1
|
Colhoun H, Malik R, Botros F, Atisso C, Gerstein H. Cardiovascular outcomes in patients with type 2 diabetes and reduced eGFR and albuminuria: a REWIND post hoc subgroup analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3350] [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
Background/Introduction
Diabetic kidney disease affects up to 40% of people with diabetes and is associated with higher cardiovascular (CV) risk. REWIND was a multicentre, randomised, double-blind, placebo-controlled trial with a primary outcome of first occurrence of the composite endpoint of CV death, nonfatal myocardial infarction, or nonfatal stroke (Major Adverse Cardiovascular Event [MACE]-3). Dulaglutide treatment reduced the incidence of MACE-3 in patients with type 2 diabetes (T2D) with or without established CV disease.
Purpose
This REWIND post hoc subgroup analysis evaluated the effect of dulaglutide on MACE-3 in patients with an eGFR<60 and ≥60 mL/min/1.73m2 and patients with micro-/macro-albuminuria (UACR ≥30 mg/g) or normoalbuminuria (UACR <30 mg/g).
Methods
Eligible patients were those ≥50 years old with T2D who had either a previous CV event or CV risk factors. Patients were randomised (1:1) to dulaglutide 1.5 mg or placebo, both in addition to standard of care. A Cox proportional hazards model with treatment, eGFR subgroup (<60 and ≥60 mL/min/1.73 m2), and treatment by eGFR subgroup interaction was used to analyse time to the first occurrence of MACE-3. These analyses were also conducted for albuminuria subgroups (micro-/macro-albuminuria or normoalbuminuria). Estimates of hazard ratios (HR) with 95% confidence intervals (CI) were calculated for each subgroup.
Results
At baseline, 2,199 of 9,901 patients (22.2%) had an eGFR <60 mL/min/1.73 m2, 2,676 (27.0%) had microalbuminuria, and 791 (8.0%) had macroalbuminuria. This post hoc subgroup analysis showed that dulaglutide treatment was consistently associated with MACE-3 risk reduction in patients with eGFR <60 and ≥60 mL/min/1.73 m2 (HR [95% CI]: 0.93 [0.76–1.13] and 0.86 [0.75–0.99], respectively; interaction p=0.545). Similarly, MACE-3 risk reduction was consistent in patients with micro-/macro-albuminuria or normoalbuminuria (HR [95% CI]: 0.84 [0.72–0.99] and 0.93 [0.79–1.10], respectively; interaction p=0.374).
Conclusions
Regardless of baseline eGFR or albuminuria status, dulaglutide reduces MACE-3 outcomes in patients with T2D and established CV disease or multiple CV risk factors.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Eli Lilly and Company
Collapse
Affiliation(s)
- H Colhoun
- University of Edinburgh, Edinburgh, United Kingdom
| | - R Malik
- Eli Lilly and Company, Indianapolis, United States of America
| | - F Botros
- Eli Lilly and Company, Indianapolis, United States of America
| | - C Atisso
- Eli Lilly and Company, Indianapolis, United States of America
| | | |
Collapse
|
2
|
Rashid S, Melone M, Tarnopolsky M, Schulze K, Gerstein H, Yusuf S, Anand S. 422 Accelerated Adipose Tissue Dysfunction and Cardiovascular Risk in Individuals of South Asian Ethnicity. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.397] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
3
|
Bordeleau L, Dagenais G, Yakubovich N, Yusuf S, Probstfield J, Riddle M, Ryden L, Xu L, Bosch J, Gerstein H. Incident cancers in people with dysglycemia and other cardiovascular risk factors: Cohort study of the ORIGIN trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1504] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
4
|
Hanefeld M, Koehler C, Hoffmann C, Wilhelm K, Kamke W, Gerstein H. Effect of targeting normal fasting glucose levels with basal insulin glargine on glycaemic variability and risk of hypoglycaemia: a randomized, controlled study in patients with early Type 2 diabetes. Diabet Med 2010; 27:175-80. [PMID: 20546261 DOI: 10.1111/j.1464-5491.2009.02915.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The purpose of this sub-study of the Outcome Reduction with Initial Glargine Intervention (ORIGIN) trial was to determine efficacy and safety of targeting normal fasting plasma glucose (FPG) levels in patients with early Type 2 diabetes treated with insulin glargine in comparison with standard care. METHODS Participants were randomly allocated to insulin or standard care. Insulin was titrated to reach FPG <or= 5.3 mmol/l. Two years after randomization in a small subset (43 glargine, 32 standard care), continuous glucose measurement (CGMS System Gold), including a test meal, was performed. Sixteen volunteers with normal oral glucose tolerance test (OGTT) served as control subjects. Objectives were glycaemic variability, standard deviation (sd), mean amplitude of glucose excursion (MAGE) with postprandial glucose excursion after the test meal, time spent < 3.0 mmol/l interstitial glucose. RESULTS Participants allocated to insulin and standard care had FPG levels of 5.3 and 6.1 mmol/l (P = 0.019) and glycated haemoglobin (HbA(1c)) 5.7% and 5.9%, respectively (P < 0.025). Time (min/24 h) spent at low glucose levels was not significantly different between groups (30.6 +/- 83.8 min control subjects, 33.7 +/- 75.1 min insulin, 10.6 +/- 50.6 min standard care). Standard deviation and MAGE were similar for glargine and standard care, but significantly higher than in control subjects. If FPG was < 5.3 mmol/l, the postprandial glucose excursion was in the range seen in control subjects. CONCLUSIONS Treatment to target of FPG < 5.3 mmol/l with insulin glargine was not associated with significantly increased risk of hypoglycaemia. Strict control of FPG with insulin glargine was effective to control postprandial glucose excursion, but had no significant effect on sd and MAGE.
Collapse
Affiliation(s)
- M Hanefeld
- GWT-TUD GmbH, Center for Clinical Studies, Dresden, Germany.
| | | | | | | | | | | |
Collapse
|
5
|
Gammie SC, D'Anna KL, Gerstein H, Stevenson SA. Neurotensin inversely modulates maternal aggression. Neuroscience 2008; 158:1215-23. [PMID: 19118604 DOI: 10.1016/j.neuroscience.2008.11.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 11/11/2008] [Accepted: 11/26/2008] [Indexed: 11/29/2022]
Abstract
Neurotensin (NT) is a versatile neuropeptide involved in analgesia, hypothermia, and schizophrenia. Although NT is released from and acts upon brain regions involved in social behaviors, it has not been linked to a social behavior. We previously selected mice for high maternal aggression (maternal defense), an important social behavior that protects offspring, and found significantly lower NT expression in the CNS of highly protective females. Our current study directly tested NT's role in maternal defense. Intracerebroventricular (i.c.v.) injections of NT significantly impaired defense in terms of time aggressive and number of attacks at all doses tested (0.05, 0.1, 1.0, and 3.0 microg). Other maternal behaviors, including pup retrieval, were unaltered following NT injections (0.05 microg) relative to vehicle, suggesting specificity of NT action on defense. Further, i.c.v. injections of the NT receptor 1 (NT1) antagonist, SR 48692 (30 microg), significantly elevated maternal aggression in terms of time aggressive and attack number. To understand where NT may regulate aggression, we examined Fos following injection of either 0.1 microg NT or vehicle. Thirteen of 26 brain regions examined exhibited significant Fos increases with NT, including regions expressing NT1 and previously implicated in maternal aggression, such as lateral septum, bed nucleus of stria terminalis, paraventricular nucleus, and central amygdala. Together, our results indicate that NT inversely regulates maternal aggression and provide the first direct evidence that lowering of NT signaling can be a mechanism for maternal aggression. To our knowledge, this is the first study to directly link NT to a social behavior.
Collapse
Affiliation(s)
- S C Gammie
- Department of Zoology, University of Wisconsin, Madison, WI 53706, USA.
| | | | | | | |
Collapse
|
6
|
Andrieu S, Barberger-Gateau P, Raffaitin C, Berr C, Tzourio C, Dartigues JF, Gin H, Fitten LJ, Ortiz F, Fairbanks L, Bartzokis G, Lu P, Ringman J, Heyn PC, Locher JL, Salvà A, Andrieu S, Fernández E, Vellas B, van de Rest O, Geleijnse JM, Kok FJ, van Staveren WA, Beekman ATF, Hoefnagels WHL, de Groot CPGM, Angevaren M, Aufdemkampe G, Verhaar HJJ, Aleman A, Vannees L, Arkin S, Florez H, Gerstein H, Sheridan P, Bosch J, Goldberg R, Kaspar KM, Drawert SM, Marcus RL, Kidde J, Dibble L, Addison O, LaStayo PC, Scarmeas N, Stern Y, Schupf N, Luchsinger JA, Sharkey JR, Laditka JN, Laditka SB, Liu R, Hochhalter A, Robare JF, Türner N, Judge M, Foster TC, Erdos B, Cudykier I, Scarpace PJ, Weiss LA, Bergstrom J, Kritz-Silverstein D, Barrett-Connor E, Yurko-Mauro K, Nelson E, Quinn J, Sattler FR, Castaneda-Sceppa C, Binder EF, Schroeder ET, Wang Y, Bhasin S, Kawakubo M, Stewart Y, Hahn C, Colletti P, Roubenoff R, Yarasheski KE, Azen SP, Aoki Y, Yamamoto T, Otuka T, Blanc-Bisson C, Bourdel-Marchasson I, Bocock MA, Keller HH, Bowman G, Baxter J, Oken B, Frei B, Traber M, Leonard S, Kaye J, Shannon J, Quinn J, Carlsson M, Gustafson Y, Eriksson S, Littbrand H, Håglin L, Danthiir V, Wilson C, Nettelbeck T, Burns N, Wittert G, Noakes M, Clifton P, DiMaria-Ghalili RA, Grieger JA, Nowson CA, Wattanapenpaiboon NT, Holstein J, Robinson C, Hartmann C, Rueb S, Heffel L, Dintaman S, Reynolds J, Fleming L, Crull M, Goldey J, Serper LL, Hubbard R, Westengard J, Horning M, Ishige Y, Aoki Y, Keller HH, Keller HH, LaStayo PC, Marcus RL, Smith S, Kidde J, Dibble L, Butler C, Hill M, LaStayo PC, Marcus RL, Dibble L, Kidde J, Peters C, Meier W, Laughlin GA, Kritz-Silverstein D, von Muhlen D, Barrett-Connor E, Olariu L, Petcu M, Tulcan C, Pup M, Otilingam P, Gate M, Pasinetti GM, Ray B, Chauhan NB, Bailey JA, Lahiri DK, Shatenstein B, Kergoat MJ, Reid I, Chicoine ME, Vaz L, Stewart R, Sabbah W, Tsakos G, D’Aiuto F, Watt RG, Sturman M, Kelly J, Fleischman D, Leurgans S, Bennett D, Morris MC, Suominen MH, Muurinen S, Soini H, Pitkälä KH, Yamamoto T, Fujinoki C, Aoki Y. 3rd IANA (International Academy on Nutrition and Aging) Meeting Nutrition, Exercise & Alzheimer and Clinical Trials on Sarcopenia August 1–2, 2008 Hyatt Regency Tamaya Resort 1300 Tuyuna Trail Santa Ana Pueblo, NM USA. J Nutr Health Aging 2008. [DOI: 10.1007/bf02982702] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
Scearce-Levie K, Roberson ED, Gerstein H, Cholfin JA, Mandiyan VS, Shah NM, Rubenstein JLR, Mucke L. Abnormal social behaviors in mice lacking Fgf17. Genes Brain Behav 2008; 7:344-54. [PMID: 17908176 DOI: 10.1111/j.1601-183x.2007.00357.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The fibroblast growth factor family of secreted signaling molecules is essential for patterning in the central nervous system. Fibroblast growth factor 17 (Fgf17) has been shown to contribute to regionalization of the rodent frontal cortex. To determine how Fgf17 signaling modulates behavior, both during development and in adulthood, we studied mice lacking one or two copies of the Fgf17 gene. Fgf17-deficient mice showed no abnormalities in overall physical growth, activity level, exploration, anxiety-like behaviors, motor co-ordination, motor learning, acoustic startle, prepulse inhibition, feeding, fear conditioning, aggression and olfactory exploration. However, they displayed striking deficits in several behaviors involving specific social interactions. Fgf17-deficient pups vocalized less than wild-type controls when separated from their mother and siblings. Elimination of Fgf17 also decreased the interaction of adult males with a novel ovariectomized female in a social recognition test and reduced the amount of time opposite-sex pairs spent engaged in prolonged, affiliative interactions during exploration of a novel environment. After social exploration of a novel environment, Fgf17-deficient mice showed less activation of the immediate-early gene Fos in the frontal cortex than wild-type controls. Our findings show that Fgf17 is required for several complex social behaviors and suggest that disturbances in Fgf17 signaling may contribute to neuropsychiatric diseases that affect such behaviors.
Collapse
Affiliation(s)
- K Scearce-Levie
- Gladstone Institute of Neurological Disease, San Francisco, CA 94158-2261, USA.
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Pazoles CJ, Gerstein H. NOV-002, a chemoprotectant/immunomodulator, added to first-line carboplatin/paclitaxel in advanced non-small cell lung cancer (NSCLC): A randomized Phase 1/2, open-label, controlled study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17021 Background: NOV-002 is a proprietary formulation of oxidized glutathione that modulates production of cytokines and hematopoietic growth factors. A randomized, multi-site advanced NSCLC trial conducted in the Russian Federation showed a one-year survival rate of 63% with NOV-002 + cytotoxic chemotherapy compared to 17% with cytotoxic chemotherapy alone. Methods: Forty-four chemotherapy-naïve, Stage IIIB/IV NSCLC patients (ECOG 0–2, stratified by disease stage) were randomized to one of three groups for six months of treatment: Groups A and B: NOV-002 in combination with carboplatin and paclitaxel (C+P). For each nominal 21-day chemotherapy cycle, these groups received 60 mg of NOV-002 i.v. daily for the first 4 days, then 60 mg i.m. (A) or s.c. (B) weekdays for the next 17 days. Group C: C+P alone. Initial doses of C and P in all three groups were 225 mg/m2 and AUC 6, respectively. Initiation of repeat C+P cycles required an absence of hematologic and other toxicities in excess of pre-defined values. Primary study endpoints included tumor response (scans performed at baseline and then every two months) and safety. Results: An intent-to-treat analysis of the best overall objective tumor response (WHO criteria), showed that 11 out of 16 (69%) Group B patients demonstrated greater than 50% tumor shrinkage versus 5 out of 15 (33%) in the control group (C) (p = 0.044, logistic regression stratified on disease stage). Six out of 13 (46%) patients in Group A demonstrated an objective response. 100% of NOV-002 treated patients in Group B and 85% in Group A were able to complete four cycles of C+P compared to 50% of control patients (Group C) (p = 0.004, chi square). NOV-002 was well-tolerated in this patient population. Conclusions: These data continue to suggest increased efficacy of NOV-002 plus cytotoxic chemotherapy compared to chemotherapy alone in advanced NSCLC. [Table: see text]
Collapse
Affiliation(s)
- C. J. Pazoles
- Novelos Therapeutics Inc, Newton, MA; Cancer Research of Long Island, Great Neck, NY
| | - H. Gerstein
- Novelos Therapeutics Inc, Newton, MA; Cancer Research of Long Island, Great Neck, NY
| |
Collapse
|
9
|
Santaguida PL, Balion C, Hunt D, Morrison K, Gerstein H, Raina P, Booker L, Yazdi H. Diagnosis, prognosis, and treatment of impaired glucose tolerance and impaired fasting glucose. Evid Rep Technol Assess (Summ) 2005:1-11. [PMID: 16194123 PMCID: PMC4780988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
|
10
|
Josse RG, Chiasson JL, Ryan EA, Lau DCW, Ross SA, Yale JF, Leiter LA, Maheux P, Tessier D, Wolever TMS, Gerstein H, Rodger NW, Dornan JM, Murphy LJ, Rabasa-Lhoret R, Meneilly GS. Acarbose in the treatment of elderly patients with type 2 diabetes. Diabetes Res Clin Pract 2003; 59:37-42. [PMID: 12482640 DOI: 10.1016/s0168-8227(02)00176-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS To study the effect of acarbose, an alpha-glucosidase inhibitor, on glycemic control in elderly patients with type 2 diabetes. METHODS Elderly patients with type 2 diabetes treated with diet alone were randomly treated in a double-blind fashion with placebo (n=99) or acarbose (n=93) for 12 months. RESULTS After 12 months of therapy, there was a statistically significant difference in the change in glycated haemoglobin (HbA(1c)) (-0.6%) in the acarbose group versus placebo, as well as in the incremental post-prandial glucose values (-2.1 mmol h/l) and mean fasting plasma glucose (-0.7 mmol/l). Although there was no effect of acarbose on insulin release, there was a clear effect of acarbose to decrease relative insulin resistance (-0.8) (HOMA method). In addition, acarbose was generally well tolerated and safe in the elderly; most discontinuations were due to gastrointestinal side effects such as flatulence and diarrhea. There were no cases of hypoglycemia reported, and no clinically relevant changes in laboratory abnormalities or vital signs during the study. CONCLUSIONS Acarbose improves the glycemic profile and insulin sensitivity in elderly patients with type 2 diabetes who are inadequately controlled on diet alone.
Collapse
Affiliation(s)
- R G Josse
- Division of Endocrinology and Metabolism, University of Toronto, Ont, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
CONTEXT Type 2 diabetes is a growing clinical and public health problem. Preventive efforts related to lifestyle modification are not always successful; therefore, alternative prevention strategies need to be studied. OBJECTIVE To investigate the effectiveness of ramipril, an angiotensin-converting enzyme inhibitor, in preventing diabetes among high-risk persons. DESIGN, SETTING, AND PARTICIPANTS The randomized, controlled Heart Outcomes Prevention Evaluation trial of 5720 patients older than 55 years without known diabetes but with vascular disease who were followed up for a mean of 4.5 years. The study included 267 hospitals in 19 countries and was conducted between 1994 and 1999. INTERVENTION Patients were randomly assigned to receive ramipril, up to 10 mg/d (n = 2837), or placebo (n = 2883). MAIN OUTCOME MEASURE Diagnosis of diabetes determined from self-report at follow-up visits every 6 months, compared between the 2 groups. RESULTS One hundred and two individuals (3.6%) in the ramipril group developed diabetes compared with 155 (5.4%) in the placebo group (relative risk [RR], 0.66; 95% confidence interval [CI], 0.51-0.85, P<.001). Similar results were noted when different diagnostic criteria were used; in the ramipril group, the RR for diagnosis of diabetes and hemoglobin A(1c) greater than 110% was 0.60 (95% CI, 0.43-0.85), for initiation of glucose-lowering therapy, 0.56 (95% CI, 0.41-0.77), and for both, 0.51 (95% CI, 0.34-0.76). These effects were also consistently seen in several subgroups examined. CONCLUSIONS Ramipril is associated with lower rates of new diagnosis of diabetes in high-risk individuals. Because these results have important clinical and public health implications, this hypothesis requires prospective confirmation.
Collapse
Affiliation(s)
- S Yusuf
- Canadian Cardiovascular Collaboration Project Office, Hamilton General Hospital, 237 Barton St East, Hamilton, Ontario, Canada L8L 2X2.
| | | | | | | | | | | | | |
Collapse
|
12
|
Anand SS, Yusuf S, Jacobs R, Davis AD, Yi Q, Gerstein H, Montague PA, Lonn E. Risk factors, atherosclerosis, and cardiovascular disease among Aboriginal people in Canada: the Study of Health Assessment and Risk Evaluation in Aboriginal Peoples (SHARE-AP). Lancet 2001; 358:1147-53. [PMID: 11597669 DOI: 10.1016/s0140-6736(01)06255-9] [Citation(s) in RCA: 196] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Little is known about the rates of cardiovascular disease (CVD), atherosclerosis, and their risk factors among Canada's Aboriginal people. To establish the relative prevalence of risk factors, atherosclerosis, and CVD, we undertook a population-based study among people of Aboriginal and European ancestry in Canada. METHODS We randomly recruited 301 Aboriginal people from the Six Nations Reservation, and 326 people of European origin from Hamilton, Toronto, and Edmonton, Canada. Clinical CVD was defined by history or electrocardiographic findings, atherosclerosis was measured by B-mode carotid ultrasonography, and conventional and new CVD risk factors were measured using standardised methods. FINDINGS Aboriginal people had significantly more carotid atherosclerosis (mean of the maximum intimal-medial thickness 0.82 (SD 0.20) mm vs 0.78 (0.20) mm, p=0.027), and had a higher frequency of CVD (18.5% vs 7.6%, p=0.00002) compared with Europeans. Aboriginal people had significantly higher rates of smoking, glucose intolerance, obesity, abdominal obesity, and substantially higher concentrations of fibrinogen, and plasminogen activator inhibitor-1. Aboriginal people had significantly higher rates of unemployment and a lower annual household income. For any given income level, Aboriginal people had higher rates of risk factors and CVD compared with the Europeans. INTERPRETATION A significant proportion of Aboriginal people live in poverty which is associated with high rates of CVD and CVD risk factors. Improvement of the socioeconomic status of Aboriginal people might be a key to reduce CVD in this group.
Collapse
Affiliation(s)
- S S Anand
- Preventive Cardiology and Therapeutics Research Program, Department of Medicine, McMaster University, Ontario, L8L 2X2, Hamilton, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, Kelemen L, Yi C, Lonn E, Gerstein H, Hegele RA. Differences in risk factors, atherosclerosis and cardiovascular disease between ethnic groups in Canada: the study of health assessment and risk in ethnic groups (SHARE). Indian Heart J 2000; 52:S35-43. [PMID: 11339439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
Cardiovascular disease rates vary greatly between ethnic groups in Canada. To establish whether this variation can be explained by differences in disease risk factors and subclinical atherosclerosis, we undertook a population-based study of three ethnic groups in Canada: South Asians, Chinese and Europeans. A total of 985 participants were recruited from three cities (Hamilton, Toronto and Edmonton) by stratified random sampling. Clinical cardiovascular disease was defined by history or electrocardiographic findings. Carotid atherosclerosis was measured with B-mode ultrasonography. Conventional (smoking, hypertension, diabetes, raised cholesterol) and novel risk factors (markers of a prothrombotic state) were measured. Within each ethnic group and overall, the degree of carotid atherosclerosis was associated with a higher prevalence of cardiovascular disease. South Asians had the highest prevalence of this condition compared with Europeans and Chinese (11%, 5% and 2%, respectively; p=0.0004). Despite this finding, Europeans had more atherosclerosis (mean of the maximum intimal medial thickness 0.75 [0.16] mm) than South Asians (0.72 [0.15] mm) and Chinese (0.69 [0.16] mm). South Asians had an increased prevalence of glucose intolerance, higher total and low-density lipoprotein cholesterol, higher triglycerides and lower high-density lipoprotein cholesterol, and much greater abnormalities in novel risk factors including higher concentrations of fibrinogen, homocysteine, lipoprotein(a), and plasminogen activator inhibitor-1. Although there are differences in conventional and novel risk factors between ethnic groups, this variation and the degree of atherosclerosis only partly explains the higher rates of cardiovascular disease among South Asians compared with Europeans and Chinese. The increased risk of cardiovascular events could be due to factors affecting plaque rupture, the interaction between prothrombotic factors and atherosclerosis, or as yet undiscovered risk factors.
Collapse
Affiliation(s)
- S S Anand
- Departments of Medicine, Pathology and Molecular Medicine, McMaster University, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, Kelemen L, Yi C, Lonn E, Gerstein H, Hegele RA, McQueen M. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet 2000; 356:279-84. [PMID: 11071182 DOI: 10.1016/s0140-6736(00)02502-2] [Citation(s) in RCA: 688] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiovascular disease rates vary greatly between ethnic groups in Canada. To establish whether this variation can be explained by differences in disease risk factors and subclinical atherosclerosis, we undertook a population-based study of three ethnic groups in Canada: South Asians, Chinese, and Europeans. METHODS 985 participants were recruited from three cities (Hamilton, Toronto, and Edmonton) by stratified random sampling. Clinical cardiovascular disease was defined by history or electrocardiographic findings. Carotid atherosclerosis was measured with B-mode ultrasonography. Conventional (smoking, hypertension, diabetes, raised cholesterol) and novel risk factors (markers of a prothrombotic state) were measured. FINDINGS Within each ethnic group and overall, the degree of carotid atherosclerosis was associated with a higher prevalence of cardiovascular disease. South Asians had the highest prevalence of this condition compared with Europeans and Chinese (11%, 5%, and 2%, respectively, p=0.0004). Despite this finding, Europeans had more atherosclerosis (mean of the maximum intimal medial thickness 0.75 [0.16] mm) than South Asians (0.72 [0.15] mm), and Chinese (0.69 [0.16] mm). South Asians had an increased prevalence of glucose intolerance, higher total and LDL cholesterol, higher triglycerides, and lower HDL cholesterol, and much greater abnormalities in novel risk factors including higher concentrations of fibrinogen, homocysteine, lipoprotein (a), and plasminogen activator inhibitor-1. INTERPRETATION Although there are differences in conventional and novel risk factors between ethnic groups, this variation and the degree of atherosclerosis only partly explains the higher rates of cardiovascular disease among South Asians compared with Europeans and Chinese. The increased risk of cardiovascular events could be due to factors affecting plaque rupture, the interaction between prothrombotic factors and atherosclerosis, or as yet undiscovered risk factors.
Collapse
Affiliation(s)
- S S Anand
- Department of Medicine, McMaster University, Ontario, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
Angiotensin converting enzyme (ACE) inhibitors have been shown to reduce the risk of death, worsening heart failure and recurrent infarction in patients with left ventricular dysfunction and heart failure. They have also been shown to reduce mortality in the acute phase of myocardial infarction. They have been demonstrated to reduce major vascular events and progression of renal disease in diabetes with hypertension, compared to placebo and to calcium channel blockers. Current trials are evaluating their role in preventing major vascular events in patients with coronary artery disease, strokes and Type II diabetes who are normotensive.
Collapse
Affiliation(s)
- S Yusuf
- Division of Cardiology, McMaster University and The Hamilton Health Sciences Corporation Research Centre, Ontario, Canada
| | | | | | | |
Collapse
|
16
|
Jaeschke R, Guyatt G, Gerstein H, Patterson C, Molloy W, Cook D, Harper S, Griffith L, Carbotte R. Does treatment with L-thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism? J Gen Intern Med 1996; 11:744-9. [PMID: 9016421 DOI: 10.1007/bf02598988] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if health-related quality of life (HRQL) in patients of middle age and older with elevated thyroid-stimulating hormone (TSH) and normal total thyroid hormone levels-subclinical hypothyroidism-improves with L-thyroxine replacement therapy. DESIGN Randomized, double-blind, placebo-controlled trial. SETTING Outpatient clinic. PATIENTS Thirty-seven patients with subclinical hypothyroidism, most with symptoms consistent with hypothyroidism, over 55 years of age. INTERVENTIONS Placebo or L-thyroxine replacement therapy to achieve normal TSH level. MEASUREMENTS AND MAIN RESULTS Disease-specific and general HRQL, cognitive function, bone mineral density, lipid levels. The mean daily dose of L-thyroxine replacement in the active group was 68 +/- 21 micrograms. TSH decreased by 8.6 mIU/L (95% confidence interval [CI] 4.1 to 13.1) and T4 increased by 27.9 nmol/L (95% CI 14.8 to 41.2). There was a statistically significant improvement in a composite psychometric memory score in treated versus control patients; all other outcomes showed similar findings in the two groups. Although confidence intervals for most measures did not exclude an important improvement in HRQL with thyroid replacement, no measure of symptoms or HRQL either showed clinically important trends in favor of treatment, or approached conventional levels of statistical significance. CONCLUSIONS In middle-aged and older patients with elevated TSH and normal T4, it may not be harmful to follow biochemical and clinical status even in the presence of nonspecific symptoms potentially associated with hypothyroidism.
Collapse
Affiliation(s)
- R Jaeschke
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
BACKGROUND South Asians who have settled overseas and those in urban India have an increased risk of ischaemic heart disease (IHD). Reasons for this increased risk are unclear. Most studies have been based on migrants to western nations, so their findings may not apply to most south Asians, who live in their own countries. Therefore, we assessed the relative importance of risk factors for IHD among South Asians in Bangalore, India. METHODS We conducted a prospective hospital-based case-control study of 200 Indian patients with a first acute myocardial infarction (AMI) and 200 age and sex matched controls. We recorded prevalence of the following risk factors for IHD: diet, smoking, alcohol use, socioeconomic status, waist to hip ratio (WHR), blood glucose, serum insulin, oral glucose tolerance test, and lipid profile. FINDINGS The most important predictor of AMI was current smoking (odds ratio [OR] 3.6, p < 0.001) of cigarettes or beedis (a local form of tobacco), with individuals who currently smoked 10 or more per day having an OR of 6.7 (p < 0.001). History of hypertension and of overt diabetes mellitus were also independent risk factors (OR 2.69 [p = 0.001] and 2.64 [p = 0.004], respectively). Among all individuals, fasting blood glucose was a strong predictor of risk over the entire range, including at values usually regarded as normal (OR adjusted for smoking, hypertension, and WHR 1.62 for 1 SD increase, p < 0.001). Abdominal obesity (as measured by WHR) was also a strong independent predictor across the entire range of measures (OR adjusted for smoking, hypertension, and blood glucose 2.24 for 1 SD increase; p < 0.001). Compared with individuals with no risk factors, individuals with multiple risk factors had greatly increased risk of AMI (eg, OR of 10.6 for the group with smoking and elevated glucose). Lipid profile was not associated with AMI. In univariate analyses, higher socioeconomic (income) status (OR 0.32, p = 0.005 highest vs lowest; OR 0.75 middle vs lowest) and vegetarianism (OR = 0.55, p = 0.006), seemed to be protective. The impact of vegetarianism was closely correlated with blood glucose and WHR. INTERPRETATION Smoking cessation, treatment of hypertension, and reduction in blood glucose and central obesity (perhaps through dietary modification) may be important in preventing IHD in Asian Indians.
Collapse
Affiliation(s)
- P Pais
- Department of Medicine, St John's Medical College, Bangalore, India
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
The effects of Adaptic and Avitene on bone healing were evaluated histologically. The studied materials were placed in osseous defects created in rat tibias with a #8 round bur in a slow-speed handpiece. The materials were left in situ for experimental periods of 7, 14, 28, 60, 90, and 120 days. Histological evaluation of specimens from each of these periods demonstrated that Avitene was resorbed and did not impede bone healing. Adaptic was not resorbed at the end of the longest experimental period, 120 days. This material caused a foreign body reaction characterized by encapsulation of the Adaptic by fibrous connective tissues. Both Adaptic and Avitene were satisfactory hemostatic agents. The results of this study suggest that Adaptic should be used only in those situations where complete retrieval of the material from surgical sites can be assured.
Collapse
|
19
|
|
20
|
Miserendino LJ, Brantley WA, Walia HD, Gerstein H. Cutting efficiency of endodontic hand instruments. Part 4. Comparison of hybrid and traditional instrument designs. J Endod 1988; 14:451-4. [PMID: 3273314 DOI: 10.1016/s0099-2399(88)80134-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
21
|
|
22
|
Meister RC, Meister F, Haasch GC, Gerstein H. Etiology and treatment of internal and external resorption. Gen Dent 1987; 35:402-7. [PMID: 3481726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
23
|
Stamos DE, Sadeghi EM, Haasch GC, Gerstein H. An in vitro comparison study to quantitate the debridement ability of hand, sonic, and ultrasonic instrumentation. J Endod 1987; 13:434-40. [PMID: 3482102 DOI: 10.1016/s0099-2399(87)80061-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
24
|
|
25
|
|
26
|
|
27
|
|
28
|
Hohenfeldt PR, Aurelio JA, Gerstein H. Electrochemical corrosion in the failure of apical amalgam. Report of two cases. Oral Surg Oral Med Oral Pathol 1985; 60:658-60. [PMID: 3865139 DOI: 10.1016/0030-4220(85)90371-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Apicoectomy with retrograde amalgam is an accepted procedure for treating teeth that cannot be treated by nonsurgical methods. Some of these fail to heal for no apparent reason. Evidence is presented that indicates that some of these failures are caused by corrosion of the apical amalgam. Two cases are described in which the sinus tract that was associated with the failing retrograde amalgam was resolved without further surgery. To bring about the resolution, a zinc-enriched amalgam was placed in the crown that through an intervening conductor, reduced the rate of corrosion at the apex.
Collapse
|
29
|
|
30
|
|
31
|
|
32
|
|
33
|
|
34
|
Chenail B, Gerstein H. Precise selective anaesthesia using a pressure syringe. J Can Dent Assoc 1984; 50:404-5. [PMID: 6375837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
35
|
|
36
|
|
37
|
|
38
|
Abstract
An unusual case of an IgM producing lymphoproliferative disorder is presented. Using immunofluorescent techniques, this study shows that the heavy chain is associated with kappa light chain in some cells, and with lambda light chain in other cells. This indicates the presence of two distinct malignant cell populations in this patient.
Collapse
|
39
|
|
40
|
|
41
|
Meister F, Miles MJ, Gerstein H, Mayer JC. Correction of an endodontic defect using a pedicle flap. Gen Dent 1983; 31:34-37. [PMID: 6572176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
42
|
Gerstein H. [Internal and external resorption. Review and case report]. Rev Esp Endodoncia 1983; 1:39-44. [PMID: 6591304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
43
|
|
44
|
Austin BP, Keating KM, Hohenfeldt PR, Gerstein H. Osseous reactions to bimetallic couples composed of amalgam and gold implanted in rat tibias. Oral Surg Oral Med Oral Pathol 1982; 54:79-92. [PMID: 6956831 DOI: 10.1016/0030-4220(82)90421-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Small, bimetallic couples were manufactured by condensing dental amalgam against a gold post which has been placed in polyethylene tubing. These devices were placed in rat tibias and osseous reactions were evaluated microscopically up to 112 days after surgery. The low current levels generated by the bimetallic couples used in this study did not affect the healing rate of the surgical osseous defect. Statistical analysis demonstrated that there were equal amounts of bone deposited at the anodes and cathodes of the experimental implants at all time intervals studied. The small currents produced by experimental implants did not interfere with the normal healing process, and the implications of this study in clinical situations are discussed.
Collapse
|
45
|
Lehman JW, Pricco D, Gerstein H. Endodontic surgery on a maxillary central incisor via a lingual approach. Report of a case. Oral Surg Oral Med Oral Pathol 1982; 53:637-41. [PMID: 6954446 DOI: 10.1016/0030-4220(82)90354-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This article reports the case of a maxillary right central incisor with a periapical lesion and an associated periodic palatal swelling of more than 12 years' duration, during nonsurgical root canal treatment, the root canal exhibited persistent suppuration. Upon palpation, the buccal plate of bone appeared to be intact. The lesion appeared to be associated with the palatal surface. A palatal surgical approach was used in an attempt to prevent a through-and-through defect.
Collapse
|
46
|
Abstract
Four methods of canal preparation are tested: hand instrumentation with preflaring and step back, Giromatic, Union Broach Endo Angle, and the Kerr Endolift. The preparations are analyzed with plastic blocks and extracted human teeth. Hand instrumentation with preflaring and step-back is superior to and safer than the mechanized endodontic devices. With proper care and technique, some mechanized endodontic devices can produce adequate canal preparations.
Collapse
|
47
|
Meister F, Gerstein H, Sigaroudi K, Ziebert GJ. Periodontal considerations in clinical crown lengthening procedures. Gen Dent 1981; 29:401-405. [PMID: 6955236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
48
|
|
49
|
Meister F, Lommel TJ, Gerstein H, Bell WA. An additional clinical observation in two cases of vertical root fracture. Oral Surg Oral Med Oral Pathol 1981; 52:91-6. [PMID: 7024889 DOI: 10.1016/0030-4220(81)90179-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
50
|
Abstract
A case is presented of extreme loss of tooth substance, most probably as a result of dentifrice abrasion. The lesions resulted in many instances of pulpal death and periapical pathosis. In most instances, an opening into the pulp chamber could not be demonstrated using an explorer. In two instances, an opening into the pulp chamber was present and probable. This communication with the oral cavity resulted in pulpal pathosis and an accompanying periapical lesion. In most cases of dental abrasion and erosion, or both, pulpal pathosis and periapical pathosis do not occur because of the ability of the pulp to lay down dentin as the pulp recedes. The findings in this case are not typical.
Collapse
|