Statin therapy intensity and physical activity after acute coronary syndrome

Introduction/Purpose

High-intensity statin after acute coronary syndrome (ACS) may cause reduced physical activity because of statin-associated muscle symptoms. We aimed to assess the association between statin intensity and physical activity one year after ACS.

Methods

We studied patients from the Special Program University Medicine-Acute Coronary Syndromes (SPUM-ACS) study, a large multicenter prospective Swiss cohort. In a cross-sectional assessment one year after the index ACS, we identified high-intensity, low/moderate intensity, and no statin users. Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ). Using a multivariable adjusted negative binomial hurdle model, metabolic equivalent-minutes per week (MET-min/week) were first stratified into sedentary and physically active categories, and then analyzed continuously among physically active patients. Models were adjusted for age, sex, education, body mass index, depression, type of ACS, pre-existing chronic disease, premature coronary heart disease, LDL-cholesterol, anti-hypertensive treatment, cardiac rehabilitation, and follow-up medical visits after hospital discharge.

Results

Among the 2274 patients included in the SPUM-ACS cohort, 1222 (53.7%) were on high intensity statin, 890 (39.1%) on low/moderate intensity statin, and 162 (7.1%) were not on statin. Compared to no statin users, low/moderate intensity statin users were more likely to be physically active than sedentary, with a fully adjusted odds ratio (OR) of 2.78, 95% confidence interval (CI) 1.11–6.93. A similar association was found when comparing non-users with high-intensity statin users, with a fully adjusted OR of 4.18, 95% CI 1.65–10.60. Among physically active patients, physical activity level median scores were 2792.5 MET-min/week in no statin category, 2712.0 and 2839.5 in moderate/low statin category and high statin category respectively (p=0.307), showing no statistically significant difference with median ratios of 1.02, 95% CI 0.84–1.22 and 1.06, 95% CI of 0.88–1.27 for low/moderate intensity and high-intensity statin use, respectively.

Conclusion

One year after an ACS, neither low/moderate nor high-intensity statin was associated with reduced physical activity compared to no statin use. These findings go against the belief that statin therapy may lead to reduced physical activity among ACS patients because of associated muscular symptoms.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Center for primary care and public health (Unisanté)

Forage system is the key driver of mountain milk specificity

The aims of this work were to determine the effect of upland origin on milk composition when comparing similar lowland and upland production system and to highlight the factors responsible for the added value of upland milk from commercial farms. Tanker milk from 55 groups of farms (264 farms in total) in France, Slovakia, and Slovenia was collected twice during the indoor season and 3 times during the outdoor season. The tanker rounds were selected in each country to be balanced according to their origin (lowland or upland) and within upland or lowland groups, according to the forage systems: corn-based or grass-based forage system. At each milk sampling, the production conditions were recorded through on-farm surveys. The milk was analyzed for gross composition, carotenoids, minerals, fatty acids, phenolic compound derivatives, volatile organic compound concentrations, and color. The milk from upland and lowland areas differed in their contents of a few constituents. Upland milk was richer in not identified (n.i.) retention time (Rt) 13,59, 4-methylpentylbenzene, 1-methyl-2-n-hexylbenzene, and β-caryophyllene than lowland milk. These differences could be most likely attributable to the utilization of highly diversified and extensively managed semi-natural grasslands. The higher forbs content of upland pastures could be related as well to the richness in C18:3n-3, CLA cis-9,trans-11, MUFA, and PUFA we observed in upland compared with lowland milk during the outdoor season. In contrast, grazing on lowland pastures rich in grasses gave a yellower milk that was richer in β-carotene. Out of the few compounds showing a significant effect of origin or its interaction, most of the milk constituents were unaffected by the origin at all. However, almost all milk constituents differed according to the forage system and the season, and the differences observed between seasons can be attributed to differences in the cow diet composition.

Dietary cation-anion difference and day length have an effect on milk calcium content and bone accretion of dairy cows

Milk and dairy products are an important source of Ca for humans. Recent studies have shown fluctuations in cow milk Ca content during the year in France, with high values in winter and with corn silage diets, and a decrease during May and June and with grass diets. The aim of this study was to identify the reasons for this seasonal decrease in milk Ca content by testing the effect of 2 levels of dietary cation-anion differences (DCAD; 0 mEq/kg of dry matter for DCAD 0 and 400 mEq/kg for DCAD 400) and 2 day lengths (8 h of light/d for short days: SD; and 16 h/d for long days: LD) on the Ca balances of dairy cows. The DCAD treatments were designed to mimic diets based either on corn silage or on herbage. The cows were only illuminated by solarium lights providing UVA and UVB. The trial was conducted according to 2 simultaneous replicates of a 4×4 Latin square design using 8 dairy cows averaging 103±44 d in milk with 4 periods of 14 d. Data were analyzed by ANOVA with a model including treatment, cow, and period effects. No significant interaction was found between day length and DCAD treatments. With DCAD 400 compared with DCAD 0, blood pH increased and plasma ionized Ca content decreased, whereas the plasma total Ca content did not differ between treatments. Milk Ca content, however, increased with DCAD 400 compared with DCAD 0, in relation to a decrease in the amount of Ca excreted in urine. The DCAD had no significant effect on protein and casein contents and DCAD 400 tended to decrease milk yield. This illustrates that the udder did not decrease Ca uptake from the blood at high DCAD even though DCAD 400 decreased the mammary availability of Ca by decreasing the proportion of blood ionized Ca. Milk Ca and casein contents were significantly lower with LD compared with SD, whereas day length had no effect on milk yield after 14 d of treatment. Bone accretion of cows increased when the Ca content of milk increased (i.e., with DCAD 400 compared with DCAD 0 and with SD compared with LD). This work suggests that long and sunny days could explain part of the seasonal decrease in milk Ca content in summer and refutes the hypothesis that low milk Ca contents at grazing could be due to the high DCAD of herbage.

Effects of Rumen or Duodenal Glucose Infusions on Intake in Dairy Cows Fed Fresh Perennial Ryegrass Indoors

The aim of this study was to determine whether the intake of fresh highly digestible ryegrass could be limited by the total amount of energy absorbed. Moreover, it investigated whether the limitation was more specific to energy absorbed as volatile fatty acids in the rumen compared with energy absorbed in the lower gastrointestinal tract. Four treatments were compared: infusion of 1.25 kg of glucose into the rumen (R1.25), infusion of 2.5 kg of glucose into the rumen (R2.5), infusion of 1.5 kg of glucose into the duodenum (D1.5), and a control treatment consisting of water and salts. Treatments R2.5 and D1.5 were assumed to supply about 16.5 MJ of net energy for lactation. All treatments consisted of 2 infusions, one into the rumen and the other into the duodenum, with one of these infusions being a control. All infused solutions were isoosmotic with osmolarities around 340 and 330 mmol/L for rumen and duodenum, respectively. Treatments were compared using 4 dairy cows in mid lactation according to a 4 x 4 Latin square design replicated twice during 8 periods of 7 d each. Cows were housed in tie stalls and fed ad libitum with fresh perennial ryegrass cut every morning during the spring at 28 d of regrowth. Intake and feeding behavior were measured, as well as concentrations of ruminal fermentation products and some blood metabolites. The pepsin-cellulase organic matter digestibility of the offered herbage averaged 0.76 +/- 0.011. The average dry matter intake of herbage was 15.5 +/- 0.52 kg/d. The glucose infusions decreased dry matter intake by 0.95 kg/d compared with the control, but had the same satiating effect regardless of site or dose of infusion. The average concentration of volatile fatty acids in rumen fluid was 97.9 +/- 2.03 mmol/L and the molar proportion of propionate was 21.6 +/- 0.19 mmol/100 mmol. Glucose infusions into the rumen led to a decrease in the molar proportions of acetate from 64.4 on the control treatment to 60.9 mmol/100 mmol on R2.5 and increased the molar proportions of butyrate from 10.2 (control) to 13.5 mmol/100 mmol on R2.5, and minor acids (valerate and caproate), from 1.27 (control) to 2.54 mmol/100 mmol on R2.5, proportionally to the dose infused. These results suggested that energy nutrients can limit intake in dairy cows fed high-digestibility ryegrass and that butyrate and minor acids would have a limited satiating effect compared with propionate.

Picking the S1, S1' and S2' pockets of matrix metalloproteinases. A niche for potent acyclic sulfonamide inhibitors

A series of acyclic hydroxamic acids harboring strategically placed alpha-arylsulfonamido and thioether groups was synthesized and found to be potent inhibitors of various MMPs. An unprecedented cleavage of t-butyl hydroxamates to hydroxamic acids was found.

A structural rationale for the design of water soluble peptide-derived neurokinin-1 antagonists

Molecular models of a pharmacophore for NK1 neurokinin antagonists and of ligand-receptor complexes for the human NK1 G protein-coupled receptor are presented. The models develop a structural rationale for the discovery of the recently described highly potent peptidomimetic NK1 antagonists S18523 and S19752 which were designed to be water soluble. Water solubility was conferred on these compounds by introduction of an anionic butyl-tetrazole substituent on the scaffold of dipeptide-derived NK1 antagonist analogues. The models provide convincing evidence that the anionic butyl-tetrazole moieties of S18523 and S19752 protrude outside the membrane-spanning domain of the receptor and do not interfere significantly with the core of the antagonist binding site. It is emphasized that this result could only be obtained through the combination of the two modelling approaches. The result suggest a general way to modify the transport properties of the peptidomimetic antagonists without altering the receptor-binding interaction, and it outlines the potential of including the combination of pharmacophore models and crude models of receptor-ligand complexes early in the drug design process.

New tripeptidic thrombin inhibitors. Influence of P2 and P3 residues on activity and selectivity

Structural variations of P2 and P3 residues in tripeptidic boroarginine thrombin inhibitors led to compounds with similar potency than reference compound DuP 714, but with enhanced selectivity for thrombin compared to plasmin.

Molecular lipophilicity potential, a tool in 3D QSAR: method and applications

A new method is presented to calculate the Molecular Lipophilicity Potential (MLP). The method is validated by showing that the MLP thus generated on the solvent-accessible surface can be used to back-calculate log P. Because the MLP is shown to be sensitive to conformational effects, the MLP/log P relation is best sought by taking all conformers into account. The MLP method presented here can be used as a third field in CoMFA studies, as illustrated with two series of alpha 1-adrenoceptor ligands. In the first series, the steric, electrostatic and lipophilic fields are highly intercorrelated, and taken separately yield comparable models. In the second series of ligands, the best model is obtained with the lipophilic field alone, allowing insights into ligand-receptor interactions.

[New cases of chromoblastomycosis: importances of anatomo-pathologic examinations]

Several cases of chromoblastomycosis have been observed, for 7 years, in the laboratory of Pathology, in the IMTSSA . Their various aspects are described. The diagnosis includes three stages: clinic, mycology and pathology. The most frequent clinical lesions have been observed on the legs. Often, they were like a malignant tumour (carcinoma). The fungal investigation, by direct research of fungi in the lesions, is carried out scarcely, because it is difficult. It should be completed by cultures, in order to isolate the pathogenic agent, but its identification is not possible, if it is not carried out by a laboratory of mycology. The most simple technique , adapted to tropical areas, is the pathological examination. It reveals several points of interest: by analyzing the cutaneous lesions (in order to eliminate a carcinoma)--observing the intensity of the inflammatory reaction--but, first of all, the discovery of the thick-walled dark cells. Two techniques are usual, for staining, but they could be improved by using other special techniques, in order to analyse more carefully the lesions.

Screening blood donors for Plasmodium falciparum malariae. Application of ready-to-use homologous antigens

Prevention of post-transfusion malaria remains a worrying problem. Until now it was very difficult to obtain homologous antigens, and immunologic methods used to detect malaria were expensive. We tested the ready-to-use Plasmodium falciparum prepared slides using the IFA (indirect fluorescent antibody) test on 866 selected potentially dangerous donors and known malaria cases. We found that it is a simple, quick, reliable and inexpensive method that can be easily used by blood banks and improve blood transfusion safety.

[Identification of blood donors capable of transmitting P. falciparum. Use of homologous antigenic preparations ready for use]

The smears of P. falciparum parasited blood ready to be employed, that we have tested in indirect immunofluorescence to detect blood donors who can be at the origin of post transfusional paludism, seem to offer a very important progress to us for the improvement of transfusion security. Their routine use can be recommended because their easy way of using allows their adoption by very many transfusion centers.

[Prepyloric ulcer and gastric schistosomiasis (report of a Tananarive case) (author's transl)]

The authors report on a case of a 37 years old man, from Madagascar, who had a gastric ulcer. The biopsies which were performed during endoscopy, gave evidence of ova of schistosoma inside the gastric mucosa. There was also a rectal and hepatic schistosomiasis (S. mansoni). Evolution was good with specific treatment (Niridazole). Short review of litterature, and discussion.

[Distribution of HBs antigen in Tananarive (author's transl)]

This survey has been conducted among blood donors and patients with hepatitis, cirrhosis, liver carcinomas and various causes of liver dysfunction or enlargement. The frequency is 5,4 p. 100 among blood donors and 50 p. 100 among cases of hepatitis.

[Thyphoid fever in Tananarive (Madagascar): a review of 20o cases (author's transl)]

A clinical and biological study of 200 cases in Tananarive. The conventional clinical form is still frequent because patients have no immunity and report too late to the hospital. The main complications concern the heart and the digestive tract. Hemoculture is the main clue for the diagnosis. Biochemical and specially enzymatic unconventional data whichs have been recently reported are frequently observed. No resistance to chloramphenicol has yet been detected in Tananarive.

[Shigellosis in Tananarive (Madagascar). II : Bacteriologic and therapeutic features (author's transl)]

In acute dysenteries or diarrhoeas shigellae are the bacterial organisms which are the most frequently isolated from coprocultures. The most frequent sub-group is sub-group B (S. flexniri). In vitro, shigellae are sensible to all antibiotics but often resistant to sulfamids. Treatment is not difficult.

[Shigellosis in Tananarive (Madagascar) I - Epidemiologic and clinic features (author's transl)]

Reviewing 67 cases of human adult shigellosis observed in Madagascar, the authors emphasize some epidemiologic and clinic features : high frequency during rainy season, usual dysenteriform aspect or diarrhoeas with fever, hemorragic forms, severity according to anterior state of colon and rectum, severity if cases associated with amoebiasis or schistosomiasis (Schistosoma mansoni).

[Distribution of HBs antigen in Tananarive (author's transl)]

This survey has been conducted among blood donors and patients with hepatitis, cirrhosis, liver carcinomas and various causes of liver dysfunction or enlargement. The frequency is 5,4 p. 100 among blood donors and 50 p. 100 among cases of hepatitis.

[Human meat-borne salmonellosis: epidemiological reflections on a bacteriological survey of the butchers' shops of a large town (author's transl)]

The bacteriological examination of 100 butchers' blocks has led to the identification of eight strains (two from the same sample) of Salmonella belonging to the following serotypes: S. wien, S. coeln (horsemeat), S. newport (poultry), S. infantis, S. derby, S. panama, S. bredeney, S. sofia. The relative importance of these serotypes in the region of Toulon is considered and compared to the frequency of human serotypes, the most important of which is S. typhi murium. The methods used for isolation seem to have little influence on these apparently-conflicting results.