1
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Jenkins DJA, Willett WC, Yusuf S, Hu FB, Glenn AJ, Liu S, Mente A, Miller V, Bangdiwala SI, Gerstein HC, Sieri S, Ferrari P, Patel AV, McCullough ML, Le Marchand L, Freedman ND, Loftfield E, Sinha R, Shu XO, Touvier M, Sawada N, Tsugane S, van den Brandt PA, Shuval K, Khan TA, Paquette M, Sahye-Pudaruth S, Patel D, Siu TFY, Srichaikul K, Kendall CWC, Sievenpiper JL. Association of glycaemic index and glycaemic load with type 2 diabetes, cardiovascular disease, cancer, and all-cause mortality: a meta-analysis of mega cohorts of more than 100 000 participants. Lancet Diabetes Endocrinol 2024; 12:107-118. [PMID: 38272606 DOI: 10.1016/s2213-8587(23)00344-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND There is debate over whether the glycaemic index of foods relates to chronic disease. We aimed to assess the associations between glycaemic index (GI) and glycaemic load (GL) and type 2 diabetes, cardiovascular disease, diabetes-related cancers, and all-cause mortality. METHODS We did a meta-analysis of large cohorts (≥100 000 participants) identified from the Richard Doll Consortium. We searched the Cochrane Library, MEDLINE, PubMed, Embase, Web of Science, and Scopus for cohorts that prospectively examined associations between GI or GL and chronic disease outcomes published from database inception to Aug 4, 2023. Full-article review and extraction of summary estimates data were conducted by three independent reviewers. Primary outcomes were incident type 2 diabetes, total cardiovascular disease (including mortality), diabetes-related cancers (ie, bladder, breast, colorectal, endometrial, hepatic, pancreatic, and non-Hodgkin lymphoma), and all-cause mortality. We assessed comparisons between the lowest and highest quantiles of GI and GL, adjusting for dietary factors, and pooling their most adjusted relative risk (RR) estimates using a fixed-effects model. We also assessed associations between diets high in fibre and whole grains and the four main outcomes. The study protocol is registered with PROSPERO, CRD42023394689. FINDINGS From ten prospective large cohorts (six from the USA, one from Europe, two from Asia, and one international), we identified a total of 48 studies reporting associations between GI or GL and the outcomes of interest: 34 (71%) on various cancers, nine (19%) on cardiovascular disease, five (10%) on type 2 diabetes, and three (6%) on all-cause mortality. Consumption of high GI foods was associated with an increased incidence of type 2 diabetes (RR 1·27 [95% CI 1·21-1·34]; p<0·0001), total cardiovascular disease (1·15 [1·11-1·19]; p<0·0001), diabetes-related cancer (1·05 [1·02-1·08]; p=0·0010), and all-cause mortality (1·08 [1·05-1·12]; p<0·0001). Similar associations were seen between high GL and diabetes (RR 1·15 [95% CI 1·09-1·21]; p<0·0001) and total cardiovascular disease (1·15 [1·10-1·20]; p<0·0001). Associations between diets high in fibre and whole grains and the four main outcomes were similar to those for low GI diets. INTERPRETATION Dietary recommendations to reduce GI and GL could have effects on health outcomes that are similar to outcomes of recommendations to increase intake of fibre and whole grain. FUNDING Banting and Best and the Karuna Foundation.
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Affiliation(s)
- David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada.
| | - Walter C Willett
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Frank B Hu
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea J Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Simin Liu
- Center for Global Cardiometabolic Health, Department of Epidemiology, Department of Medicine, and Department of Surgery, Brown University, Providence, RI, USA
| | - Andrew Mente
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Victoria Miller
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pietro Ferrari
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | | | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erikka Loftfield
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xiao-Ou Shu
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mathilde Touvier
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and Statistics, Nutritional Epidemiology Research Team, Bobigny, France; French Network for Nutrition and Cancer Research, Jouy-en-Josas, France
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan; International University of Health and Welfare Graduate School of Public Health, Tokyo, Japan
| | - Piet A van den Brandt
- GROW School for Oncology and Developmental Biology, and Department of Epidemiology, Care and Public Health Research Institute-School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Tauseef Ahmad Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
| | - Melanie Paquette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Teenie Fei Yi Siu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Korbua Srichaikul
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
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2
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Carey CN, Paquette M, Sahye-Pudaruth S, Dadvar A, Dinh D, Khodabandehlou K, Liang F, Mishra E, Sidhu M, Brown R, Tandon S, Wanyan J, Bazinet RP, Hanley AJ, Malik V, Sievenpiper JL, Jenkins DJ. The Environmental Sustainability of Plant-Based Dietary Patterns: A Scoping Review. J Nutr 2023; 153:857-869. [PMID: 36809853 DOI: 10.1016/j.tjnut.2023.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A large part of the existential threat associated with climate change is the result of current human feeding patterns. Over the last decade, research evaluating the diet-related environmental impacts of plant-based diets has emerged, and a synthesis of the available data is now due. OBJECTIVES The objectives of the study were as follows: 1) to compile and summarize the literature on diet-related environmental impacts of plant-based dietary patterns; 2) to assess the nature of the data on impacts of plant-based dietary patterns on both environmental parameters and health (e.g., if land use is reduced for a particular diet, is cancer risk also reduced?); and 3) to determine where sufficient data exist for meta-analyses, in addition to identifying gaps within the literature. METHODS Global peer-reviewed studies on the environmental impacts of plant-based diets were searched in Ovid MEDLINE, EMBASE, and Web of Science. After removing duplicates, the screening identified 1553 records. After 2 stages of independent review by 2 reviewers, 65 records met the inclusion criteria and were eligible to be used in synthesis. RESULTS Evidence suggests that plant-based diets may offer lower greenhouse gas emissions (GHGEs), land use, and biodiversity loss than offered by standard diets; however, the impact on water and energy use may depend on the types of plant-based foods consumed. Further, the studies were consistent in demonstrating that plant-based dietary patterns that reduce diet-related mortality also promote environmental sustainability. CONCLUSIONS Overall, there was agreement across the studies regarding the impact of plant-based dietary patterns on GHGE, land used, and biodiversity loss despite varied plant-based diets assessed.
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Affiliation(s)
- Cassandra N Carey
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Melanie Paquette
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Abolfazl Dadvar
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Dorothy Dinh
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Fred Liang
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Ekta Mishra
- McMaster University, Toronto, Ontario, Canada
| | - Mandeep Sidhu
- School of Global Health, York University, Toronto, Ontario, Canada
| | - Ramon Brown
- Department of Biology, Western University, Toronto, Ontario, Canada
| | - Shilpa Tandon
- Farncombe Family Digestive Health Research Institute, McMaster University, Toronto, Ontario, Canada
| | - Jessica Wanyan
- Department of Human Biology, University of Toronto, Toronto, Ontario, Canada
| | - Richard P Bazinet
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Anthony J Hanley
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Vasanti Malik
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David Ja Jenkins
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
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3
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Brocherie F, Paquette M, Dupont AC, Margue F, Seil R, Martens G. Défis de thermorégulation et d’altitude chez les athlètes de haut niveau : synthèse ReFORM de la déclaration de consensus du Comité International Olympique. Sci Sports 2023. [DOI: 10.1016/j.scispo.2022.12.001] [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: 02/13/2023]
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4
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Jenkins DJA, Chiavaroli L, Mirrahimi A, Mitchell S, Faulkner D, Sahye-Pudaruth S, Paquette M, Coveney J, Olowoyeye O, Patel D, Pichika SC, Bashyam B, Maraj T, Gillett C, de Souza RJ, Augustin LSA, Blanco Mejia S, Nishi SK, Leiter LA, Josse RG, McKeown-Eyssen GE, Berger AR, Connelly PW, Srichaikul K, Kendall CWC, Sievenpiper JL, Moody AR. Glycemic Index Versus Wheat Fiber on Arterial Wall Damage in Diabetes: A Randomized Controlled Trial. Diabetes Care 2022; 45:2862-2870. [PMID: 36326712 PMCID: PMC9862401 DOI: 10.2337/dc22-1028] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High cereal fiber and low-glycemic index (GI) diets are associated with reduced cardiovascular disease (CVD) risk in cohort studies. Clinical trial evidence on event incidence is lacking. Therefore, to make trial outcomes more directly relevant to CVD, we compared the effect on carotid plaque development in diabetes of a low-GI diet versus a whole-grain wheat-fiber diet. RESEARCH DESIGN AND METHODS The study randomized 169 men and women with well-controlled type 2 diabetes to counseling on a low GI-diet or whole-grain wheat-fiber diet for 3 years. Change in carotid vessel wall volume (VWV) (prespecified primary end point) was assessed by MRI as an indication of arterial damage. RESULTS Of 169 randomized participants, 134 completed the study. No treatment differences were seen in VWV. However, on the whole-grain wheat-fiber diet, VWV increased significantly from baseline, 23 mm3 (95% CI 4, 41; P = 0.016), but not on the low-GI diet, 8 mm3 (95% CI -10, 26; P = 0.381). The low-GI diet resulted in preservation of renal function, as estimated glomerular filtration rate, compared with the reduction following the wheat-fiber diet. HbA1c was modestly reduced over the first 9 months in the intention-to-treat analysis and extended with greater compliance to 15 months in the per-protocol analysis. CONCLUSIONS Since the low-GI diet was similar to the whole-grain wheat-fiber diet recommended for cardiovascular risk reduction, the low-GI diet may also be effective for CVD risk reduction.
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Affiliation(s)
- David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arash Mirrahimi
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sandra Mitchell
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Dorothea Faulkner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Melanie Paquette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Judy Coveney
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Omodele Olowoyeye
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sathish Chandra Pichika
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Mathematics and Statistics, University of Windsor, Windsor, Ontario, Canada
| | - Balachandran Bashyam
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tishan Maraj
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Chantal Gillett
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | | | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephanie K Nishi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada.,Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Universitat Rovira i Virgili, Reus, Spain.,Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Robert G Josse
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gail E McKeown-Eyssen
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alan R Berger
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Philip W Connelly
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Korbua Srichaikul
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada.,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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5
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Jenkins DJA, Jones PJH, Abdullah MMH, Lamarche B, Faulkner D, Patel D, Sahye-Pudaruth S, Paquette M, Bashyam B, Pichika SC, Kavanagh ME, Patel P, Liang F, Brown R, Zhao T, Phan M, Mathiyalagan G, Tandon S, Vuksan V, Jovanovski E, Sievenpiper JL, Kendall CWC, Leiter LA, Josse RG. Low-carbohydrate vegan diets in diabetes for weight loss and sustainability: a randomized controlled trial. Am J Clin Nutr 2022; 116:1240-1250. [PMID: 36156115 DOI: 10.1093/ajcn/nqac203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/19/2022] [Accepted: 07/20/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Low-carbohydrate, high animal fat and protein diets have been promoted for weight loss and diabetes treatment. We therefore tested the effect of a low-carbohydrate vegan diet in diabetes as a potentially healthier and more ecologically sustainable low-carbohydrate option. OBJECTIVES We sought to compare the effectiveness of a low-carbohydrate vegan diet with a moderate-carbohydrate vegetarian diet on weight loss and metabolic measures in diabetes. METHODS One hundred and sixty-four male and female participants with type 2 diabetes were randomly assigned to advice on either a low-carbohydrate vegan diet, high in canola oil and plant proteins, or a vegetarian therapeutic diet, for 3 mo, with both diets recommended at 60% of calorie requirements. Body weight, fasting blood, blood pressure, and 7-d food records, to estimate potential greenhouse gas emissions, were obtained throughout the study with tests of cholesterol absorption undertaken at baseline and end of study on 50 participants. RESULTS Both low-carbohydrate vegan and vegetarian diets similarly but markedly reduced body weight (-5.9 kg; 95% CI: -6.5, -5.28 kg; and -5.23 kg; 95% CI: -5.84, -4.62 kg), glycated hemoglobin (-0.99%; 95% CI: -1.07, -0.9%; and -0.88%; 95% CI: -0.97, -0.8%), systolic blood pressure (-4 mmHg; 95% CI: -7, -2 mmHg; and -6 mmHg; 95% CI: -8, -3 mmHg), and potential greenhouse gas emissions, but only for potential greenhouse gas emissions was there a significant treatment difference of -0.63 kgCO2/d (95% CI: -0.99, -0.27 kgCO2/d) favoring the low-carbohydrate vegan diet. CONCLUSIONS Low-carbohydrate vegan and vegetarian diets reduced body weight, improved glycemic control and blood pressure, but the more plant-based diet had greater potential reduction in greenhouse gas emissions.Trial registration number: clinicaltrials.gov identifier NCT02245399.
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Affiliation(s)
- David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital, Toronto, Ontario, Canada
| | - Peter J H Jones
- Nutritional Fundamentals for Health Inc., Vaudreuil-Dorion, Quebec, Canada
| | | | - Benoit Lamarche
- Centre santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec City, Quebec, Canada
| | - Dorothea Faulkner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Melanie Paquette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Balachandran Bashyam
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Sathish C Pichika
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Mathematics and Statistics, University of Windsor, Windsor, Ontario, Canada
| | - Meaghan E Kavanagh
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Pooja Patel
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Fred Liang
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ramon Brown
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tiffany Zhao
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Mila Phan
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gajuna Mathiyalagan
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Shilpa Tandon
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Vladmir Vuksan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Elena Jovanovski
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital, Toronto, Ontario, Canada.,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital, Toronto, Ontario, Canada
| | - Robert G Josse
- Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada
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6
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Jenkins DJA, Sahye-Pudaruth S, Khodabandehlou K, Liang F, Kasmani M, Wanyan J, Wang M, Selvaganesh K, Paquette M, Patel D, Glenn AJ, Srichaikul K, Kendall CWC, Sievenpiper JL. Systematic review and meta-analysis examining the relationship between postprandial hypotension, cardiovascular events, and all-cause mortality. Am J Clin Nutr 2022; 116:663-671. [PMID: 35675216 PMCID: PMC9437988 DOI: 10.1093/ajcn/nqac158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/31/2022] [Accepted: 06/03/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Postprandial hypotension (PPH) has been reported to be associated with syncope, falls, adverse cardiovascular outcomes, and increased all-cause mortality. It has been reported to have an incidence as high as 30% in the elderly and persons with diabetes. We therefore performed a meta-analysis to determine the relation of PPH with cardiovascular disease (CVD) events and all-cause mortality. OBJECTIVES Our objective was to conduct a systematic review and meta-analysis of cohort and cross-sectional studies to determine the association of PPH with CVD and all-cause mortality. METHODS We searched the databases MEDLINE, EMBASE, and Cochrane library up to 13 April 2022 for prospective cohort and cross-sectional studies that examined the association of PPH with CVD outcomes and all-cause mortality. Data were analyzed using the generic inverse variance method with a random-effects model. Grading of Recommendations, Assessment, Development, and Evaluation approach assessed the certainty of evidence. RESULTS Seven studies that included 2389 participants met our inclusion criteria. PPH was associated with each outcome individually, including increased all-cause mortality, total CVD, CVD mortality, and stroke. CVD outcomes and all-cause mortality combined were also associated with PPH (RR: 1.52; 95% CI: 1.05, 2.18; P = 0.03; I2 = 77%). The certainty of evidence was graded as very low due to significant heterogeneity and the limited number of studies. CONCLUSIONS This assessment indicates an association of PPH with CVD and all-cause mortality. Further studies are required to improve CVD and mortality estimates, but the potential seriousness of CVD and all-cause mortality as outcomes of PPH justifies more screening, diagnosis, and research.
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Affiliation(s)
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Fred Liang
- Department of Physiology and Immunology, University of Toronto, Toronto, Ontario
| | - Maaria Kasmani
- School of Medicine, University College of Dublin, Dublin, Ireland
| | - Jessica Wanyan
- Department of Human Biology, University of Toronto, Toronto, Ontario
| | - Maggie Wang
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Melanie Paquette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andrea J Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Korbua Srichaikul
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
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7
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Glenn AJ, Boucher BA, Kavcic CC, Khan TA, Paquette M, Kendall CWC, Hanley AJ, Jenkins DJA, Sievenpiper JL. Development of a Portfolio Diet Score and Its Concurrent and Predictive Validity Assessed by a Food Frequency Questionnaire. Nutrients 2021; 13:nu13082850. [PMID: 34445009 PMCID: PMC8398786 DOI: 10.3390/nu13082850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022] Open
Abstract
The Portfolio Diet, a plant-based portfolio of cholesterol-lowering foods, has been shown to reduce low-density lipoprotein cholesterol (LDL-C), and other cardiovascular risk factors, in randomized controlled trials (RCTs). It is not known if these beneficial effects translate to a lower incidence OF cardiovascular disease (CVD). To support examinations between Portfolio Diet adherence and disease, a Portfolio Diet score (PDS) was developed and its predictive and concurrent validity was assessed within the Toronto Healthy Diet Study, a six-month RCT in overweight adults. Predictive validity was assessed using change in the PDS measured by food frequency questionnaire (FFQ) and concomitant change in LDL-C from baseline to six months using multiple linear regression, adjusted for potential confounders (n = 652). Concurrent validity was assessed in a subset of participants (n = 50) who completed the FFQ and a 7-day diet record (7DDR) at baseline. The PDS determined from each diet assessment method was used to derive correlation coefficients and Bland–Altman plots to assess the between-method agreement. The change in PDS was inversely associated with change in LDL-C (β coefficients: −0.01 mmol/L (95% confidence intervals (CIs): −0.02, −0.002; p = 0.02). The correlation between the PDS from the FFQ and 7DDR was 0.69 (95% CIs: 0.48, 0.85). The Bland–Altman plot showed reasonable agreement between the score from the FFQ and 7DDR. These findings indicate predictive validity of the PDS with lower LDL-C, and reasonable concurrent validity of the PDS as assessed by an FFQ against a 7DDR.
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Affiliation(s)
- Andrea J. Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Beatrice A. Boucher
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
| | - Chloe C. Kavcic
- School of Nutrition, Ryerson University, Toronto, ON M5B 2K3, Canada;
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Melanie Paquette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Anthony J. Hanley
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1A6, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (A.J.G.); (B.A.B.); (T.A.K.); (M.P.); (C.W.C.K.); (A.J.H.); (D.J.A.J.)
- Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1A6, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Correspondence: ; Tel.: +1-416-867-3732
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8
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Jenkins DJA, Spence JD, Giovannucci EL, Kim YI, Josse RG, Vieth R, Sahye-Pudaruth S, Paquette M, Patel D, Blanco Mejia S, Viguiliouk E, Nishi SK, Kavanagh M, Tsirakis T, Kendall CWC, Pichika SC, Sievenpiper JL. Supplemental Vitamins and Minerals for Cardiovascular Disease Prevention and Treatment: JACC Focus Seminar. J Am Coll Cardiol 2021; 77:423-436. [PMID: 33509399 DOI: 10.1016/j.jacc.2020.09.619] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Abstract
This is an update of the previous 2018 systematic review and meta-analysis of vitamin and mineral supplementation on cardiovascular disease outcomes and all-cause mortality. New randomized controlled trials and meta-analyses were identified by searching the Cochrane library, Medline, and Embase, and data were analyzed using random effects models and classified by the Grading of Recommendations Assessment Development and Evaluation approach. This updated review shows similar findings to the previous report for preventive benefits from both folic acid and B vitamins for stroke and has been graded with moderate quality. No effect was seen for the commonly used multivitamins, vitamin D, calcium, and vitamin C, and an increased risk was seen with niacin (with statin) for all-cause mortality. Conclusive evidence for the benefit of supplements across different dietary backgrounds, when the nutrient is sufficient, has not been demonstrated.
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Affiliation(s)
- David J A Jenkins
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - J David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Edward L Giovannucci
- Departments of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Young-In Kim
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Robert G Josse
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Reinhold Vieth
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Melanie Paquette
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Effie Viguiliouk
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephanie K Nishi
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Meaghan Kavanagh
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tom Tsirakis
- Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Sathish C Pichika
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Mathematics and Statistics, University of Windsor, Windsor, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada; Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
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9
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Jenkins DJA, Kitts D, Giovannucci EL, Sahye-Pudaruth S, Paquette M, Blanco Mejia S, Patel D, Kavanagh M, Tsirakis T, Kendall CWC, Pichika SC, Sievenpiper JL. Selenium, antioxidants, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2020; 112:1642-1652. [PMID: 33053149 PMCID: PMC7727482 DOI: 10.1093/ajcn/nqaa245] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [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: 03/30/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Antioxidants have been promoted for cardiovascular disease (CVD) risk reduction and for the prevention of cancer. Our preliminary analysis suggested that only when selenium was present were antioxidant mixtures associated with reduced all-cause mortality. OBJECTIVE We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the effect of selenium supplementation alone and of antioxidant mixtures with or without selenium on the risk of CVD, cancer, and mortality. METHODS We identified studies using the Cochrane Library, Medline, and Embase for potential CVD outcomes, cancer, and all-cause mortality following selenium supplementation alone or after antioxidant supplement mixtures with and without selenium up to June 5, 2020. RCTs of ≥24 wk were included and data were analyzed using random-effects models and classified by the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS The meta-analysis identified 9423 studies, of which 43 were used in the final analysis. Overall, no association of selenium alone or antioxidants was seen with CVD and all-cause mortality. However, a decreased risk with antioxidant mixtures was seen for CVD mortality when selenium was part of the mix (RR: 0.77; 95% CI: 0.62, 0.97; P = 0.02), with no association when selenium was absent. Similarly, when selenium was part of the antioxidant mixture, a decreased risk was seen for all-cause mortality (RR: 0.90; 95% CI: 0.82, 0.98; P = 0.02) as opposed to an increased risk when selenium was absent (RR: 1.09; 95% CI: 1.04, 1.13; P = 0.0002). CONCLUSION The addition of selenium should be considered for supplements containing antioxidant mixtures if they are to be associated with CVD and all-cause mortality risk reduction. This trial was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42019138268.
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Affiliation(s)
| | - David Kitts
- Food Nutrition and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward L Giovannucci
- Department of Nutrition and Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Melanie Paquette
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Meaghan Kavanagh
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tom Tsirakis
- Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sathish C Pichika
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Department of Mathematics and Statistics, University of Windsor, Windsor, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
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10
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Abstract
Familial chylomicronemia syndrome (FCS) is a rare autosomal recessive disorder of chylomicron metabolism causing severe elevation of triglyceride (TG) levels (>10 mmol L-1 ). This condition is associated with a significant risk of recurrent acute pancreatitis (AP). AP caused by hypertriglyceridaemia (HTG) has been associated with a worse prognosis and higher mortality rates compared to pancreatitis of other aetiology. Despite its association with poor quality of life and increased lifelong risk of HTG-AP, few healthcare providers are familiar with FCS. Because this condition is under-recognized, the majority of FCS patients are diagnosed after age 20 often after consulting several physicians. Although other forms of severe HTG such as multifactorial chylomicronemia have been associated with high atherosclerotic cardiovascular disease (ASCVD) risk and metabolic abnormalities, ASCVD and metabolic syndrome are not usually observed in FCS patients. Because FCS is a genetic condition, the optimal diagnosis strategy remains genetic testing. The presence of bi-allelic pathogenic mutations in LPL, APOC2, GPIHBP1, APOA5 or LMF1 genes confirms the diagnosis. However, some cases of FCS caused by autoantibodies against LPL or GPIHBP1 proteins have also been reported. Furthermore, a clinical score for the diagnosis of FCS has been proposed but needs further validation. Available treatment options to lower triglycerides such as fibrates or omega-3 fatty acids are not efficacious in FCS patients. Currently, the cornerstone of treatment remains a lifelong very low-fat diet, which prevents the formation of chylomicrons. Finally, inhibitors of apo C-III and ANGPTL3 are in development and may eventually constitute additional treatment options for FCS patients.
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Affiliation(s)
- A Baass
- From the, Lipids, Nutrition and Cardiovascular Prevention Clinic, Montreal Clinical Research Institute, Québec, Canada.,Divisions of Experimental Medicine and Medical Biochemistry, Department of Medicine, McGill University, Québec, Canada
| | - M Paquette
- From the, Lipids, Nutrition and Cardiovascular Prevention Clinic, Montreal Clinical Research Institute, Québec, Canada
| | - S Bernard
- From the, Lipids, Nutrition and Cardiovascular Prevention Clinic, Montreal Clinical Research Institute, Québec, Canada.,Division of Endocrinology, Department of Medicine, Université de Montreal, Montreal, Canada
| | - R A Hegele
- Department of Medicine, University of Western Ontario and Robarts Research Institute, Ontario, Canada
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11
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Lip GYH, Diener HC, Dubner SJ, Halperin JL, Rothman KJ, Ma CS, Lu S, Paquette M, Riou Franca L, Zint K, Teutsch C, Huisman MV. P4783Treatment persistence of patients with atrial fibrillation on VKA or NOAC: Data from GLORIA-AF Phase III 1-year interim analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1159] [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
Oral anticoagulation (OAC) persistence is important for optimizing stroke prevention in patients with atrial fibrillation (AF); non-vitamin K oral anticoagulants (NOACs) generally show better persistence than vitamin K antagonists (VKAs), while the impact of dosing regimens remains unclear. We compared treatment persistence of NOACs and VKAs, and of NOAC dosing regimens in the prospective GLORIA-AF registry program.
Methods
Patients newly diagnosed with AF were enrolled in Phase III of GLORIA-AF (2014–2016) from 4 geographical regions (North America [NA], Europe, Asia and Latin America). Treatment persistence after 1 year for i) NOAC (dabigatran, rivaroxaban, apixaban, edoxaban) vs VKA, and ii) twice daily (bid, dabigatran, apixaban) vs once daily (od; rivaroxaban, edoxaban) NOAC treatment was analysed using multivariable Cox analysis; propensity score trimming was used to reduce bias due to unmeasured confounders. Missing data was handled by multiple imputation.
Results
Overall, 21,592 patients were enrolled (4970 [23%] patients on VKAs, 12,797 [59%] on NOACs, 2391 [11%] on antiplatelets, and 1426 [6.6%] received no therapy; 8 [0.04%] received other treatment). After trimming, 11,935 and 4484 patients treated with NOACs and VKAs, respectively, were compared. NOACs had better treatment persistence than VKAs (discontinuation hazard ratio [HR]=0.75, 95% confidence interval [CI] 0.69–0.81). Other relevant associations were decreased OAC persistence for symptomatic AF, NA and Asia regions (Table). There was no difference in treatment persistence for patients on a bid (N=7842) vs od (N=4098) NOAC (discontinuation HR=0.94, 95% CI 0.86–1.02).
Conclusion
In this 1-year interim analysis of GLORIA-AF Phase III, treatment persistence was improved with NOACs vs VKAs, whereas for NOACs, dosing regimen (bid vs od) had no impact on treatment persistence.
Acknowledgement/Funding
The GLORIA-AF Registry program was funded by Boehringer-Ingelheim
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Affiliation(s)
- G Y H Lip
- University of Liverpool, Institute of Cardiovascular Science, Liverpool, United Kingdom
| | - H.-C Diener
- University of Duisburg-Essen, Duisberg, Germany
| | - S J Dubner
- Clínica y Maternidad Suizo Argentina, Caba, Argentina
| | - J L Halperin
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - K J Rothman
- RTI Health Solutions, Research Triangle Institute, Durham, United States of America
| | - C.-S Ma
- Beijing Anzhen Hospital, Beijing, China
| | - S Lu
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, United States of America
| | - M Paquette
- Boehringer Ingelheim, Burlington, Canada
| | - L Riou Franca
- Boehringer Ingelheim International, Ingelheim am Rhein, Germany
| | - K Zint
- Boehringer Ingelheim International, Ingelheim am Rhein, Germany
| | - C Teutsch
- Boehringer Ingelheim International, Ingelheim am Rhein, Germany
| | - M V Huisman
- Leiden University Medical Center, Leiden, Netherlands (The)
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12
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Lajeunesse-Trempe F, Dufour R, du Souich P, Paquette M, Kaduka LU, Christensen DL. Anthropometric measures and their association with risk factors for cardio-metabolic diseases in Kenyan adults. Ann Hum Biol 2019; 45:486-495. [PMID: 30608195 DOI: 10.1080/03014460.2018.1562568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The prevalence of cardio-metabolic diseases (CMD) is drastically increasing worldwide. Anthropometric measures of fat accumulation are correlated with CMD and Metabolic Syndrome (MS), but few studies have addressed this association in sub-Saharan African populations. AIM To investigate the association between anthropometric features, MS and other CMD risk factors in a population from Kenya. SUBJECTS AND METHODS In this cross-sectional study including 1405 Kenyans, anthropometric measurements including visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) were carried out. Fasting blood glucose and standard oral glucose tolerance test, fasting serum insulin and plasma lipids were analysed. Homeostatic model assessment of insulin resistance was calculated. Systolic and diastolic blood pressures were measured. RESULTS CMD risk factors and MS were associated with all anthropometric features, except for high-density lipoprotein cholesterol levels (p < 0.05). The strongest association between MS and anthropometrics was seen with SAT (β = 1.45 ± 0.32 in men and 0.88 ± 0.14 in women, both p < 0.05). CONCLUSIONS Anthropometric measures, especially features of central obesity such as VAT and SAT, are relevant indicators of cardio-metabolic health in Kenyan populations. SAT is the strongest predictor of MS. These results highlight the need for further research on the pathological implication of VAT and SAT, in order to understand patterns of fat distribution and cardio-metabolic health among different ethnic groups.
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Affiliation(s)
- F Lajeunesse-Trempe
- a Faculty of Medicine , University of Montreal , Montreal , Canada.,b Nutrition, Metabolism and Atherosclerosis Clinic , Montreal Clinical Research Institute, affiliated with University of Montreal , Montreal , Canada
| | - R Dufour
- b Nutrition, Metabolism and Atherosclerosis Clinic , Montreal Clinical Research Institute, affiliated with University of Montreal , Montreal , Canada.,c Department of Nutrition , University of Montreal , Montreal , Canada
| | - P du Souich
- b Nutrition, Metabolism and Atherosclerosis Clinic , Montreal Clinical Research Institute, affiliated with University of Montreal , Montreal , Canada.,d Department of Pharmacology and Physiology, Faculty of Medicine , University of Montreal , Montreal , Canada
| | - M Paquette
- b Nutrition, Metabolism and Atherosclerosis Clinic , Montreal Clinical Research Institute, affiliated with University of Montreal , Montreal , Canada
| | - L U Kaduka
- e Centre for Public Health Research , KEMRI , Nairobi , Kenya
| | - D L Christensen
- f Department of Public Health , University of Copenhagen , Copenhagen , Denmark
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Dubner SJ, Huisman MV, Diener HC, Halperin JL, Rothman KJ, Ma CS, Bergler-Klein J, Zint K, Riou Franca L, Lu S, Teutsch C, Paquette M, Lip GYH. P2887Two-year outcomes of dabigatran etexilate treatment in patients with co-morbid heart failure and atrial fibrillation: the GLORIA-AF registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S J Dubner
- Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - M V Huisman
- Leiden University Medical Center, Leiden, Leiden, Netherlands
| | - H C Diener
- University Hospital Essen, Essen, Germany
| | - J L Halperin
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - K J Rothman
- RTI Health Solutions, Research Triangle Institute, Durham, United States of America
| | - C S Ma
- Beijing Anzhen Hospital, Atrial Fibrillation Center, Beijing, China People's Republic of
| | - J Bergler-Klein
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - K Zint
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - L Riou Franca
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - S Lu
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, United States of America
| | - C Teutsch
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - M Paquette
- Boehringer Ingelheim Corporation, Ontario, Burlington, Canada
| | - G Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
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14
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Paquette M, Huisman MV, Lip GYH, Diener HC, Dubner SJ, Halperin JL, Rothman KJ, Ma CS, Lu S, Riou Franca L, Teutsch C, Zint K, Nieuwlaat R. P4799When are atrial fibrillation patients at risk to discontinue anticoagulation treatment? Results from the GLORIA-AF Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Paquette
- Boehringer Ingelheim Corporation, Ontario, Canada
| | - M V Huisman
- Leiden University Medical Center, Leiden, Netherlands
| | - G Y H Lip
- University of Birmingham, Birmingham, United Kingdom
| | - H.-C Diener
- University Hospital of Essen (Ruhr), Essen, Germany
| | - S J Dubner
- Clinic and Maternity Suizo Argentina, Buenos Aires, Argentina
| | - J L Halperin
- Mount Sinai School of Medicine, New York, United States of America
| | - K J Rothman
- RTI Health Solutions, Durham, United States of America
| | - C S Ma
- Beijing Anzhen Hospital, Beijing, China People's Republic of
| | - S Lu
- Boehringer Ingelheim Corporation, Ridgefield, CT, United States of America
| | - L Riou Franca
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - C Teutsch
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - K Zint
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
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Beier L, Franca LR, Lip GYH, Huisman MV, Zint K, Halperin JL, Diener HC, Dubner SJ, Ma CS, Teutsch C, Paquette M, Minkenberg R, Lu S, Rothman KJ. P5140Geographic region, stroke risk and renal function strongly affect treatment choice for stroke prevention in patients with non-valvular AF: results from the GLORIA-AF registry program. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Beier
- c/o Theresa Oberst, Nürnberg, Germany
| | - L R Franca
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - G Y H Lip
- Birmingham City Hospital, Birmingham, United Kingdom
| | - M V Huisman
- Leiden University Medical Center, Leiden, Netherlands
| | - K Zint
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - J L Halperin
- Mount Sinai School of Medicine, New York, United States of America
| | - H.-C Diener
- University Hospital of Essen (Ruhr), Essen, Germany
| | - S J Dubner
- Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - C.-S Ma
- Beijing Anzhen Hospital, Beijing, China People's Republic of
| | - C Teutsch
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - M Paquette
- Boehringer Ingelheim Corporation, Burlington, Ontario, Canada
| | - R Minkenberg
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - S Lu
- Boehringer Ingelheim Corporation, Ridgefield, Connecticut, United States of America
| | - K J Rothman
- RTI Health Solutions, Durham, North Carolina, United States of America
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Halperin JL, Teutsch C, Huisman MV, Diener HC, Rothman KJ, Ma CS, Dubner SJ, Zint K, Riou Franca L, Paquette M, Lip GYH. P2896Two-year outcomes of dabigatran etexilate in patients with atrial fibrillation with and without a history of coronary artery disease: data from GLORIA-AF. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J L Halperin
- Mount Sinai School of Medicine, New York, United States of America
| | - C Teutsch
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - M V Huisman
- Leiden University Medical Center, Leiden, Netherlands
| | | | - K J Rothman
- RTI Health Solutions, Research Triangle Park, United States of America
| | - C S Ma
- Beijing Anzhen Hospital, Beijing, China People's Republic of
| | - S J Dubner
- Clinic and Maternity Suizo Argentina, Buenos Aires, Argentina
| | - K Zint
- Boehringer Ingelheim GmbH, Ingelheim, Germany
| | - L Riou Franca
- Boehringer Ingelheim Corporation, Ridgefield, CT, United States of America
| | - M Paquette
- Boehringer Ingelheim Corporation, Burlington, Canada
| | - G Y H Lip
- University of Birmingham, Birmingham, United Kingdom
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17
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Huisman MV, Diener HC, Dubner SJ, Halperin JL, Rothman KJ, Ma CS, Lu S, Paquette M, Teutsch C, Franca LR, Zint K, Lip GYH. P3862A prospective global registry on oral antithrombotic treatment in patients with atrial fibrillation: GLORIA-AF Phase III baseline characteristics. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M V Huisman
- Leiden University Medical Center, Leiden, Netherlands
| | - H.-C Diener
- University Hospital of Essen (Ruhr), Essen, Germany
| | - S J Dubner
- Clinic and Maternity Suizo Argentina, Buenos Aires, Argentina
| | - J L Halperin
- Mount Sinai School of Medicine, New York, United States of America
| | - K J Rothman
- RTI Health Solutions, Durham, United States of America
| | - C.-S Ma
- Beijing Anzhen Hospital, Beijing, China People's Republic of
| | - S Lu
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, United States of America
| | - M Paquette
- Boehringer Ingelheim Ltd., Ontario, Burlington, Canada
| | - C Teutsch
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - L R Franca
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - K Zint
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - G Y H Lip
- Birmingham City Hospital, Birmingham, United Kingdom
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Jenkins DJ, Spence JD, Giovannucci EL, Kim YI, Josse R, Vieth R, Blanco Mejia S, Viguiliouk E, Nishi S, Sahye-Pudaruth S, Paquette M, Patel D, Mitchell S, Kavanagh M, Tsirakis T, Bachiri L, Maran A, Umatheva N, McKay T, Trinidad G, Bernstein D, Chowdhury A, Correa-Betanzo J, Del Principe G, Hajizadeh A, Jayaraman R, Jenkins A, Jenkins W, Kalaichandran R, Kirupaharan G, Manisekaran P, Qutta T, Shahid R, Silver A, Villegas C, White J, Kendall CW, Pichika SC, Sievenpiper JL. Supplemental Vitamins and Minerals for CVD Prevention and Treatment. J Am Coll Cardiol 2018; 71:2570-2584. [DOI: 10.1016/j.jacc.2018.04.020] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/26/2018] [Accepted: 04/17/2018] [Indexed: 12/14/2022]
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Lip GYH, Van Der Wall SJ, Teutsch C, Rothman KJ, Diener HC, Dubner SJ, Ma CS, Paquette M, Lu S, Riou Franca L, Zint K, Halperin JL, Huisman MV. 200Safety of uninterrupted dabigatran in cardiovascular interventions in the GLORIA-AF registry program. Europace 2018. [DOI: 10.1093/europace/euy015.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- GYH Lip
- Birmingham City Hospital, Birmingham, United Kingdom
| | | | - C Teutsch
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - K J Rothman
- RTI Health Solutions, North Carolina, United States of America
| | - H-C Diener
- University Hospital of Essen (Ruhr), Essen, Germany
| | - S J Dubner
- Clinica y maternidad Suizo Argentina, Buenos Aires, Argentina
| | - C S Ma
- Beijing Anzhen Hospital, Beijing, China People's Republic of
| | - M Paquette
- Boehringer Ingelheim Corporation, Ontario, Canada
| | - S Lu
- Boehringer Ingelheim Corporation, Ridgefield, United States of America
| | - L Riou Franca
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - K Zint
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - J L Halperin
- Mount Sinai School of Medicine, New York, United States of America
| | - M V Huisman
- Leiden University Medical Center, Leiden, Netherlands
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20
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Lip G, Teusch C, Huisman M, Diener H, Dubner S, Ma C, Rothman K, Elsaesser A, Paquette M, Zint K, Bartels D, Halperin J. P4600Prescribing of dabigatran etexilate in accordance with the European label for stroke prevention in atrial fibrillation: Findings from the GLORIA-AF Registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4600] [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: 11/13/2022] Open
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21
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Jenkins DJA, Boucher BA, Ashbury FD, Sloan M, Brown P, El-Sohemy A, Hanley AJ, Willett W, Paquette M, de Souza RJ, Ireland C, Kwan N, Jenkins A, Pichika SC, Kreiger N. Effect of Current Dietary Recommendations on Weight Loss and Cardiovascular Risk Factors. J Am Coll Cardiol 2017; 69:1103-1112. [PMID: 28254171 DOI: 10.1016/j.jacc.2016.10.089] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 09/17/2016] [Accepted: 10/18/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Dietary recommendations emphasize increased consumption of fruit, vegetables, and whole grain cereals for prevention of chronic disease. OBJECTIVES This study assessed the effect of dietary advice and/or food provision on body weight and cardiovascular disease risk factors. METHODS Healthy overweight men (n = 209) and women (n = 710), mean age 44.7 years, body mass index [BMI] 32.4 kg/m2, were randomized between November 2005 and August 2009 to receive Health Canada's food guide (control, n = 486) or 1 of 3 interventions: dietary advice consistent with both Dietary Approaches to Stop Hypertension (DASH) and dietary portfolio principles (n = 145); weekly food provision reflecting this advice (n = 148); or food delivery plus advice (n = 140). Interventions lasted 6 months with 12-month follow-up. Semiquantitative food frequency questionnaires and fasting blood, anthropometric and blood pressure measurements were obtained at baseline, 6 months, and 18 months. RESULTS Participant retention at 6 and 18 months was 91% and 81%, respectively, after food provision compared to 67% and 57% when no food was provided (p < 0.0001). Test and control treatments showed small reductions in body weight (-0.8 to -1.2 kg), waist circumference (-1.1 to -1.9 cm), and mean arterial pressure (0.0 to -1.1 mm Hg) at 6 months and Framingham coronary heart disease risk score at 18 months (-0.19 to -0.42%), which were significant overall. Outcomes did not differ among test and control groups. CONCLUSIONS Provision of foods increased retention but only modestly increased intake of recommended foods. Current dietary recommendations showed small overall benefits in coronary heart disease risk factors. Additional dietary strategies to maximize these benefits are required. (Fruits, Vegetables, and Whole Grains: A Community-based Intervention; NCT00516620).
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Affiliation(s)
- David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Beatrice A Boucher
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Fredrick D Ashbury
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Preventive Oncology, University of Calgary, Calgary, Alberta, Canada; Department of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Margaret Sloan
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Patrick Brown
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anthony J Hanley
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Walter Willett
- Nutrition Department, Harvard School of Public Health, Harvard University, Boston, Massachusetts
| | - Melanie Paquette
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Christopher Ireland
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Natalie Kwan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amy Jenkins
- Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Food Science, University of Guelph, Guelph, Ontario, Canada
| | - Sathish C Pichika
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nancy Kreiger
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Dubner SJ, Huisman MV, Diener HC, Halperin J, Rothman KJ, Ma CS, Zint K, Riou Franca L, Lu S, Teutsch C, Paquette M, Lip GYH. P281Baseline characteristics of patients with atrial fibrillation with and without comorbid heart failure: the GLORIA-AF registry. Europace 2017. [DOI: 10.1093/ehjci/eux141.009] [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: 11/14/2022] Open
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23
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Paquette M. Experiences of nurse handover. Br J Nurs 2016; 25:620. [PMID: 27281596 DOI: 10.12968/bjon.2016.25.11.620a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Paquette M, Le Blanc O, Lucas SJE, Thibault G, Bailey DM, Brassard P. Effects of submaximal and supramaximal interval training on determinants of endurance performance in endurance athletes. Scand J Med Sci Sports 2016; 27:318-326. [DOI: 10.1111/sms.12660] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 12/21/2022]
Affiliation(s)
- M. Paquette
- Department of Kinesiology; Faculty of Medicine; Université Laval; Québec QC Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec; Québec QC Canada
| | - O. Le Blanc
- Department of Kinesiology; Faculty of Medicine; Université Laval; Québec QC Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec; Québec QC Canada
| | - S. J. E. Lucas
- School of Sport, Exercise and Rehabilitation Sciences; University of Birmingham; Birmingham UK
- Department of Physiology; University of Otago; Dunedin New Zealand
| | - G. Thibault
- Department of Kinesiology; Faculty of Medicine; Université Laval; Québec QC Canada
| | - D. M. Bailey
- Neurovascular Research, Laboratory, Faculty of Life Sciences and Education; University of South Wales; South Wales UK
- Sondes Moléculaires en Biologie; Laboratoire Chimie Provence UMR 6264 CNRS; Université de Provence Marseille; Marseille France
| | - P. Brassard
- Department of Kinesiology; Faculty of Medicine; Université Laval; Québec QC Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec; Québec QC Canada
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Tyldesley S, Tran E, Paquette M, Jay J, Liu M, Hamm J, Duncan G, Pickles T. OC-0049 THE IMPACT OF COMORBIDITIES ON THE BENEFITS OF PROLONGED ANDROGEN ABLATION IN PATIENTS WITH T3-4 PROSTATE CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70388-2] [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: 10/28/2022]
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Tran E, Tyldesley S, Paquette M, Hamm J, Liu M, Lim J, Keyes M, Kwan W, Pickles T. Population-based Validation of the Bolla Study in T3-4 Prostate Cancer in British Columbia. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.630] [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: 11/26/2022]
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Caon J, Paquette M, Pickles T. Statin and ASA Use in Regards to Comorbidity and Outcome in Men with Prostate Cancer Treated with Curative Intent Radiation Therapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.687] [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: 10/15/2022]
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28
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Berrang T, Paquette M, Woods R, Speers C, Hayshi A, Lerch L, Walter C, Smith S, Olivotto I. Can We Predict Which Women with a Negative Sentinel Lymph Node Biopsy Are at High Risk of a False Negative Result? Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-303] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Standard of care for women with a positive sentinel lymph node biopsy (SLNB) is to have a completion axillary lymph node dissection (cALND). For women with a negative SLNB, cALND is often not performed, accepting that a proportion will have a false negative (FN) result. FN rates are commonly reported based on surgeon experience. In the absence of cALND, information on FN rates will not be available, and other means of assessing the risk for FN SLNB is needed.Materials and Methods: Between May 1999 and December 2006, 1661 women with early-stage breast cancer that had undergone SLNB followed by cALND, were identified from our provincial database: 77 FN, 560 true positive (TP), and 1024 true negative (TN). FN cases were matched 1:3 with TN cases by date of SLNB. Chi-square and Wilcoxon Rank-sum tests were used to screen variables and those with moderate association were identified and included in subsequent models. Logistic regression was used to develop a multivariable model to predict the probability of FN vs. TN status. ROC curves were used to estimate the optimal probability cut-off, at which sensitivity (SN) and specificity (SP) were maximized. The model's performance was then assessed using a cross-validation technique.Results: Factors examined that did not significantly affect FN vs. TN status rate included: age, body mass index, previous breast surgery, histology, estrogen receptor status, margin status, tumor palpability, injection technique (peritumoral, periareolar), mapping agent used (yes/no), and SLNB done pre vs. post breast surgery (all p=NS). Factors identified that significantly affected FN vs. TN status (p<0.05) and thus included for potential use in the model included: tumor size, tumor grade, lymphovascular invasion (+/-LVI), tumor site (central/medial, lateral, other), type of breast surgery (mastectomy vs. lumpectomy), pre-operative lymphoscintiscan (yes/no), colloid (yes/no), number of SLN (1 vs. >1). The final model contained 5 variables: T stage (1 vs. 2), tumor grade, number of SLN removed, tumor site, and LVI. ROC identified an optimal probability cut-point for this model of 0.217 (21.7% risk of FN) with a corresponding SN of 71% and SP of 70%. In the cross-validation, the model correctly classified 66% of cases (SN of 73%, SP of 64%) with an AUC of 0.76. With increasing FN risk, SN declined and SP increased such that at a FN risk of 30%, this model had a SN 56%, SP 77%, and accuracy 72%. Using this model a woman with a T1, lateral, grade 3, 1 SLN and LVI- had a predicted FN risk of 21.5%, increasing to 52.2% if she were LVI+.Discussion: For women with early breast cancer, a negative SLNB result has a significant impact on prognosis and recommendations for further systemic and radiation therapy, this model (T size, tumor grade, number of SLN removed, tumor site, and LVI) is the first that would offer a quantitative prediction of FN risk in this setting, which could influence further discussion and therapeutic decision making. Potential refinements of this model will be explored, incorporating 'lower-priority' variables.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 303.
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Affiliation(s)
- T. Berrang
- 1British Columbia Cancer Agency, BC, Canada
| | | | - R. Woods
- 1British Columbia Cancer Agency, BC, Canada
| | - C. Speers
- 1British Columbia Cancer Agency, BC, Canada
| | - A. Hayshi
- 2University of British Columbia, BC, Canada
| | - L. Lerch
- 2University of British Columbia, BC, Canada
| | - C. Walter
- 1British Columbia Cancer Agency, BC, Canada
| | - S. Smith
- 1British Columbia Cancer Agency, BC, Canada
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Abstract
Previous studies have shown temporal variations in gentamicin-induced renal toxicity characterized by a peak when administered during the resting period and a trough during the active period. This time-dependent toxicity was also altered according to the macronutrient composition of dietary regimens offered to female rats. In the present study, adult female Sprague-Dawley rats were adapted to semipurified isocaloric diets containing 20% casein or soy-protein (10% fat each) or to a standard chow diet (18.1% mixed proteins; 4.5% fat). The animals were then chronically treated for 10 days with a nephrotoxic dose of gentamicin sulfate (40 mg/kg/day ip) or a saline solution administered in the middle of their resting period (1200 h) or in the middle of their activity period (0000 h). Body weights of rats injected in the middle of their resting period decreased over the last 6 days of gentamicin treatment. Total 12-h light and 12-h dark food intakes were decreased in gentamicin-treated rats. Rats fed the standard chow diet had significantly lower corticocellular regeneration, serum creatinine and blood urea nitrogen compared to those fed the casein- and soy-containing diets. The present study demonstrates that chronic gentamicin-induced renal toxicity varies temporally according to the time of administration and that a mixed protein diet containing a lower fat level can protect against gentamicin-induced nephrotoxicity.
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Affiliation(s)
- M Paquette
- School of Dietetics and Human Nutrition, Macdonald Campus of McGill University, Montreal, Québec, Canada H9X 3V9
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Lee DS, Dorian P, Downar E, Burns M, Yeo EL, Gold WL, Paquette M, Lau W, Newman DM. Thrombogenicity of radiofrequency ablation procedures: what factors influence thrombin generation? Europace 2001; 3:195-200. [PMID: 11467460 DOI: 10.1053/eupc.2001.0167] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Thromboembolic complications have been reported after radiofrequency ablation but the low incidence of overt clinical events has been a limitation to the study of factors affecting thrombogenic risk. The aim of this study was to determine whether radiofrequency ablation has a procoagulant effect and to examine variables that affect thrombio generation. METHODS AND RESULTS Thirty-seven consecutive patients who underwent radiofrequency ablation were studied prospectively. Blood samples were assayed for thrombin-antithrombin III (TAT) and d-dimer (DD) at five different time points: (1) baseline; (2) after sheath insertion; (3) after electrophysiological study but before radiofrequency ablation; (4) at completion of the procedure; and (5) 24 h post-procedure. TAT levels were within the normal range at baseline and increased significantly after sheath insertion from 2.1 +/- 1.2 microg l(-1) to 13.3 +/- 16.0 microg l(-1) (P<0.01). Levels increased further to 24.0 +/- 19.9 microg l(-1) (P<0.01) after electrophysiological study but did not increase after radiofrequency ablation. TAT normalized at 24 h. DD increased significantly from baseline values (230.2 +/- 176.8 ng ml(-1)) to 285.4 +/- 237.4 ng ml(-1) (P=0.019) after sheath insertion. There was a further significant increase after electrophysiological study to 423.4 +/- 324.3 ng ml(-1) (P<0.01), and a slight but non-significant increase to 464.4 +/- 307.4 ng ml(-1) after radiofrequency ablation (P=0.159). DD remained elevated at 24 h. Procedure duration was the only variable that correlated with the relative increase in TAT and DD. The patients with the longest procedure durations had more catheters inserted, more radiofrequency applications and largely consisted of accessory bypass tract-mediated tachycardias. Heparin administration significantly blunted the relative increase in TAT after radiofrequency ablation (P=0.005). CONCLUSION Radiofrequency ablation procedures confer an increased risk of thrombosis. Catheterization and diagnostic study contribute largely to the thrombogenic stimulus. Thrombogenicity is increased in prolonged, complex procedures and is decreased in patients who have been administered heparin during the procedure.
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Affiliation(s)
- D S Lee
- St Michael's Hospital, Division of Cardiology, Toronto, Canada
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Baker B, Paquette M, Szalai JP, Driver H, Perger T, Helmers K, O'Kelly B, Tobe S. The influence of marital adjustment on 3-year left ventricular mass and ambulatory blood pressure in mild hypertension. Arch Intern Med 2000; 160:3453-8. [PMID: 11112239 DOI: 10.1001/archinte.160.22.3453] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Of psychosocial stressors, job strain has been associated with a sustained increase in blood pressure. The impact of marital factors on blood pressure and target organ has not been explored. OBJECTIVES To evaluate whether marital adjustment, measured at baseline by self-report (Dyadic Adjustment Scale) influences left ventricular mass index (LVMI) and ambulatory blood pressure measured over 3 years in patients with mild hypertension. METHODS A prospective cohort study was conducted on 103 cohabiting males or females, including 72 with technically adequate echocardiograms, who at baseline were unmedicated, employed, and living with a significant other, all for a minimum of 6 months and had repeated elevated office diastolic blood pressure. MAIN OUTCOME MEASURES Left ventricular mass by M-mode echocardiography indexed to body surface area and blood pressure were measured by ambulatory blood pressure every 15 minutes (daytime) and hourly between 11 PM and 7 AM. RESULTS Marital adjustment, smoking, drinking, and baseline LVMI contributed significantly to the prediction of 3-year LVMI (semipartial correlation, sr(2) = 0.04, 0.07, 0.03, and 0.22; P =.03,.008,.08, and <.001, respectively) together accounting for 36% of the total variability in follow-up LVMI. Three-year ambulatory blood pressure measures were not significantly related to marital adjustment but there were correlations with Dyadic Adjustment Scale subscales. Low or high levels of spousal contact during 3-year ambulatory blood pressure monitoring were associated with an increase or decrease of 3-year, 24-hour diastolic blood pressure, consistent with the quality of marital adjustment (P =.04) or marital satisfaction (Dyadic Adjustment Scale subscale, P =.008). CONCLUSIONS In a cohort of subjects with mild essential hypertension, marital adjustment had an influence on 3-year LVMI. Depending on the quality of marital adjustment, spousal contact at 3 years was associated with an increase or decrease of 3-year diastolic blood pressure. Confirmation of these results, including objective marital assessment and the participation of normotensive subjects, is required. Arch Intern Med. 2000;160:3453-3458.
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Affiliation(s)
- B Baker
- 3D Edith Cavell Wing, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8.
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36
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Abstract
Although ICD therapy is seen as an irrevocable mode of therapy in most patients, a small number of patients do have their devices permanently explanted. The long-term outcome in these patients has not been described. The purpose of this single center study was to evaluate the long-term outcome of patients whose ICD was explanted and not replaced and to propose clinical variables that can be considered when making the decision to discontinue therapy. Ten of 323 (3.1%) patients in our ICD registry had their devices permanently explanted or turned off between 1986 and December 1998. The devices had been in place for 39 +/- 31 months preexplant. No patient had received appropriate therapy prior to surgery, which was indicated for infection or lead fracture. All patients are alive and well 75 +/- 30 months postexplant with 1 (10%) patient requiring late reimplantation. We reviewed the English language literature describing ICD explanation without replacement. A total of 151 patients were reported in eight studies and were followed for up to 30 months postexplant. Excluding patients with terminal illness or heart transplantation 57.6% survived without reimplantation. In selected patients, after not using an ICD for a long period and when clinical circumstances justify, device therapy may be discontinued with some degree of safety.
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Affiliation(s)
- M Geist
- Division of Cardiology, St. Michael's Hospital and University of Toronto, Canada.
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Abstract
Patients with atrial fibrillation (AF) report impaired health-related quality of life (QOL). Differences between men and women with AF have not been described and personality attributes such as somatization (tendency to amplify benign bodily sensations) may mediate potential gender differences in QOL. Patients with AF (n = 264, 59% men) who participated in the Canadian Trial of Atrial Fibrillation (n = 403) completed validated QOL questionnaires at baseline, 3 months, and 12 months after antiarrhythmic drug treatment. Women were significantly older than men and a greater proportion had hypertension, but other cardiac variables did not differ between women and men. At baseline, after controlling for significant clinical and demographic factors, women reported worse physical health (p = 0.002) and functional capacity (p < 0.001), but not mental health or general well-being. Women also had more frequent and severe cardiac symptoms than men (both p < 0.001). Physical health improved significantly from baseline to 3 months for women (p = 0.002), but not for men (p = 0.066). Conversely, mental health improved for men (p = 0.007), but not for women. Cardiac symptom frequency and severity improved over time for women and men (all p < 0.001). Tendency to somatize predicted poor QOL, and women had higher scores than men (p = 0.023). However, after controlling for somatization, women still had worse physical function, functional capacity, and symptom burden than men. Independent of cardiac disease severity and age, women with AF had significantly more impaired QOL than men, specifically on domains related to physical rather than emotional functioning. Personality attributes may have a role in influencing QOL outcomes.
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Affiliation(s)
- M Paquette
- St. Michael's Hospital, Toronto, Ontario, Canada
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Dorian P, Jung W, Newman D, Paquette M, Wood K, Ayers GM, Camm J, Akhtar M, Luderitz B. The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J Am Coll Cardiol 2000; 36:1303-9. [PMID: 11028487 DOI: 10.1016/s0735-1097(00)00886-x] [Citation(s) in RCA: 419] [Impact Index Per Article: 17.5] [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
OBJECTIVES We sought to assess the impact of intermittent atrial fibrillation (AF) on health-related quality of life (QoL). BACKGROUND Intermittent AF is a common condition with little data on health-related QoL questionnaires to guide investigational therapies. METHODS Outpatients from four centers, with documented AF (n = 152), completed validated QoL questionnaires (Medical Outcomes Study Short Form 36 [SF-36], Specific Activity, Symptom Checklist, Illness Intrusiveness and University of Toronto AF Severity Scales). Comparison groups were made up of healthy individuals (n = 47) and four cardiac control groups: published (n = 78) and created for study (n = 69) percutaneous transluminal coronary angioplasty (PTCA); published heart failure (n = 216) and published postmyocardial infarction (MI) (n = 107). RESULTS Across all domains of the SF-36, AF patients reported substantially worse QoL than healthy controls (1.3 to 2.0 standard deviation units), with scores of 24%, 23%, 16% and 30% lower than healthy individuals on measures of physical and social functioning, mental and general health, respectively (all p < 0.001). Patients with AF were either significantly worse (p < 0.05, published controls) or as impaired (study controls) as either PTCA or post-MI patients on all domains of the SF-36 and the same as heart failure controls on SF-36 psychological subscales. Patients with AF were as impaired or worse than study PTCA controls on measures of illness intrusiveness, activity limitations and symptoms. Associations between objective disease indexes and subjective QoL measures had poor correlations and accounted for <6% of the total variability in QoL scores. CONCLUSIONS Quality of life is as impaired in patients with intermittent AF as in patients with significant structural heart disease. Patients' perception of QoL is not dependent on the objective measures of disease severity that are usually employed.
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Affiliation(s)
- P Dorian
- St. Micheal's Hospital, Toronto, Ontario, Canada
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Greene M, Newman D, Geist M, Paquette M, Heng D, Dorian P. Is electrical storm in ICD patients the sign of a dying heart? Outcome of patients with clusters of ventricular tachyarrhythmias. Europace 2000; 2:263-9. [PMID: 11227599 DOI: 10.1053/eupc.2000.0104] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electrical storm in patients with implanted cardioverter defibrillators (ICDs) is purported to carry an ominous prognosis. METHODS AND RESULTS We retrospectively compared 40 patients with electrical storm (defined as three or more episodes of ventricular arrhythmia requiring ICD therapy in a 24 h period) with those only having isolated appropriate ICD therapy (n=57) and with patients having no or only inappropriate ICD therapy (n=125). All patients received ICDs for documented sustained VT or VF. There was no significant difference in age, sex, ejection fraction, total follow-up time, or underlying heart disease between any of the three groups. Patients who had electrical storm received their first appropriate ICD therapy 275 +/- 369 days post-implant (35% had storm as their first event) with storm occurring an average of 599 +/- 710 days post-implant. Patients had 1.5 +/- 1.0 storms in total (median= 1), with 55 +/- 91 episodes per storm. There were no significant differences in actuarial survival at 5-year follow-up between the three groups. Eighty percent of storm patients were alive 5 years post-implant. CONCLUSION Storm is a common occurrence in ICD patients, can occur at any time during the follow-up period, and does not independently confer increased mortality.
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Affiliation(s)
- M Greene
- Division of Cardiology, St Michael's Hospital, University of Toronto, Canada
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Mok E, Paquette M, Thibault L. Effect of quipazine, a selective 5-HT3 agonist, on dietary self-selection of different macronutrient diets in male and female rats. Appetite 2000; 34:313-25. [PMID: 10888295 DOI: 10.1006/appe.2000.0321] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Macronutrient intakes, 2h and 12h, following administration of a selective 5-HT3 agonist, quipazine, N methyl, dimaleate (QUIPAZINE; 2.5, 5.0 and 7.5 mg/kg, i.p.) at dark onset were examined in three groups of adult male and female Wistar rats fed different sources of the three macronutrients: Group 1 (casein, corn starch, safflower oil), Group 2 (egg protein, corn starch/sucrose, lard) and Group S (casein hydrolysate, maltose dextrin, butter). QUIPAZINE decreased total food intake only in female rats from Group 1 (2 h) at a dose of 7.5 mg/kg and Group 2 (2h and 12h) with doses of 2.5 and 7.5 mg/kg. Intakes from corn starch and corn starch/sucrose diet (12h) were reduced in male and female rats, respectively, with doses of 2.5 and 7.5 mg/kg of QUIPAZINE. In conclusion, when provided with different sources of the three macronutrients, quipazine injection reduces specifically carbohydrate ingestion from corn starch-containing diets in male and female rats. Thus, the nature of the macronutrient source is of major importance to assess the effect of a drug on nutrient-specific selection.
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Affiliation(s)
- E Mok
- School of Dietetics and Human Nutrition, McGill University, Ste Anne de Bellevue, Quebec, Canada
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Nanthakumar K, Paquette M, Newman D, Deno DC, Malden L, Gunderson B, Gilkerson J, Greene M, Heng D, Dorian P. Inappropriate therapy from atrial fibrillation and sinus tachycardia in automated implantable cardioverter defibrillators. Am Heart J 2000; 139:797-803. [PMID: 10783212 DOI: 10.1016/s0002-8703(00)90010-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [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: 11/22/2022]
Abstract
BACKGROUND Inappropriate therapy from supraventricular tachyarrhythmias (atrial fibrillation [AF] and sinus tachycardia [ST]) in patients with implanted cardioverter defibrillators is a major challenge. We tested the performance of stability algorithms from 3 manufacturers for episodes of inappropriate therapy delivered because of AF and an onset algorithm for all episodes of inappropriate therapy caused by ST. METHODS Therapy was classified as caused by ventricular tachycardia (VT), ST, or AF from review of stored intracardiac electrograms, history, clinical information, and R-R data before study inception. By using 30 to 60 R-R intervals before therapy, sensitivity and specificity for a family of stability values and percentage of onset values were calculated for each manufacturer and receiver operating characteristic curves generated. RESULTS Of the 217 patients monitored, 62 (29%) received inappropriate therapy, and 40 had complete R-R information available. Of the 40 patients, 21 patients received therapy for AF, 19 for ST, and 1 patient for noise; 15 (38%) also received appropriate therapy for VT. We analyzed 83 episodes of VT from 18 patients, 94 episodes of AF from 21 patients, and 56 episodes of ST from 19 patients. Specificity, in the clinically relevant sensitivity range of >/=95%, was comparable across manufacturers at about 40%. An onset value of 80% was associated with 91% sensitivity and 95% specificity for the specific algorithm tested. CONCLUSIONS Inappropriate therapy is a common problem in implantable cardiac defibrillators. The performance of the stability algorithms used to differentiate AF from VT was less than ideal, though comparable across manufacturers. The onset algorithm accurately differentiates ST from VT.
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Nanthakumar K, Dorian P, Paquette M, Hutchison S, Andrews J, Newman D. Effect of physiological mechanical perturbations on intact human myocardial repolarization. Cardiovasc Res 2000; 45:303-9. [PMID: 10728350 DOI: 10.1016/s0008-6363(99)00261-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the relationship between acute decreases in right ventricular volume during Valsalva strain (with resultant changes in autonomic neural tone) and measures of local endocardial repolarization time independent of heart rate and autonomic neural tone. METHODS Patients implanted with a stimulus to T wave (Stim-T) sensing pacemaker specially adapted to output a validate measure of beat to beat local repolarization (n = 9) performed Valsalva manoeuvers (40 mmHg for 15 s) while paced at a cycle length of 500 ms. Stim-T intervals were measured before and after autonomic blockade (Block: 0.03 mg/kg i.v. atropine +/- 0.15 mg/kg propranolol). Right ventricular end diastolic volume was estimated by simultaneous 2D-echocardiography. RESULTS Without autonomic blockade, compared to baseline, repolarization significantly prolonged during Valsalva strain (1.1 +/- 0.7%) and shortened during release (-1.4 +/- 1.0%). After block, strain related repolarization prolongation was also observed (1.0 +/- 0.6%), with significantly less release related repolarization shortening (-0.8 +/- 0.8%) compared to pre-block (P < 0.05). Right ventricular end diastolic volume decreased during strain by 11 +/- 10 and 9 +/- 16% from baseline, pre- and post-block respectively (P < 0.05). CONCLUSION In a chronically instrumented human model, an acute physiologic volume reduction modestly prolongs right ventricular repolarization independent of changes in rate or autonomic tone.
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Affiliation(s)
- K Nanthakumar
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Irvine J, Basinski A, Baker B, Jandciu S, Paquette M, Cairns J, Connolly S, Roberts R, Gent M, Dorian P. Depression and risk of sudden cardiac death after acute myocardial infarction: testing for the confounding effects of fatigue. Psychosom Med 1999; 61:729-37. [PMID: 10593621 DOI: 10.1097/00006842-199911000-00001] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.0] [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: 11/25/2022]
Abstract
OBJECTIVES This study examined the impact of depressive symptoms and social support on 2-year sudden cardiac death (SCD) risk, controlling for fatigue symptoms. METHODS Myocardial infarction (MI) patients (N = 671) participating in the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial completed measures of depression, hostility, and social support. RESULTS After controlling for significant biological predictors, psychosocial predictors of increased SCD risk in the survival analysis were greater social network contacts (RR = 1.04; 95% CI = 1.01-1.06; p < .007), lower social participation (RR = 0.98; 95% CI = 0.96-1.00; p < .05), and, in placebo-treated patients, elevated depressive symptoms (RR = 2.45; 95% CI = 1.14-5.35; p < .02). Fatigue was associated with SCD (RR = 1.31; 95% CI = 1.11-1.53; p < .001), and, when included in the model, diminished the influence of depression (RR = 1.73; 95% CI = 0.75-3.98; p = .20). When the cognitive-affective depressive symptoms were examined separately from somatic symptoms, there was a trend for an association between cognitive-affective symptoms and SCD in placebo-treated patients after controlling for fatigue (RR = 1.09; 95% CI = 0.99-1.19, p < .06). CONCLUSIONS Symptoms of depression and fatigue overlap in patients with MI. The trend for the cognitive-affective symptoms of depression to be associated with SCD risk, even after controlling for dyspnea/fatigue, suggests that the association between depression and mortality after AMI cannot be entirely explained as a confound of cardiac-related fatigue. The independent contribution of social participation suggests a role of both depressive symptomatology and social factors in influencing mortality risk after MI.
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Affiliation(s)
- J Irvine
- Toronto General Hospital, University Health Network, Department of Psychiatry, University of Toronto, Ontario, Canada.
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Lee SD, Dorian P, Geist M, Davies E, Barr A, Dunne C, Paquette M, Newman D. Validation of a noninvasive measure of local myocardial repolarization in a conscious human model: adaptation of repolarization to changes in rate. J Cardiovasc Electrophysiol 1999; 10:1171-9. [PMID: 10517648 DOI: 10.1111/j.1540-8167.1999.tb00292.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 12/01/2022]
Abstract
INTRODUCTION A commercial pacemaker sensor measure of the unipolar endocardial stimulus to T wave interval may accurately reflect changes in the monophasic action potential duration at 90% repolarization (APD90). This sensor system was used to study the kinetics of adaptation of repolarization duration to changes in heart rate in humans. METHODS AND RESULTS Patients were studied using an external pacemaker capable of displaying all stimulus to T wave intervals for each paced beat. Right ventricular stimulation was delivered via the pacemaker and compared simultaneously to APD90. Steady-state pacing was simulated by 60 seconds of pacing at cycle lengths (CLs) 350 to 700 msec. Adaptation to a new ventricular rate was analyzed with a sudden 200-msec decrease in CL. The relation between repolarization measure and steady-state CL (n = 16) was linear with a slope of 0.16 and 0.19 for APD90 and stimulus to T wave interval, respectively (P = NS). The adaptation of both repolarization measures to a sudden change in rate were best modeled by a biexponential function. Stimulus to T wave interval exhibited a parallel course to APD90, and an analysis of normalized differences between APD90 and stimulus to T wave interval followed an approximately normal distribution, with 93.5% of the paired differences within 2 SD of the mean. CONCLUSION A pacemaker sensor measure of stimulus to T wave interval accurately parallels APD90 during both steady-state and sudden changes in rate. Repolarization in human endocardium follows a linear relation to steady-state CL and adapts to a new rate with a biexponential function. This model represents a novel method for studying human cardiac repolarization.
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Affiliation(s)
- S D Lee
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Canada
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Irvine J, Baker B, Smith J, Jandciu S, Paquette M, Cairns J, Connolly S, Roberts R, Gent M, Dorian P. Poor adherence to placebo or amiodarone therapy predicts mortality: results from the CAMIAT study. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial. Psychosom Med 1999; 61:566-75. [PMID: 10443767 DOI: 10.1097/00006842-199907000-00023] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [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: 10/25/2022]
Abstract
OBJECTIVE This study examined the relationship between adherence, mortality, and psychosocial factors. METHODS Subjects were 1141 patients participating in the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial. Poor adherence to study medication (amiodarone or placebo), measured by pill count over 2 years, was defined as the lower 20th percentile of the pill count distribution. Predictors of adherence were also studied and included demographic and cardiac variables and, in a subset of participants (N = 671), measures of depression, distress, hostility, and social support. RESULTS In survival analysis controlling for cardiac and demographic variables, poor adherence in the placebo and amiodarone groups was associated with an increased risk of sudden cardiac death (relative risk (RR) = 2.11, 95% confidence interval (CI) = 1.03-4.56, p < .05; and RR = 3.15, 95% CI = 1.34-7.44, p < .01, respectively), total cardiac mortality (RR = 2.04, 95% CI = 1.12-3.72, p < .02; and RR = 2.49, 95% CI = 1.32-4.72, p < .01, respectively), and all-cause mortality (RR = 2.25, 95% CI = 1.27-3.97, p < .001; and RR = 2.34, 95% CI = 1.32-4.17, p < .004, respectively). Logistic regression analysis identified two predictors of poor adherence to placebo: age > 70 years (odds ratio = 2.18, 95% CI = 1.11-4.29, p < .03) and social activities in the month before the index heart attack (odds ratio = 1.02, 95% CI = 1.00-1.04, p < .05). CONCLUSIONS Poor adherence is associated with a greater risk of mortality. The relationship between adherence and social activities suggests a higher motivation to adhere to treatment in individuals more engaged in enjoyable activities.
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Affiliation(s)
- J Irvine
- The Toronto Hospital, Department of Psychiatry, University of Toronto, Ontario, Canada.
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Nanthakumar K, Newman D, Paquette M, Greene M, Rakovich G, Dorian P. Circadian variation of sustained ventricular tachycardia in patients subject to standard adrenergic blockade. Am Heart J 1997; 134:752-7. [PMID: 9351744 DOI: 10.1016/s0002-8703(97)70060-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 02/05/2023]
Abstract
Morning peaks in the circadian variation of sustained ventricular tachycardia (VT) may reflect the contribution of sympathetic activation to onset of VT. We hypothesized that adrenergic blockade would eliminate this morning peak. Fifty-four patients using a defibrillator had 1114 time-stamped episodes of VT requiring therapy with a device: 1012 episodes with and 102 episodes without antiadrenergic medications. Nine patients had episodes both with and without antiadrenergic medication and were examined separately. In patients taking antiadrenergic agents, data fitted to a harmonic regression model revealed a morning peak at 9:00 AM (R2= 0.542; p < 0.05), with a secondary peak at 4 PM. Those not receiving antiadrenergic therapy had a similar morning peak. Antiadrenergic agents as used in standard clinical practice do not prevent circadian variation in onset of VT. This variation may be mediated by systems other than adrenergic receptor-linked activation or may reflect inadequacy of adrenergic blockade in standard clinical dosing.
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Affiliation(s)
- K Nanthakumar
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Sattar SA, Taylor YE, Paquette M, Rubino J. In-hospital evaluation of 7.5% hydrogen peroxide as a disinfectant for flexible endoscopes. Can J Infect Control 1996; 11:51-54. [PMID: 8868803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The effectiveness of Sporox (Reckitt and Colman Inc, New Jersey), a 7.5% solution of hydrogen peroxide, was compared with that of Cidex (Johnson & Johnson), a 2% solution of alkaline glutaraldehyde, in the manual disinfection of flexible endoscopes at a large general hospital. For disinfection with Sporox, a soaking time of 10 mins at room temperature was used. The same disinfectant bath was used for nearly seven weeks and the Sporox level was monitored using reagent strips supplied with the product. Controls included endoscopes with precleaning (enzyme-detergent) but without any disinfection, and endoscopes that were precleaned and disinfected in Cidex only. A total of 3 mL of sterile normal saline was used for sampling each channel and immediately plated to detect aerobic and anaerobic bacteria as well as mycobacteria. There were 76 endoscopes sampled. Of these, 55 were disinfected in Sporox, 13 were disinfected in Cidex and eight were precleaned but not disinfected. None of the samples from endoscopes disinfected with either Sporox or Cidex yielded isolates generally regarded as pathogenic for humans. The findings of this in-hospital study indicate that Sporox is at least as efficacious as Cidex in the disinfection of flexible endoscopes between patients. In addition, the exposure time to Sporox was half as long compared with Cidex, and hydrogen peroxide is much less toxic to humans and the environment. Therefore, Sporox appears to have considerable potential as a safer substitute for glutaradehyde-based products in the decontamination of flexible endoscopes.
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