1
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Atzl M, Muendlein A, Winder T, Fraunberger P, Brandtner EM, Geiger K, Klausberger M, Duerkop M, Sprenger L, Mutschlechner B, Volgger A, Benda M, Severgnini L, Jaeger JB, Drexel H, Lang A, Leiherer A. SARS-CoV-2 RBD-specific and NP-specific antibody response of healthcare workers in the westernmost Austrian state Vorarlberg: a prospective cohort study. BMJ Open 2022; 12:e052130. [PMID: 35613821 PMCID: PMC9174531 DOI: 10.1136/bmjopen-2021-052130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Austria, and particularly its westernmost federal state Vorarlberg, developed an extremely high incidence rate during the COVID-19 pandemic. Healthcare workers (HCWs) worldwide are known to have an increased risk of contracting the disease within the working environment and, therefore, the seroprevalence in this population is of particular interest. We thus aimed to analyse SARS-CoV-2-specific antibody dynamics in Vorarlberg HCWs. DESIGN Prospective cohort study of HCWs including testing at three different time points for the prevalence of anti-SARS-CoV-2 IgG antibodies specific for nucleocapsid protein (NP) and receptor-binding domain (RBD). SETTING All five state hospitals of Vorarlberg. PARTICIPANTS A total of 395 HCWs, enrolled in June 2020 (time point 1 (t1)), 2 months after the end of the first wave, retested between October and November at the beginning of the second wave (time point 2 (t2)) and again at the downturn of the second wave in January 2021 (time point 3 (t3)). MAIN OUTCOMES We assessed weak and strong seropositivity and associated factors, including demographic and clinical characteristics, symptoms consistent with COVID-19 infection, infections verified by reverse transcription PCR (RT-PCR) and vaccinations. RESULTS At t1, 3% of HCWs showed strong IgG-specific responses to either NP or RBD. At t2, the rate had increased to 4%, and at t3 to 14%. A strong response was found to be stable for up to 10 months. Overall, only 55% of seropositive specimen had antibodies against both antigens RBD and NP; 29% had only RBD-specific and 16% only NP-specific antibodies. Compared with the number of infections found by RT-PCR, the number of HCWs being seropositive was 38% higher. CONCLUSION AND RELEVANCE Serological testing based on only one antigen implicates the risk of missing infections; thus, the set of antigens should be broadened in the future. The seroprevalence among participating HCWs was comparable to the general population in Austria. Nevertheless, in view of undetected infections, monitoring and surveillance should be reconsidered.
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Affiliation(s)
- Michele Atzl
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Thomas Winder
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Peter Fraunberger
- Medical Central Laboratories, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Eva-Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Miriam Klausberger
- Department of Biotechnology, University of Natural Resources and Life Sciences (BOKU) Vienna, Wien, Austria
| | - Mark Duerkop
- Department of Biotechnology, University of Natural Resources and Life Sciences (BOKU) Vienna, Wien, Austria
| | - Lukas Sprenger
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Beatrix Mutschlechner
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Andreas Volgger
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Magdalena Benda
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Luciano Severgnini
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Johannes B Jaeger
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Department of Internal Medicine and Intensive Care, Academic Teaching Hospital Bregenz, Bregenz, Austria
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Alois Lang
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Medical Central Laboratories, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
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2
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Reimann P, Ulmer H, Mutschlechner B, Benda M, Severgnini L, Volgger A, Lang T, Atzl M, Huynh M, Gasser K, Grabher C, Mink S, Fraunberger P, Petrausch U, Hartmann B, Winder T. Efficacy and safety of heterologous booster vaccination with Ad26.COV2.S after BNT162b2 mRNA COVID-19 vaccine in haemato-oncological patients with no antibody response. Br J Haematol 2021; 196:577-584. [PMID: 34872162 DOI: 10.1111/bjh.17982] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 01/11/2023]
Abstract
Patients with haemato-oncological malignancies are one of the high-risk groups for a severe course in case of COVID-19 infections. Furthermore, vaccination results in significantly lower response rates in haematological malignancies and lower antibody levels in patients with solid cancer. We investigated efficacy and safety of a heterologous booster vaccination with Ad26.COV2.S DNA vector vaccine in haemato-oncological patients without antibody response after double-dose BNT162b2 messenger (m-)RNA COVID-19 vaccine. A total of 32 haemato-oncological non-responders to double-dose BNT162b2 received a heterologous booster vaccination with Ad26.COV2.S. Blood samples were assessed directly before the vaccination (T0) and four weeks after (T1). Safety assessment was performed using a standardised questionnaire. The overall response rate was 31%, with a mean (SD) antibody titre of 693·79 (1 096·99) binding activity units (BAU)/ml. Patients with chronic lymphocytic leukaemia or lymphoma showed a significantly lower response rate (P = 0·048). Adverse events were reported in 29·6% of patients, of which 7·1% were graded as severe, including grade III and IV events following the Common Terminology Criteria of Adverse Events (CTCAE). The heterologous booster vaccination with Ad26.COV2.S led to a serological response in nine out of 29 patients without response after double-dose BNT162b2. Furthermore, the vaccination was safe in our cohort, leading to mainly mild local and systemic reactions. Overall, this vaccination regimen should be further evaluated to increase the response rate in the highly vulnerable population of haemato-oncological patients.
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Affiliation(s)
- Patrick Reimann
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Beatrix Mutschlechner
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein.,Department of Internal Medicine I, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Magdalena Benda
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
| | - Luciano Severgnini
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Andreas Volgger
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Theresia Lang
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Michele Atzl
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Minh Huynh
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Klaus Gasser
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | | | - Sylvia Mink
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein.,Medical Central Laboratories, Feldkirch, Austria
| | | | - Ulf Petrausch
- University of Zurich, Zurich, Switzerland.,Onkozentrum Zürich, Swiss Tumour Immunology Institute, Zürich, Switzerland
| | - Bernd Hartmann
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Thomas Winder
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria.,University of Zurich, Zurich, Switzerland
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3
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Leiherer A, Muendlein A, Saely CH, Larcher B, Mader A, Maechler M, Sprenger L, Mutschlechner B, Benda M, Laaksonen R, Laaperi M, Jylha A, Fraunberger P, Drexel H. The ceramide- and phosphatidylcholine- based Coronary Event Risk Test2 (CERT2) and cardiovascular mortality in men and women with type 2 diabetes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The recently introduced Coronary Event Risk Test version 2 (CERT2) is a validated cardiovascular risk predictor score that uses circulating ceramide and phosphatidylcholine concentrations.
The purpose of this study was to investigate the power of CERT2 to predict cardiovascular mortality in 280 male and 121 female patients with type 2 diabetes (T2DM).
Prospectively, we recorded 55 cardiovascular deaths in men and 19 in women during a mean follow-up time of 7.6±3.6 and 8.1±3.4 years respectively.
Overall, cardiovascular survival decreased with increasing CERT2 risk categories (figure 1). In Cox regression models, CERT2 significantly predicted the incidence of cardiovascular mortality in male patients with T2DM (unadj. HR 1.82 [1.39–2.37] per standard deviation; p<0.001), the unadj. HR in women was 1.36 [0.83–2.22]; p=0.228). After adjustment for age, BMI, current smoking, LDL cholesterol, HDL cholesterol, hypertension, and statin use the HR in men was 1.73 [1.31–2.29]; p<0.001) and 1.40 [083–2.36]; p=0.210 in women. Interaction terms CERT2 x gender were non-significant both in univariate analysis (p=0.354) and after multivariate adjustment (p=0.359).
We conclude that sex does not significantly impact the association of CERT2 with cardiovascular mortality in patients with T2DM.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | | | | | - A Jylha
- Zora Biosciences, Espoo, Finland
| | | | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
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4
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Mader A, Sprenger L, Vonbank A, Larcher B, Maechler M, Mutschlechner B, Benda M, Leiherer A, Muendlein A, Drexel H, Saely CH. Remnant cholesterol in patients with established cardiovascular disease predicts cardiovascular events both among patients with type 2 diabetes and among non-diabetic subjects. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Remnant cholesterol, which is calculated as total cholesterol minus LDL cholesterol minus HDL cholesterol has attracted interest as a marker of cardiovascular event risk.
The purpose of this study was to investiage whether remnant cholesterol has the power to predict cardiovascular events in patients with established cardiovascular disease.
We enrolled 1822 consecutive patients with established cardiovascular disease, including 1472 with angiographically proven stable CAD, 350 with sonographically proven peripheral artery disease. Prospectively, cardiovascular events were recorded over a mean follow-up period of 6.2±3.2 years.
At baseline, remnant cholesterol was significantly higher in patients with T2DM (n=608) than in non-diabetic subjects (27±25 vs. 21±21 mg/dl; p<0.001). During follow-up, 584 of our patients suffered cardiovascular events; the event rate was significantly higher in patients with T2DM than in non-diabetic subjects (45.4 vs. 32.2%; p<0.001). Remnant cholesterol in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index and LDL cholesterol independently predicted cardiovascular events in the total study population (standardized adjusted HR 1.15 [1.07–1.23]; p<0.001), and in patients with T2DM as well as in non-diabetic subjects (standardized adjusted HRs 1.17 [1.03–1.34]; p=0.013 and 1.12 [1.01–1.23]; p=0.028, respectively).
From our data we conclude that remnant cholesterol in patients with established cardiovascular disease predicts cardiovascular events both among patients with T2DM and among non-diabetic subjects.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | - A Vonbank
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | - A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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5
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Leiherer A, Muendlein A, Geiger K, Saely CH, Larcher B, Mader A, Maechler M, Sprenger L, Mutschlechner B, Benda M, Fraunberger P, Drexel H. The new myokine myonectin is significantly associated with type 2 diabetes in elderly patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The novel myokine myonectin is predominantly expressed in skeletal muscle and is involved in the regulation of metabolic homeostasis. A putative association between myonectin and type 2 diabetes mellitus (T2DM) has been discussed controversially in current literature.
The purpose of this study was to investigate the association between myonectin and T2DM at different ages.
We measured myonectin in 410 vascular risk patients with a mean age of 66 years.
Myonectin did not correlate with age (r=−0.19; p=0.697). From our patients 219 (53%) were >65 years, with a mean age of 74 years and 191 ≤65 years, with a mean age of 57 years. The prevalence of T2DM was 40.6% vs. 42.4% in the older as compared to the younger age group. Myonectin concentrations were significantly decreased in elderly patients with T2DM compared to non-diabetic subjects (1.8 vs. 4.2 ng/ml; p=0.002), whereas no significant difference was observed in younger patients (2.6 vs. 2.3 ng/ml; p=0.183). Concordantly, regression analysis revealed an unadjusted odds ratio (OR) of 0.24 [0.07–0.81] (p=0.021) for the association between myonectin and T2DM in elderly patients but not in younger patients (OR=1.08 [0.80–1.45]; p=0.609). The association between myonectin and T2D; remained significant after adjusting for sex, body mass index, LDL cholesterol, HDL cholesterol, current smoking, as well as statin intake in elderly but remained non-significant in younger patients (OR=0.23 [0.07–0.81]; p=0.021 vs. OR=1.05 [0.76–1.46]; p=0.769).
We conclude that plasma myonectin levels are significantly associated with T2DM, particularly in elderly vascular risk patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - K Geiger
- VIVIT Institute, Feldkirch, Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | | | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
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6
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Sprenger L, Vonbank A, Larcher B, Mader A, Maechler M, Mutschlechner B, Benda M, Leiherer A, Muendlein A, Drexel H, Saely CH. Type 2 diabetes, chronic kidney disease and major cardiovascular events in patients with established coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Both type 2 diabetes (T2DM) and chronic kidney disease (CKD) confer a high risk of cardiovascular disease (CVD), and these conditions frequently coincide.
The purpose of this study was to investigate the single and joint effects of T2DM and CKD on major cardiovascular events (MACE) in a high-risk population of patients with established coronary artery disease (CAD).
We prospectively investigated 1460 patients with angiographically proven CAD over 10.4±4.8 years, of whom 454 (30.8%) had T2DM and 251 (17.1%) had CKD.
MACE occurred more frequently in T2DM patients than in non-diabetic subjects (40.4% vs 28.7%, p<0.001) and in patients with CKD (eGFR <60ml/min/1.73m2) than in those with an eGRF ≥60ml/min/1.73m2 (51.6% vs 28.3%, p<0.001). When both, T2DM and CKD were considered, 863 subjects had neither T2DM nor CKD, 346 had T2DM but not CKD, 148 did not have diabetes but had CKD, and 103 had both T2DM and CKD. When compared with the incidence of MACE among patients with neither T2DM nor CKD (25.3%), MACE occurred more frequently in patients with T2DM who did not have CKD (35.8%; p<0.001) as well as in non-diabetic patients with CKD (47.6%; p<0.001) and occurred most freuently in patients with both, T2DM and CKD (57.4%; p<0.001), in whom the incidence of MACE was higher than in those with T2DM but not CKD (p<0.001) or those without T2DM but with CKD (p=0.025); the incidence of MACE was higher in non-diabetic CKD patients than in T2DM patients who did not have CKD (p=0.041). In Cox regression analysis, T2DM (HR=1.46 [1.20–1.78]; p<0.001) and CKD (HR=1.81 [1.45–2.27]; p<0.001) were mutually independent predictors of MACE after multivariate adjustment.
We conclude that T2DM and CKD are mutually independent risk factors for MACE in patients with established CAD. CAD patients with both CKD and T2DM are an extremely high risk for MACE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - A Vonbank
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | - A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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7
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Mader A, Maechler M, Larcher B, Sprenger L, Mutschlechner B, Benda M, Leiherer A, Muendlein A, Vonbank A, Drexel H, Saely CH. Type 2 diabetes significantly modulates the power of lipoprotein(a) to predict cardiovascular events and mortality in young coronary artery disease patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Lipoprotein(a) [Lp(a)] is an important cardiovascular risk factor especially in young individuals.
The purpose of this study was to investigate whether Lp(a) has the power to predict cardiovascular events in young coronary artery disease (CAD) patients with type 2 diabetes (T2DM).
Lp(a) was measured in a cohort of 731 patients with angiographically proven CAD who were aged <65 years. Vascular events were recorded over a mean follow-up of 6.6±3.2 years.
At baseline, 216 patients had T2DM, and 515 did not have diabetes. During follow-up, 30.2% of our patients suffered cardiovascular events. Lp(a) proved to be a strong and independent predictor of vascular events in the total study cohort (standardized adjusted HR=1.30 [1.07–1.56]; p=0.007). In subgroup analyses by diabetes status, Lp(a) significantly predicted vascular events in non-diabetic patients (standardized adjusted HR= 1.39 [1.12–1.74]; p=0.003) but not in diabetic patients (standardized adjusted HR=0.93 [0.63–1.38]; p=0.731). An interaction term Lp(a) x T2DM was significant (p=0.002), indicating that T2DM significantly modulated the power of Lp(a) to predict cardiovascular events.
We conclude that Lp(a) significantly modulates the power of Lp(a) to predict cardiovascular events in CAD patients <65 years.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | - A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - A Vonbank
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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8
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Saely CH, Vonbank A, Larcher B, Mader A, Maechler M, Sprenger L, Mutschlechner B, Benda M, Leiherer A, Muendlein A, Drexel H. Type 2 diabetes and risk of major cardiovascular events in peripheral artery disease versus coronary artery disease patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The prevalence of type 2 diabetes (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD.
The purpose of this study was to investigate how the incidence of major cardiovascular events compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes (T2DM).
We prospectively recorded major cardiovascular events and death over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123).
When compared to the incidence of MACE in CAD+/T2DM- patients (25.1%), it was significantly higher in CAD+/T2DM+ patients (35.4%; p<0.001), in PAD+/T2DM- patients (30.2%; p=0.022) and in PAD+/T2DM+ patients (47.2%; p<0.001). Patients with both PAD and T2DM in turn were at a higher risk than CAD+/T2DM+ or PAD+/T2DM- patients (p=0.001 and p<0.001, respectively). The incidence of MACE did not differ significantly between PAD+/T2DM- and CAD+/T2DM+ patients (p=0.413). Compared to patients with CAD, Cox regression analyses after multivariate adjustment showed an adjusted hazard ratio of 1.46 [1.14–1.87], p=0.002 for the presence of PAD. Conversely, T2DM increased the risk of MACE after multivariate adjustment in CAD and PAD patients (adjusted HR 1.58 [1.27–1.98], p<0.001).
In conclusion, our data show that T2DM and the presence of PAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of MACE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - A Vonbank
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | - A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
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9
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Benda M, Mutschlechner B, Ulmer H, Grabher C, Severgnini L, Volgger A, Reimann P, Lang T, Atzl M, Huynh M, Gasser K, Petrausch U, Fraunberger P, Hartmann B, Winder T. Serological SARS-CoV-2 antibody response, potential predictive markers and safety of BNT162b2 mRNA COVID-19 vaccine in haematological and oncological patients. Br J Haematol 2021; 195:523-531. [PMID: 34346068 PMCID: PMC8444745 DOI: 10.1111/bjh.17743] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 01/03/2023]
Abstract
Haemato‐oncological patients are at risk in case of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection. Currently, vaccination is the best‐evaluated preventive strategy. In the present study, we aimed to assess serological response, predictive markers, and safety of BNT162b2 in haemato‐oncological patients. A total of 259 haemato‐oncological patients were vaccinated with two 30 µg doses of BNT162b2 administered 21 days apart. Serological response was assessed by ELECSYS® Anti‐SARS‐CoV‐2‐S immunoassay before vaccination, and at 3 and 7 weeks after the first dose (T1, T2). Safety assessment was performed. At T2 spike protein receptor binding domain (S/RBD) antibodies were detected in 71·4% of haematological and in 94·5% of oncological patients (P < 0·001). Haematological patients receiving systemic treatment had a 14·2‐fold increased risk of non‐responding (95% confidence interval 3·2–63·3, P = 0·001). Subgroups of patients with lymphoma or chronic lymphocytic leukaemia were at highest risk of serological non‐response. Low immunoglobulin G (IgG) level, lymphocyte‐ and natural killer (NK)‐cell counts were significantly associated with poor serological response (P < 0·05). Vaccination was well tolerated with only 2·7% of patients reporting severe side‐effects. Patients with side‐effects developed a higher S/RBD‐antibody titre compared to patients without side‐effects (P = 0·038). Haematological patients under treatment were at highest risk of serological non‐response. Low lymphocytes, NK cells and IgG levels were found to be associated with serological non‐response. Serological response in oncological patients was encouraging. The use of BNT162b2 is safe in haemato‐oncological patients.
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Affiliation(s)
- Magdalena Benda
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
| | - Beatrix Mutschlechner
- Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein.,Department of Internal Medicine I, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | | | - Luciano Severgnini
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Andreas Volgger
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Patrick Reimann
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Theresia Lang
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Michele Atzl
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Minh Huynh
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Klaus Gasser
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Ulf Petrausch
- University of Zurich, Zurich, Switzerland.,Onkozentrum Zürich, Swiss Tumor Immunology Institute, Zurich, Switzerland
| | | | - Bernd Hartmann
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Thomas Winder
- Department of Internal Medicine II, Feldkirch Academic Teaching Hospital, Feldkirch, Austria.,University of Zurich, Zurich, Switzerland
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Maechler M, Vonbank A, Larcher B, Mader A, Sprenger L, Mutschlechner B, Leiherer A, Zanolin-Purin D, Muendlein A, Drexel H, Saely C. Single and joint impact of type 2 diabetes and of congestive heart failure on Albuminuria. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Zitt E, Davidovic T, Schimpf J, Abbassi-Nik A, Mutschlechner B, Ulmer H, Benda MA, Sprenger-Mähr H, Winder T, Lhotta K. The Safety and Immunogenicity of the mRNA-BNT162b2 SARS-CoV-2 Vaccine in Hemodialysis Patients. Front Immunol 2021; 12:704773. [PMID: 34220867 PMCID: PMC8242233 DOI: 10.3389/fimmu.2021.704773] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/02/2021] [Indexed: 12/22/2022] Open
Abstract
Background Hemodialysis patients are at high risk for severe COVID-19. SARS-CoV-2 vaccination related safety and immunogenicity data in these patients are rare. Methods In this observational study SARS-CoV-2-seronegative hemodialysis patients were vaccinated with two doses of the Pfizer/BioNTech mRNA-BNT162b2 vaccine (COMIRNATY® 30 µg) and followed for 90 days. Local and systemic side effects were assessed at every dialysis session during the first post-vaccination week after the first and second vaccine dose. Immunogenicity was determined four weeks after vaccination by quantifying anti-SARS-CoV-2 spike protein IgG antibodies (LIAISON® SARS-CoV-2-TrimericS IgG chemiluminescent immunoassay) expressed in binding activity units per milliliter (BAU/mL) adapted to the WHO International standard. Results Fifty patients (32% women, 68% men) with a mean (SD) age of 67.6 (14.8) years were included. Mild local reactions occurred in 38% after the first injection, and in 29.2% with mild, in 2.1% with moderate and in 2.1% with severe degree after the second injection. Systemic reactive events occurred less often, with diarrhea (4% mild, 4% moderate) and fatigue (8% mild) being the most frequent ones. After the first injection 42% of the patients developed a positive response using the assay specific cut-off value of 33.8 binding activity units per milliliter (BAU/mL) with a median (Q1, Q3) anti-SARS-CoV-2 spike IgG concentration of 20.0 (11.7, 51.0) BAU/mL. After the second injection the percentage of seropositive patients increased to 97.9% with an anti-SARS-CoV-2 spike IgG concentration of 1075 (290.8, 1735) BAU/mL. Higher age and immunosuppression were associated with lower, calcitriol treatment and prior seroconversion to hepatitis B vaccination with significantly higher antibody concentration. Conclusions The mRNA-BNT162b2 SARS-CoV-2 vaccine appears to be safe and well-tolerated and shows a high immunogenicity in hemodialysis patients.
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Affiliation(s)
- Emanuel Zitt
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria.,Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Tamara Davidovic
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Judith Schimpf
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Armin Abbassi-Nik
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Beatrix Mutschlechner
- Department of Internal Medicine 1, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Magdalena A Benda
- Department of Internal Medicine 2, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Hannelore Sprenger-Mähr
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Thomas Winder
- Department of Internal Medicine 2, Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Karl Lhotta
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria.,Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
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Saely CH, Maechler M, Mader A, Larcher B, Sprenger L, Mutschlechner B, Klement M, Zanolin-Purin D, Leiherer A, Muendlein A, Vonbank A, Drexel H. REMNANT CHOLESTEROL IN PATIENTS WITH ESTABLISHED CORONARY ARTERY DISEASE PREDICTS CARDIOVASCULAR EVENTS BOTH AMONG PATIENTS WITH TYPE 2 DIABETES AND AMONG NON-DIABETIC SUBJECTS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02922-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Leiherer A, Muendlein A, Saely CH, Laaksonen R, Laaperi M, Larcher B, Mader A, Maechler M, Sprenger L, Mutschlechner B, Vonbank A, Fraunberger P, Drexel H. COMPARISON OF TWO RECENT CERAMIDE-BASED CORONARY RISK PREDICTION SCORES: CERT AND CERT-2. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02925-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Muendlein A, Geiger K, Leiherer A, Zach C, Larcher B, Mader A, Maechler M, Sprenger L, Mutschlechner B, Vonbank A, Saely CH, Heinzle C, Fraunberger P, Drexel H. THE NEW MYOKINE MYONECTIN IS SIGNIFICANTLY ASSOCIATED WITH TYPE 2 DIABETES IN PATIENTS WITH PERIPHERAL ARTERY DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03147-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Saely CH, Sprenger L, Vonbank A, Larcher B, Mader A, Maechler M, Mutschlechner B, Zanolin-Purin D, Leiherer A, Muendlein A, Drexel H. LIPOPROTEIN(A) AND VASCULAR RISK IN PATIENTS WITH ESTABLISHED CARDIOVASCULAR DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02873-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Saely CH, Sprenger L, Vonbank A, Larcher B, Mader A, Maechler M, Mutschlechner B, Zanolin-Purin D, Leiherer A, Muendlein A, Drexel H. CHRONIC KIDNEY DISEASE IS A TYPE 2 DIABETES RISK EQUIVALENT IN PATIENTS WITH ESTABLISHED CORONARY ARTERY DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Larcher B, Vonbank A, Mader A, Maechler M, Sprenger L, Mutschlechner B, Leiherer A, Zanolin-Purin D, Muendlein A, Drexel H, Saely CH. HAND GRIP STRENGTH AND TYPE 2 DIABETES ARE MUTUALLY INDEPENDENT PREDICTORS OF CARDIOVASCULAR EVENTS AND OF MORTALITY IN PATIENTS WITH ESTABLISHED CARDIOVASCULAR DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02883-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Saely CH, Vonbank A, Maechler M, Larcher B, Sprenger L, Mader A, Mutschlechner B, Zanolin-Purin D, Klement M, Leiherer A, Muendlein A, Drexel H. NON-ALCOHOLIC FATTY LIVER DISEASE AND TYPE 2 DIABETES ARE MUTUALLY INDEPENDENT PREDICTORS OF CARDIOVASCULAR EVENTS IN PATIENTS WITH ESTABLISHED CARDIOVASCULAR DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02881-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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