or standard (systolic <140 mmHg). Sex-specific quartiles of waist-to-height ratio were used as the measure of central obesity. The primary ACCORD outcome (a composite of nonfatal myocardial infarction [MI], nonfatal stroke, or CVD death) and three secondary outcomes (nonfatal MI, fatal or nonfatal stroke, and CVD death) were examined using proportional hazard models. RESULTS There was no evidence that the effect of intensively lowering blood pressure differed by quartile of waist-to-height ratio for any of the four outcomes (P > 0.25 in all cases). Controlling for waist-to-height quartile had no significant impact on previously published results for intensive blood pressure therapy. Waist-to-height ratio was significantly related to CVD mortality (hazard ratio 2.32 [95% CI 1.40-3.83], P = 0.0009 comparing the heaviest to lightest quartiles), but not to the other outcomes (P > 0.09 in all cases). CONCLUSIONS Intensive lowering of blood pressure versus standard treatment does not ameliorate CVD risk in individuals with DM and hypertension. These results did not vary by quartile of waist-to-height ratio.
Collapse
|
50
|
Rosero-Bixby L, Dow WH. Predicting mortality with biomarkers: a population-based prospective cohort study for elderly Costa Ricans. Popul Health Metr 2012; 10:11. [PMID: 22694922 PMCID: PMC3507767 DOI: 10.1186/1478-7954-10-11] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 05/22/2012] [Indexed: 01/26/2023] Open
Abstract
Background Little is known about adult health and mortality relationships outside high-income nations, partly because few datasets have contained biomarker data in representative populations. Our objective is to determine the prognostic value of biomarkers with respect to total and cardiovascular mortality in an elderly population of a middle-income country, as well as the extent to which they mediate the effects of age and sex on mortality. Methods This is a prospective population-based study in a nationally representative sample of elderly Costa Ricans. Baseline interviews occurred mostly in 2005 and mortality follow-up went through December 2010. Sample size after excluding observations with missing values: 2,313 individuals and 564 deaths. Main outcome: prospective death rate ratios for 22 baseline biomarkers, which were estimated with hazard regression models. Results Biomarkers significantly predict future death above and beyond demographic and self-reported health conditions. The studied biomarkers account for almost half of the effect of age on mortality. However, the sex gap in mortality became several times wider after controlling for biomarkers. The most powerful predictors were simple physical tests: handgrip strength, pulmonary peak flow, and walking speed. Three blood tests also predicted prospective mortality: C-reactive protein (CRP), glycated hemoglobin (HbA1c), and dehydroepiandrosterone sulfate (DHEAS). Strikingly, high blood pressure (BP) and high total cholesterol showed little or no predictive power. Anthropometric measures also failed to show significant mortality effects. Conclusions This study adds to the growing evidence that blood markers for CRP, HbA1c, and DHEAS, along with organ-specific functional reserve indicators (handgrip, walking speed, and pulmonary peak flow), are valuable tools for identifying vulnerable elderly. The results also highlight the need to better understand an anomaly noted previously in other settings: despite the continued medical focus on drugs for BP and cholesterol, high levels of BP and cholesterol have little predictive value of mortality in this elderly population.
Collapse
Affiliation(s)
- Luis Rosero-Bixby
- University of California at Berkeley, School of Public Health, 239 University Hall, #7360, Berkeley, CA, 94720-7360, USA.
| | | |
Collapse
|