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Paradissis C, Cottrell N, Coombes ID, Wang WYS, Barras MA. Unplanned rehospitalisation due to medication harm following an Acute Myocardial Infarction. Cardiology 2024:000538773. [PMID: 38615668 DOI: 10.1159/000538773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/28/2024] [Indexed: 04/16/2024]
Abstract
Introduction The contribution of medication harm to rehospitalisation and adverse patient outcomes after an acute myocardial infarction (AMI) needs exploration. Rehospitalisation is costly to both patients and the healthcare facility. Following an AMI, patients are at risk of medication harm as they are often older, have multiple comorbidities and polypharmacy. This study aimed to quantify and evaluate medication harm causing unplanned rehospitalisation after an AMI. Methods This was a retrospective cohort study of patients discharged from a quaternary hospital post-AMI. All rehospitalisations within 18 months were identified using medical record review and coding data. The primary outcome measure was medication harm rehospitalisation. Preventability, causality and severity assessments of medication harm were conducted. Results A total of 1564 patients experienced an AMI and 415 (26.5%) were rehospitalised. Eighty-nine patients (5.7% of total population; 6.0% of those discharged) experienced a total of 101 medication harm events. Those with medication harm were older (p=0.007) and had higher rates of heart failure (p=0.005), chronic kidney disease (CKD) (p=0.046), chronic obstructive pulmonary disease (COPD) (p=0.037) and a prior history of ischaemic heart disease (p=0.005). Gastrointestinal (GI) bleeding, acute kidney injury (AKI) and hypotension were the most common medication harm events. Forty percent of events were avoidable and 84% were classed as 'serious'. Furosemide, antiplatelets and angiotensin-converting enzyme inhibitors (ACEi) were the most commonly implicated medications. The median time to medication harm rehospitalisation was 79 days (interquartile range [IQR]: 16-200 days). Conclusion Medication harm causes unplanned rehospitalisation in 5.7% of all AMI patients (1 in 17 patients; 6.0% of those discharged). The majority of harm was serious and occurred within the first 200 days of discharge. This study highlights that measures to attenuate the risk of medication harm rehospitalisation are essential, including post-discharge medication management.
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Harrop DL, Bryce V, Kitchener T, Grugan S, Renouf S, Mitchell S, Hasking G, Pauza D, Richards G, Ng ACT, Wang WYS. Effects of a culturally informed model of care for Aboriginal and Torres Strait Islander patients with acute coronary syndrome in a tertiary hospital in Australia: a pre-post, quasi-experimental, interventional study. Lancet Glob Health 2024; 12:e623-e630. [PMID: 38485429 DOI: 10.1016/s2214-109x(23)00601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander (Indigenous) peoples with cardiac disease in Australia have worse outcomes than non-Indigenous people with cardiac disease. We hypothesised that the implementation of a culturally informed model of care for Indigenous patients hospitalised with acute coronary syndrome (ACS) would improve their clinical outcomes. METHODS For this pre-post, quasi-experimental, interventional study, cohorts of Indigenous patients before and after the implementation of a model of care were compared. The novel, culturally informed, multidisciplinary-team model of care was a local programme of care developed to reduce morbidity and mortality from cardiac conditions among Indigenous Australians. All index admissions in the 24-month pre-implementation period (Jan 1 2013, to Dec 31, 2014) were analysed, as were all index admissions in the 12-month post-implementation period (Oct 1, 2015, to Sept 30, 2016). Comparisons were also made with non-Indigenous cohorts in the same timeframes. Admissions were excluded if the patient did not survive to hospital discharge. The study was conducted at Princess Alexandra Hospital, a tertiary hospital in metropolitan Brisbane (QLD, Australia). Data on presentation, comorbidities, investigations, treatment, and for outcomes were manually collected from a consolidated clinical information application. Mortality data were obtained from the Queensland Registry of Births, Deaths, and Marriages. The primary outcome was a composite of death, acute myocardial infarction, unplanned revascularisation, and cardiac readmission at 90 days after index admission, assessed in all patients. FINDINGS The Indigenous cohorts included 199 patients admitted with ACS before the model of care was implemented (85 [43%] were female and 114 [57%] were male) and 119 admitted post-implementation (62 [52%] were female and 57 [48%] were male). The non-Indigenous cohorts included 440 patients with ACS before the model of care was implemented (140 [32%] were female and 300 [68%] were male) and 467 admitted post-implementation (143 [31%] were female and 324 [69%] were male). Compared with the pre-implementation group, Indigenous patients admitted post-implementation had a significant reduction in the primary outcome (67 [34%] of 199 vs 24 [20%] of 119; hazard ratio 0·60, 95% CI 0·40-0·90; p=0·012), which was driven by a reduction in unplanned cardiac readmissions (64 [32%] of 199 vs 21 [18%] of 119; 0·55, 0·35-0·85; p=0·0060). There was no significant change in non-Indigenous patients between the pre-implementation and post-implementation timeframes in the composite endpoint at 90 days (81 [18%] of 440 vs 93 [20%] of 467; 1·08, 0·83-1·41; p=0·54). Pre-implementation, there was significantly more incidence of the primary outcome in Indigenous patients than non-Indigenous patients (p<0·0001), with no significant difference in the post-implementation period (p=0·92). INTERPRETATION Clinical outcomes for Indigenous patients admitted to a tertiary hospital in Australia improved after implementation of a culturally informed model of care, with a reduction in the disparity in incidence of primary endpoints that existed between Indigenous and non-Indigenous patients before implementation. FUNDING Queensland Department of Health Aboriginal and Torres Strait Islander Health Division (now First Nations Health Office).
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Affiliation(s)
- Danielle L Harrop
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Vivian Bryce
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tanya Kitchener
- Aboriginal and Torres Strait Islander Liaison Service, Mater Hospital, Brisbane, QLD, Australia
| | - Sean Grugan
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Sonia Renouf
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Scott Mitchell
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Debra Pauza
- First Nations Health Office, Queensland Health, Brisbane, QLD, Australia
| | - Gregory Richards
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Sen J, Wang WYS, Ng ACT. The Unraveling Complexity: Atrial Fibrillation's Influence on Severe Aortic Stenosis. Am J Cardiol 2024; 215:72-73. [PMID: 38160918 DOI: 10.1016/j.amjcard.2023.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Jonathan Sen
- Princess Alexandra Hospital, Queensland, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia; Faculty of Medicine, the University of Queensland, Melbourne, Australia
| | - William Y S Wang
- Princess Alexandra Hospital, Queensland, Australia; Faculty of Medicine, the University of Queensland, Melbourne, Australia
| | - Arnold C T Ng
- Princess Alexandra Hospital, Queensland, Australia; Faculty of Medicine, the University of Queensland, Melbourne, Australia.
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Najman JM, Kisely S, Scott JG, Ushula TW, Williams GM, Clavarino AM, McGee TR, Mamun AA, Wang WYS. Gender differences in cardiovascular disease risk: Adolescence to young adulthood. Nutr Metab Cardiovasc Dis 2024; 34:98-106. [PMID: 38016890 DOI: 10.1016/j.numecd.2023.09.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND AIMS Gender differences in cardiovascular disease (CVD) have been well documented but rarely for young adults and the extent to which gender related lifestyle differences may contribute to gender differences in CVD risk experienced by young adults have not been reported. METHODS AND RESULTS Data are from a long-running cohort study, the Mater-University of Queensland Study of Pregnancy (MUSP). We track gender differences in CVD related behaviours at 21 and 30 years (consumption of a Western Diet/Health-Oriented Diet, cigarette smoking, vigorous physical exercise, heavy alcohol consumption). At 30 years we compare males and females for CVD risk, and the extent to which lifestyle behaviours at 21 and 30 years contribute to CVD risk. At both 21 and 30 years of age, males more frequently consume a Western Diet and less often a Health Oriented Diet. By contrast, males are also much more likely to report engaging in vigorous physical activity. On most CVD markers, males exhibit much higher levels of risk than do females at both 21 and 30 years. At 30 years of age males have about five times the odds of being at high risk of CVD. Some lifestyle behaviours contribute to this additional risk. CONCLUSION Young adult males much more frequently engage in most CVD related risk behaviours and males have a higher level of CVD risk. Gender differences in CVD risk remain high even after adjustment for CVD lifestyles, though dietary factors independently contribute to CVD risk at 30 years.
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Affiliation(s)
- Jake M Najman
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Herston, Qld 4006, Australia.
| | - Steve Kisely
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia
| | - James G Scott
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia; Child and Youth Mental Health Service, Children's Health Queensland, South Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Tolassa W Ushula
- UQ Poche Centre for Indigenous Health, The University of Queensland, 74 High Street, Toowong, Qld 4066, Australia
| | - Gail M Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Herston, Qld 4006, Australia
| | - Alexandra M Clavarino
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Road, Herston, Qld 4006, Australia
| | - Tara R McGee
- School of Criminology and Criminal Justice, Griffith University, 176 Messines Ridge Road, Mount Gravatt, Qld 4122, Australia
| | - Abdullah A Mamun
- School of Criminology and Criminal Justice, Griffith University, 176 Messines Ridge Road, Mount Gravatt, Qld 4122, Australia
| | - William Y S Wang
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia
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Ushula TW, Mamun A, Darssan D, Wang WYS, Williams GM, Whiting SJ, Najman JM. Dietary patterns explaining variations in blood biomarkers in young adults are associated with the 30-year predicted cardiovascular disease risks in midlife: A follow-up study. Nutr Metab Cardiovasc Dis 2023; 33:1007-1018. [PMID: 36958973 DOI: 10.1016/j.numecd.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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND AND AIMS To examine a combined effect of dietary intakes, blood lipid and insulin resistance in young adulthood on the risk of predicted CVD through midlife. METHODS AND RESULTS Data of young adults from a birth cohort study in Australia were used. Reduced rank regression (RRR) and partial least squares (PLS) methods identified dietary patterns rich in meats, refined grains, processed and fried foods, and high-fat dairy and low in whole grains and low-fat dairy from dietary intakes obtained at 21-years, and blood lipids and measures of insulin resistance measured at 30-years of age. Using standard CVD risk factors measured at 30-years of age, the Framingham Heart Study risk-prediction algorithms were used to calculate the 30-year predicted Framingham CVD risk scores. The scores represent Hard CVD events; coronary death, myocardial infarction and stroke and Full CVD events; Hard CVD plus coronary insufficiency and angina pectoris, transient ischaemic attack, intermittent claudication, and congestive heart failure in midlife. Sex-specific upper quartiles of CVD risk scores were used to define high-risk groups. Modified Poisson regression models were used to estimate relative risks (RRs) with 95% CI. Greater adherence to the diet identified applying RRR in young adulthood was associated with higher risks of predicted Hard CVD (RR: 1.60; 1.14, 2.25) and Full CVD (RR: 1.46; 1.04, 2.05) events in midlife. The diet from PLS showed similar trend of association for the risk of predicted Hard CVD events (RR: 1.49; 1.03, 2.16) in adjusted models. CONCLUSION Dietary patterns associated with variations in blood lipids and insulin resistance in young adulthood are associated with increased risks of predicted CVD events in midlife. The findings suggest that diet induced altered blood lipids and insulin resistance in the life course of young adulthood could increase the risks of CVD events in later life.
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Affiliation(s)
- Tolassa W Ushula
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston, QLD 4006, Australia; UQ Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, 74 High Street, Toowong, QLD, 4066, Australia; Nutrition and Dietetics Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
| | - Abdullah Mamun
- UQ Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, 74 High Street, Toowong, QLD, 4066, Australia; The ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, 80 Meiers Road, Indooroopilly, QLD 4068, Australia
| | - Darsy Darssan
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston, QLD 4006, Australia
| | - William Y S Wang
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - Gail M Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston, QLD 4006, Australia
| | - Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, Canada
| | - Jake M Najman
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston, QLD 4006, Australia
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Chong A, Wahi S, Wang WYS, Levitt K, Woo A, Yan AT, Connelly KA, Leong-Poi H. Utility of Doppler Systolic Timing Intervals in Discriminating "True" Severe from "Pseudo-Severe" Stenosis in Classical Low-Flow Low-Gradient Aortic Stenosis. J Am Soc Echocardiogr 2023:S0894-7317(23)00192-X. [PMID: 37044170 DOI: 10.1016/j.echo.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Adrian Chong
- Department of Cardiology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia 4102; Faculty of Medicine, University of Queensland, Princess Alexandra Hospital-Southside Clinical Unit, 199 Ipswich Road, Woolloongabba, Queensland, Australia 4102
| | - Sudhir Wahi
- Department of Cardiology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia 4102; Faculty of Medicine, University of Queensland, Princess Alexandra Hospital-Southside Clinical Unit, 199 Ipswich Road, Woolloongabba, Queensland, Australia 4102
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, Australia 4102; Faculty of Medicine, University of Queensland, Princess Alexandra Hospital-Southside Clinical Unit, 199 Ipswich Road, Woolloongabba, Queensland, Australia 4102
| | - Kevin Levitt
- Division of Cardiology, Michael Garron Hospital, Toronto, ON, Canada
| | - Anna Woo
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew T Yan
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Cardiology, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Network, Toronto, ON, Canada
| | - Kim A Connelly
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Cardiology, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Network, Toronto, ON, Canada
| | - Howard Leong-Poi
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Cardiology, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Network, Toronto, ON, Canada.
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Ushula TW, Mamun A, Darssan D, Wang WYS, Williams GM, Whiting SJ, Najman JM. Dietary patterns and young adult body mass change: A 9-year longitudinal study. Eur J Nutr 2023; 62:1657-1666. [PMID: 36763149 DOI: 10.1007/s00394-023-03101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE While excessive weight gain is highest during young adulthood, the extent to which specific dietary patterns are associated with changes in measures of body mass in this course of life remains unknown. We aimed to examine the associations of dietary patterns at 21 years with changes in body weight and body mass index (BMI) between 21 and 30 years. METHODS We used data on young adults from a long-running birth cohort in Australia. Western and prudent dietary patterns were identified applying principal component analysis to 33 food groups obtained by a food frequency questionnaire at 21 years. Body weight and height were measured at 21 and 30 years. Multivariable regression models, using generalized estimating equations, were adjusted for concurrent changes in sociodemographic and lifestyle variables in evaluating the effect of identified dietary patterns on changes in weight and BMI over time. RESULTS In the fully adjusted model, young adults in the highest tertile of the Western pattern had a mean weight gain of 9.9 (95% CI 8.5, 11.3) kg compared to those in the lowest that had a mean weight gain of 7.1 (95% CI 5.6, 8.5) kg, P-for linear trend = 0.0015. The corresponding values for mean gains in BMI were 3.1 (95% CI 2.7, 3.6) kg/m2 for young adults in the highest tertile compared to 2.4 (95% CI 1.9, 2.9) kg/m2 for those in lowest, P-for linear trend = 0.0164. There was no evidence of a significant association between the prudent pattern and mean changes in each outcome over time in this study. CONCLUSIONS The findings of the current study show that greater adherence to the Western diet at 21 years was positively associated with increases in body weight and BMI from 21 to 30 years of age, whereas the prudent diet had no significant association with these outcomes. The findings provide evidence that the adverse effects of the Western diet on weight gain in young adulthood could partly be prevented through optimising diet in the early course of life.
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Affiliation(s)
- Tolassa W Ushula
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston, QLD, 4006, Australia.
- Nutrition and Dietetics Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
| | - Abdullah Mamun
- UQ Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, 74 High Street, Toowong, QLD, 4066, Australia
- The ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, 80 Meiers Road, Indooroopilly, QLD, 4068, Australia
| | - Darsy Darssan
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston, QLD, 4006, Australia
| | - William Y S Wang
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gail M Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston, QLD, 4006, Australia
| | - Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, Canada
| | - Jake M Najman
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston, QLD, 4006, Australia
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Sawyer MKL, Gould PA, Ng ACT, Wang WYS. What is the Relationship Between Epicardial Adipose Tissue, Left Atrial Low Voltage Zones and Atrial Fibrillation? Heart Lung Circ 2022; 31:1429-1431. [PMID: 36436840 DOI: 10.1016/j.hlc.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael K L Sawyer
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Paul A Gould
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia.
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Ushula TW, Mamun A, Darssan D, Wang WYS, Williams GM, Whiting SJ, Najman JM. Dietary patterns and the risk of abnormal blood lipids among young adults: A prospective cohort study. Nutr Metab Cardiovasc Dis 2022; 32:1165-1174. [PMID: 35260316 DOI: 10.1016/j.numecd.2022.01.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 11/11/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS The extent to which dietary patterns influence the risk of abnormal blood lipids throughout young adulthood remains unclear. The aim was to investigate whether early young adulthood dietary patterns predict the risk of abnormal blood lipids during later young adulthood. METHODS AND RESULTS We used data from a long running birth cohort study in Australia. Western dietary pattern rich in meats, processed foods and high-fat dairy products and prudent pattern rich in fruit, vegetables, fish, nuts, whole grains and low-fat dairy products were derived using principal component analysis at the 21-year follow-up from dietary data obtained using a food frequency questionnaire. After 9-years, fasting blood samples of all participants were collected and their total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterols and triglyceride (TG) levels were measured. Abnormal blood lipids were based on clinical cut-offs for total, LDL and HDL cholesterols, and TG and relative distributions for total:HDL and TG:HDL cholesterols ratios. Log-binomial models were used to estimate risk of each outcome in relation to dietary patterns. Greater adherence to the Western pattern predicted increased risks of high LDL (RR: 1.47; 95%CI: 1.06, 2.03) and TG (1.90; 1.25, 2.86), and high ratios of total:HDL (1.48; 1.00, 2.19) and TG:HDL (1.78; 1.18, 2.70) cholesterols in fully adjusted models. Conversely, a prudent pattern predicted reduced risks of low HDL (0.58; 0.42, 0.78) and high TG (0.66; 0.47, 0.92) and high total:HDL (0.71; 0.51, 0.98) and TG:HDL (0.61; 0.45, 0.84) cholesterols ratios. CONCLUSION This is the first prospective study to show greater adherence to unhealthy Western diet predicted increased risks of abnormal blood lipids, whereas healthy prudent diet predicted lower such risks in young adults. Addressing diets in early course may improve cardiovascular health of young adults.
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Affiliation(s)
- Tolassa W Ushula
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston QLD 4006, Australia; Nutrition and Dietetics Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly QLD 4068, Australia; The ARC Centre of Excellence for Children and Families Over the Life Course, The University of Queensland, 80 Meiers Road, Indooroopilly QLD 4068, Australia; Queensland Alliance for Environmental Health Sciences, The University of Queensland, 80 Meiers Road, Indooroopilly QLD 4068, Australia
| | - Darsy Darssan
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston QLD 4006, Australia
| | - William Y S Wang
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - Gail M Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston QLD 4006, Australia
| | - Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, Canada
| | - Jake M Najman
- School of Public Health, Faculty of Medicine, The University of Queensland, 266 Herston Rd, Herston QLD 4006, Australia
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Huang LYI, Fogarty SJ, Garrahy P, Ng ACT, Wang WYS. Prospective Intervention on Discharge Summaries Improves Rates of Patients Following Up with General Practitioners Post Hospital Cardiology Discharge. J Gen Intern Med 2021; 36:1479-1480. [PMID: 32462573 PMCID: PMC8131433 DOI: 10.1007/s11606-020-05818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Luke Y I Huang
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
| | - Samuel J Fogarty
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
| | - Paul Garrahy
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
| | - William Y S Wang
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, Australia.
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Mitchell S, Michael H, Highden-Smith S, Bryce V, Grugan S, Yong HB, Renouf S, Kitchener T, Wang WYS. Culturally safe and sustainable solution for Closing the Gap-registered patients discharging from a tertiary public hospital. AUST HEALTH REV 2021; 44:200-204. [PMID: 32192571 DOI: 10.1071/ah18160] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/06/2019] [Indexed: 11/23/2022]
Abstract
This case study describes the development, implementation and review of a sustainable and culturally sensitive procedure for a hospital-funded discharge medicine subsidy for Aboriginal and Torres Strait Islander patients registered with the Closing the Gap (CTG) program discharging from a public hospital. A 7-day fully subsidised medication supply was approved to be offered to Aboriginal and Torres Strait Islander patients admitted under cardiac care teams, including cardiology and cardiothoracic surgery patients. Patients were offered the option of a 7-day supply free of cost to them or a full Pharmaceutical Benefits Scheme (PBS) supply if preferred. A general practitioner (GP) appointment was organised within 7 days of discharge to ensure patients received ongoing supply of their medications as well as timely clinical review after discharge. Over a 34-month period from September 2015 to June 2018, 535 Aboriginal and Torres Strait Islander patients were admitted to the hospital under cardiac care teams. Of these patients, 296 received a subsidised discharge medication supply with a total cost of A$6314.56 to the hospital over the trial period, with a mean cost of A$21.26 per discharge. The provision of subsidised medications through the CTG program has improved the continuity of care for Aboriginal and Torres Strait Islander patients. The culturally sensitive approach is well received and has allowed smooth transition back to the community. This site-specific and state-based funding model was found to be financially sustainable at a public hospital.
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Affiliation(s)
- Scott Mitchell
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. ; ; ; ; ; ; and Corresponding authors. Emails: ;
| | - Hayley Michael
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. ; ; ; ; ; ; and Corresponding authors. Emails: ;
| | - Stephanie Highden-Smith
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. ; ; ; ; ;
| | - Vivian Bryce
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. ; ; ; ; ;
| | - Sean Grugan
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. ; ; ; ; ;
| | - Hua Bing Yong
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. ; ; ; ; ;
| | - Sonia Renouf
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. ; ; ; ; ;
| | - Tanya Kitchener
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. ; ; ; ; ;
| | - William Y S Wang
- Princess Alexandra Hospital, Queensland Health, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. ; ; ; ; ; ; and Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia.
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12
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Arnold RH, Tideman PA, Devlin GP, Carroll GE, Elder A, Lowe H, Macdonald PS, Bannon PG, Juergens C, McGuire M, Mariani JA, Coffey S, Faddy S, Brown A, Inglis S, Wang WYS. Rural and Remote Cardiology During the COVID-19 Pandemic: Cardiac Society of Australia and New Zealand (CSANZ) Consensus Statement. Heart Lung Circ 2020; 29:e88-e93. [PMID: 32487432 PMCID: PMC7203036 DOI: 10.1016/j.hlc.2020.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
THE CHALLENGES Rural and remote Australians and New Zealanders have a higher rate of adverse outcomes due to acute myocardial infarction, driven by many factors. The prevalence of cardiovascular disease (CVD) is also higher in regional and remote populations, and people with known CVD have increased morbidity and mortality from coronavirus disease 2019 (COVID-19). In addition, COVID-19 is associated with serious cardiac manifestations, potentially placing additional demand on limited regional services at a time of diminished visiting metropolitan support with restricted travel. Inter-hospital transfer is currently challenging as receiving centres enact pandemic protocols, creating potential delays, and cardiovascular resources are diverted to increasing intensive care unit (ICU) and emergency department (ED) capacity. Regional and rural centres have limited staff resources, placing cardiac services at risk in the event of staff infection or quarantine during the pandemic. MAIN RECOMMENDATIONS Health districts, cardiologists and government agencies need to minimise impacts on the already vulnerable cardiovascular health of regional and remote Australians and New Zealanders throughout the COVID-19 pandemic. Changes in management should include.
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Affiliation(s)
| | - Philip A Tideman
- Integrated Cardiovascular Clinical Network SA, Adelaide, SA, Australia
| | | | - Gerard E Carroll
- Calvary Hospital, Wagga Wagga, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Alex Elder
- Orange Health Service, Orange, NSW, Australia
| | - Harry Lowe
- Orange Health Service, Orange, NSW, Australia; Concord Hospital, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - Peter S Macdonald
- University of New South Wales, Sydney, NSW, Australia; St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - Paul G Bannon
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Craig Juergens
- Orange Health Service, Orange, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; Liverpool Hospital, Sydney, NSW, Australia
| | - Mark McGuire
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia
| | - Justin A Mariani
- Alfred Hospital, Melbourne, Bairnsdale Hospital, Bairnsdale and Monash University, Melbourne, Vic, Australia
| | - Sean Coffey
- University of Otago, Dunedin, and Southern District Health Board, Dunedin, New Zealand
| | | | - Alex Brown
- South Australian Health and Medical Research Institute (SAHMRI) and University of Adelaide, Adelaide, SA, Australia
| | - Sally Inglis
- CSANZ Cardiovascular Nursing Council, University of Technology, Sydney, NSW, Australia
| | - William Y S Wang
- CSANZ Indigenous Health Council, Princess Alexandra Hospital, Brisbane, and University of Queensland, Brisbane, QLD, Australia
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13
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Robinson J, Wang WYS, Kaye G. Mobile echodensities on intracardiac device leads: Is it always a cause for concern? Pacing Clin Electrophysiol 2020; 43:388-393. [PMID: 32149409 DOI: 10.1111/pace.13899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/18/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with cardiac implantable electronic devices (CIEDs) frequently undergo transthoracic echocardiography (TTE). As a result, incidental mobile echodensities (MEDs) attached to device leads are commonly detected. The aim of this study was to estimate the incidence and clinical outcomes of incidental MEDs on CIED leads. METHODS A retrospective analysis performed between 2011 and 2018 identified 3548 TTE studies performed on 1849 patients with CIEDs. RESULTS MEDs were identified in 30 patients (1.6%) without clinical suspicion of infective endocarditis (IE). Patients with incidental MEDs were apyrexial, and those tested demonstrated low inflammatory markers and negative blood cultures (BC). In this group, the majority (83%) of MEDs were in the right atrium and no MEDs were detected near the tricuspid valve. Transesophageal echocardiography (TEE) did not influence clinical outcomes. No patient required long-term antibiotics or lead extraction and no IE-related deaths were identified from electronic health records during a mean follow-up period of 43 months (1-89). In contrast, nine patients with suspected IE were all pyrexial with elevated inflammatory markers, had positive BC, and had proven IE. In these cases, the majority of MEDs were at the device lead/tricuspid valve interface. MEDs close to the tricuspid valve were strongly associated with IE (P < .0001). CONCLUSIONS The incidence of MEDs on CIED leads detected on routine TTE was 1.6%. Conservative management of asymptomatic patients with normal inflammatory markers and BC without TEE, antibiotics, or lead extraction did not reveal any signal for long-term adverse events within the limitations of the study.
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Affiliation(s)
- James Robinson
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gerry Kaye
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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14
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Huang LYI, Fogarty SJ, Ng ACT, Wang WYS. Rates and predictors of general practitioner (GP) follow-up postdischarge from a tertiary hospital cardiology unit: a retrospective cohort study. BMJ Open 2019; 9:e031627. [PMID: 31666271 PMCID: PMC6830598 DOI: 10.1136/bmjopen-2019-031627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Previous studies in cardiac patients noted that early patient follow-up with general practitioners (GPs) after hospital discharge was associated with reduced rates of hospital readmissions. We aimed to identify patient, clinical and hospital factors that may influence GP follow-up of patients discharged from a tertiary cardiology unit. DESIGN Single centre retrospective cohort study. SETTING Australian metropolitan tertiary hospital cardiology unit. PARTICIPANTS 1079 patients discharged from the hospital cardiology unit within 3 months from May to July 2016. OUTCOME MEASURES GP follow-up rates (assessed by telephone communication with patients' nominated GP practices), demographic, clinical and hospital factors predicting GP follow-up. RESULTS We obtained GP follow-up data on 983 out of 1079 (91.1%) discharges in the study period. Overall, 7, 14 and 30-day GP follow rates were 50.3%, 66.5% and 79.1%, respectively. A number of patient, clinical and hospital factors were associated with early GP follow-up, including pacemaker and defibrillator implantation, older age and having never smoked. Documented recommendation for follow-up in discharge summary was the strongest predictor for 7-day follow-up (p<0.001). CONCLUSION After discharge from a cardiology admission, half of the patients followed up with their GP within 7 days and most patients followed up within 30 days. Patient and hospital factors were associated with GP follow-up rates. Identification of these factors may facilitate prospective interventions to improve early GP follow-up rates.
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Affiliation(s)
- Luke Y I Huang
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Samuel J Fogarty
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - William Y S Wang
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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15
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Ng ACT, Strudwick M, van der Geest RJ, Ng ACC, Gillinder L, Goo SY, Cowin G, Delgado V, Wang WYS, Bax JJ. Impact of Epicardial Adipose Tissue, Left Ventricular Myocardial Fat Content, and Interstitial Fibrosis on Myocardial Contractile Function. Circ Cardiovasc Imaging 2019; 11:e007372. [PMID: 30354491 DOI: 10.1161/circimaging.117.007372] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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] [Indexed: 12/16/2022]
Abstract
Background Current understanding of metabolic heart disease consists of a myriad of different pathophysiological mechanisms. Epicardial adipose tissue (EAT) is increasingly recognized as metabolically active and associated with adverse cardiovascular outcomes. The present study aimed to investigate the effect of increased EAT volume index on left ventricular (LV) myocardial fat content and burden of interstitial myocardial fibrosis and their subsequent effects on LV myocardial contractile function. Methods and Results A total of 40 volunteers (mean age, 35±10 years; 26 males) of varying body mass index (25.0±4.1 kg/m2; range, 19.3-36.3 kg/m2) and without diabetes mellitus or hypertension were prospectively recruited. EAT volume index, LV myocardial fat content, and extracellular volume were quantified by magnetic resonance imaging. LV myocardial contractile function was quantified by speckle tracking echocardiography global longitudinal strain on the same day as magnetic resonance imaging examination. Mean total EAT volume index, LV myocardial fat content, and extracellular volume were 30.0±19.6 cm3/m2, 5.06%±1.18%, and 27.5%±0.5%, respectively. On multivariable analyses, increased EAT volume index and insulin resistance were independently associated with both increased LV myocardial fat content content and higher burden of interstitial myocardial fibrosis. Furthermore, increased EAT volume index was independently associated with LV global longitudinal strain. Conclusions Increased EAT volume index and insulin resistance were independently associated with increased myocardial fat accumulation and interstitial myocardial fibrosis. Increased EAT volume index was associated with detrimental effects on myocardial contractile function as evidenced by a reduction in LV global longitudinal strain.
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Affiliation(s)
- Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital (A.C.T.N., L.G., S.Y.G., W.Y.S.W.).,Centre for Advanced Imaging (A.C.T.N., G.C., W.Y.S.W.).,The University of Queensland, Australia. Departments of Cardiology (A.C.T.N., V.D., J.J.B.).,Leiden University Medical Centre, The Netherlands. Faculty of Medicine, South Western Sydney Clinical School, The University of New South Wales, Australia (A.C.T.N.)
| | - Mark Strudwick
- Medical Imaging and Radiation Science, Monash University, Victoria, Australia (M.S.)
| | | | - Austin C C Ng
- Cardiology Department, The University of Sydney, Concord Hospital, New South Wales, Australia (A.C.C.N.)
| | - Lisa Gillinder
- Department of Cardiology, Princess Alexandra Hospital (A.C.T.N., L.G., S.Y.G., W.Y.S.W.)
| | - Shi Yi Goo
- Department of Cardiology, Princess Alexandra Hospital (A.C.T.N., L.G., S.Y.G., W.Y.S.W.)
| | - Gary Cowin
- Centre for Advanced Imaging (A.C.T.N., G.C., W.Y.S.W.)
| | - Victoria Delgado
- The University of Queensland, Australia. Departments of Cardiology (A.C.T.N., V.D., J.J.B.)
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital (A.C.T.N., L.G., S.Y.G., W.Y.S.W.).,Centre for Advanced Imaging (A.C.T.N., G.C., W.Y.S.W.)
| | - Jeroen J Bax
- The University of Queensland, Australia. Departments of Cardiology (A.C.T.N., V.D., J.J.B.)
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16
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Ha T, Korczyk D, Ng ACT, Wang WYS. When can heart failure treatment be stopped safely? Lancet 2019; 394:217. [PMID: 31327365 DOI: 10.1016/s0140-6736(19)30492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/26/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Tina Ha
- Department of Cardiology, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane 4102, Australia
| | - Dariusz Korczyk
- Department of Cardiology, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane 4102, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane 4102, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane 4102, Australia.
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17
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Zhao L, Harrop DL, Ng ACT, Wang WYS. Epicardial Adipose Tissue Is Associated With Left Atrial Dysfunction in People Without Obstructive Coronary Artery Disease or Atrial Fibrillation. Can J Cardiol 2018; 34:1019-1025. [PMID: 30049356 DOI: 10.1016/j.cjca.2018.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT) is a metabolically active visceral fat depot. Although EAT volume is associated with the incidence and burden of atrial fibrillation (AF), its role in subclinical left atrial (LA) dysfunction is unclear. This study aims to evaluate the relationships between EAT volumes, LA function, and LA global longitudinal strain. METHODS One hundred and thirty people without obstructive coronary artery disease or AF were prospectively recruited into the study in Australia and underwent cardiac computed tomography and echocardiography. EAT volume was quantified from cardiac computed tomography. Echocardiographic 3-dimensional (3D) volumetric measurements and 2D speckle-tracking analysis were performed. RESULTS Using the overall median body surface area-indexed total EAT volume (EATi), the study cohort was divided into 2 groups of larger and smaller EATi volume. Subjects with larger EATi volume had significantly impaired LA reservoir function (3D LA ejection fraction, 46.1% ± 8.9% vs 49.0% ± 7.0%, P = 0.044) and reduced LA global longitudinal strain (37.6% ± 10.2% vs 44.1% ± 10.7%, P < 0.001). Total EATi volume was a predictor of impaired 2D LA global longitudinal strain (standardized β = -0.204, P = 0.034), reduced 3D LA ejection fraction (standardized β = -0.208, P = 0.036), and reduced 3D active LA ejection fraction (standardized β = -0.211, P = 0.017). Total EATi volume, rather than LA EATi volume, was the more important predictor of LA dysfunction. CONCLUSIONS Indexed EAT volume is independently associated with subclinical LA dysfunction and impaired global longitudinal strain in people without obstructive coronary artery disease or a history of AF.
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Affiliation(s)
- Lei Zhao
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Danielle L Harrop
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia.
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18
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Affiliation(s)
- Arnold C. T. Ng
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
- Centre for Advanced Imaging, The University of Queensland, Australia
- Department of Cardiology, Princess Alexandra Hospital, Faculty of Medicine, The University of Queensland, Australia
| | - William Y. S. Wang
- Centre for Advanced Imaging, The University of Queensland, Australia
- Department of Cardiology, Princess Alexandra Hospital, Faculty of Medicine, The University of Queensland, Australia
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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19
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Ng ACT, Goo SY, Roche N, van der Geest RJ, Wang WYS. Epicardial Adipose Tissue Volume and Left Ventricular Myocardial Function Using 3-Dimensional Speckle Tracking Echocardiography. Can J Cardiol 2016; 32:1485-1492. [PMID: 27720272 DOI: 10.1016/j.cjca.2016.06.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/14/2016] [Accepted: 06/19/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although epicardial adipose tissue (EAT) volume is associated with increased incidence of coronary artery disease (CAD), its role in myocardial systolic dysfunction is unclear. The present study aimed to identify independent determinants of EAT volume in patients without obstructive CAD, and to evaluate the association between EAT volume (vs other measures of obesity) and myocardial systolic strain analysis. METHODS We prospectively recruited 130 patients without obstructive CAD on contrast-enhanced cardiac computed tomography imaging and normal left ventricular ejection fraction on 3-dimensional (3D) echocardiography. EAT volume was quantified from cardiac computed tomography imaging, and 3D multidirectional (longitudinal, circumferential, radial, and area) strain were measured. RESULTS The mean EAT volume was 97.5 ± 43.7 cm3. In multivariable analysis, measures of obesity (body mass index [P = 0.007] and waist/hip ratio [P = 0.001]) were independently associated with larger EAT volume. EAT volume was correlated with 3D global longitudinal (r = 0.601; P < 0.001), circumferential (r = 0.375; P < 0.001), radial (r = -0.546; P < 0.001), and area (r = 0.558; P < 0.001) strain. In multivariable analyses, epicardial fat volume was the strongest predictor of 3D global longitudinal (standardized β = 0.512; P < 0.001), circumferential (standardized β = 0.242; P = 0.006), radial (standardized β = -0.422; P < 0.001), and area (standardized β = 0.428; P < 0.001) strain. In contrast, other measures of obesity including body mass index and waist/hip ratio were not independent determinants of 3D multidirectional global strain (all P > 0.05). CONCLUSIONS EAT volume is independently associated with impaired myocardial systolic function despite preserved 3D left ventricular ejection fraction and absence of obstructive CAD, and might play a significant role in the pathophysiology of diabetic, obesity, and metabolic heart disease.
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Affiliation(s)
- Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia.
| | - Shi Yi Goo
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
| | - Nicole Roche
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
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20
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Law WP, Wang WYS, Moore PT, Mollee PN, Ng ACT. Cardiac Amyloid Imaging with 18F-Florbetaben PET: A Pilot Study. J Nucl Med 2016; 57:1733-1739. [PMID: 27307344 DOI: 10.2967/jnumed.115.169870] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/16/2016] [Indexed: 02/06/2023] Open
Abstract
Our aim was to determine the feasibility of 18F-florbetaben PET in diagnosing cardiac amyloidosis. METHODS 18F-florbetaben PET was performed on 14 patients: 5 amyloid light chain, 5 amyloid transthyretin, and 4 control with hypertensive heart disease. Qualitative and quantitative assessments of 18F-florbetaben activity were performed using the SUVmean of the left ventricular myocardium and blood pool and calculation of target-to-background SUV ratio. Myocardial 18F-forbetaben retention was also calculated as the percentage mean myocardial SUV change between 0 and 5 min and 15 and 20 min after radiotracer injection. Global left ventricular longitudinal and right ventricular free wall longitudinal strain were calculated using 2-dimensional speckle-tracking echocardiography. RESULTS Target-to-background SUV ratio and percentage myocardial 18F-forbetaben retention were higher in amyloid patients than in hypertensive controls. A cutoff of 40% was able to differentiate between cardiac amyloid patients and hypertensive controls. Percentage myocardial 18F-forbetaben retention was an independent determinant of both global left ventricular longitudinal and right ventricular free wall longitudinal strain via an inverse curve relationship. CONCLUSION 18F-florbetaben PET imaging can accurately identify and differentiate between cardiac amyloidosis and hypertensive heart disease. Percentage myocardial 18F-florbetaben retention was an independent determinant of myocardial dysfunction in cardiac amyloidosis.
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Affiliation(s)
- W Phillip Law
- Medical Imaging Department, Princess Alexandra Hospital, Brisbane, Australia .,School of Medicine, University of Queensland, Brisbane, Australia
| | - William Y S Wang
- School of Medicine, University of Queensland, Brisbane, Australia.,Cardiology Department, Princess Alexandra Hospital, Brisbane, Australia; and
| | - Peter T Moore
- Cardiology Department, Princess Alexandra Hospital, Brisbane, Australia; and
| | - Peter N Mollee
- School of Medicine, University of Queensland, Brisbane, Australia.,Amyloidosis Centre, Princess Alexandra Hospital, Brisbane, Australia
| | - Arnold C T Ng
- School of Medicine, University of Queensland, Brisbane, Australia.,Cardiology Department, Princess Alexandra Hospital, Brisbane, Australia; and
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21
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Gillinder L, Goo SY, Cowin G, Strudwick M, van der Geest RJ, Wang WYS, Ng ACT. Quantification of Intramyocardial Metabolites by Proton Magnetic Resonance Spectroscopy. Front Cardiovasc Med 2015; 2:24. [PMID: 26664896 PMCID: PMC4671339 DOI: 10.3389/fcvm.2015.00024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 02/26/2015] [Accepted: 04/26/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To define intramyocardial triglyceride (TG), creatine (Cr), and choline (Cho) in healthy volunteers, and determine the feasibilities, scan durations and agreements between cardiac proton magnetic resonance spectroscopy ([(1)H]-MRS) performed with fewer signal averages versus a reference standard with 128 signal averages. MATERIALS AND METHODS Thirty-one participants underwent [(1)H]-MRS using 16, 32, 64, and 128 signal averages. Intramyocardial TG, Cr, or Cho contents relative to water were calculated and expressed as a percentage. RESULTS Mean intramyocardial TG, Cr, and Cho were 1.30 ± 1.13, 0.19 ± 0.18, and 0.24 ± 0.28%, respectively. The feasibilities for quantifying intramyocardial TG, Cr, and Cho using fewer signal averages ranged from 93.5 to 100, 90.3 to 93.5, and 90.3 to 96.8%, respectively. Scan durations for 16, 32, 64, and 128 signal averages were 1.1 ± 0.5, 2.6 ± 0.9, 5.9 ± 2.0, and 13.2 ± 4.5 min, respectively (p < 0.001). Agreements with the reference standard 128 signal average was higher for quantification of intramyocardial TG compared to Cr and Cho. CONCLUSION Quantification of intramyocardial TG with [(1)H]-MRS with only 64 signal averages was highly feasible, showed excellent agreement with 128 signal averages, and had significantly shorter scan duration. By contrast, quantifying Cr and Cho using fewer signal averages had lower feasibilities and agreements compared to 128 signal averages.
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Affiliation(s)
- Lisa Gillinder
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland , Brisbane, QLD , Australia
| | - Shi Yi Goo
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland , Brisbane, QLD , Australia
| | - Gary Cowin
- Centre for Advanced Imaging, The University of Queensland , Brisbane, QLD , Australia
| | - Mark Strudwick
- Centre for Advanced Imaging, The University of Queensland , Brisbane, QLD , Australia
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center , Leiden , Netherlands
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland , Brisbane, QLD , Australia ; Centre for Advanced Imaging, The University of Queensland , Brisbane, QLD , Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland , Brisbane, QLD , Australia ; Centre for Advanced Imaging, The University of Queensland , Brisbane, QLD , Australia
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22
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Musameh MD, Wang WYS, Nelson CP, Lluís-Ganella C, Debiec R, Subirana I, Elosua R, Balmforth AJ, Ball SG, Hall AS, Kathiresan S, Thompson JR, Lucas G, Samani NJ, Tomaszewski M. Analysis of gene-gene interactions among common variants in candidate cardiovascular genes in coronary artery disease. PLoS One 2015; 10:e0117684. [PMID: 25658981 PMCID: PMC4320092 DOI: 10.1371/journal.pone.0117684] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 12/30/2014] [Indexed: 11/19/2022] Open
Abstract
Objective Only a small fraction of coronary artery disease (CAD) heritability has been explained by common variants identified to date. Interactions between genes of importance to cardiovascular regulation may account for some of the missing heritability of CAD. This study aimed to investigate the role of gene-gene interactions in common variants in candidate cardiovascular genes in CAD. Approach and Results 2,101 patients with CAD from the British Heart Foundation Family Heart Study and 2,426 CAD-free controls were included in the discovery cohort. All subjects were genotyped with the Illumina HumanCVD BeadChip enriched for genes and pathways relevant to the cardiovascular system and disease. The primary analysis in the discovery cohort examined pairwise interactions among 913 common (minor allele frequency >0.1) independent single nucleotide polymorphisms (SNPs) with at least nominal association with CAD in single locus analysis. A secondary exploratory interaction analysis was performed among all 11,332 independent common SNPs surviving quality control criteria. Replication analyses were conducted in 2,967 patients and 3,075 controls from the Myocardial Infarction Genetics Consortium. None of the interactions amongst 913 SNPs analysed in the primary analysis was statistically significant after correction for multiple testing (required P<1.2x10-7). Similarly, none of the pairwise gene-gene interactions in the secondary analysis reached statistical significance after correction for multiple testing (required P = 7.8x10-10). None of 36 suggestive interactions from the primary analysis or 31 interactions from the secondary analysis was significant in the replication cohort. Our study had 80% power to detect odds ratios > 1.7 for common variants in the primary analysis. Conclusions Moderately large additive interactions between common SNPs in genes relevant to cardiovascular disease do not appear to play a major role in genetic predisposition to CAD. The role of genetic interactions amongst less common SNPs and with medium and small magnitude effects remain to be investigated.
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Affiliation(s)
- Muntaser D. Musameh
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
- * E-mail:
| | - William Y. S. Wang
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Christopher P. Nelson
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | | | - Radoslaw Debiec
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Isaac Subirana
- Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain
- Epidemiology and Public Health Network (CIBERESP), Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain
| | - Anthony J. Balmforth
- Division of Epidemiology, LIGHT, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Stephen G. Ball
- University of Leeds, MCRC, Leeds Institute of Genetics, Health and Therapeutics, Leeds, United Kingdom
| | - Alistair S. Hall
- Division of Epidemiology, LIGHT, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Sekar Kathiresan
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - John R. Thompson
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Gavin Lucas
- Cardiovascular Epidemiology and Genetics, IMIM, Barcelona, Spain
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Maciej Tomaszewski
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
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Singbal Y, Vollbon W, Huynh LT, Wang WYS, Ng ACT, Wahi S. Exploring Noninvasive Tricuspid dP/dt as a Marker of Right Ventricular Function. Echocardiography 2015; 32:1347-51. [PMID: 25556710 DOI: 10.1111/echo.12877] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 12/20/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function assumes prognostic significance in various disease states, but RV geometry is not amenable to volumetric assessment by two-dimensional echocardiography. Intra-ventricular pressure rate of rise (dP/dt) predicts myocardial contractility and adjusting for the maximal regurgitant velocity (Vmax) corrects for preload. We examined the relationship of noninvasive tricuspid dP/dt and dP/dt/Vmax with RV ejection fraction (RVEF) by cardiac magnetic resonance imaging (CMR) as a measure of RV function. METHODS Fifty CMRs and echocardiograms performed within 30 days were included. Tricuspid regurgitation (TR) spectral Doppler trace was analyzed offline. TR dP/dt was calculated using simplified Bernoulli equation (dP/dt between 1 and 2 m/sec). dP/dt/Vmax was calculated as a ratio of dP/dt and TR Vmax . RV end-diastolic (EDV) and end-systolic volumes (ESV) were obtained from contouring of steady-state-free precession axial stack CMR images; RVEF was calculated as [(RVEDV - RVESV)/RVEDV] × 100. RVEF >42% was considered normal. RESULTS Majority of studies were suitable for analysis. Median age was 48 years (IQR = 36-63); 56.4% were female (n = 22/39). There was correlation between dP/dt and RVEF (r(2) = 0.51, P < 0.01) which improved with dP/dt/Vmax (r(2) = 0.59, P < 0.01). dP/dt >400 mmHg/sec had a positive predictive value of 91%, sensitivity and specificity of 74% and 84% respectively for normal RVEF. Inter-observer agreement and repeatability analysis showed no significant difference. CONCLUSION Tricuspid dP/dt correlates well with CMR RVEF. A dP/dt of more than 400 mmHg/sec strongly predicts normal RVEF. Adjusting for preload (dP/dt/Vmax) further improves this correlation.
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Affiliation(s)
- Yash Singbal
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | | | | | - William Y S Wang
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Arnold C T Ng
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Sudhir Wahi
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
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Tsai JPJ, Tian J, Wang WYS, Ng ACT. Glycated hemoglobin vs fasting plasma glucose as a predictor of left ventricular dysfunction after ST-elevation myocardial infarction. Can J Cardiol 2014; 31:44-9. [PMID: 25547549 DOI: 10.1016/j.cjca.2014.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/25/2014] [Accepted: 10/26/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The World Health Organization and the American Diabetes Association recommend a level of glycated hemoglobin (HbA1c) ≥ 6.5% as diagnostic for diabetes. However, concordance between fasting plasma glucose (FPG) and HbA1c levels in acutely unwell patients is unknown. Furthermore, the prognostic value of HbA1c for left ventricular (LV) dysfunction is unclear. This study aimed to evaluate the concordance between HbA1c levels and FPG in consecutive patients with acute ST-elevation MI (STEMI) and compare their prognostic value in predicting LV dysfunction and elevated filling pressures on echocardiography. METHODS A total of 142 patients with a first incidence of STEMI were prospectively recruited. LV diastolic function was defined as mean septal and lateral early diastolic velocities (average e'); filling pressure was the ratio of transmitral E velocity to average e' (average E/e'). RESULTS Mean FPG and HbA1c levels were 7.7 ± 2.8 mmol/L and 6.5% ± 1.6%, respectively. Of 109 patients without previous diabetes, HbA1c levels identified an additional 18 patients (16.5%) as having diabetes, and the concordance with FPG was poor. Between diabetic and nondiabetic patients, there were no differences in LV end-diastolic volume (116 ± 37 vs 118 ± 43 mL; P = 0.78), end-systolic volume (69 ± 33 vs 68 ± 35 mL; P = 0.93), and ejection fraction (42 ± 12 vs 44 ± 11%; P = 0.49). On multivariable analyses, average e' was independently associated with HbA1c (β = -0.161; P = 0.045) but not FPG (P = 0.82). Similarly, average E/e' was independently associated with HbA1c (β = 0.168; P = 0.04) but not FPG (P = 0.32). Receiver operating characteristic curve analysis showed that an HbA1c cutoff of 6.4% (area under the curve, 0.68; P = 0.002) was associated with an elevated LV filling pressure. CONCLUSIONS Only HbA1c was independently associated with impaired LV diastolic function and increased filling pressures after STEMI.
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Affiliation(s)
- Josh P J Tsai
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
| | - Jenny Tian
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia.
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Butterly SJ, Indrajith M, Garrahy P, Ng ACT, Gould PA, Wang WYS. Stress-induced takotsubo cardiomyopathy in survivors of the 2011 Queensland floods. Med J Aust 2013; 198:109-10. [PMID: 23373503 DOI: 10.5694/mja12.11620] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/08/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Stuart J Butterly
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD.
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Hall T, Stanton T, Wang WYS, Ng ACT. Stroke prevention in atrial fibrillation: an update on current management strategies. Panminerva Med 2013; 55:43-58. [PMID: 23474663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Stroke attributed to atrial fibrillation (AF) confers significant morbidity and mortality. In the past, warfarin has been the only successful stroke prevention agent available. However, it is often underutilized due to its well-known limitations, leaving many patients without adequate stroke protection. The last decade has seen significant strides forward in the field of anticoagulation for AF. The development of several novel oral anticoagulants that have superior efficacy, improved safety profile and fixed doses without the need for regular monitoring make them favorable as viable alternatives to warfarin. Improved risk scoring systems for both thromboembolism and bleeding have also allowed clinicians to better target patients most likely to benefit from these new therapies. In addition, non-pharmacological approaches to stroke prevention such as left atrial appendage exclusion devices may be useful in patients whom anticoagulation therapy is contraindicated. These new pharmacological and non-pharmacological options for stroke prevention in AF permit clinicians to tailor their management of patients according to individual needs and characteristics. The present review aims to outline the latest up-to-date management of AF in stroke prevention.
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Affiliation(s)
- T Hall
- Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
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Tomaszewski M, Charchar FJ, Nelson CP, Barnes T, Denniff M, Kaiser M, Debiec R, Christofidou P, Rafelt S, van der Harst P, Wang WYS, Maric C, Zukowska-Szczechowska E, Samani NJ. Pathway analysis shows association between FGFBP1 and hypertension. J Am Soc Nephrol 2011; 22:947-55. [PMID: 21436287 DOI: 10.1681/asn.2010080829] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Variants in the gene encoding fibroblast growth factor 1 (FGF1) co-segregate with familial susceptibility to hypertension, and glomerular upregulation of FGF1 associates with hypertension. To investigate whether variants in other members of the FGF signaling pathway may also associate with hypertension, we genotyped 629 subjects from 207 Polish families with hypertension for 79 single nucleotide polymorphisms in eight genes of this network. Family-based analysis showed that parents transmitted the major allele of the rs16892645 polymorphism in the gene encoding FGF binding protein 1 (FGFBP1) to hypertensive offspring more frequently than expected by chance (P=0.005). An independent cohort of 807 unrelated Polish subjects validated this association. Furthermore, compared with normotensive subjects, hypertensive subjects had approximately 1.5- and 1.4-fold higher expression of renal FGFBP1 mRNA and protein (P=0.04 and P=0.001), respectively. By immunohistochemistry, hypertension-related upregulation of FGFBP1 was most apparent in the glomerulus and juxtaglomerular space. Taken together, these data suggest that FGFBP1 associates with hypertension and that systematic analysis of signaling pathways can identify previously undescribed genetic associations.
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Affiliation(s)
- Maciej Tomaszewski
- Department of Cardiovascular Sciences, University of Leicester, Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester LE3 9QP, UK.
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28
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Kaess BM, Barnes TA, Stark K, Charchar FJ, Waterworth D, Song K, Wang WYS, Vollenweider P, Waeber G, Mooser V, Zukowska-Szczechowska E, Samani NJ, Hengstenberg C, Tomaszewski M. FGF21 signalling pathway and metabolic traits - genetic association analysis. Eur J Hum Genet 2010; 18:1344-8. [PMID: 20717167 DOI: 10.1038/ejhg.2010.130] [Citation(s) in RCA: 21] [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] [Indexed: 11/09/2022] Open
Abstract
Fibroblast growth factor 21 (FGF21) is a novel master regulator of metabolic profile. The biological actions of FGF21 are elicited upon its klotho beta (KLB)-facilitated binding to FGF receptor 1 (FGFR1), FGFR2 and FGFR3. We hypothesised that common polymorphisms in the FGF21 signalling pathway may be associated with metabolic risk. At the screening stage, we examined associations between 63 common single-nucleotide polymorphisms (SNPs) in five genes of this pathway (FGF21, KLB, FGFR1, FGFR2, FGFR3) and four metabolic phenotypes (LDL cholesterol - LDL-C, HDL-cholesterol - HDL-C, triglycerides and body mass index) in 629 individuals from Silesian Hypertension Study (SHS). Replication analyses were performed in 5478 unrelated individuals of the Swiss CoLaus cohort (imputed genotypes) and in 3030 directly genotyped individuals of the German Myocardial Infarction Family Study (GerMIFS). Of 54 SNPs that met quality control criteria after genotyping in SHS, 4 (rs4733946 and rs7012413 in FGFR1; rs2071616 in FGFR2 and rs7670903 in KLB) showed suggestive association with LDL-C (P=0.0006, P=0.0013, P=0.0055, P=0.011, respectively) and 1 (rs2608819 in KLB) was associated with body mass index (P=0.011); all with false discovery rate q<0.5. Of these, only one FGFR2 polymorphism (rs2071616) showed replicated association with LDL-C in both CoLaus (P=0.009) and men from GerMIFS (P=0.017). The direction of allelic effect of rs2071616 upon LDL-C was consistent in all examined populations. These data show that common genetic variations in FGFR2 may be associated with LDL-C in subjects of white European ancestry.
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Affiliation(s)
- Bernhard M Kaess
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, UK
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Wang WYS. Validity of reported genetic risk factors for acute coronary syndrome. JAMA 2007; 298:1758-9; author reply 1759. [PMID: 17940227 DOI: 10.1001/jama.298.15.1758-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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30
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Tomaszewski M, Charchar FJ, Lynch MD, Padmanabhan S, Wang WYS, Miller WH, Grzeszczak W, Maric C, Zukowska-Szczechowska E, Dominiczak AF. Fibroblast growth factor 1 gene and hypertension: from the quantitative trait locus to positional analysis. Circulation 2007; 116:1915-24. [PMID: 17909102 DOI: 10.1161/circulationaha.107.710293] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The distal portion of the long arm of chromosome 5 is linked to hypertension and contains functional candidate blood pressure-regulating genes. METHODS AND RESULTS Tightening the grid of microsatellite markers under this quantitative trait locus in the Silesian Hypertension Study (629 individuals from 207 Polish hypertensive families) provided enhanced support for linkage of this region to blood pressure (maximal Z=3.51, P=0.0002). The fine mapping, comparative genomics, and functional prioritization identified fibroblast growth factor 1 gene (FGF1) as the positional candidate. Linkage disequilibrium mapping based on 51 single nucleotide polymorphisms spanning the locus showed no overlap between 3 independent haploblocks of FGF1 and the adjacent extragenic chromosomal regions. Single and multilocus family-based analysis revealed that genetic variation within FGF1 haploblock 1 was associated with hypertension and identified a common intronic single nucleotide polymorphism, rs152524, as the major driver of this association (P=0.0026). Real-time quantitative polymerase chain reaction and Western blotting analysis of renal tissue obtained from subjects undergoing unilateral nephrectomy showed an increase in both mRNA and protein FGF1 expression in hypertensive patients compared with normotensive controls. Renal immunohistochemistry revealed that FGF1 was expressed exclusively within the glomerular endothelial and mesangial cells. CONCLUSIONS Our data demonstrate that genetic variation within FGF1 cosegregates with elevated blood pressure in hypertensive families and that this association is likely to be mediated by upregulation of renal FGF1 expression. The results of our study will need to be replicated in other cohorts.
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Affiliation(s)
- Maciej Tomaszewski
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
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Speirs HJL, Wang WYS, Benjafield AV, Morris BJ. No association with hypertension of CLCNKB and TNFRSF1B polymorphisms at a hypertension locus on chromosome 1p36. J Hypertens 2005; 23:1491-6. [PMID: 16003175 DOI: 10.1097/01.hjh.0000174300.73992.cc] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Chromosome 1p36 has been linked to essential hypertension and systolic blood pressure. This locus contains the chloride channel-Kb gene (CLCNKB) and the tumour necrosis factor receptor 2 gene (TNFRSF1B). Polymorphisms of each of these have shown association with hypertension, and a CLCNKB T481S variant alters receptor function. Here we performed association studies in a well-characterized cohort of hypertensives and normotensives whose blood pressure status matched that of both their parents. METHODS The study involved 196 essential hypertensives and 321 normotensives. These were genotyped for TNFRSF1B variants T-1710A upstream, A257G in exon 2, a CA-repeat polymorphism in intron 4, E232K and M196R in exon 6, and T1668G and T1690C in the 3'-untranslated region, and the T481S variant of CLCNKB. RESULTS The CLCNKB T481S variant showed no association with hypertension. Thermodynamic modelling of the 3'-untranslated region of TNFRSF1B mRNA predicted that the T1668G variant alters the stem-loop structure and thus the mRNA stability and expression. However, neither this nor the other TNFRSF1B polymorphisms, either alone or after haplotype analysis, were associated with hypertension. Moreover, for each gene the blood pressure, body mass index, plasma sodium and plasma lipid concentrations were generally similar across genotypes. CONCLUSION Our data fail to support previous association findings for TNFRSF1B and CLCNKB at the chromosome 1p36 locus implicated in hypertension.
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Affiliation(s)
- Helen J L Speirs
- Basic & Clinical Genomics Laboratory, School of Medical Sciences and Institute for Biomedical Research, The University of Sydney, Australia
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Payne F, Smyth DJ, Pask R, Cooper JD, Masters J, Wang WYS, Godfrey LM, Bowden G, Szeszko J, Smink LJ, Lam AC, Burren O, Walker NM, Nutland S, Rance H, Undlien DE, Rønningen KS, Guja C, Ionescu-Tîrgovişte C, Todd JA, Twells RCJ. No evidence for association of the TATA-box binding protein glutamine repeat sequence or the flanking chromosome 6q27 region with type 1 diabetes. Biochem Biophys Res Commun 2005; 331:435-41. [PMID: 15850778 DOI: 10.1016/j.bbrc.2005.03.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Indexed: 01/19/2023]
Abstract
Susceptibility to the autoimmune disease type 1 diabetes has been linked to human chromosome 6q27 and, moreover, recently associated with one of the genes in the region, TATA box-binding protein (TBP). Using a much larger sample of T1D families than those studied by others, and by extensive re-sequencing of nine other genes in the proximity, in which we identified 279 polymorphisms, 83 of which were genotyped in up to 725 T1D multiplex and simplex families, we obtained no evidence for association of the TBP CAG/CAA (glutamine) microsatellite repeat sequence with disease, or for nine other genes, PDCD2, PSMB1, KIAA1838, DLL1, dJ894D12.4, FLJ25454, FLJ13162, FLJ11152, PHF10 and CCR6. This study also provides an exon-based tag single nucleotide polymorphism map for these 10 genes that can be used for analysis of other diseases.
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Affiliation(s)
- Felicity Payne
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Hills Road, Cambridge, UK
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Benjafield AV, Wang WYS, Speirs HJL, Morris BJ. Genome-wide scan for hypertension in Sydney Sibships: the GENIHUSS study. Am J Hypertens 2005; 18:828-32. [PMID: 15925743 DOI: 10.1016/j.amjhyper.2004.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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: 08/31/2004] [Accepted: 12/29/2004] [Indexed: 11/22/2022] Open
Abstract
We report here the results of the GENIHUSS study (GENetic Investigation of Hypertension Undertaken in Sydney Sibships)-a genome-wide scan to identify loci linked to essential hypertension (HT). Subjects were Anglo-Celtic Australian sibpairs resident in or near Sydney, Australia, with onset of HT before age 60 years (mean, 44 +/- 13 SD years). A 10-cM scan involving 400 microsatellite markers and 252 HT sibpairs was followed by fine mapping of the most promising locus using 296 HT sibpairs (481 individuals from 200 families). Multipoint and two-point nonparametric linkage analyses were performed using MAPMAKER/SIBS, GENEHUNTER II, and SPLINK. Suggestive loci were found on chromosomes 1 (4 cM) and 4 (129 cM). The chromosome 4 locus coincided with a QTL for systolic blood pressure (BP) in the Australian Victorian Family Heart Study, and the locus on chromosome 1 contains the chloride channel gene CLCNKB and tumor necrosis factor receptor 2 gene TNFRSF1B, which have each shown association with HT. Our study adds to findings of HT loci emanating from genome scans.
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Affiliation(s)
- Adam V Benjafield
- Basic & Clinical Genomics Laboratory, School of Medical Sciences and Institute for Biomedical Research, The University of Sydney, Sydney, Australia
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Abstract
To fully understand the allelic variation that underlies common diseases, complete genome sequencing for many individuals with and without disease is required. This is still not technically feasible. However, recently it has become possible to carry out partial surveys of the genome by genotyping large numbers of common SNPs in genome-wide association studies. Here, we outline the main factors - including models of the allelic architecture of common diseases, sample size, map density and sample-collection biases - that need to be taken into account in order to optimize the cost efficiency of identifying genuine disease-susceptibility loci.
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Affiliation(s)
- William Y S Wang
- Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 2XY, UK
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Wang WYS, Pike N. The allelic spectra of common diseases may resemble the allelic spectrum of the full genome. Med Hypotheses 2005; 63:748-51. [PMID: 15325027 DOI: 10.1016/j.mehy.2003.12.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2003] [Accepted: 12/04/2003] [Indexed: 11/20/2022]
Abstract
Identification of the genes responsible for common human diseases promises to be one of the most significant advances in medical knowledge and treatment. To date, the numerous attempts to identify the genes responsible for complex and multi-factorial common diseases have met with only a handful of successes. The key to calculating the optimal effort and ideal approach to successful identifications lies with understanding the likely allelic spectrum of the target disease. The allelic spectrum describes the number of disease loci and the frequency of each disease allele. It has been implicitly assumed that disease spectra are biased towards either commonness or rareness relative to the allelic spectrum of the overall human genome. We present a hypothesis that the allelic spectra of common diseases are generally similar to the spectrum that characterizes the entire genome. This hypothesis is supported by the fact that only a few loci have major significance to familial disease risks and that there may be many disease loci which each make a minor contribution to a disease. Additionally, although relatively few alleles of the human genome have been examined for disease involvement, current estimates of the number of disease genes are very high. Because selection will have been operating only weakly and for a relatively short time on most of the alleles associated with complex diseases, spectra that are characteristic of near-neutral selection may well apply. We thus propose that the hitherto neglected hypothesis that puts the likely allelic spectra of common diseases in the middle ground between the prevailing hypotheses of spectral skew towards rareness or commonness is the most likely. By using this hypothesis as the null, research resources may be optimally allocated and greater success in identifying disease genes may be achieved.
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Affiliation(s)
- William Y S Wang
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 2XY, UK.
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Speirs HJL, Katyk K, Kumar NN, Benjafield AV, Wang WYS, Morris BJ. Association of G-protein-coupled receptor kinase 4 haplotypes, but not HSD3B1 or PTP1B polymorphisms, with essential hypertension. J Hypertens 2004; 22:931-6. [PMID: 15097232 DOI: 10.1097/00004872-200405000-00014] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To perform association studies of polymorphisms of the potential candidate essential hypertension (HT) genes GRK4, PTP1B and HSD3B1. METHODS Subjects consisted of 168 unrelated, Caucasian essential hypertensive (HT) patients and 312 normotensive (NT) controls. Biological power was increased by ensuring subjects in each group had parents with the same blood pressure (BP) status as theirs. Three GRK4gamma variants (R65L, A142V and A486V), one HSD3B1 variant (T<---C Leu) and one PTP1B variant (1484insG) were genotyped by polymerase chain reaction and restriction enzyme digestion or by homogenous MassEXTEND Assay. RESULTS The V allele of the A486V variant of GRK4gamma, but not the R65L or A142V variants, showed an association with HT (P = 0.02). The V allele was also associated with an elevation in systolic blood pressure (SBP) (P = 0.002). Although the L65 and the V142 alleles tracked with elevation in diastolic (DBP), this was seen only in male HTs (P = 0.009; P = 0.002, respectively). Haplotype frequencies differed between the HT and NT groups, particularly for the R, V, V haplotype combination of R65L, A142V and A486V, respectively. Neither of the HSD3B1 or PTP1B variants were associated with HT. CONCLUSION Genetic variation in GRK4gamma was associated with HT in the subjects studied.
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Affiliation(s)
- Helen J L Speirs
- Basic & Clinical Genomics Laboratory, School of Medical Sciences and Institute for Biomedical Research, The University of Sydney, Sydney, NSW 2006, Australia
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Tomaszewski M, Charchar FJ, Lacka B, Pesonen U, Wang WYS, Zukowska-Szczechowska E, Grzeszczak W, Dominiczak AF. Epistatic interaction between beta2-adrenergic receptor and neuropeptide Y genes influences LDL-cholesterol in hypertension. Hypertension 2004; 44:689-94. [PMID: 15364898 DOI: 10.1161/01.hyp.0000143844.81979.61] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Beta2-adrenergic receptor gene and neuropeptide Y gene may potentially influence lipid metabolism and overall energy balance. Therefore, we examined associations of these genes with lipid fractions and obesity-related phenotypes in hypertensive subjects. A total of 638 white individuals from 212 Polish families with clustering of essential hypertension were phenotyped for cardiovascular risk determinants. Each subject was genotyped for functional polymorphisms of beta2-adrenergic receptor gene (Arg16Gly and Gln27Glu) and neuropeptide Y (Leu7Pro). Of 3 common haplotypes of beta2-adrenergic receptor gene, Arg16Gln27 was overtransmitted to offspring with elevated levels of total cholesterol (Z=2.2; P=0.026) and LDL-cholesterol (Z=3.2; P=0.002). Individually, Leu7Pro was not associated with any of the metabolic phenotypes in family-based tests or case-control analyses. However, in the presence of Arg allele of Arg16Gly and Gln allele of Gln27Glu, homozygosity for Leu variant of the Leu7Pro polymorphism was associated with 2.1-increased odds ratio (confidence interval, 1.10 to 3.81; P=0.024) of elevated LDL in hypertensive subjects, independent of age, gender, body mass index, adjusted blood pressures, antihypertensive therapy, and use of nonselective beta-blockers and diuretics. Consistently, there was a significant multilocus association among variants of Arg16Gly, Gln27Glu, and Leu7Pro in hypertensive probands with elevated LDL (cases; P=0.028) but not in hypertensive subjects with normal LDL (controls). This study revealed an association of LDL-cholesterol with beta2-adrenergic receptor gene haplotype and provided evidence for epistatic interaction between beta2-adrenergic receptor gene and neuropeptide Y gene in determination of LDL-cholesterol in patients with essential hypertension.
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Affiliation(s)
- Maciej Tomaszewski
- British Heart Foundation Glasgow Cardiovascular Research Centre, Division of Cardiovascular and Medical Sciences, University of Glasgow, Western Infirmary, Glasgow G11 6NT, United Kingdom.
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Benjafield AV, Wang WYS, Morris BJ. No association of angiotensin-converting enzyme 2 gene (ACE2) polymorphisms with essential hypertension. Am J Hypertens 2004; 17:624-8. [PMID: 15233982 PMCID: PMC7110370 DOI: 10.1016/j.amjhyper.2004.02.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2003] [Accepted: 02/26/2004] [Indexed: 01/21/2023] Open
Abstract
Recent intriguing findings from genetic linkage, knockout, and physiologic studies in mice and rats led us to conduct the first investigation of the novel angiotensin-converting enzyme 2 gene (ACE2) in human hypertension (HT). We genotyped four single nucleotide polymorphisms (SNP) (A→G at nucleotide 1075 in intron 1, G→A at nucleotide 8790 in intron 3, C→G at nucleotide 28330 in intron 11, and G→C at nucleotide 36787 in intron 16) in HT (n = 152) and normotensive (NT, n = 193) groups having inherently high biological power (>80%) due to our inclusion only of subjects whose parents had the same BP status as themselves. The SNPs were in linkage disequilibrium (D′ = 54% to 100%, P = .05 to 0.0001). Because ACE2 is on the X chromosome, data for each sex were analyzed separately. Minor allele frequencies in HT versus NT were as follows: for the intron 1 variant 0.21 versus 0.17 in female subjects (P = .31) and 0.25 versus 0.29 in male subjects (P = .60); intron 3 variant 0.22 versus 0.18 in female subjects (P = .35) and 0.15 versus 0.20 in male subjects (P = .47); intron 11 variant 0.39 versus 0.46 in male subjects (P = 0.17) and 0.31 versus 0.30 in male subjects (P = .96); intron 16 variant 0.20 versus 0.19 in female subjects (P = .72) and 0.17 versus 0.17 in male subjects (P = .95). Haplotype analysis was also negative. These data provide little support for ACE2 in genetic predisposition to HT.
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Affiliation(s)
- Adam V Benjafield
- Basic Clinical Genomics Laboratory, School of Medical Sciences and Institute for Biomedical Research, The University of Sydney, Sydney, Australia
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Abstract
Several lines of evidence suggest the involvement of the human endogenous retrovirus (HERV)-K18 in the etiology of type 1 diabetes. HERV-K18 encodes for a T-cell superantigen (SAg). T-cells with T-cell receptor Vbeta7 chains reactive to the SAg and HERV-K18 mRNA were enriched in the tissues at the onset of the disease. HERV-K18 transcription and SAg function in cells capable of efficient presentation are induced by proinflammatory stimuli such as viruses and interferon-alpha and may trigger progression of disease to insulitis or from insulitis to overt diabetes. Allelic variation of HERV-K18 or the DNA flanking it, the CD48 gene, could modulate genetic susceptibility. Analysis of 14 polymorphisms in the locus using 754 diabetic families provided positive evidence of association of three variants belonging to a single haplotype (P = 0.0026), present at 21.8% frequency in the population. Genotype analysis suggested a dominantly protective effect of this haplotype (P = 0.0061). Further genetic and functional analyses are required to confirm these findings.
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Affiliation(s)
- Samuel Marguerat
- Department of Genetics and Microbiology, University of Geneva Medical School, Geneva, Switzerland
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Abstract
Large-scale discovery and validation of single-nucleotide polymorphisms (SNPs) facilitates indirect association mapping. It has recently been estimated that, in Europeans, 77% of all SNPs with frequency of 10% or more could be ascertained through linkage disequilibrium (LD) by genotyping variants in the database dbSNP. Using a sampling approach from 73 genes with near complete SNP maps, we show here the usefulness of SNP maps at different densities and the large variability of SNP coverage in different genomic regions. While even sparse SNP maps are of some value to genetic mapping, in order to undertake disease association studies providing at least 80% of SNPs in 90% of genes, much denser maps need to be constructed, at more than one SNP per kb in some regions.
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Affiliation(s)
- William Y S Wang
- JDRF/WT Diabetes and Inflammation Laboratory, Cambridge Institute for Medical Research, University of Cambridge, UK
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Meats A, Pike N, An X, Raphael K, Wang WYS. The Effects of Selection for early (day) and late (dusk) Mating lines of Hybrids ofBactrocera tryoniandBactrocera neohumeralis. Genetica 2003; 119:283-93. [PMID: 14686607 DOI: 10.1023/b:gene.0000003683.42395.51] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Bactrocera neohumeralis and Bactrocera tryoni are closely related tephritid fruit fly species. B. neohumeralis mates throughout the day (in bright light) and B. tryoni mates at dusk. The two species can also be distinguished by the colour of their calli (prothoracic sclerites) which are brown and yellow, respectively. The F1 hybrids can mate both in bright light just before dusk and during dusk and have calli that are partly brown and partly yellow. The F2 hybrids have a wider range of callus patterns and mating occurs more widely in the day as well as at dusk. We directly selected hybrid stocks for mating time, creating 'early' (day-mating) and 'late' (dusk-mating) lines. As an apparently inadvertent consequence, the two types of line respectively had predominantly brown and predominantly yellow calli and thus came to closely resemble the original two species in both behaviour and appearance. Lines that were evenly selected (half for day and half for dusk) essentially retained the mating pattern of F2 hybrids. Selection for callus colour alone also affected the distribution of mating times in a predictable way. We propose a genetical model to account for the results and discuss them in the light of the apparent maintenance of species integrity in nature.
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Affiliation(s)
- A Meats
- School of Biological Sciences, Fruit Fly Research Centre, University of Sydney, Sydney, NSW 2006, Australia.
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Abstract
Bactrocera tryoni (Froggatt) and B. neohumeralis (Hardy) (Diptera: Tephritidae) are sympatric species which hybridise readily in the laboratory yet remain distinct in the field. B. tryoni mates only at dusk and B. neohumeralis mates only during the day, but hybrids can mate at both times. We investigated the inheritance of mating time in successively backcrossed hybrid stocks to establish whether mating with either species is more likely. The progeny of all backcrosses to B. tryoni mated only at dusk. The majority of the progeny of the first and a minority of the progeny of the second backcross to B. neohumeralis also mated at dusk, but the third successive B. neohumeralis backcross produced flies that mated only during the day. This trend towards dominance of the B. tryoni trait was also reflected in a diagnostic morphological character. We discuss the possible genetic background for these phenomena and propose that unidirectional gene flow might explain how the two species remain distinct in the face of natural hybridisation.
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Affiliation(s)
- N Pike
- Fruit Fly Research Centre, School of Biological Sciences, University of Sydney, 2006, Australia.
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Twells RCJ, Mein CA, Phillips MS, Hess JF, Veijola R, Gilbey M, Bright M, Metzker M, Lie BA, Kingsnorth A, Gregory E, Nakagawa Y, Snook H, Wang WYS, Masters J, Johnson G, Eaves I, Howson JMM, Clayton D, Cordell HJ, Nutland S, Rance H, Carr P, Todd JA. Haplotype structure, LD blocks, and uneven recombination within the LRP5 gene. Genome Res 2003; 13:845-55. [PMID: 12727905 PMCID: PMC430919 DOI: 10.1101/gr.563703] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patterns of linkage disequilibrium (LD) in the human genome are beginning to be characterized, with a paucity of haplotype diversity in "LD blocks," interspersed by apparent "hot spots" of recombination. Previously, we cloned and physically characterized the low-density lipoprotein-receptor-related protein 5 (LRP5) gene. Here, we have extensively analysed both LRP5 and its flanking three genes, spanning 269 kb, for single nucleotide polymorphisms (SNPs), and we present a comprehensive SNP map comprising 95 polymorphisms. Analysis revealed high levels of recombination across LRP5, including a hot-spot region from intron 1 to intron 7 of LRP5, where there are 109 recombinants/Mb (4882 meioses), in contrast to flanking regions of 14.6 recombinants/Mb. This region of high recombination could be delineated into three to four hot spots, one within a 601-bp interval. For LRP5, three haplotype blocks were identified, flanked by the hot spots. Each LD block comprised over 80% common haplotypes, concurring with a previous study of 14 genes that showed that common haplotypes account for at least 80% of all haplotypes. The identification of hot spots in between these LD blocks provides additional evidence that LD blocks are separated by areas of higher recombination.
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Affiliation(s)
- Rebecca C J Twells
- JDRF/WT Diabetes and Inflammation Laboratory, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 2XY, UK.
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Benjafield AV, Iwai N, Ishikawa K, Wang WYS, Morris BJ. Overweight, But Not Hypertension, Is Associated with SAH Polymorphisms in Caucasians with Essential Hypertension. Hypertens Res 2003; 26:591-5. [PMID: 14567496 DOI: 10.1291/hypres.26.591] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The gene SAH (chromosome 16p12.3) is of interest in the etiology of human hypertension. In Caucasians a PstI restriction fragment length polymorphism (RFLP) of SAH has been correlated with body weight in individuals with hypertension. To extend this finding we carried out a case-control study of several recently identified polymorphisms in SAH: 1) an insertion/deletion of TTTAA at nucleotide --1037 in the promoter; 2) an insertion/deletion of two Alu like sequences in intron 1; and 3) an A-G variant in intron 12 located 7 bp upstream from exon 13. Subjects were 121 hypertensives with 2 hypertensive parents and 178 normotensives whose parents were both normotensive. All were Anglo-Celtic Caucasians and 51% of the hypertensives were overweight (body mass index (BMI)>25 kg/m2). The SAH promoter and intron 1 variants, but not the intron 12 or PstI RFLP, were in linkage disequilibrium (LD) (D'=100%, p<0.001). We found no association between any of the polymorphisms and hypertension. However, the frequency of the minor allele of the intron 1 polymorphism (0.20) was higher in overweight than in normal weight hypertensives (0.07) (p=0.013). This association was supported by the weak tracking of plasma lipid variables with this allele (p values=0.01-0.04), although these lost their statistical significance after correction for multiple comparisons. In conclusion, the present data offers support for variation in SAH having a role in predisposition to overweight in hypertensives.
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Affiliation(s)
- Adam V Benjafield
- Basic & Clinical Genomics Laboratory, School of Medical Science and Institute for Biomedical Research, The University of Sydney, Sydney, Australia
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Wang WYS, Cordell HJ, Todd JA. Association mapping of complex diseases in linked regions: estimation of genetic effects and feasibility of testing rare variants. Genet Epidemiol 2003; 24:36-43. [PMID: 12508254 DOI: 10.1002/gepi.10216] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Association mapping in linked regions is a current major approach for the identification of genes for complex diseases. Loci contributing to linkage, even with small values of sibling recurrence risk (lambda(s)), may be equivalent to substantial underlying genetic effects for association studies. For disease alleles with a frequency as low as 1%, highly reliable association studies (80% power for significance level alpha=10(-6)) require only 277, 781, and 1289 families or cases and controls for loci detected with lambda(s) of 1.5, 1.1, and 1.05, respectively, under a multiplicative genetic model. Under alternative models, provided epistatic effects are minor, larger achievable sample sizes will provide sufficient power to map almost any disease gene that may have initially contributed to linkage.
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Affiliation(s)
- William Y S Wang
- Department of Medical Genetics, University of Cambridge, Cambridge, UK
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Tomaszewski M, Brain NJR, Charchar FJ, Wang WYS, Lacka B, Padmanabahn S, Clark JS, Anderson NH, Edwards HV, Zukowska-Szczechowska E, Grzeszczak W, Dominiczak AF. Essential hypertension and beta2-adrenergic receptor gene: linkage and association analysis. Hypertension 2002; 40:286-91. [PMID: 12215468 DOI: 10.1161/01.hyp.0000029105.21202.fe] [Citation(s) in RCA: 53] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A region on human chromosome 5 (5q31.1-qter) contains several genes that encode important blood pressure regulators and thus is a good candidate for analysis of linkage and association with hypertension. We recruited 638 individuals from 212 Polish pedigrees with clustering of essential hypertension. These subjects were genotyped for 11 microsatellite markers that span this region to test for linkage to essential hypertension and systolic and diastolic blood pressures. The segment of this region of approximately 7 cM delineated by D5S1480 and D5S500 markers was linked to blood pressures in multipoint analysis. In 2-point analysis, D5S1480--the marker in close proximity to beta2-adrenergic receptor gene--reached the maximal linkage to essential hypertension and adjusted systolic and diastolic blood pressures, implicating this gene as a positional candidate for further association studies. Arg16Gly, Gln27Glu, and Thr164Ile--3 functional single nucleotide polymorphisms within the beta2-adrenergic receptor gene--were tested for association with essential hypertension. None of these polymorphisms showed a significant association with essential hypertension, separately or in the haplotype analysis. This study provided evidence of linkage of 5q31.1-5qter region to essential hypertension in the European population. Moreover, it implicated the chromosomal segment in close proximity to D5S1480 and D5S500. The detailed analysis of 3 single nucleotide polymorphisms does not support the role of the beta2-adrenergic receptor gene as a major causative gene for the detected linkage.
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Affiliation(s)
- Maciej Tomaszewski
- British Heart Foundation Blood Pressure Group, Department of Medicine and Therapeutics, University of Glasgow, Glasgow, United Kingdom
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Medley TL, Cole TJ, Gatzka CD, Wang WYS, Dart AM, Kingwell BA. Fibrillin-1 genotype is associated with aortic stiffness and disease severity in patients with coronary artery disease. Circulation 2002; 105:810-5. [PMID: 11854120 DOI: 10.1161/hc0702.104129] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated pulse pressure is associated strongly with adverse cardiovascular outcome; however, the genetic basis of this condition is unknown. This study examined whether genotypic variation in the extracellular matrix protein fibrillin-1, the Marfan gene, was associated with aortic stiffening and therefore could contribute to cardiovascular risk associated with pulse pressure elevation in coronary disease. METHODS AND RESULTS Patients (n=145; 113 men), 62+/-9 years of age (mean+/-SD), with angiographically confirmed coronary disease, were studied. Carotid applanation tonometry was used to assess central blood pressures, and in conjunction with Doppler velocimetry, to assess aortic input and characteristic impedance. Fibrillin-1 genotype was characterized by a variable nucleotide tandem repeat and 2 single-nucleotide polymorphisms. The variable nucleotide tandem repeat was a good predictor of underlying haplotypes with 3 genotypes (2-2, 2-4, and 2-3) accounting for 86% of the population. The 2-3 genotype had higher input impedance (P=0.002), characteristic impedance (P=0.005), and carotid pulse pressure (P=0.002) compared with the 2-2 and 2-4 genotypes. Disease severity assessed by previous angioplasties and the number of patients with a stenosis >90% was also greater in the 2-3 genotype. Furthermore, in a multivariate analysis, fibrillin-1 genotype and central pulse pressure were independent of conventional risk factors in determining coronary disease severity. There was no difference in age, sex ratio, body mass index, smoking status, cholesterol level, or medication among the 3 genotypes. CONCLUSIONS Although a causative link has not been shown, these data are consistent with an important role for fibrillin-1 genotype in cardiovascular risk associated with large-artery stiffening and pulse pressure elevation in individuals with coronary disease.
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Affiliation(s)
- Tanya L Medley
- Alfred and Baker Medical Unit, Baker Medical Research Institute Prahran, Victoria, Australia
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