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Landau Prat D, Kapelushnik N, Zloto O, Leshno A, Klang E, Sina S, Segev S, Arazi M, Soudry S, Ben Simon GJ. Prevalence of common and rare ophthalmic findings in adults attending a medical survey institute. Int Ophthalmol 2024; 44:43. [PMID: 38334834 PMCID: PMC10857980 DOI: 10.1007/s10792-024-03026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To examine the ophthalmic data from a large database of people attending a general medical survey institute, and to investigate ophthalmic findings of the eye and its adnexa, including differences in age and sex. METHODS Retrospective analysis including medical data of all consecutive individuals whose ophthalmic data and the prevalences of ocular pathologies were extracted from a very large database of subjects examined at a single general medical survey institute. RESULTS Data were derived from 184,589 visits of 3676 patients (mean age 52 years, 68% males). The prevalence of the following eye pathologies were extracted. Eyelids: blepharitis (n = 4885, 13.3%), dermatochalasis (n = 4666, 12.7%), ptosis (n = 677, 1.8%), ectropion (n = 73, 0.2%), and xanthelasma (n = 160, 0.4%). Anterior segment: pinguecula (n = 3368, 9.2%), pterygium (n = 852, 2.3%), and cataract or pseudophakia (n = 9381, 27.1%). Cataract type (percentage of all phakic patients): nuclear sclerosis (n = 8908, 24.2%), posterior subcapsular (n = 846, 2.3%), and capsular anterior (n = 781, 2.1%). Pseudophakia was recorded for 697 patients (4.6%), and posterior subcapsular opacification for 229 (0.6%) patients. Optic nerve head (ONH): peripapillary atrophy (n = 4947, 13.5%), tilted disc (n = 3344, 9.1%), temporal slope (n = 410, 1.1%), ONH notch (n = 61, 0.2%), myelinated nerve fiber layer (n = 94, 0.3%), ONH drusen (n = 37, 0.1%), optic pit (n = 3, 0.0%), and ON coloboma (n = 4, 0.0%). Most pathologies were more common in males except for ONH, and most pathologies demonstrated a higher prevalence with increasing age. CONCLUSIONS Normal ophthalmic data and the prevalences of ocular pathologies were extracted from a very large database of subjects seen at a single medical survey institute.
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Affiliation(s)
- Daphna Landau Prat
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel.
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
| | - Noa Kapelushnik
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Ari Leshno
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Eyal Klang
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
- The Sami Sagol AI Hub, ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Sigal Sina
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Shlomo Segev
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
- Institute for Medical Screening, Sheba Medical Center, Tel Hashomer, Israel
| | - Mattan Arazi
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | | | - Guy J Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
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Moshkovits Y, Goldman A, Tiosano S, Kaplan A, Kalstein M, Bayshtok G, Segev S, Grossman E, Segev A, Maor E. Mild renal impairment is associated with increased cardiovascular events and all-cause mortality following cancer diagnosis. Eur J Cancer Prev 2024; 33:11-18. [PMID: 37401480 DOI: 10.1097/cej.0000000000000828] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND The association between mildly decreased renal function and cardiovascular (CV) outcomes in cancer patients remains unestablished. AIMS We sought to explore this association in asymptomatic self-referred healthy adults. METHOD We followed 25, 274 adults, aged 40-79 years, who were screened in preventive healthcare settings. Participants were free of CV disease or cancer at baseline. The estimated glomerular filtration rate (eGFR) was calculated according to the CKD Epidemiology Collaboration equation and categorized into groups [≤59, 60-69, 70-79, 80-89, 90-99, ≥100 (ml/min/1.73 m²)]. The outcome included a composite of death, acute coronary syndrome, or stroke, examined using a Cox model with cancer as a time-dependent variable. RESULTS Mean age at baseline was 50 ± 8 years and 7973 (32%) were women. During a median follow-up of 6 years (interquartile range: 3-11), 1879 (7.4%) participants were diagnosed with cancer, of them 504 (27%) develop the composite outcome and 82 (4%) presented with CV events. Multivariable time-dependent analysis showed an increased risk of 1.6, 1.4, and 1.8 for the composite outcome among individuals with eGFR of 90-99 [95% confidence interval (CI): 1.2-2.1 P = 0.01], 80-89 (95% CI: 1.1-1.9, P = 0.01) and 70-79 (95% CI: 1.4-2.3, P < 0.001), respectively. The association between eGFR and the composite outcome was modified by cancer with 2.7-2.9 greater risk among cancer patients with eGFR of 90-99 and 80-89 but not among individuals free from cancer ( Pinteraction < 0.001). CONCLUSION Patients with mild renal impairment are at high risk for CV events and all-cause mortality following cancer diagnosis. eGFR evaluation should be considered in the CV risk assessment of cancer patients.
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Affiliation(s)
- Yonatan Moshkovits
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan
- Sackler School of Medicine, Tel Aviv University
| | - Adam Goldman
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - Shmuel Tiosano
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan
- Sackler School of Medicine, Tel Aviv University
| | - Alon Kaplan
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan
- Sackler School of Medicine, Tel Aviv University
| | - Maia Kalstein
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan
- Sackler School of Medicine, Tel Aviv University
| | | | - Shlomo Segev
- Sackler School of Medicine, Tel Aviv University
- The Institute for Medical Screening, Sheba Medical Center
| | - Ehud Grossman
- Sackler School of Medicine, Tel Aviv University
- Internal Medicine Department, Sheba Medical Center, Ramat-Gan, Israel
| | - Amit Segev
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan
- Sackler School of Medicine, Tel Aviv University
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan
- Sackler School of Medicine, Tel Aviv University
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Landau Prat D, Kapelushnik N, Arazi M, Zloto O, Leshno A, Klang E, Sina S, Segev S, Soudry S, Ben Simon GJ. Glaucoma Prediction Models Based on Ocular and Systemic Findings. Ophthalmic Res 2023; 67:29-38. [PMID: 38109866 DOI: 10.1159/000535879] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/26/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Our aim was to explore the impact of various systemic and ocular findings on predicting the development of glaucoma. METHODS Medical records of 37,692 consecutive patients examined at a single medical center between 2001 and 2020 were analyzed using machine learning algorithms. Systemic and ocular features were included. Univariate and multivariate analyses followed by CatBoost and Light gradient-boosting machine prediction models were performed. Main outcome measures were systemic and ocular features associated with progression to glaucoma. RESULTS A total of 7,880 patients (mean age 54.7 ± 12.6 years, 5,520 males [70.1%]) were included in a 3-year prediction model, and 314 patients (3.98%) had a final diagnosis of glaucoma. The combined model included 185 systemic and 42 ocular findings, and reached an ROC AUC of 0.84. The associated features were intraocular pressure (48.6%), cup-to-disk ratio (22.7%), age (8.6%), mean corpuscular volume (MCV) of red blood cell trend (5.2%), urinary system disease (3.3%), MCV (2.6%), creatinine level trend (2.1%), monocyte count trend (1.7%), ergometry metabolic equivalent task score (1.7%), dyslipidemia duration (1.6%), prostate-specific antigen level (1.2%), and musculoskeletal disease duration (0.5%). The ocular prediction model reached an ROC AUC of 0.86. Additional features included were age-related macular degeneration (10.0%), anterior capsular cataract (3.3%), visual acuity (2.0%), and peripapillary atrophy (1.3%). CONCLUSIONS Ocular and combined systemic-ocular models can strongly predict the development of glaucoma in the forthcoming 3 years. Novel progression indicators may include anterior subcapsular cataracts, urinary disorders, and complete blood test results (mainly increased MCV and monocyte count).
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Affiliation(s)
- Daphna Landau Prat
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Noa Kapelushnik
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mattan Arazi
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel,
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel,
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ari Leshno
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Sami Sagol AI Hub, ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel
| | - Sigal Sina
- The Sami Sagol AI Hub, ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel
- Computer Science, Bar-Ilan University, Ramat Gan, Israel
| | - Shlomo Segev
- Institute of Medical Screening, Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | - Guy J Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Gorenstein L, Onn A, Green M, Mayer A, Segev S, Marom EM. A Novel Artificial Intelligence Based Denoising Method for Ultra-Low Dose CT Used for Lung Cancer Screening. Acad Radiol 2023; 30:2588-2597. [PMID: 37019699 DOI: 10.1016/j.acra.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] [Revised: 01/23/2023] [Accepted: 02/19/2023] [Indexed: 04/05/2023]
Abstract
RATIONALE AND OBJECTIVES To assess ultra-low-dose (ULD) computed tomography as well as a novel artificial intelligence-based reconstruction denoising method for ULD (dULD) in screening for lung cancer. MATERIALS AND METHODS This prospective study included 123 patients, 84 (70.6%) men, mean age 62.6 ± 5.35 (55-75), who had a low dose and an ULD scan. A fully convolutional-network, trained using a unique perceptual loss was used for denoising. The network used for the extraction of the perceptual features was trained in an unsupervised manner on the data itself by denoising stacked auto-encoders. The perceptual features were a combination of feature maps taken from different layers of the network, instead of using a single layer for training. Two readers independently reviewed all sets of images. RESULTS ULD decreased average radiation-dose by 76% (48%-85%). When comparing negative and actionable Lung-RADS categories, there was no difference between dULD and LD (p = 0.22 RE, p > 0.999 RR) nor between ULD and LD scans (p = 0.75 RE, p > 0.999 RR). ULD negative likelihood ratio (LR) for the readers was 0.033-0.097. dULD performed better with a negative LR of 0.021-0.051. Coronary artery calcifications (CAC) were documented on the dULD scan in 88(74%) and 81(68%) patients, and on the ULD in 74(62.2%) and 77(64.7%) patients. The dULD demonstrated high sensitivity, 93.9%-97.6%, with an accuracy of 91.7%. An almost perfect agreement between readers was noted for CAC scores: for LD (ICC = 0.924), dULD (ICC = 0.903), and for ULD (ICC = 0.817) scans. CONCLUSION A novel AI-based denoising method allows a substantial decrease in radiation dose, without misinterpretation of actionable pulmonary nodules or life-threatening findings such as aortic aneurysms.
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Affiliation(s)
- Larisa Gorenstein
- Department of Diagnostic Radiology, Sheba Medical Center, Tel Hashomer, Israel; Diagnostic Radiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Onn
- Institute of Pulmonology, Division of Internal Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Michael Green
- Department of Computer Science, Ben-Gurion University of the Negev
| | - Arnaldo Mayer
- Department of Diagnostic Radiology, Sheba Medical Center, Tel Hashomer, Israel; Diagnostic Radiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Segev
- Institute for Medical Screening, Division of Internal Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Edith Michelle Marom
- Department of Diagnostic Radiology, Sheba Medical Center, Tel Hashomer, Israel; Diagnostic Radiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Landau Prat D, Zloto O, Kapelushnik N, Leshno A, Klang E, Sina S, Segev S, Soudry S, Ben Simon GJ. Big Data Analysis of Glaucoma Prevalence in Israel. J Glaucoma 2023; 32:962-967. [PMID: 37566879 DOI: 10.1097/ijg.0000000000002281] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Abstract
PRCIS The prevalence of glaucoma in the adult population included in this study was 2.3%. Normal values of routine eye examinations are provided including age and sex variations. PURPOSE The purpose of this study was to analyze the prevalence of glaucoma in a very large database. METHODS Retrospective analysis of medical records of patients examined at the Medical Survey Institute of a tertiary care university referral center between 2001 and 2020. A natural language process (NLP) algorithm identified patients with a diagnosis of glaucoma. The main outcome measures included the prevalence and age distribution of glaucoma. The secondary outcome measures included the prevalence and distribution of visual acuity (VA), intraocular pressure (IOP), and cup-to-disc ratio (CDR). RESULTS Data were derived from 184,589 visits of 36,762 patients (mean age: 52 y, 68% males). The NLP model was highly sensitive in identifying glaucoma, achieving an accuracy of 94.98% (area under the curve=93.85%), and 633 of 27,517 patients (2.3%) were diagnosed as having glaucoma with increasing prevalence in older age. The mean VA was 20/21, IOP 14.4±2.84 mm Hg, and CDR 0.28±0.16, higher in males. The VA decreased with age, while the IOP and CDR increased with age. CONCLUSIONS The prevalence of glaucoma in the adult population included in this study was 2.3%. Normal values of routine eye examinations are provided including age and sex variations. We proved the validity and accuracy of the NLP model in identifying glaucoma.
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Affiliation(s)
- Daphna Landau Prat
- Goldschleger Eye Surveillance Institution & Medical Screening Institute
- Talpiot Medical Leadership Program, Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Ofira Zloto
- Goldschleger Eye Surveillance Institution & Medical Screening Institute
- Talpiot Medical Leadership Program, Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Noa Kapelushnik
- Goldschleger Eye Surveillance Institution & Medical Screening Institute
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Ari Leshno
- Goldschleger Eye Surveillance Institution & Medical Screening Institute
- Talpiot Medical Leadership Program, Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Eyal Klang
- Talpiot Medical Leadership Program, Sheba Medical Center
- The Sami Sagol AI Hub, ARC Innovation Center, Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Sigal Sina
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Shlomo Segev
- Institute for Medical Screening, Chaim Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | | | - Guy J Ben Simon
- Goldschleger Eye Surveillance Institution & Medical Screening Institute
- Talpiot Medical Leadership Program, Sheba Medical Center
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
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Moshkovits Y, Goldman A, Beckerman P, Tiosano S, Kaplan A, Kalstein M, Bayshtok G, Segev S, Grossman E, Segev A, Maor E. Baseline renal function and the risk of cancer among apparently healthy middle-aged adults. Cancer Epidemiol 2023; 86:102428. [PMID: 37482051 DOI: 10.1016/j.canep.2023.102428] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/02/2023] [Revised: 06/16/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The association between mildly impaired renal function with all-site and site-specific cancer risk is not established. We aim to explore this association among apparently healthy adults. METHODS We followed 25,073 men and women, aged 40-79 years, free of cancer or cardiovascular disease at baseline who were screened annually in preventive healthcare settings. The estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration equation (CKD-EPI) and classified into four mutually exclusive groups: <60, 60-74, 75-89, ≥90 (mL/min/1.73 m²). The primary outcome was all-site cancer while the secondary outcome was site-specific cancer. Cancer data was available from a national registry. RESULTS Mean age at baseline was 50 ± 8 years and 7973 (32 %) were women. During a median follow-up of 9 years (IQR 3-16) and 256,279 person years, 2045 (8.2 %) participants were diagnosed with cancer. Multivariable Cox model showed a 1.2 (95 %CI: 1.0-1.4 p = 0.05), 1.2 (95 %CI: 1.0-1.4 p = 0.02), and 1.4 (95 %CI: 1.1-1.7 p = 0.003) higher risk for cancer with eGFR of 75-89, 60-74, and < 60, respectively. Site-specific analysis demonstrated a 1.8 (95 %CI: 1.2-2.6 p = 0.004), 1.7 (95 %CI: 1.2-2.6 p = 0.004) and 2.2 (95 %CI: 1.3-3.6 p = 0.002) increased risk for prostate cancer with eGFR of 75-89, 60-74, and < 60, respectively. eGFR< 60 was associated with a 2.0 (95 %CI: 1.1-3.7 p = 0.03) and 3.7 (95 %CI: 1.1-13.1 p = 0.04) greater risk for melanoma and gynecological caner respectively. CONCLUSIONS CKD stage 2 and worse is independently associated with higher risk for cancer incidence, primarily prostate cancer. Early intervention and screening are warranted among these individuals in order to reduce cancer burden.
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Affiliation(s)
- Yonatan Moshkovits
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Adam Goldman
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pazit Beckerman
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel; The Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat-Gan, Israel
| | - Shmuel Tiosano
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Alon Kaplan
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Maia Kalstein
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | | | - Shlomo Segev
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel; The Institute for Medical Screening, Sheba Medical Center, Ramat-Gan, Israel
| | - Ehud Grossman
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Internal Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Amit Segev
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
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Ukashi O, Pflantzer B, Barash Y, Klang E, Segev S, Ozeri DJ, Veisman I, Lahat A, Laish I, Kopylov U, Oppenheim A. Cardiovascular Risk Factors and Physical Fitness Among Subjects with Asymptomatic Colonic Diverticulosis. Dig Dis Sci 2023; 68:902-912. [PMID: 35695973 DOI: 10.1007/s10620-022-07572-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/26/2022] [Accepted: 05/18/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND The association between diverticular disease and atherosclerotic cardiovascular disease (ASCVD) has been demonstrated previously, mainly in symptomatic subjects. AIMS To evaluate 10 years cardiovascular risk, exercise performance and association to ASCVD among subjects with asymptomatic diverticulosis. METHODS A retrospective cross-sectional cohort of self-referred participants in a medical screening program, who underwent a screening colonoscopy. Demographics, clinical and laboratory variables, ASCVD score, and metabolic equivalents (METs) during treadmill stress test were compared between subjects with and without diverticulosis as diagnosed on screening colonoscopy. RESULTS 4586 participants underwent screening colonoscopy; 799 (17.4%) had diverticulosis. Among 50-69 yo participants, diverticulosis subjects had a higher ASCVD score compared to non-diverticulosis subjects. Exercise performance was comparable between the groups, across all age groups. Using logistic regression analysis, advanced age group (50-59 yo Adjusted odds ratio (AOR) [95% confidence interval (CI)] 2.57 (1.52-4.34), p < 0.001; 60-69 yo, AOR 2.87 (2.09-3.95), p < 0.001; ≥ 70 yo AOR 4.81 (3.23-7.15), p < 0.001; compared to < 50 yo age group), smoking [AOR 1.27 (1.05-1.55), p = 0.016], HTN [AOR 1.27 (1.03-1.56), p = 0.022], obesity [AOR 1.36 (1.06-1.74), p = 0.014] and male sex [AOR 1.29 (1.02-1.64), p = 0.036] were associated with diverticular detection during screening colonoscopy. Among males, achieving METs score ≥ 10 was inversely associated with diverticular detection during screening colonoscopy [AOR 0.64 (0.43-0.95), p = 0.027]. CONCLUSIONS Ten years probability for ASCVD estimated by the ASCVD score is higher among subjects with asymptomatic diverticulosis compared to subjects without diverticulosis. Improved exercise performance is demonstrated for the first time to correlate with decreased probability for diverticular disease in screening colonoscopy.
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Affiliation(s)
- Offir Ukashi
- Department of Gastroenterology, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel.
- Department of Internal Medicine A, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Barak Pflantzer
- Department of Internal Medicine A, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yiftach Barash
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel
- DeepVision Lab, Sheba Medical Center, Ramat-Gan, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel
- DeepVision Lab, Sheba Medical Center, Ramat-Gan, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Institute of Medical Screening, Sheba Medical Center, Ramat-Gan, Israel
| | - David J Ozeri
- Department of Internal Medicine A, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Rheumatology, Sheba Medical Center, Ramat-Gan, Israel
| | - Ido Veisman
- Department of Gastroenterology, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ido Laish
- Department of Gastroenterology, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Amit Oppenheim
- Department of Internal Medicine A, Sheba Medical Center, Ha'ela 1, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Moshkovits Y, Tiosano S, Kaplan A, Kalstein M, Bayshtok G, Kivity S, Segev S, Grossman E, Segev A, Maor E, Fardman A. Serum Uric Acid Significantly Improves the Accuracy of Cardiovascular Risk Score Models. Eur J Prev Cardiol 2022; 30:524-532. [PMID: 36378558 DOI: 10.1093/eurjpc/zwac275] [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] [Received: 08/05/2022] [Revised: 10/07/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022]
Abstract
Abstract
Aims
This study evaluated the impact of serum uric acid (sUA) on the accuracy of pooled cohort equations (PCE) model, Systematic Coronary Risk Evaluation score 2 (SCORE2) and SCORE2-Older Persons.
Methods
We evaluated 19,769 asymptomatic self-referred adults aged 40-79 years free of cardiovascular disease and diabetes who were screened annually in a preventive healthcare setting. sUA levels were expressed as a continuous as well as dichotomous variable (upper sex-specific tertiles defined as high sUA). The primary endpoint was the composite of death, acute coronary syndrome or stroke, after excluding subjects diagnosed with metastatic cancer during follow up.
Results
Mean age was 50 ± 8 years and 69% were men. During median follow up of 6 years, 1,658 (8%) subjects reached the study endpoint. PCE, SCORE2 and high sUA were independently associated with the study endpoint in a multivariable model (p < .001 for all). Continuous net reclassification improvement analysis showed a 13% improvement in the accuracy of classification when high sUA was added to either PCE or SCORE2 model (p < .001 for both). sUA remained independently associated with the study endpoint among normal-weight subjects in the SCORE2 model (HR 1.3, 95% CI 1.1-1.6) but not among overweight individuals (p for interaction = .01). Subgroup analysis resulted in a significant 16-20% improvement in the model performance among normal-weight and low-risk subjects (p < .001 for PCE; p = .026 and p < .001 for SCORE2, respectively).
Conclusions
sUA significantly improves the classification accuracy of PCE and SCORE2 models. This effect is especially pronounced among normal-weight and low-risk subjects.
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Affiliation(s)
- Yonatan Moshkovits
- Leviev Heart Center, Sheba Medical Center , Ramat-Gan , Israel
- Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
| | - Shmuel Tiosano
- Leviev Heart Center, Sheba Medical Center , Ramat-Gan , Israel
- Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
| | - Alon Kaplan
- Leviev Heart Center, Sheba Medical Center , Ramat-Gan , Israel
- Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
| | - Maia Kalstein
- Leviev Heart Center, Sheba Medical Center , Ramat-Gan , Israel
- Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
| | | | - Shaye Kivity
- Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
- The Institute for Medical Screening, Sheba Medical Center , Ramat-Gan , Israel
| | - Ehud Grossman
- Leviev Heart Center, Sheba Medical Center , Ramat-Gan , Israel
- Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
| | - Amit Segev
- Leviev Heart Center, Sheba Medical Center , Ramat-Gan , Israel
- Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center , Ramat-Gan , Israel
- Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
| | - Alexander Fardman
- Leviev Heart Center, Sheba Medical Center , Ramat-Gan , Israel
- Sackler School of Medicine, Tel Aviv University , Tel-Aviv , Israel
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9
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Moshkovits Y, Tiosano S, Kaplan A, Kalstein M, Bayshtok G, Kivity S, Segev S, Grossman E, Segev A, Maor E, Fardman A. Serum uric acid levels significantly improve the accuracy of cardiovascular risk score models. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2271] [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
This study evaluated the impact of serum uric acid (sUA) on the accuracy of atherosclerotic cardiovascular disease (ASCVD) pooled cohort equations (PCE) model, Systematic Coronary Risk Evaluation score 2 (SCORE2) and SCORE2-Older Persons (OP).
Methods
We evaluated 19,789 asymptomatic self-referred adults aged 40–79 years who were screened annually in a preventive healthcare setting. All subjects were free of cardiovascular disease and diabetes at baseline. sUA levels were expressed as a continuous as well as dichotomous variable (categorized into sex-specific tertiles, with the upper tertiles defined as high sUA). Mortality and cancer data were available for all subjects from nationwide registries. The primary endpoint was the composite of death, acute coronary syndrome and stroke, after excluding subjects diagnosed with lymphatic spread cancer during follow up.
Results
Mean age of study population was 50±8 years and 69% were men. During median follow up of 6 years [2.0–13.1], 1,658 (8%) subjects reached the study endpoint. ASCVD, SCORE2 risk and high sUA were all independently associated with the study endpoint in the multivariable Cox regression model (p<0.001 for all). Continuous net reclassification improvement analysis showed an improvement of 13% in the accuracy of classification when high sUA was added to the PCE and SCORE2 models (p<0.001 for both). sUA remained independently associated with the study endpoint among normal-weight subjects in the SCORE 2 model (HR 1.3, 95% CI 1.1–1.6) but not among overweight individuals (p for interaction = 0.01). Addition of sUA to the models in normal-weight subgroup (N=6,624) resulted in a significant 20% improvement in the model performance for both SCORE2 and ASCVD when sUA was incorporated as dichotomous variable (p<0.001 for ASCVD and p=0.026 for SCORE2 model).
Conclusions
sUA significantly improves classification accuracy of PCE and SCORE 2 models. This effect is especially pronounced among normal weight subjects.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - S Tiosano
- Sheba Medical Center , Tel Aviv , Israel
| | - A Kaplan
- Sheba Medical Center , Tel Aviv , Israel
| | - M Kalstein
- Sheba Medical Center , Tel Aviv , Israel
| | | | - S Kivity
- Tel Aviv University , Tel Aviv , Israel
| | - S Segev
- Sheba Medical Center , Tel Aviv , Israel
| | - E Grossman
- Sheba Medical Center , Tel Aviv , Israel
| | - A Segev
- Sheba Medical Center , Tel Aviv , Israel
| | - E Maor
- Sheba Medical Center , Tel Aviv , Israel
| | - A Fardman
- Sheba Medical Center , Tel Aviv , Israel
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10
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Shlomai G, Shemesh J, Segev S, Koren-Morag N, Grossman E. The Multi-Ethnic Study of Atherosclerosis-Calcium Score Improves Statin Treatment Allocation in Asymptomatic Adults. Front Cardiovasc Med 2022; 9:855390. [PMID: 35911540 PMCID: PMC9334900 DOI: 10.3389/fcvm.2022.855390] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background The current categorization of cardiovascular (CV) risk broadens the indications for statin therapy. Coronary artery calcium (CAC) identifies those who are most likely to benefit from primary prevention with statin therapy. The multi-ethnic study of atherosclerosis-calcium (MESA-C) includes CAC for CV risk stratification. Objective We aimed to establish whether the MESA-C score improves allocation to statin treatment in a cohort of asymptomatic adults. We also analyzed patient survival according to their risk score calculation. Design A retrospective analysis of asymptomatic adults. Participants A total of 632 consecutive subjects free of coronary artery disease (CAD) and/or stroke, mean age 56 ± 7 years, 84% male, underwent clinical evaluations and CAC measurements. Main Measures PCE and MESA-C risk scores were calculated for each subject. According to the 10-year risk for CV events, subjects were classified into moderate and high CV risk (≥7.5%) for whom a statin is clearly indicated, or borderline and low CV risk (<7.5%). Key Results During mean follow-up of 6.5 ± 3.3 years, 52 subjects experienced their first CV event. Those with a MESA-C risk score < 7.5% had favorable outcomes even when the PCE indicated a risk of ≥ 7.5%. The MESA-C score improved the discrimination of CV risk with the ROC curves C-statistics increasing from 0.653 for the PCE to 0.770 for the MESA-C. Of those, 84% (99/118) with borderline CV risk (5–7.5%) according to the PCE score, were reallocated by the MESA-C score into a higher (≥7.5%) or lower (<5%) CV risk category. Furthermore, subjects with low MESA-C scores had the highest survival rate regardless of the PCE risk, while those with high MESA-C risks had the lowest survival rate regardless of the PCE risk. Conclusion In asymptomatic subjects, the MESA-C score improves allocation to statin treatment and CV risk discrimination, while both scores are essential for more precise survival estimations.
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Affiliation(s)
- Gadi Shlomai
- Department of Internal Medicine D and Hypertension Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
- The Division of Endocrinology, Diabetes and Metabolism, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joseph Shemesh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Grace Ballas Cardiac Research Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shlomo Segev
- Periodic Examination Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Nira Koren-Morag
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Epidemiology and Preventive Medicine, Ramat Gan, Israel
| | - Ehud Grossman
- Department of Internal Medicine D and Hypertension Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
- Department of Epidemiology and Preventive Medicine, Ramat Gan, Israel
- *Correspondence: Ehud Grossman,
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11
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Ukashi O, Pflantzer B, Barash Y, Klang E, Segev S, Yablecovitch D, Kopylov U, Ben-Horin S, Laish I. Risk factors and prediction algorithm for advanced neoplasia on screening colonoscopy for average-risk individuals. Therap Adv Gastroenterol 2022; 15:17562848221101291. [PMID: 35795377 PMCID: PMC9252006 DOI: 10.1177/17562848221101291] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Screening with colonoscopy for all average-risk population is probably not cost-effective due to the limited sources and over-generalization of the risk, and risk stratification can be used to optimize colorectal cancer screening. OBJECTIVES We aimed to assess risk factors for advanced neoplasia (AN) and a classification tree algorithm to predict the risk. DESIGN This is a retrospective cross-sectional study. METHODS This study was composed of consecutive asymptomatic average-risk individuals undergoing first screening colonoscopy between 2008 and 2019. Detailed characteristics including background diseases, habits, and medications were collected. We used multivariable logistic regression to investigate the associations between clinical variables and the presence of AN and built a classification algorithm to predict AN. RESULTS A total of 3856 patients were included (73.2% male, median age 55). Adenoma and AN detection rate were 15.8% and 3.4%, respectively. On multivariable analysis, predictors of AN [odds ratio (OR), 95% confidence interval (CI)] were age (1.04, 1.01-1.06, p = 0.003), male sex (2.69, 1.56-4.64, p < 0.001), and smoking (1.97, 1.38-2.81, p < 0.001). A classification tree algorithm showed that smoking was the most important risk factor for prediction of AN (4.9% versus 2.4%, p < 0.001), followed by age with a cutoff value of 60 in the smokers (8.4% versus 3.8%, p = 0.001) and 50 in the non-smokers (2.9% versus 0.9%, p = 0.004). CONCLUSION Smoking habits, old age, and male gender are highly associated with an increased risk for AN and should be incorporated in the individualized risk-assessment to adapt a screening program.
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Affiliation(s)
| | - Barak Pflantzer
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel,The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yiftach Barash
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel,DeepVision Lab, Sheba Medical Center, Tel Hashomer, Israel
| | - Eyal Klang
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel,DeepVision Lab, Sheba Medical Center, Tel Hashomer, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Institute of Medical Screening, Sheba Medical Center, Tel Hashomer, Israel
| | - Doron Yablecovitch
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Laish
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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12
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Peled Y, Ram E, Klempfner R, Segev S, Maor E. Triglyceride-Glucose Index as a Potential Marker for the Development of Heart Failure in Healthy Adults. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1110] [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: 10/18/2022] Open
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13
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Tiosano S, Fardman A, Kaplan A, Kalstein M, Moshkovits Y, Segev S, Beckerman P, Segev A, Grossman E, Maor E. MILD RENAL DYSFUNCTION IS ASSOCIATED WITH INCIDENT ATRIAL FIBRILLATION AMONG HEALTHY ADULTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02475-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Fardman A, Tiosano S, Kaplan A, Kalstein M, Moshkovits Y, Segev S, Klempfner R, Segev A, Grossman E, Maor E. Incident cardiovascular events among middle-age men are associated with increased risk of subsequent prostate cancer diagnosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Prostate cancer is the second most common malignancy in men worldwide, but incidence is highly dependent on screening.
Purpose
We aimed to examine whether incident cardiovascular disease (CVD) events are associated with increased risk of future prostate cancer in middle-aged men.
Methods
We evaluated asymptomatic self-referred men who participated in a screening program. All subjects were free of CVD and cancer at baseline. CVD was defined as the composite of acute coronary syndrome, percutaneous coronary intervention, or stroke. Study endpoint was the development of cancer during follow up. Cancer and mortality data were available for all subjects from national registries. Cox regression models were applied with CVD as a time-dependent covariate and death as a competing risk event.
Results
Final study population included 18,282 subjects. Median age was 47 years (Interquartile range [IQR] 41–54). During median follow up time of 12 years (IQR 4–17) 2,047 (11%) subjects developed CVD, 406 (2.2%) developed prostate cancer and 694 (4%) died. Compared with patients who were free of CVD or prostate cancer during follow up, risk of death was 4, 6 and 15 times higher for patients who developed CVD event, prostate cancer, or both during follow up, respectively (p <.001 for all). Time dependent survival analysis showed that subjects who developed CVD during follow up were 60% more likely to develop prostate cancer (95% Confidence Interval [CI] 1.2–2.1, p=.001). However, after multivariable adjustment, this association was no longer significant. Interaction analysis demonstrated that the association of incident CVD with the risk of future cancer diagnosis was age dependent such that in middle-aged men (age≤55 years; N=14,473) incident CVD was associated with a significant 70% increased risk of subsequent cancer diagnosis in multivariable model (95% CI 1.13–2.6, p=.011, p for interaction=.002). Exploratory analysis of men younger than 55 showed that independent association of incident CVD with subsequent cancer diagnosis was different among subjects with normal body mass index (BMI) (≤25 kg/m2) compared with those with increased BMI (HR 0.55; 95% CI [0.22–1.42]; p value=0.23 vs. 1.6; 95% CI [1.007–2.54]; p value=.047; p for interaction=.058, respectively).
Conclusion
Incident CVD is independently associated with increased risk of subsequent prostate cancer diagnosis among men ≤55 years. Routine prostate cancer surveillance should be considered after CVD event in this population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Fardman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Tiosano
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Kaplan
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - M Kalstein
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Y Moshkovits
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - R Klempfner
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Grossman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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15
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Kaplan A, Fardman A, Tiosano S, Segev S, Scheinowitz M, Segev A, Klempfner R, Grossman E, Maor E. Predictors of deterioration in cardiorespiratory fitness among healthy adults: the importance of sex and obesity. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2465] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Cardiorespiratory fitness (CRF) is associated with cardiovascular co-morbidities and is a strong predictor of adverse cardiovascular outcomes. However, data on the natural history of cardiorespiratory fitness among healthy subjects is limited.
Purpose
This study investigated what are the predictors of deterioration in CRF over time.
Methods
We investigated 36,239 men and women who were annually screened in a tertiary medical center and completed an exercise stress test in all visits, with a total of 175,596 annual visits. Subjects who failed to complete maximal exercise stress test according to the Bruce protocol at their first baseline visit were excluded. In addition, subjects with less than five visits to the center or those who developed ischemic heart disease during follow-up were excluded. Fitness was categorized into age- and sex-specific quintiles (Q) according to Bruce protocol treadmill time. Change in CRF between the first baseline visit and the fifth visit was used to calculate fitness deterioration. The primary study endpoint was defined as the lower sex-specific quintile of change in metabolic equivalents (METS) between visits 1 and 5. Logistic regression models were applied.
Results
Final study population included 10,841 subjects. The mean age of the study population was 49±10 years, the mean BMI was 26±4, and 8107 (75%) were men. Median METS at baseline were 10.8 (IQR 9–12.6) and 11.1 (IQR 9.4–13) at the first and fifth visit, respectively (p<0.001 for METS between visits). Overall, 2189 (20%) subjects met the study endpoint. CFR deterioration was higher among women as compared to men (p=0.023). Out of obesity, hypertension, fasting blood glucose, LDL, and HDL cholesterol, after adjustments for age, sex, and baseline CFR, only obesity was independently associated with fitness deterioration in the multivariate model (OR=1.4 95% CI 1.2–1.5, p<0.001). The association of obesity with fitness deterioration was modified by sex such that the risk of CRF deterioration was more pronounced in women (OR=1.6 95% CI 1.3–2, p<0.001) than in men (OR=1.3 95% CI 1.1–1.4, p<0.001).
Conclusion
Obesity is an independent predictor of future CRF deterioration. The effect of obesity on future CRF deterioration is more pronounced among women as compared to men.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kaplan
- Sheba Medical Center, Tel Aviv, Israel
| | - A Fardman
- Sheba Medical Center, Tel Aviv, Israel
| | - S Tiosano
- Sheba Medical Center, Tel Aviv, Israel
| | - S Segev
- Sheba Medical Center, Tel Aviv, Israel
| | | | - A Segev
- Sheba Medical Center, Tel Aviv, Israel
| | | | | | - E Maor
- Sheba Medical Center, Tel Aviv, Israel
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16
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Fardman A, Tiosano S, Kaplan A, Kalstein M, Moshkovits Y, Segev S, Klempfner R, Segev A, Grossman E, Maor E. Incident cardiovascular events among healthy subjects are associated with increased risk of subsequent cancer diagnosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2856] [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
Introduction
While Cardiovascular disease (CVD) and cancer share common risk factors, data on the temporal association between the occurrence of CVD and cancer is limited.
Purpose
This study investigated the association between incident CVD events future cancer among apparently healthy subjects.
Methods
We evaluated asymptomatic self-referred adults who participated in a screening program. All subjects were free of CVD and cancer at baseline. CVD was defined as the composite of acute coronary syndrome, percutaneous coronary intervention, or stroke. Study endpoint was the development of cancer during follow up. Cancer and mortality data were available for all subjects from national registries. Cox regression models were applied with CVD as a time-dependent covariate and death as a competing risk event.
Results
Final study population included 26,574 subjects. Median age was 46 years (Interquartile range [IQR] 40–53) and 69% were men. During median follow up time of 10 years (IQR 3–16) 2,463 (9%) subjects developed CVD, 2,040 (8%) developed cancer and 869 (3%) died. Most common cancer types were prostate among men (N=406, 2.2%) and breast among women (N=283, 3.4%). Compared with patients who were free of CVD and cancer during follow up, risk of death was 5, 34 and 54 times higher for patients who developed CVD event, cancer, or both during follow up, respectively (p <.001 for all). Time dependent survival analysis showed that subjects who developed CVD during follow up were 50% more likely to develop cancer in a univariate model (95% Confidence Interval [CI] 1.3–1.7, p<.001). Interaction analysis demonstrated that the association of incident CVD with the risk of future cancer diagnosis was age dependent such that in younger subjects (≤52 years; N=19,052) incident CVD was associated with a significant 30% increased risk of subsequent cancer diagnosis (95% CI 1.03–1.67, p=.027) while in older subjects incident CVD was not associated with increased risk of cancer in the multivariable model (p for interaction =.018).
Conclusion
Incident CVD is independently associated with increased risk of subsequent cancer diagnosis among young adults. Active cancer surveillance should be considered among young patients recovering from a CVD event.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Fardman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Tiosano
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Kaplan
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - M Kalstein
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Y Moshkovits
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - R Klempfner
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Grossman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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17
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Eden Friedman Y, Steinberg DM, Canetti M, Cohen I, Segev S, Salomon O. An impact of lipid profile and lipid lowering drugs on ≥70 year olds of an upper socioeconomic class: a retrospective cohort study. Lipids Health Dis 2021; 20:120. [PMID: 34587967 PMCID: PMC8480056 DOI: 10.1186/s12944-021-01529-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/28/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Life expectancy has greatly increased, generating an improvement in screening programs for disease prevention, lifesaving drugs and medical devices. The impact of lowering low-density lipoprotein cholesterol (LDL-C) in the very elderly is not well-established. Our aim was to explore the association of LDL-C, high density lipoprotein cholesterol (HDL-C) and lipid lowering drugs (LLDs) on cognitive decline, malignancies and overall survival. METHODS This was a retrospective cohort study. Our study comprised 1498 (72.7%) males and 561 (27.3%) females, aged ≥70 who had attended the Institute for Medical Screening (IMS), Sheba Medical Center, Israel at least twice during 2013-2019. Data were obtained from the computerized database of the IMS. A manual quality control to identify potential discrepancies was performed. RESULTS Overall, 6.3% of the subjects treated with LLDs (95/1421) versus 4.2% not treated (28/638), cognitively declined during the study years. No statistically significant effects of LDL-C, HDL-C and LLDs on cognitive decline were observed after correcting for age, prior stroke and other vascular risk factors. With regard to cancer, after adjusting for confounders and multiple inferences, no definite relationships were found. CONCLUSIONS This analysis of an elderly, high socioeconomic status cohort suggests several relationships between the use of LLDs and health outcomes, some beneficial, especially, with regard to certain types of cancer, but with a higher risk of cognitive decline. Further studies are warranted to clarify the health effects of these medications in the elderly.
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Affiliation(s)
- Yehudit Eden Friedman
- Internal Medicine Department E, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David M Steinberg
- Department of Statistics and Operations Research, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Michal Canetti
- Internal Medicine Department E, Sheba Medical Center, Tel Hashomer, Israel
| | - Ido Cohen
- Internal Medicine Department E, Sheba Medical Center, Tel Hashomer, Israel
| | - Shlomo Segev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Medical Screening, Sheba Medical Center, Tel Hashomer, Israel
| | - Ophira Salomon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel.
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18
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Bernstein-Molho R, Galmor L, Laitman Y, Segev S, Friedman E. Yield of targeted genotyping for the recurring pathogenic variants in cancer susceptibility genes in a healthy, multiethnic Israeli population. Cancer 2021; 127:3599-3604. [PMID: 34157778 DOI: 10.1002/cncr.33560] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/03/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several recurring pathogenic variants in BRCA1/BRCA2 and other cancer susceptibility genes are encountered in ethnically diverse Jewish populations. The yield of genotyping for these recurring pathogenic variants in healthy Israeli individuals unselected for ethnicity, sex, or a family history of cancer has not been previously reported. METHODS Individuals voluntarily participating in annual medical surveillance at the Institute of Medical Screening of Sheba Medical Center were offered genotyping for predominant pathogenic variants in BRCA1/BRCA2 and recurring variants in CHEK2, MUTYH, APC, and the Lynch syndrome genes via a chip-based assay at the oncogenetic service of Sheba Medical Center from May 15, 2018, to December 15, 2020. All study participants were unrelated to one another. The study was approved by the Sheba ethics committee. RESULTS Overall, 1764 individuals, including 1008 females (57%), with a mean age of 54.2 years (range, 25-86 years) were genotyped. The yield of the testing was 4% (71 of 1764), and it was higher in Ashkenazi Jews (AJs) and mixed AJ-non-AJ participants (4.75% [58 of 1222]; 1.8% for BRCA1/BRCA2 pathogenic variants) than non-AJ patients (2.2% [9 of 401]; 1% for BRCA1 pathogenic variants). When BRCA1/BRCA2 pathogenic variants were excluded, 2.44% carried low-penetrance variants, including CHEK2 c.1283C>T (n = 3), APC c.3920T>A (n = 36), and heterozygous MUTYH c.1187G>A (n = 4). A family history of cancer was not associated with a higher yield of pathogenic variant detection. CONCLUSIONS The observed rates of positive genotyping in a healthy, unselected, multiethnic Israeli population warrant consideration of the inclusion of targeted genotyping of selected pathogenic variants in high-penetrance and perhaps lower penetrance cancer susceptibility genes for all Jewish individuals in Israel, regardless of their ethnicity or family history of cancer.
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Affiliation(s)
- Rinat Bernstein-Molho
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Breast Cancer Unit, Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Lee Galmor
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Laitman
- Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Medical Screening, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Eitan Friedman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Oncogenetics Unit, Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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19
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Orland Y, Beeri MS, Levy S, Israel A, Ravona-Springer R, Segev S, Elkana O. Physical fitness mediates the association between age and cognition in healthy adults. Aging Clin Exp Res 2021; 33:1359-1366. [PMID: 32557334 DOI: 10.1007/s40520-020-01621-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/31/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physical fitness is an important contributor to healthy aging that improves cognition. Older adults who engage in cardiorespiratory fitness activities show less cognitive decline. AIMS To examine whether physical fitness acts as a potential protective mechanism shielding against the negative associations between age and cognition. Specifically, we examined whether physical fitness mediates the relationship between age and processing speed. METHODS 114 (M = 63.80, SD = 10.63) senior executives completed a computerized cognitive battery composed of four processing speed tasks. Level of physical fitness was assessed on a treadmill stress test and reported in metabolic equivalents (METs). RESULTS Older age was associated with slower processing speed (r = 0.25, p = 0.007), whereas greater physical fitness was associated with faster processing speed (r = -0.30, p = 0.001). Path analysis indicated that the association between age and processing speed was fully mediated by the level of physical fitness (Indirect effect: β = 0.10, p = 0.008; Direct effect: β = 0.16, p = 0.20). CONCLUSIONS AND DISCUSSION The findings indicate that physical fitness is a strong mediator of the relationship between age and processing speed and imply that physical fitness makes a major contribution to cognitive reserve during the aging process. The results may suggest that the decrease in physical fitness during aging may partially account for slower cognitive processing.
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Affiliation(s)
- Yaara Orland
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Rabeinu Yerucham St., P.O.Box 8401, 68114, Yaffo, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sigal Levy
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Rabeinu Yerucham St., P.O.Box 8401, 68114, Yaffo, Israel
| | - Ariel Israel
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | | | - Shlomo Segev
- Institute of Medical Screening, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Rabeinu Yerucham St., P.O.Box 8401, 68114, Yaffo, Israel.
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20
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Younis A, Berkovitch A, Segev S, Kivity S, Klempfner R, Abu-Much A, Goldenberg I, Maor E. High fitness might be associated with the development of new-onset atrial fibrillation in obese non-athletic adults. Int J Clin Pract 2020; 74:e13638. [PMID: 32750733 DOI: 10.1111/ijcp.13638] [Citation(s) in RCA: 1] [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] [Received: 01/15/2020] [Accepted: 07/28/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Data on the association between AF and fitness are conflicting. OBJECTIVES The aim of this analysis was to investigate the association between fitness, obesity and incidence of atrial fibrillation (AF) among apparently healthy non-athlete adults. METHODS We investigated 20 410 self-referred subjects who were annually screened in a tertiary medical centre. All subjects were free of AF and completed maximal exercise stress test according to the Bruce protocol at baseline. Fitness was categorised into age- and sex-specific quintiles (Q) according to the treadmill time. Subjects were categorised to low (Q1-Q2) and high fitness (Q3-5) groups. The primary end point was new-onset AF during follow-up. RESULTS Mean age was 48 ± 10 years and 72% were men. A total of 463 (2.3%) events occurred during an average follow-up of 8 ± 5 years corresponding to an AF event rate of 0.3% per person year. Univariate and multivariate models showed that AF risk was similar in both fitness groups. However, AF event rate was 0.55% per person year among high fitness obese subjects, compared with 0.31% for low fitness obese subjects (P < .01). Subgroup interaction analysis showed that AF risk is obesity-dependent, such that in the obese group (≥30 kg/m2 ) high fitness was independently associated with a significant 79% increased AF risk (95% CI 1.15-2.78; P = .01), whereas among non-obese subjects the rate of events was similar between both fitness groups (P for interaction = (.02)). CONCLUSIONS Our findings suggest that high fitness might be associated with increased AF risk among obese subjects.
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Affiliation(s)
- Arwa Younis
- University of Rochester Medical Center, Rochester, NY, USA
| | - Anat Berkovitch
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Shlomo Segev
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Shaye Kivity
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Robert Klempfner
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Arsalan Abu-Much
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | | | - Elad Maor
- Chaim Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
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21
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Fardman A, Oppenheim A, Banschick G, Rabia R, Segev S, Klempfner R, Fourey D, Percik R, Grossman E, Maor E. Incident cardiovascular events and risk of subsequent cancer diagnosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3267] [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
Cardiovascular disease (CVD) and cancer share common risk factors. This study investigated the association of CVD diagnosis and the risk of future cancer.
Methods
We evaluated asymptomatic self-referred adults aged 40–79 years who participated in a screening program. All subjects were free of CVD and cancer at baseline. CVD was defined as the composite of acute coronary syndrome, percutaneous coronary intervention or stroke. Cancer and mortality data were available for all subjects from national registries. Primary end-point was development of cancer during follow up. Cox regression models were applied with CVD as a time-dependent covariate and death as a competing risk event.
Results
Final study population included 15,486 subjects. Median age was 50 years (Interquartile range [IQR] 44–55) and 72% were men. During median follow up time of 11 years (IQR 6–15) 1,028 (7%) subjects developed CVD, 1,281 (8%) developed cancer and 499 (3%) died. Most common cancer types were prostate among men (N=277, 1.8%) and breast among women (N=187, 1.2%). Time dependent survival analysis showed that subjects who developed CVD during follow up were 60% more likely to develop cancer (95% Confidence Interval [CI] 1.3–1.95, p<0.001). However, after adjustment for known predictors of cancer, the association of incident CVD with cancer diagnosis was no longer significant (p=0.21). Interaction analysis demonstrated that the association of incident CVD with the risk of future cancer diagnosis was age dependent such that in younger subjects (<50 years; N=7,649) incident CVD was associated with a significant 2 fold increased risk of subsequent cancer diagnosis (95% CI 1.2–3.6, p=0.014) while in older subjects incident CVD was not associated with increased risk of cancer in the multivariable model (p for interaction =0.035; Figure 1).
Conclusions
Incident CVD is independently associated with 2-fold increased risk of subsequent cancer diagnosis among young adults. Our analysis underscores the importance of cancer surveillance among young patients following a CVD event.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Fardman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Oppenheim
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - R Rabia
- Tel Aviv University, Tel Aviv, Israel
| | - S Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - R Klempfner
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - D Fourey
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - R Percik
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Grossman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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22
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Lapidot Y, Amir A, Ben-Simon S, Veitsman E, Cohen-Ezra O, Davidov Y, Weiss P, Bradichevski T, Segev S, Koren O, Ben-Ari Z, Safran M. Alterations of the salivary and fecal microbiome in patients with primary sclerosing cholangitis. Hepatol Int 2020; 15:191-201. [PMID: 32949377 DOI: 10.1007/s12072-020-10089-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a chronic, progressive liver disease known for its frequent concurrence with inflammatory bowel disease. PSC can progress to cirrhosis, end-stage liver disease, hepatobiliary cancer, and/or colorectal cancer. The etiopathogenesis of PSC remains poorly understood, and, as such, pharmacotherapy has yet to be definitively established. Little is known about the salivary microbiome in PSC and PSC-IBD. This study aimed to evaluate the oral microbiome of patients with PSC, with association to these patient's fecal microbial composition. METHODS Saliva, fecal samples and Food Frequency Questionnaires were collected from 35 PSC patients with or without concomitant inflammatory bowel disease and 30 age- and BMI-matched healthy volunteers. 16S rRNA gene sequencing was performed using Illumina MiSeq platform. RESULTS The salivary microbial signature of PSC was significantly altered as compared to healthy controls, independent of concomitant IBD, and was comprised of 19 significantly altered species, of which, eight species were consistently overrepresented in both fecal and saliva of patients with PSC, including Veillonella, Scardovia and Streptococcus. CONCLUSIONS PSC is characterized by microbial dysbiosis in the gut and the salivary microbiome, independently from IBD. The PSC dysbiotic signature includes a reduction in autochthonous bacteria and an increased relative abundance of pathogenic bacteria, including an invasion of oral bacteria to the gut. PSC is a strong modulator of the microbial profile, in the gut and the oral microbiome. These results may lead to the development of biomarkers for screening and early diagnosis or the development of personalized medicine in PSC.
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Affiliation(s)
- Y Lapidot
- Liver Research Laboratory, Sheba Medical Center, Tel Hashomer, Israel. .,Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel. .,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - A Amir
- Cancer Research Center, Sheba Medical Center, Ramat-Gan, Israel
| | - S Ben-Simon
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - E Veitsman
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel.,The Liver Unit, Rambam Health Care Campus, Haifa, Israel
| | - O Cohen-Ezra
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Y Davidov
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - P Weiss
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - T Bradichevski
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - S Segev
- Medical Screening Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - O Koren
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Z Ben-Ari
- Liver Research Laboratory, Sheba Medical Center, Tel Hashomer, Israel.,Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Safran
- Liver Research Laboratory, Sheba Medical Center, Tel Hashomer, Israel.,Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
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23
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Fardman A, Banschick GD, Rabia R, Percik R, Fourey D, Segev S, Klempfner R, Grossman E, Maor E. Cardiorespiratory fitness and survival following cancer diagnosis. Eur J Prev Cardiol 2020; 28:1242-1249. [PMID: 34551084 DOI: 10.1177/2047487320930873] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Received: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
Data on the association of cardiorespiratory fitness with survival of cancer patients are limited. This study aimed to evaluate the association between midlife cardiorespiratory fitness and survival after a subsequent cancer diagnosis.
Methods
We evaluated 19,134 asymptomatic self-referred adults who were screened in preventive healthcare settings. All subjects were free of cardiovascular disease and cancer at baseline and completed a maximal exercise stress test. Fitness was categorised into age-specific and sex-specific quintiles according to the treadmill time and dichotomised to low (quintiles 1–2) and high fitness groups.
Results
The mean age was 50 ± 8 years and 72% were men. During a median follow-up of 13 years (interquartile range 7–16) 517 (3%) died. Overall, 1455 (7.6%) subjects developed cancer with a median time to cancer diagnosis of 6.4 years (interquartile range 3–10). Death from the time of cancer diagnosis was significantly lower among the high fitness group (Plog rank = 0.03). Time-dependent analysis showed that subjects who developed cancer during follow-up were more likely to die (P < 0.001). The association of cancer with survival was fitness dependent such that in the lower fitness group cancer was associated with a higher risk of death, whereas among the high fitness group the risk of death was lower (hazard ratio 20 vs. 15; Pfor interaction = 0.047). The effect modification persisted after applying a 4-year blanking period between fitness assessment and cancer diagnosis (Pfor interaction = 0.003).
Conclusion
Higher midlife cardiorespiratory fitness is associated with better survival among cancer patients. Our findings support fitness assessment in preventive healthcare settings.
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Affiliation(s)
| | | | - Razi Rabia
- Sackler School of Medicine, Tel-Aviv University, Israel
| | - Ruth Percik
- Sackler School of Medicine, Tel-Aviv University, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center, Israel, Leviev Heart Center, Chaim Sheba Medical Center, Israel
| | - Dana Fourey
- Sackler School of Medicine, Tel-Aviv University, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center, Israel, Leviev Heart Center, Chaim Sheba Medical Center, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel-Aviv University, Israel
- Institute for Medical Screening, Chaim Sheba Medical Center, Israel
| | - Robert Klempfner
- Sackler School of Medicine, Tel-Aviv University, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center, Israel, Leviev Heart Center, Chaim Sheba Medical Center, Israel
| | - Ehud Grossman
- Sackler School of Medicine, Tel-Aviv University, Israel
| | - Elad Maor
- Sackler School of Medicine, Tel-Aviv University, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center, Israel, Leviev Heart Center, Chaim Sheba Medical Center, Israel
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24
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Fardman A, Banschick GD, Rabia R, Percik R, Segev S, Klempfner R, Grossman E, Maor E. Cardiorespiratory Fitness Is an Independent Predictor of Cardiovascular Morbidity and Mortality and Improves Accuracy of Prediction Models. Can J Cardiol 2020; 37:241-250. [PMID: 32428619 DOI: 10.1016/j.cjca.2020.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although cardiorespiratory fitness (CRF) is a strong independent predictor of adverse cardiovascular outcomes, it is not considered as a risk enhancer by current guidelines. METHODS We evaluated asymptomatic self-referred adults aged 40 to 79 years of age, free of cardiovascular disease at baseline, who were screened annually and completed baseline exercise stress test. Baseline CRF was dichotomized into 2 groups: low (metabolic equivalents < 8) and high. The primary endpoint was the composite of death, nonfatal acute coronary syndrome, and stroke after excluding subjects diagnosed with metastatic cancer during follow-up. RESULTS Study population included 15,445 subjects with median age of 49 years (interquartile range: 44-55). During median follow-up of 8 years 1362 (9%) subjects developed the study endpoint. Kaplan-Meier survival analysis showed that both fitness and atherosclerotic cardiovascular disease (ASCVD) were associated with developing of the study endpoint (P < 0.001 for both). Cox regression model with adjustment for ASCVD risk consistently showed that lower fitness was associated with a significant 23% higher risk to develop the study endpoint (P = 0.001). Continuous net reclassification improvement analysis showed an overall improvement of 11.4% (95% confidence interval, 8%-14.6%; P value < 0.001) in the accuracy of classification when fitness was added to the ASCVD model. CONCLUSIONS Low CRF is a strong independent predictor of the cardiovascular morbidity and mortality in asymptomatic adults. Addition of fitness to the pooled cohort ASCVD risk significantly improves the accuracy of the model.
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Affiliation(s)
- Alexander Fardman
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Razi Rabia
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ruth Percik
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Institute for Medical Screening, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Robert Klempfner
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Institute for Medical Screening, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ehud Grossman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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25
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Much AA, Fardman A, Segev S, Klempfner R, Grossman E, Segev A, Maor E. NON-PHARMACOLOGICAL IMPROVEMENT IN HDL CHOLESTEROL IS NOT ASSOCIATED WITH REDUCED CARDIOVASCULAR RISK IN APPARENTLY HEALTHY ADULTS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32609-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Fardman A, Banschick GD, Rabia R, Kivity S, Twig G, Segev S, Klempfner R, Percik R, Grossman E, Maor E. SERUM URIC ACID LEVELS IMPROVE ATHEROSCLEROTIC CARDIOVASCULAR DISEASE POOLED COHORT EQUATIONS MODEL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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27
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Fardman A, Banschick GD, Rabia R, Segev S, Klempfner R, Fourey D, Percik R, Grossman E, Maor E. P626Higher fitness is associated with improved survival among cancer patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0234] [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: 11/12/2022] Open
Abstract
Abstract
Background
Cardio-respiratory fitness (CRF) is a known predictor of cardiovascular morbidity and mortality. However, data on the association of CRF with survival following a diagnosis of cancer is limited.
Purpose
To evaluate the association between CRF in a large cohort of asymptomatic adults and a probability of survival after subsequent cancer diagnosis.
Methods
We evaluated asymptomatic self-referred adults aged 40–79 years who were screened annually at a tertiary medical center. All subjects were free of cardiovascular disease and cancer at baseline and completed maximal exercise stress test according to the Bruce protocol. Fitness was categorized into age- and sex-specific quintiles (Q) according to Bruce protocol treadmill time with Q1-Q2 defined as low fitness and Q3-Q5 as higher fitness. Cancer data was available from a national cancer registry. The primary end point was all-cause mortality.
Results
Final study population in included 15,800 subjects. Mean age was 51±8 years and 72% were men. During median follow up of 13 years (IQR 7–16) 1,312 (8%) subjects developed cancer and 486 (3%) died. Most common cancer types were prostate in 302 (23%) and breast cancer in 189 (14%) patients. No difference was found in distribution of major cancer types between different fitness categories. Univariate Cox regression with cancer as a time dependent covariate showed that subjects who developed cancer during follow up were 19 times more likely to die (95% CI 15.5–22.5, p<0.001). Kaplan Meier analysis showed that the cumulative probability of death from the time of cancer diagnosis was significantly lower among high fitness patients (34% ± 4% vs. 25% ± 3%, p Log rank = 0.008; Figure 1). Multivariate interaction analysis with cancer as a time dependent covariate showed that cancer-related risk of death was fitness-dependent, such that in the lower fitness group cancer was associated with 18 folds increased risk of death (95% CI: 13.5–23) whereas among high fitness group the risk of death was lower (HR=13; 95% CI: 10–17; p for interaction = 0.048).
Conclusions
Low CRF is associated with worse survival among subjects diagnosed as having cancer during follow up. These findings support the effectiveness of fitness assessment in preventive health care settings.
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Affiliation(s)
- A Fardman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - R Rabia
- Tel Aviv University, Tel Aviv, Israel
| | - S Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - R Klempfner
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - D Fourey
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - R Percik
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Grossman
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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28
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Gueta I, Klempfner R, Markovits N, Halkin H, Segev S, Rott D, Peled Y, Loebstein R. Clinically significant incidental QTc prolongation is subject to within-individual variability. Ann Noninvasive Electrocardiol 2019; 25:e12699. [PMID: 31498534 DOI: 10.1111/anec.12699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/15/2019] [Accepted: 08/04/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Prolonged QTc interval observed in daily practice is often deemed to be drug induced and might result in drug discontinuation, with possible therapeutic consequences. However, whether clinically significant prolonged QTc may be due to within-individual variability occurs has yet to be described. METHODS A retrospective cohort study documenting within-individual QTc variability in subjects attending annual routine medical evaluation. At each visit, QT interval was measured and corrected for heart rate using Bazett and three other commonly used formulae. Outcome measures were rates of ΔQTc ≥60 msec, absolute QTc ≥500 msec and QTc ≥25% from baseline. RESULTS A total of 188 subjects [54 (29%)] females were recruited. Mean age at first ECG was 54 ± 12.8 years with mean time interval of 12.2 ± 1.1 months between measurements. Mean Bazett QTc was higher compared to the other 3 formulae: 412 ± 20 vs. 400 ± 16 msec. Using Bazett formula, 18/188 (9.6%) and 5/188 (2.7%) subjects showed at least one measurement with ΔQTc ≥60 msec and QTc ≥500 msec, respectively. Of the former, 5/18 (27.8%) showed QTc ≥25% prolongation. In multivariate analysis, QTc ≥500 msec was significantly associated with number of measurements (HR: 5.01, 95%CI: 1.21-20.78, p = .026) with no effect of other known confounders. Lower rates were demonstrated with the other three formulae. CONCLUSION In clinical practice, significant prolonged QTc may be attributed to within-individual variability, particularly when adjusting the QT interval with Bazett correction. This should be taken into consideration when decisions on changing current drug regimens are to be made.
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Affiliation(s)
- Itai Gueta
- The Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Klempfner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Noa Markovits
- The Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hillel Halkin
- The Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Institute for Medical Screening, Sheba Medical Center, Tel Hashomer, Israel
| | - David Rott
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Yael Peled
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Ronen Loebstein
- The Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fardman A, Banschick GD, Rabia R, Segev S, Klempfner R, Grossman E, Maor E. CARDIORESPIRATORY FITNESS IMPROVES THE ACCURACY OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE POOLED COHORT RISK MODEL. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32308-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Berkovitch A, Younis A, Grossman Y, Segev S, Kivity S, Sidi Y, Beinart R, Goldenberg I, Maor E. Relation of Neutrophil to Lymphocyte Ratio to Risk of Incident Atrial Fibrillation. Am J Cardiol 2019; 123:396-401. [PMID: 30502048 DOI: 10.1016/j.amjcard.2018.10.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 01/02/2023]
Abstract
Clinical and experimental data support a critical role for inflammation in cardiovascular disease. The purpose of the current study was to examine the relation between an inflammatory marker, neutrophil-to-lymphocyte ratio (NLR), and incident atrial fibrillation (AF) in asymptomatic adults. We investigated 21,118 self-referred men and women who were annually screened in a tertiary medical center. All subjects were free of AF at baseline and had their serum NLR calculated at the first annual visit. Subjects were divided into 2 groups based on their baseline NLR: Low (<2.83; n = 17,524) and high (≥2.83; n = 3,594; Upper Sextile). The primary endpoint was new onset AF during follow-up. Mean age of study population was 48 ± 10 years and 72% were men. A total of 563 (2.7%) incident events occurred during an average follow-up of 7.5 ± 5 years. Unadjusted Cox regression analysis demonstrated that each 1 unit increase in NLR was associated with a significant 14% increase in risk of occurrence of a first AF event (95% confidence interval 1.06 to 1.23, p < 0.001) and 20% increased risk of death. Kaplan-Meier's survival analysis showed that the cumulative probability of incident AF was significantly higher among subjects with high NLR compared with low NLR group (p = 0.006). Interaction analysis with adjustment to clinical parameters showed that NLR-related risk was age-dependent, such that in the younger age-group (< =50 years) high NLR group had two folds increased risk for AF event compared with low NLR group (95% confidence interval 1.08 to 3.51; p = 0.027) whereas among older subjects the rate of events was similar between both NLR groups (p = NS; p for interaction = 0.024). In conclusion, our findings suggest that high NLR is associated with increased risk of new onset AF. This finding is more pronounced among young adults.
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Berkovitch A, Younis A, Sidi Y, Kivity S, Segev S, Goldenberg I, Maor E. P1886Neutrophil to lymphocyte ratio is associated with increased risk of new atrial fibrillation among asymptomatic middle age adults. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1886] [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)
- A Berkovitch
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Younis
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Y Sidi
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Kivity
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - S Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - I Goldenberg
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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Elkana O, Dayman V, Franko M, Israel A, Springer RR, Segev S, Beeri MS. The association of total cholesterol with processing speed is moderated by age in mid- to late-age healthy adults. Exp Aging Res 2018; 44:179-186. [PMID: 29303427 DOI: 10.1080/0361073x.2017.1422585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/21/2022]
Abstract
OBJECTIVES To investigate the nature of the association of normal levels of total cholesterol with cognitive function and the contribution of age to this association. METHODS A sample of 61 senior executives, who were summoned for an annual medical examination with approximately four measurements of total cholesterol during 4 years, were examined with a computerized cognitive battery assessing mental processing speed as a sensitive measure of cognitive decline. We examined the association of total cholesterol with processing speed and the moderating effect of age on this association. RESULTS A multiple regression analysis yielded a significant interaction between cholesterol and age for processing speed (p = .045). In order to examine the source of the interaction, simple slope analysis was performed. A significant negative high correlation was found for young subjects (p = .021), while no significant correlation was observed at middle (p = .286) or older (p = .584) age. The difference in slopes was robust to adjustment for potential confounding factors, including body mass index, and fasting glucose. CONCLUSIONS Within the normal range, higher total cholesterol levels were associated with better processing speed in younger ages and this association diminished with increasing age. Our findings highlight the important role of brain cholesterol in good cognitive functioning.
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Affiliation(s)
- Odelia Elkana
- a Behavioral Sciences , Academic College of Tel Aviv-Yaffo , Tel Aviv , Israel
| | - Vitali Dayman
- a Behavioral Sciences , Academic College of Tel Aviv-Yaffo , Tel Aviv , Israel
| | - Motty Franko
- a Behavioral Sciences , Academic College of Tel Aviv-Yaffo , Tel Aviv , Israel
| | - Ariel Israel
- b The Joseph Sagol Neuroscience Center, Sheba Medical Center , Tel Hashomer , Israel
| | | | - Shlomo Segev
- d Institute of Medical Screening , Sheba Medical Center Tel Hashomer , Ramat Gan , Israel
| | - Michal Schnaider Beeri
- b The Joseph Sagol Neuroscience Center, Sheba Medical Center , Tel Hashomer , Israel.,e The Icahn School of Medicine at Mount Sinai , Department of Psychiatry , New York , NY , USA
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Shouval R, Katz S, Nagler A, Merkel D, Ben-Zvi I, Segev S, Sidi Y, Goldenberg I, Kivity S, Maor E. Gender disparities in the functional significance of anemia among apparently healthy adults. Eur J Haematol 2017; 98:435-442. [PMID: 28122139 DOI: 10.1111/ejh.12849] [Citation(s) in RCA: 4] [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] [Accepted: 01/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data on the functional impact of anemia on cardiorespiratory fitness (CRF) and survival in healthy individuals are limited. Our aim was to evaluate the association between anemia thresholds, low CRF, and survival in otherwise healthy adults. METHODS Study population included 16 334 apparently healthy subjects attending annual periodic health screening examinations (71 200 annual visits), including exercise stress testing (EST). Anemia was defined by the World Health Organization (WHO) or Beutler and Waalens' (BW) criteria. Low CRF was defined as the lowest fitness quintile according to the Bruce protocol. RESULTS The mean age was 46±10 years, and 70% were men. Mean Hb levels were 13±1 and 15±1 among women and men, respectively, with higher proportion of anemia among women. The majority of anemic subjects had mild anemia. When analyzing repeated annual visits, anemia was associated with a significant 39% and 64% increased risk of low CRF according the WHO and BW criteria only in women (n=18 672). Baseline anemia at first visit was associated with 2.6- and 1.9-fold increased risk of all-cause mortality using the WHO and BW criteria, exclusively in men (n=11 511). CONCLUSIONS Overall, the functional and prognostic impact of anemia is gender dependent, based on the WHO and BW arbitrary criteria, suggesting differing mechanism and responses.
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Affiliation(s)
- Roni Shouval
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,The Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sharon Katz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Internal Medicine "F" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Drorit Merkel
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Ben-Zvi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Internal Medicine "F" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Shlomo Segev
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute for Medical Screening, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Yechezkel Sidi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Internal Medicine "C" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Ilan Goldenberg
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Shaye Kivity
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Internal Medicine "C" Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Elad Maor
- The Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Sabbag A, Berkovitch A, Sidi Y, Kivity S, Ben Zekry S, Beinart R, Segev S, Glikson M, Goldenberg I, Maor E. Poor Heart Rate Recovery Is Associated With the Development of New-Onset Atrial Fibrillation in Middle-Aged Adults. Mayo Clin Proc 2016; 91:1769-1777. [PMID: 28126153 DOI: 10.1016/j.mayocp.2016.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Received: 05/10/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the association between heart rate recovery (HRR) and new-onset atrial fibrillation (AF) in middle-aged adults. PATIENTS AND METHODS Heart rate recovery was calculated using the exercise stress test in 15,729 apparently healthy self-referred men and women who attended periodic health screening examinations between January 2000, and December 2015. All participants completed the maximal exercise stress test according to the Bruce protocol and were followed clinically on a yearly basis for a median of 6.4±4 years. The primary end point was new-onset AF. Participants were grouped according to HRR at 5 minutes, dichotomized at the median value (<73 beats/min). RESULTS Participants with low HRR were older, were more commonly men, had a higher rate of comorbidities, and were less fit. Kaplan-Meier survival analysis revealed that the cumulative probability of AF at 6 years was higher in participants with low HRR (2.1%) than in those with high HRR (0.6%) (log-rank, P<.001). Older age, male sex, obesity resting heart rate, and ischemic heart disease were all associated with increased AF risk in a univariate Cox regression model (P<.05 for all). Multivariate Cox regression analysis revealed that low HRR was independently associated with increased AF risk (hazard ratio, 1.92; 95% CI, 1.3-2.8; P<.001) after adjustment for multiple confounders. CONCLUSION Lower HRR is independently associated with the development of new-onset AF during long-term follow-up in middle-aged adults.
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Affiliation(s)
- Avi Sabbag
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Berkovitch
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yechezkel Sidi
- Departments of Internal Medicine A and C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaye Kivity
- Departments of Internal Medicine A and C, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Ben Zekry
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Beinart
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Segev
- Institute for Medical Screening, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Michael Glikson
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Perelshtein Brezinov O, Kivity S, Segev S, Sidi Y, Goldenberg I, Maor E, Klempfner R. Gender-Related Cardiovascular Risk in Healthy Middle-Aged Adults. Am J Cardiol 2016; 118:1669-1673. [PMID: 27737731 DOI: 10.1016/j.amjcard.2016.08.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Received: 05/20/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 11/18/2022]
Abstract
Men tend to develop cardiovascular disease (CVD) earlier in life than women. Whether this difference is attributable only to gender is a matter of debate. The purpose of this study was to evaluate gender differences in cardiovascular risk in a large cohort of asymptomatic men and women and explore gender-related risk in prespecified risk factor subgroups. We investigated 14,966 asymptomatic men and women free of diabetes, hypertension, or ischemic heart disease who were annually screened. The primary end point of the present study was the occurrence of ischemic or cerebrovascular disease as composite end point. Multivariate Cox proportional hazards regression modeling was used to assess the gender difference regarding CVD and to examine the association between CVD risk factors and gender. Mean age of the study population was 47 ± 10 years and 30% were women. Kaplan-Meier survival analysis showed that at 6.2 ± 3.9 years' follow-up, the rate of CVD events was 6.1% among men compared with 1.8% among women (log-rank p <0.001). Consistently, multivariate analysis demonstrated that male gender was independently associated with a significant threefold increased risk for development of CVD events (hazard ratio 3.05, CI 2.25 to 4.14). The CVD risk associated with male gender was consistent in each risk subset analyzed, including older age, low high-density lipoprotein, impaired fasting glucose, and positive family history for ischemic heart disease (all p values for gender-by-risk factor interactions <0.05). Higher performance on treadmill test had a protective effect regarding CVD development in both men and women. In conclusions, healthy middle-aged men experienced increased risk for the development of CVD events compared with women independently of traditional CVD risk factors. However, better exercise capacity is associated with a protective effect.
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Affiliation(s)
- Olga Perelshtein Brezinov
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Internal Medicine E, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Shaye Kivity
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Internal Medicine A, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Institute for Medical Screening, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shlomo Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Institute for Medical Screening, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Yechezkel Sidi
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Sheba Medical Center, Ramat Gan, Israel
| | - Robert Klempfner
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Raizes M, Elkana O, Franko M, Ravona Springer R, Segev S, Beeri MS. Higher Fasting Plasma Glucose Levels, within the Normal Range, are Associated with Decreased Processing Speed in High Functioning Young Elderly. J Alzheimers Dis 2016; 49:589-92. [PMID: 26484908 DOI: 10.3233/jad-150433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/15/2022]
Abstract
We explored the association of plasma glucose levels within the normal range with processing speed in high functioning young elderly, free of type 2 diabetes mellitus (T2DM). A sample of 41 participants (mean age = 64.7, SD = 10; glucose 94.5 mg/dL, SD = 9.3), were examined with a computerized cognitive battery. Hierarchical linear regression analysis showed that higher plasma glucose levels, albeit within the normal range (<110 mg/dL), were associated with longer reaction times (p < 0.01). These findings suggest that even in the subclinical range and in the absence of T2DM, monitoring plasma glucose levels may have an impact on cognitive function.
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Affiliation(s)
- Meytal Raizes
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Israel
| | - Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Israel
| | - Motty Franko
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Israel
| | - Ramit Ravona Springer
- Department of Psychiatry, Sheba Medical Center, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Segev
- Institute of Medical Screening, Sheba Medical Center Tel Hashomer, Israel
| | - Michal Schnaider Beeri
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,The Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
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Bitzur R, Brenner R, Maor E, Antebi M, Ziv-Baran T, Segev S, Sidi Y, Kivity S. Metabolic syndrome, obesity, and the risk of cancer development. Eur J Intern Med 2016; 34:89-93. [PMID: 27545645 DOI: 10.1016/j.ejim.2016.08.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 05/28/2016] [Revised: 07/10/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Metabolic syndrome and its components are severe global health issues that are increasing in frequency as the prevalence of obesity increases. Various studies have established a correlation between metabolic syndrome and diseases including, diabetes mellitus, non-alcoholic fatty liver disease, cirrhosis, and cardiovascular disease. In recent years, correlations have also been detected between obesity and metabolic syndrome and the prevalence of certain types of cancer. The current study examines whether obesity and metabolic syndrome components are risk factors for cancer among the adult population in Israel. METHODS A cohort study analysis was performed of 24,987 initially healthy men and women who underwent yearly medical assessments at the Institute for Medical Screening in the Sheba Medical Center. Data from the Institute for Medical Screening database was correlated with that from the Israel Cancer Center in the Ministry of Health updated to December 2013. The correlation between metabolic syndrome, obesity, and the overall risk of cancer as well as the risks of specific types of cancer were examined. RESULTS Of 20,444 subjects for whom complete data were available, 1535 were diagnosed with cancer during the mean follow-up time of 104.3months. In a multi-variant analysis, no significant correlation was found between metabolic syndrome or obesity and the incidence of cancer. When the data were stratified by gender and cancer type, however, a significant association between metabolic syndrome and breast cancer in women was observed (P=0.03, HR=1.67, 95% CI=1.05-2.67). CONCLUSION Metabolic syndrome correlates with higher than expected breast cancer incidence in women.
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Affiliation(s)
- Rafael Bitzur
- The Bert W. Strassburger Lipid Center, Sheba Medical Center, 5265601 Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Ronen Brenner
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel; Institute of Oncology, Wolfson Medical Center, Holon, Israel
| | - Elad Maor
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel; Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Sheba Medical Center, Tel Hashomer, Israel
| | - Maayan Antebi
- Department of Internal Medicine D, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Shlomo Segev
- Institute for Medical Screening, Sheba Medical Center, Israel
| | - Yechezkel Sidi
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel; Department of Internal Medicine C, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shaye Kivity
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine A, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Berger A, Grossman E, Katz M, Kivity S, Klempfner R, Segev S, Goldenberg I, Sidi Y, Maor E. Exercise systolic blood pressure variability is associated with increased risk for new-onset hypertension among normotensive adults. ACTA ACUST UNITED AC 2016; 10:527-535.e2. [DOI: 10.1016/j.jash.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/26/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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Berkovitch A, Kivity S, Klempfner R, Segev S, Milwidsky A, Erez A, Sabbag A, Goldenberg I, Sidi Y, Maor E. Body mass index and the risk of new-onset atrial fibrillation in middle-aged adults. Am Heart J 2016; 173:41-8. [PMID: 26920595 DOI: 10.1016/j.ahj.2015.11.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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] [Received: 03/19/2015] [Accepted: 11/25/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Increased body mass index (BMI) and obesity are associated with increased risk of new-onset atrial fibrillation (AF) among middle-aged adults. OBJECTIVES The objective of the study is to investigate the association between BMI and the risk for new-onset AF among middle-aged adults. METHODS We investigated 18,290 men and women who were annually screened in a tertiary medical center. Participants were divided at baseline into 3 groups: normal weight (BMI ≥18 and <25 kg/m(2), n = 7,692), overweight (BMI ≥25 and <30 kg/m(2), n = 8,032), and obese (BMI ≥30 kg/m(2), n = 2,566). The primary end point was new-onset AF during follow-up. RESULTS Mean age of study population was 49 ± 11 years, and 73% were men. A total of 288 incident events (1.6%) occurred during 6 ± 4 years. Kaplan-Meier survival analysis showed that the cumulative probability of AF at 6 years was highest among obese participants, intermediate among overweight participants, and lowest among participants with normal weight (2.1%, 1.7%, and 0.8% respectively, P < .001). Multivariable Cox regression analysis showed that overweight and obesity were independently associated with increased AF risk (hazard ratio 1.54 [P = .004] and 2.41 [P < .001], respectively). Assessment of BMI change as a time-dependent covariate in the multivariable model showed that each 1 kg/m(2) reduction in BMI during follow-up was associated with a significant 7% reduction in the risk for the occurrence of a first AF event (hazard ratio 0.93, 95% CI 0.88-0.99, P = .019). Consistently, similar analysis showed that each 5-kg weight loss during follow-up was independently associated with a significant 12% reduced risk of new-onset AF (95% CI 0.81-0.98, P = .02). CONCLUSIONS Our findings suggest that overweight and obesity are associated with increased AF risk, whereas weight reduction is independently associated with reduced risk of de novo AF.
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Affiliation(s)
- Anat Berkovitch
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Department of Internal Medicine D, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shaye Kivity
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Internal Medicine C, Chaim Sheba Medical Center, Tel Hashomer, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Israel; Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Robert Klempfner
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Institute for Medical Screening, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Assi Milwidsky
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Internal Medicine "E," Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Aharon Erez
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Avi Sabbag
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yechezkel Sidi
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Internal Medicine C, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Ben-Horin S, Izhaki Z, Haj-Natur O, Segev S, Eliakim R, Avidan B. Rarity of adenomatous polyps in ulcerative colitis and its implications for colonic carcinogenesis. Endoscopy 2016; 48:215-22. [PMID: 26427000 DOI: 10.1055/s-0034-1393119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS Despite ample research on the dysplasia to carcinoma risk in ulcerative colitis, there are scant data on the prevalence of adenomatous polyps in this population. METHODS The number and histology of all polyps detected at colonoscopies of ulcerative colitis patients aged > 50 during 2006 - 2012 were compared with similarly aged controls undergoing screening colonoscopy. RESULTS There were 206 patients with ulcerative colitis and 624 controls included in the study (mean age 61.7 ± 8.7 vs. 60.8 ± 6.1, respectively; P = 0.15). Adenomatous polyps were detected in only 13/206 colonoscopies for ulcerative colitis compared with 162 /624 controls (6.3 % vs. 25.9 %, respectively; odds ratio [OR] 0.19, 95 % confidence interval [CI] 0.1 - 0.34; P < 0.0001). When also considering all prior colonoscopies performed over 7.7 ± 4.6 years of follow-up (mean 4.1 ± 2.9 colonoscopies/patient, range 1 - 15, total 832 colonoscopies), the risk of ever finding an adenoma in ulcerative colitis patients was still significantly lower compared with controls (14.1 % vs. 25.9 %, respectively; OR 0.47, 95 %CI 0.3 - 0.72; P = 0.0005). On multivariable analysis, adenomas were positively associated with advanced age (OR 1.07/year, 95 %CI 1.03 - 1.1; P < 0.0001) and with increasing body mass index (BMI; OR 1.06/kg/m(2), 95 %CI 1.01 - 1.1; P = 0.01) and negatively associated with having ulcerative colitis (OR 0.15, 95 %CI 0.09 - 0.44; P = 0.0005). Among 115 Crohn's disease patients aged > 50 years, the rate of ever-adenomas in small-bowel Crohn's disease was similar to the controls (P = 0.8) and not influenced by 5-aminosalicylic acid use, whereas patients with colonic Crohn's disease had a significantly lower rate of adenomas compared with the controls (3.9 % vs. 25.9 %; P = 0.002). CONCLUSION Unlike patients with small-bowel Crohn's disease, patients with ulcerative colitis or with colonic Crohn's disease seldom develop sporadic adenomatous polyps. These data may provide novel clues to a possible role for colonic immune activation in restricting the adenoma to carcinoma sequence while propagating the dysplasia to carcinoma pathway.
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Affiliation(s)
- Shomron Ben-Horin
- Gastroenterology Department, Sheba Medical Center & Sackler School of Medicine Tel-Aviv University, Tel Hashomer, Israel
| | - Ziv Izhaki
- Gastroenterology Department, Sheba Medical Center & Sackler School of Medicine Tel-Aviv University, Tel Hashomer, Israel
| | - Ola Haj-Natur
- Gastroenterology Department, Sheba Medical Center & Sackler School of Medicine Tel-Aviv University, Tel Hashomer, Israel
| | - Shlomo Segev
- Institute for Medical Screening, Sheba Medical Center & Sackler School of Medicine Tel-Aviv University, Tel Hashomer, Israel
| | - Rami Eliakim
- Gastroenterology Department, Sheba Medical Center & Sackler School of Medicine Tel-Aviv University, Tel Hashomer, Israel
| | - Benjamin Avidan
- Gastroenterology Department, Sheba Medical Center & Sackler School of Medicine Tel-Aviv University, Tel Hashomer, Israel
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Israel A, Kivity S, Sidi Y, Segev S, Berkovitch A, Klempfner R, Lavi B, Goldenberg I, Maor E. Use of exercise capacity to improve SCORE risk prediction model in asymptomatic adults. Eur Heart J 2016; 37:2300-6. [PMID: 26916798 DOI: 10.1093/eurheartj/ehw053] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/08/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS The SCORE risk estimation system is used for cardiovascular risk stratification in apparently healthy adults and is based on known cardiovascular risk factors. The purpose of the current study was to evaluate whether exercise capacity can improve the accuracy of the SCORE overall survival risk estimation. METHODS AND RESULTS We investigated 22 878 asymptomatic men and women who were annually screened in a tertiary medical centre. All subjects were free of known ischaemic heart disease, and had completed maximal exercise stress test according to the Bruce protocol. The SCORE risk estimation system was used to evaluate individual cardiovascular risk for all subjects. The primary endpoint was mortality, after exclusion of patients with metastatic cancer during follow-up. The incremental contribution of exercise capacity in predicting the risk of death was evaluated by net reclassification improvement (NRI) and area under the receiver operating curve (AUROC). Mean age of the study population was 47.4 ± 10.3, and 71.6% were men. There were 505 (2.21%) deaths during a mean follow-up of 9.2 ± 4.1 years. Kaplan-Meier survival analysis showed that both SCORE and low exercise capacity were associated with reduced survival. When added to the SCORE risk prediction, exercise capacity allowed more accurate risk stratification: NRI analysis showed an overall improvement of 56.8% in the accuracy of classification and the AUROC increased (0.782 vs. 0.766). CONCLUSION Both SCORE and exercise capacity are strong independent predictors of all-cause mortality. The addition of exercise capacity to the SCORE risk model can improve the accuracy of the model.
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Affiliation(s)
- Ariel Israel
- Leviev Heart Centre, Chaim Sheba Medical Centre, Tel-Hashomer 52621, Israel Clalit Health Services, Jerusalem, Israel
| | - Shaye Kivity
- Department of Internal Medicine C, Chaim Sheba Medical Centre, Tel-Hashomer, Israel Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Centre, Tel-Hashomer, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yechezkel Sidi
- Department of Internal Medicine C, Chaim Sheba Medical Centre, Tel-Hashomer, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomo Segev
- Institute for Medical Screening, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - Anat Berkovitch
- Leviev Heart Centre, Chaim Sheba Medical Centre, Tel-Hashomer 52621, Israel
| | - Robert Klempfner
- Leviev Heart Centre, Chaim Sheba Medical Centre, Tel-Hashomer 52621, Israel
| | - Bruno Lavi
- Medical Center Management, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - Ilan Goldenberg
- Leviev Heart Centre, Chaim Sheba Medical Centre, Tel-Hashomer 52621, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elad Maor
- Leviev Heart Centre, Chaim Sheba Medical Centre, Tel-Hashomer 52621, Israel Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
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Milwidsky A, Maor E, Kivity S, Berkovitch A, Zekry SB, Tenenbaum A, Fisman EZ, Erez A, Segev S, Sidi Y, Goldenberg I, Kuperstein R. Impaired fasting glucose and left ventricular diastolic dysfunction in middle-age adults: a retrospective cross-sectional analysis of 2971 subjects. Cardiovasc Diabetol 2015; 14:119. [PMID: 26369690 PMCID: PMC4570240 DOI: 10.1186/s12933-015-0282-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 08/27/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction (LVDD) is a well-established and early echocardiographic characteristic of diabetic cardiomyopathy. However, there are limited data on the association between impaired fasting glucose (IFG) and LVDD. OBJECTIVE To determine whether IFG is associated with LVDD among middle age adults. METHODS Amongst 3781 subjects screened in an annual health survey program and referred for an echocardiogram, 2971 individuals without LV systolic dysfunction or valvular heart disease were selected. Mean age of study population was 59 ± 12 years and 75% were men. The subjects were categorized into three groups: euglycemia (N = 2025), IFG (N = 534) and diabetes mellitus (DM; N = 412). Doppler echocardiography readers were blinded to glycemic state. Subjects with impaired LV relaxation, pseudo-normal or restrictive filling patterns were defined as having LVDD. RESULTS LVDD was diagnosed in 574 (19 %) of subjects and it was more prevalent among patients with IFG and DM than in euglycemic individuals (27, 30 and 15%, respectively; p < 0.001). Patients with IFG and DM had lower ratios of early (E) to late (A) trans-mitral flow (0.9 ± 0.3 and 0.9 ± 0.3 vs. 1.1 ± 0.4, respectively, p < 0.001). LV hypertrophy (LVH) was also more prevalent among patients with IFG and DM (11 and 18%, respectively, vs. 9%; p < 0.001). Multivariate binary logistic regression model adjusted to age, gender, obesity, LVH, renal function, total, high and low density lipoprotein cholesterol, triglycerides, ischemic heart disease, hypertension and LV ejection fraction showed that patients with IFG were 43% more likely to have LVDD compared with euglycemic subjects (95% confidence interval 1.12-1.83, p = 0.004). CONCLUSIONS IFG is independently associated with a significant increase in the likelihood for the presence of LVDD in middle aged adults.
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Affiliation(s)
- Assi Milwidsky
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Department of Internal Medicine "E", Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Shaye Kivity
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Anat Berkovitch
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Sagit Ben Zekry
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Alexander Tenenbaum
- Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. .,Cardiovascular Diabetology Research Foundation, Holon, Israel.
| | - Enrique Z Fisman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. .,Cardiovascular Diabetology Research Foundation, Holon, Israel.
| | - Aharon Erez
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Shlomo Segev
- Institute for Medical Screening, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Yechezkel Sidi
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Department of Internal Medicine "E", Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Department of Internal Medicine "E", Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
| | - Rafael Kuperstein
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Sabbag A, Sidi Y, Kivity S, Beinart R, Glikson M, Segev S, Goldenberg I, Maor E. Obesity and exercise-induced ectopic ventricular arrhythmias in apparently healthy middle aged adults. Eur J Prev Cardiol 2015; 23:511-7. [DOI: 10.1177/2047487315591442] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/20/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Avi Sabbag
- Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Yechezkel Sidi
- Department of Internal Medicine C, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Shaye Kivity
- Department of Internal Medicine C, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Roy Beinart
- Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Michael Glikson
- Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Shlomo Segev
- Institute for Medical Screening, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
- Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
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Erez A, Kivity S, Berkovitch A, Milwidsky A, Klempfner R, Segev S, Goldenberg I, Sidi Y, Maor E. The association between cardiorespiratory fitness and cardiovascular risk may be modulated by known cardiovascular risk factors. Am Heart J 2015; 169:916-923.e1. [PMID: 26027631 DOI: 10.1016/j.ahj.2015.02.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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] [Received: 07/09/2014] [Accepted: 02/24/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to evaluate whether reduced cardiovascular fitness has a direct or indirect effect for the development of cardiovascular disease. METHODS We investigated 15,595 men and women who were annually screened in a tertiary medical center. All subjects were free of ischemic heart disease and had completed maximal exercise stress test according to the Bruce protocol at their first visit. Fitness was categorized into age- and sex-specific quintiles (Q) according to Bruce protocol treadmill time with Q1 as lowest fitness. Subjects were categorized at baseline into 3 groups: low fitness (Q1), moderate fitness (Q2-Q4), and high fitness (Q5). The primary end point of the current analysis was the development of a first cardiovascular event during follow-up. RESULTS Mean age of study patients was 48 ± 10 years, and 73% were men. A total of 679 events occurred during 92,092 person-years of follow-up. Kaplan-Meier survival analysis showed that the cumulative probability of cardiovascular events at 6 years was significantly higher among subjects with low fitness (P < .001). Low fitness was associated with known cardiovascular risk factors, including hypercholesterolemia (odds ratio [OR] 1.58, 95% CI 1.31-1.89), diabetes mellitus (OR 2.32, 95% CI 1.58-3.41), and obesity (OR 10.46, 95% CI 8.43-12.98). The effect of low fitness on cardiovascular events was no longer significant when including diabetes mellitus, hypercholesterolemia, and obesity as mediators (hazard ratio 0.99, 95% CI 0.82-1.19). CONCLUSIONS The association between cardiovascular fitness and adverse cardiovascular outcomes may be modulated through traditional cardiovascular risk factors. These findings need to be further validated in prospective clinical trials.
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Affiliation(s)
- Aharon Erez
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Shaye Kivity
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Anat Berkovitch
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Assi Milwidsky
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Robert Klempfner
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shlomo Segev
- Institute for Medical Screening, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yechezkel Sidi
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel
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Berger A, Grossman E, Katz M, Kivity S, Klempfner R, Segev S, Goldenberg I, Sidi Y, Maor E. Exercise blood pressure and the risk for future hypertension among normotensive middle-aged adults. J Am Heart Assoc 2015; 4:jah3935. [PMID: 25904593 PMCID: PMC4579952 DOI: 10.1161/jaha.114.001710] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The aim of the present study was to examine whether exercise blood pressure can be used to predict the development of hypertension in normotensive middle‐aged adults. Methods and Results We investigated 7082 normotensive subjects who were annually screened in a tertiary medical center and completed maximal treadmill exercise tests at each visit. After the initial 3 years, subjects were divided into approximate quartiles according to their average exercise systolic and diastolic blood pressure responses (≤158; 158 to 170; 170 to 183; ≥183 mm Hg for systolic blood pressure and ≤73; 73 to 77; 77 to 82; ≥82 mm Hg for diastolic blood pressure). Mean age of the study population was 48±9 years and 73% were men. Average baseline resting blood pressure was 120/77±12/7 mm Hg. During a follow‐up of 5±3 years, 1036 (14.6%) subjects developed hypertension. The cumulative probability of new‐onset hypertension at 5 years was significantly increased with increasing quartiles of exercise systolic blood pressure (5%, 9%, 17%, and 35%, respectively; P<0.001), with a similar association shown for diastolic blood pressure. After adjustment for baseline resting blood pressure and clinical parameters, each 5‐mm Hg increments in exercise either systolic or diastolic blood pressures were independently associated with respective 11% (P<0.001) and 30% (P<0.001) increased risk for the development of hypertension. Conclusions In normotensive middle‐aged individuals, blood pressure response to exercise is associated with future development of hypertension.
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Affiliation(s)
- Assaf Berger
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel (A.B., M.K., R.K., I.G., E.M.)
| | - Ehud Grossman
- Department of Internal Medicine D, Chaim Sheba Medical Center, Ramat Gan, Israel (E.G.) Sackler School of Medicine, Tel-Aviv University, Israel (E.G., S.K., R.K., I.G., Y.S.)
| | - Moshe Katz
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel (A.B., M.K., R.K., I.G., E.M.)
| | - Shaye Kivity
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel (S.K., Y.S.) Sackler School of Medicine, Tel-Aviv University, Israel (E.G., S.K., R.K., I.G., Y.S.)
| | - Robert Klempfner
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel (A.B., M.K., R.K., I.G., E.M.) Sackler School of Medicine, Tel-Aviv University, Israel (E.G., S.K., R.K., I.G., Y.S.)
| | - Shlomo Segev
- Institute for Medical Screening, Chaim Sheba Medical Center, Ramat Gan, Israel (S.S.)
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel (A.B., M.K., R.K., I.G., E.M.) Sackler School of Medicine, Tel-Aviv University, Israel (E.G., S.K., R.K., I.G., Y.S.)
| | - Yehezkel Sidi
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel (S.K., Y.S.) Sackler School of Medicine, Tel-Aviv University, Israel (E.G., S.K., R.K., I.G., Y.S.)
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel (A.B., M.K., R.K., I.G., E.M.) Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat Gan, Israel (E.M.)
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Katz M, Berger A, Kivity S, Segev S, Sidi Y, Grossman E, Goldenberg I, Maor E. BLOOD PRESSURE VARIABILITY AND THE RISK FOR THE DEVELOPMENT OF HYPERTENSION IN NORMOTENSIVE MIDDLE-AGED ADULTS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ramaty E, Maor E, Peltz-Sinvani N, Brom A, Grinfeld A, Kivity S, Segev S, Sidi Y, Kessler T, Sela BA, Segal G. Low ALT blood levels predict long-term all-cause mortality among adults. A historical prospective cohort study. Eur J Intern Med 2014; 25:919-21. [PMID: 25468741 DOI: 10.1016/j.ejim.2014.10.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 08/17/2014] [Revised: 10/11/2014] [Accepted: 10/24/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Increased blood levels of alanine amino transferase (ALT, also known as SGPT; serum glutamic pyruvic transaminase) serve as a marker of liver injury by various mechanisms. Less is known about the clinical implications associated with low-normal ALT levels. Previous studies showed low ALT levels to be associated with poor long-term outcomes among elderlies, serving as a biomarker for increased incidence of frailty and subsequent risk of mortality. However, it has not been determined yet whether low-normal ALT values might be predictive of frailty and mortality in younger, middle-aged adults. METHODS We conducted a historical prospective cohort analysis. RESULTS A total of 23,506 adults with ALT levels within the normal range, at the mean age of 48 ± 11 years, participating in an annual screening program for preventive medicine, were followed-up for a median period of 8.5 years during which 638 died. Low-normal ALT values (serum ALT activity <17IU/L) were found to be predictive for increased risk of all-cause mortality (HR=1.6; 95% CI 1.34-1.92; p<0.001). Statistically significant correlation was demonstrated even after applying a multifactorial model correction for age, gender, eGFR, low albumin, arterial hypertension, diabetes mellitus and ischemic heart disease. CONCLUSIONS We suggest that low-normal ALT values may serve as an independent predictive marker for increased long-term mortality in middle-aged adults.
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Affiliation(s)
- E Ramaty
- Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel.
| | - E Maor
- Leviev Heart Institute, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel
| | - N Peltz-Sinvani
- Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel
| | - A Brom
- Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel
| | | | - S Kivity
- Internal Medicine "C", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel; The Zabludovicz Center for Autoimmune Diseases, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel
| | - S Segev
- Institute of Preventive Medicine, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel
| | - Y Sidi
- Internal Medicine "C", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel
| | - T Kessler
- Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel
| | - B A Sela
- Institute of Chemical Pathology, Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel
| | - G Segal
- Department of Internal Medicine "T", Chaim Sheba Medical Center,(2) Tel Hashomer, Ramat Gan, Israel
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Yahalom G, Maor E, Hassin-Baer S, Segev S, Sidi Y, Kivity S. Cardiac stress test is normal in pre-motor Parkinson's disease. Mov Disord 2014; 29:1158-62. [PMID: 24954917 DOI: 10.1002/mds.25943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/02/2013] [Revised: 05/09/2014] [Accepted: 05/28/2014] [Indexed: 11/11/2022] Open
Abstract
Cardiac sympathetic denervation is an early nonmotor feature of Parkinson's disease (PD). The aim of the current study was to trace evidence for cardiac dysfunction abnormalities in the premotor phase of PD. We retrospectively reviewed treadmill ergometric tests of a large cohort (n = 16,841) between 2000 and 2012, that attended the Executive Screening Survey (ESS) at Sheba Medical Center. Heart rate and blood pressure profiles as well as exercise capacity were compared between subjects who later developed PD and age- and sex-matched subjects (ratio 1:2) who did not. We identified 28 subjects (24 males) who developed PD at follow-up. The PD group was older than the group of subjects who did not develop PD on first ergometric test (64.82 ± 8.82 vs. 48.91 ± 10.60 years, P < 0.001). The time between the first ergometric test and motor symptoms onset was 4.64 ± 2.86 years. Patients who later developed PD had lower maximal heart rate (P < 0.001) and lower heart rate reserve than healthy controls (P < 0.001); however, compared with age- and sex-matched subjects, subjects who developed PD had similar exercise capacity and heart rate profile during rest, exercise, and recovery, even 1 year before diagnosis. In this study, we did not detect significant signs of sympathetic dysfunction during the premotor phase of PD.
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Affiliation(s)
- Gilad Yahalom
- The Parkinson Disease and Movement Disorders Clinic, Department of Neurology and Sagol Neuroscience Center; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Berkovitch A, Kivity S, Klempfner R, Segev S, Milwidsky A, Goldenberg I, Sidi Y, Maor E. Time-dependent relation between smoking cessation and improved exercise tolerance in apparently healthy middle-age men and women. Eur J Prev Cardiol 2014; 22:807-14. [PMID: 24817697 DOI: 10.1177/2047487314535116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 01/17/2014] [Accepted: 04/19/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Smoking is an independent cardiovascular risk factor and correlates with reduced exercise tolerance. However, data on the time dependent effect of smoking cessation on exercise tolerance are limited. DESIGN AND METHODS We investigated 17,115 men and women who were annually screened at the Institute for Medical Screening of the Chaim Sheba Medical Centre. All subjects had their smoking status documented and performed an exercise stress testing (EST) according to Bruce protocol at each visit. Subjects were divided at baseline into four groups: active smokers (N = 2858), recent quitters (smoking cessation ≤2 years before baseline EST; N = 861), remote quitters (smoking cessation >2 years before the baseline EST; N = 3856) and never smokers (N = 9810). Baseline and follow up EST duration were compared among the four groups. RESULTS Recent quitters demonstrated a 2.4-fold improvement in their EST duration compared with active smokers (improvement of 24 ± 157 vs. 10 ± 157 s, respectively, p = 0.02). Multivariate logistic regression showed that recent quitters were 26% more likely to improve their exercise tolerance compared with active smokers (95% confidence interval (CI) 1.08-1.47, p = 0.003). Assessing smoking status as a time-dependent covariate during four consecutive visits demonstrated that recent quitters were 17% more likely to improve their exercise tolerance compared with active smokers (95% CI 1.02-1.34, p = 0.02), with a less pronounced benefit among remote quitters (hazard ratio = 1.11, 95% CI 1.02-1.21; p = 0.01). CONCLUSIONS Smoking cessation is independently associated with improved exercise tolerance. The benefits of smoking cessation are evident within the first two years of abstinence.
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Affiliation(s)
| | - Shaye Kivity
- Department of Internal Medicine C, Sheba Medical Centre, Israel Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Centre, Israel Sackler School of Medicine, Tel-Aviv University, Israel
| | - Robert Klempfner
- Leviev Heart Institute, Sheba Medical Centre, Israel Sackler School of Medicine, Tel-Aviv University, Israel
| | - Shlomo Segev
- Institute for Medical Screening, Sheba Medical Centre, Israel
| | - Assi Milwidsky
- Leviev Heart Institute, Sheba Medical Centre, Israel Department of Internal Medicine 'E', Tel-Aviv Medical Centre, Israel
| | - Ilan Goldenberg
- Leviev Heart Institute, Sheba Medical Centre, Israel Sackler School of Medicine, Tel-Aviv University, Israel
| | - Yechezkel Sidi
- Department of Internal Medicine C, Sheba Medical Centre, Israel Sackler School of Medicine, Tel-Aviv University, Israel
| | - Elad Maor
- Leviev Heart Institute, Sheba Medical Centre, Israel Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Centre, Israel
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Milwidsky A, Kivity S, Kopel E, Klempfner R, Berkovitch A, Segev S, Sidi Y, Goldenberg I, Maor E. Time dependent changes in high density lipoprotein cholesterol and cardiovascular risk. Int J Cardiol 2014; 173:295-9. [PMID: 24681020 DOI: 10.1016/j.ijcard.2014.03.022] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/18/2014] [Accepted: 03/09/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND High-density lipoprotein cholesterol (HDL-C) is a strong inverse predictor of cardiovascular events. The aim of the current study was to evaluate the correlation between changes in HDL-C and subsequent cardiovascular events. METHODS Study population comprised 13,037 subjects free of cardiovascular disease with a mean follow up of 6 ± 3 years. Low HDL-C was defined as < 40 mg/dl for men and <50mg/dl for women. Participants were divided into three groups based on HDL-C levels at the first and second baseline visits: persistently-low HDL-C (LL); persistently-high HDL-C (HH); and those with high HDL-C in a one visit only: intermittently high HDL-C (LH/HL). The primary endpoint was the first occurrence of a cardiovascular event. RESULTS A total of 529 (4.1%) incident events occurred during follow-up. HDL-C levels increased significantly between the two landmark visits (47.5 ± 12.6 vs. 48.1 ± 12.2, p<0.001). Kaplan-Meier survival analysis showed that the cumulative probability of cardiovascular events at 6 years was highest among subjects in the LL group (7.6%), and similar among LH/HL and HH groups (3.3% and 4%, respectively; log-rank p=0.001). Multivariate Cox regression analysis, with HDL-C as time-dependent covariate, showed that subjects with persistently low HDL-C during follow up experienced a 51% increased cardiovascular risk compared with subjects with persistently high HDL-C (p=0.026). Subjects with intermittently high HDL-C during follow up experienced similar risk to those with persistently high HDL-C (HR=1.02; p=0.89). CONCLUSIONS Variations in HDL-C levels during follow-up are associated with subsequent cardiovascular risk. Patients who retain low HDL-C levels are at the cardiovascular highest risk.
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Affiliation(s)
- Assi Milwidsky
- Leviev Heart Center, Sheba Medical Center, Israel; Department of Internal Medicine "E", Tel-Aviv Medical Center, Israel
| | - Shaye Kivity
- Department of Internal Medicine C, Sheba Medical Center, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Eran Kopel
- Leviev Heart Center, Sheba Medical Center, Israel
| | - Robert Klempfner
- Leviev Heart Center, Sheba Medical Center, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | | | - Shlomo Segev
- Institute for Medical Screening, Sheba Medical Center, Israel
| | - Yechezkel Sidi
- Department of Internal Medicine C, Sheba Medical Center, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Sheba Medical Center, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, Israel; Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Israel.
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