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Holtrop J, Bhatt DL, Ray KK, Mach F, Smulders YM, Carballo D, Steg PG, Visseren FLJ, Dorresteijn JAN. Impact of the 2021 European Society for Cardiology prevention guideline's stepwise approach for cardiovascular risk factor treatment in patients with established atherosclerotic cardiovascular disease. Eur J Prev Cardiol 2024; 31:754-762. [PMID: 38324720 DOI: 10.1093/eurjpc/zwae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 02/09/2024]
Abstract
AIMS This study aimed to evaluate the stepwise approach for cardiovascular (CV) risk factor treatment as outlined by the European Society for Cardiology 2021 guidelines on CV disease (CVD) prevention in patients with established atherosclerotic CVD (ASCVD). METHODS AND RESULTS In patients with ASCVD, included in UCC-SMART (n = 8730) and European parts of the REACH registry (n = 18 364), the 10-year CV risk was estimated using SMART2. Treatment effects were derived from meta-analyses and trials. Step 1 recommendations were LDL cholesterol (LDLc) < 1.8 mmol/L, systolic blood pressure (SBP) < 140 mmHg, using any antithrombotic medication, sodium-glucose co-transporter 2 (SGLT2) inhibition, and smoking cessation. Step 2 recommendations were LDLc < 1.4 mmol/L, SBP < 130 mmHg, dual-pathway inhibition (DPI, aspirin plus low-dose rivaroxaban), colchicine, glucagon-like peptide (GLP)-1 receptor agonists, and eicosapentaenoic acid. Step 2 was modelled accounting for Step 1 non-attainment. With current treatment, residual CV risk was 22%, 32%, and 60% in the low, moderate, and pooled (very) high European risk regions, respectively. Step 2 could prevent up to 198, 223 and 245 events per 1000 patients treated, respectively. Intensified LDLc reduction, colchicine, and DPI could be applied to most patients, preventing up to 57, 74, and 59 events per 1000 patients treated, respectively. Following Step 2, the number of patients with a CV risk of <10% could increase from 20%, 6.4%, and 0.5%, following Step 1, to 63%, 48%, and 12%, in the respective risk regions. CONCLUSION With current treatment, residual CV risk in patients with ASCVD remains high across all European risk regions. The intensified Step 2 treatment options result in marked further reduction of residual CV risk in patients with established ASCVD. KEY FINDINGS Guideline-recommended intensive treatment of patients with cardiovascular disease could prevent additional 198-245 new cardiovascular events for every 1000 patients treated.
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Affiliation(s)
- Joris Holtrop
- Department of Vascular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, ICTU-Global, Imperial College London, London, UK
| | - François Mach
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Yvo M Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - David Carballo
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Gabriel Steg
- Department of Cardiology, Université Paris-Cité, FACT (French Alliance for Cardiovascular Trials) NSERM1148/LVTS, AP-HP, Hôpital Bichat, Paris, France
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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2
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Lavell AHA, Schramade AE, Sikkens JJ, van der Straten K, van Dort KA, Slim MA, Appelman B, van Vught LA, Vlaar APJ, Kootstra NA, van Gils MJ, Smulders YM, de Jongh RT, Bomers MK. 25-Hydroxyvitamin D concentrations do not affect the humoral or cellular immune response following SARS-CoV-2 mRNA vaccinations. Vaccine 2024; 42:1478-1486. [PMID: 37775466 DOI: 10.1016/j.vaccine.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND To improve effectiveness of vaccination against SARS-CoV-2, it is important to identify factors that influence the immune response induced by vaccination. Evidence for the role of vitamin D in immune response against SARS-CoV-2 is contradictory. It is therefore of interest whether 25-hydroxyvitamin D (25[OH]D) concentrations affect the humoral and/or cellular response following SARS-CoV-2 vaccination. METHODS In this prospective cohort study, blood samples were collected from 98 SARS-CoV-2 naive health care workers (HCW) receiving the first two doses of either BNT162b2 or mRNA-1273 in 2021. Wild-type spike (S) protein binding and neutralizing antibodies were determined approximately three weeks after the first dose and four to five weeks after the second dose. Antigen specific T-cells and functionality (proliferative response and interferon gamma [IFN-γ] release) were determined in 18 participants four weeks after the second dose of BNT162b2. We studied the association between 25(OH)D concentrations, which were determined prior to vaccination, and humoral and cellular immune responses following vaccination. RESULTS We found no association between 25(OH)D concentrations (median 55.9 nmol/L [IQR 40.5-69.8]) and binding or neutralizing antibody titers after complete vaccination (fold change of antibody titers per 10 nmol/L 25(OH)D increase: 0.98 [95% CI 0.93-1.04] and 1.03 [95% CI: 0.96-1.11], respectively), adjusted for age, sex and type of mRNA vaccine. Subsequently, continuous 25(OH)D concentrations were divided into commonly used clinical categories (<25 nmol/L [n = 6, 6%], 25-49 nmol/L [n = 33, 34%], 50-75 nmol/L [n = 37, 38%] and ≥75 nmol/L [n = 22, 22%]), but no association with the humoral immune response following vaccination was found. Also, 25(OH)D concentrations were not associated with the SARS-CoV-2 specific T cell response. CONCLUSION No association was found between 25(OH)D concentrations and the humoral or cellular immune response following mRNA vaccination against SARS-CoV-2. Based on our findings there is no rationale to advise vitamin D optimization preceding SARS-CoV-2 vaccination in HCW with moderate vitamin D status.
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Affiliation(s)
- A H A Lavell
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - A E Schramade
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - J J Sikkens
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - K van der Straten
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Internal Medicine, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - K A van Dort
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Experimental Immunology, 1105 AZ, the Netherlands
| | - M A Slim
- Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - B Appelman
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - L A van Vught
- Amsterdam UMC Location University of Amsterdam, Center for Experimental and Molecular Medicine, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - A P J Vlaar
- Amsterdam UMC Location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - N A Kootstra
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Experimental Immunology, 1105 AZ, the Netherlands
| | - M J van Gils
- Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Y M Smulders
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - R T de Jongh
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, the Netherlands
| | - M K Bomers
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, Department of Infectious Diseases and Department of Endocrinology and Metabolism, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands.
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3
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Boxhoorn L, Smulders YM, Sigaloff KCE. [Milk-alkali syndrome: a careful history is crucial in diagnosing hypercalcemia]. Ned Tijdschr Geneeskd 2023; 167:D7621. [PMID: 37688456] [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] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Milk-alkali syndrome is a rare cause of hypercalcemia in the Netherlands, due to ingestion of large amounts of calcium and absorbable alkali. CASE DESCRIPTION A 38-year-old female patient was admitted with severe stomach pain, vomiting and weight loss. Laboratory results showed hypercalcemia and acute kidney injury. We initially suspected that the hypercalcemia was related to primary hyperparathyroidism, a malignancy with bone metastasis or a granulomatous disease. Gastroduodenoscopy, however, revealed a duodenal ulcer, which turned out to be Helicobacter pylori-related. A thorough history revealed that the patient had consumed large amounts of milk and antacids to relieve symptoms of heartburn. In light of this history, milk-alkali syndrome was diagnosed. CONCLUSION The case aims to underline the importance of a thorough history in patients with hypercalcemia. The use of over-the-counter medications and dairy products should be evaluated in all patients presenting with hypercalcemia.
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Affiliation(s)
- Lotte Boxhoorn
- Amsterdam UMC, afd. Interne Geneeskunde, Amsterdam
- Contact: Lotte Boxhoorn
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4
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Lavell AHA, Tijdink J, Buis DTP, Smulders YM, Bomers MK, Sikkens JJ. Why not to pick your nose: Association between nose picking and SARS-CoV-2 incidence, a cohort study in hospital health care workers. PLoS One 2023; 18:e0288352. [PMID: 37531335 PMCID: PMC10395815 DOI: 10.1371/journal.pone.0288352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/23/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Hospital health care workers (HCW) are at increased risk of contracting SARS-CoV-2. We investigated whether certain behavioral and physical features, e.g. nose picking and wearing glasses, are associated with infection risk. AIM To assess the association between nose picking and related behavioral or physical features (nail biting, wearing glasses, and having a beard) and the incidence of SARS-CoV-2-infection. METHODS In a cohort study among 404 HCW in two university medical centers in the Netherlands, SARS-CoV-2-specific antibodies were prospectively measured during the first phase of the pandemic. For this study HCW received an additional retrospective survey regarding behavioral (e.g. nose picking) and physical features. RESULTS In total 219 HCW completed the survey (response rate 52%), and 34/219 (15.5%) became SARS-CoV-2 seropositive during follow-up from March 2020 till October 2020. The majority of HCW (185/219, 84.5%) reported picking their nose at least incidentally, with frequency varying between monthly, weekly and daily. SARS-CoV-2 incidence was higher in nose picking HCW compared to participants who refrained from nose picking (32/185: 17.3% vs. 2/34: 5.9%, OR 3.80, 95% CI 1.05 to 24.52), adjusted for exposure to COVID-19. No association was observed between nail biting, wearing glasses, or having a beard, and the incidence of SARS-CoV-2 infection. CONCLUSION Nose picking among HCW is associated with an increased risk of contracting a SARS-CoV-2 infection. We therefore recommend health care facilities to create more awareness, e.g. by educational sessions or implementing recommendations against nose picking in infection prevention guidelines.
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Affiliation(s)
- A. H. Ayesha Lavell
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Joeri Tijdink
- Department Ethics, Law and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Philosophy, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David T. P. Buis
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Yvo M. Smulders
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Marije K. Bomers
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Jonne J. Sikkens
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
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5
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Bacour YAA, van Kanten MP, Smit F, Comans EFI, Akarriou M, de Vet HCW, Voskuyl AE, van der Laken CJ, Smulders YM. Development of a simple standardized scoring system for assessing large vessel vasculitis by 18F-FDG PET-CT and differentiation from atherosclerosis. Eur J Nucl Med Mol Imaging 2023; 50:2647-2655. [PMID: 37115211 PMCID: PMC10317865 DOI: 10.1007/s00259-023-06220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/02/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE This study is to develop a structured approach to distinguishing large-artery vasculitis from atherosclerosis using 18-fluorodeoxyglucose positron emission tomography combined with low-dose computed tomography (FDG PET/CT). METHODS FDG PET/CT images of 60 patients were evaluated, 30 having biopsy-proven giant cell arteritis (GCA; the most common form of large-artery vasculitis), and 30 with severe atherosclerosis. Images were evaluated by 12 nuclear medicine physicians using 5 criteria: FDG uptake pattern (intensity, distribution, circularity), the degree of calcification, and co-localization of calcifications with FDG-uptake. Criteria that passed agreement, and reliability tests were subsequently analysed for accuracy using receiver operator curve (ROC) analyses. Criteria that showed discriminative ability were then combined in a multi-component scoring system. Both initial and final 'gestalt' conclusion were also reported by observers before and after detailed examination of the images. RESULTS Agreement and reliability analyses disqualified 3 of the 5 criteria, leaving only FDG uptake intensity compared to liver uptake and arterial wall calcification for potential use in a scoring system. ROC analysis showed an area under the curve (AUC) of 0.90 (95%CI 0.87-0.92) for FDG uptake intensity. Degree of calcification showed poor discriminative ability on its own (AUC of 0.62; 95%CI 0.58-0.66). When combining presence of calcification with FDG uptake intensity into a 6-tiered scoring system, the AUC remained similar at 0.91 (95%CI 0.88-0.93). After exclusion of cases with arterial prostheses, the AUC increased to 0.93 (95%CI 0.91-0.95). The accuracy of the 'gestalt' conclusion was initially 89% (95%CI 86-91%) and increased to 93% (95%CI 91-95%) after detailed image examination. CONCLUSION Standardised assessment of arterial wall FDG uptake intensity, preferably combined with assessment of arterial calcifications into a scoring method, enables accurate, but not perfect, distinction between large artery vasculitis and atherosclerosis.
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Affiliation(s)
- Y A A Bacour
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - M P van Kanten
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - F Smit
- Department of Radiology and Nuclear Medicine, Alrijne Hospital, Simon, Smitweg 1, 2353GA, Leiderdorp, The Netherlands
| | - E F I Comans
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, PO Box 7057, Amsterdam 1007MB, Amsterdam, The Netherlands
| | - M Akarriou
- Department of Radiology and Nuclear Medicine, Spaarne Hospital, PO Box 770, Hoofddorp, 2130AT, The Netherlands
| | - H C W de Vet
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VrijeUniversiteit Amsterdam, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - A E Voskuyl
- Amsterdam UMC-Location VUmc, Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - C J van der Laken
- Amsterdam UMC-Location VUmc, Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands
| | - Y M Smulders
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam 1007MB, PO Box 7057, Amsterdam, The Netherlands.
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6
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Blanken AB, Raadsen R, Agca R, van Sijl AM, Smulders YM, Nurmohamed MT. Effect of anti-inflammatory therapy on vascular biomarkers for subclinical cardiovascular disease in rheumatoid arthritis patients. Rheumatol Int 2023; 43:315-322. [PMID: 36271190 PMCID: PMC9898416 DOI: 10.1007/s00296-022-05226-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/01/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the effect of 4 years of anti-inflammatory therapy on markers of subclinical vascular disease in rheumatoid arthritis patients. METHODS Carotid intima media thickness (IMT), augmentation index (AIx@75) and pulse wave velocity (PWV) measurements were performed repeatedly in 61 RA patients (30 early RA starting with csDMARDs and 31 established RA starting with adalimumab) for 4 years. These markers were also measured in 29 controls with osteoarthritis at baseline (BL). RESULTS IMT and AIx@75 at BL were higher in RA compared to OA, while PWV was higher in OA. In RA patients, AIx@75 and PWV decreased in the first 6 months after starting anti-inflammatory therapy. At 48 M, the level of AIx@75 remained lower than before therapy, while PWV at 48 M was comparable to BL (AIx@75: BL 28% (95% confidence interval 25-30%), 6 M 23% (20-26%), 48 M 25% (22-28%); PWV: BL 8.5 (7.8-9.2), 6 M 8.0 (7.1-8.9), 48 M 8.6 (7.6-9.6) m/s). IMT remained stable. There was an effect of disease activity (longitudinally, adjusted for changes over time) on IMT, AIx@75 and PWV. CONCLUSION This study suggests modest beneficial changes in some surrogate markers of subclinical vascular disease after anti-inflammatory therapy. These changes were associated with improvement in disease activity markers. Whether or not these beneficial changes ultimately predict a reduction in clinicalcardiovascular endpoints remains to be established in prospective studies.
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Affiliation(s)
- Annelies B Blanken
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, PO box 58271, 1040 HG, Amsterdam, the Netherlands. .,Amsterdam Rheumatology and Immunology Center, Location Amsterdam UMC, Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Reinder Raadsen
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, PO box 58271, 1040 HG, Amsterdam, the Netherlands
| | - Rabia Agca
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, PO box 58271, 1040 HG, Amsterdam, the Netherlands.,Amsterdam Rheumatology and Immunology Center, Location Amsterdam UMC, Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Alper M van Sijl
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, PO box 58271, 1040 HG, Amsterdam, the Netherlands.,Amsterdam Rheumatology and Immunology Center, Location Amsterdam UMC, Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Yvo M Smulders
- Amsterdam UMC, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Location Reade, Department of Rheumatology, PO box 58271, 1040 HG, Amsterdam, the Netherlands.,Amsterdam Rheumatology and Immunology Center, Location Amsterdam UMC, Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
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7
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Overgaauw A, Meijboom LJ, van Es J, Lust EJ, Serne EH, Nanayakkara P, Smulders YM, Kooter AJ, Sprengers RW, de Grooth HJ, Lely RJ, Thijs A, Noordegraaf AV, Heunks L, Elbers P, Bogaard HJ, Tuinman PR, Nossent EJ. Real-world characteristics and outcomes of patients with intermediate high risk acute pulmonary embolism. Acute Med 2023; 22:61-66. [PMID: 37306130 DOI: 10.52964/amja.0936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Exact benefits of currently recommended close monitoring in intermediate high risk acute pulmonary embolism (PE) patients are unknown. METHODS This prospective observational cohort study determined clinical characteristics, and disease course of intermediate high risk acute PE patients in an academic hospital setting . Frequency of hemodynamic deterioration, use of rescue reperfusion therapy and PE related mortality, were outcomes of interest. RESULTS Of 98 intermediate high risk PE patients included for analysis, 81 patients (83%) were closely monitored. Two deteriorated hemodynamically and were treated with rescue reperfusion therapy. One patient survived after this. CONCLUSIONS In these 98 intermediate high risk PE patients, hemodynamic deterioration occurred in three patients and rescue reperfusion therapy of two closely monitored patients led to survival of one. Underlining the need for better recognition of patients benefitting from and research in the optimal way of close monitoring.
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Affiliation(s)
- Ajc Overgaauw
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - L J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - J van Es
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - E J Lust
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - E H Serne
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - Pwb Nanayakkara
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - Y M Smulders
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - A J Kooter
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - R W Sprengers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - H J de Grooth
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - R J Lely
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - A Thijs
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - A Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Lma Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - Pwg Elbers
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - H J Bogaard
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - P R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Cardiovascular Sciences, The Netherlands
| | - E J Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
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8
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Lavell AHA, Sikkens JJ, Edridge AWD, van der Straten K, Sechan F, Oomen M, Buis DTP, Schinkel M, Burger JA, Poniman M, van Rijswijk J, de Jong MD, de Bree GJ, Peters EJG, Smulders YM, Sanders RW, van Gils MJ, van der Hoek L, Bomers MK. Recent infection with HCoV-OC43 may be associated with protection against SARS-CoV-2 infection. iScience 2022; 25:105105. [PMID: 36101832 PMCID: PMC9458542 DOI: 10.1016/j.isci.2022.105105] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/15/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022] Open
Abstract
Antibodies against seasonal human coronaviruses (HCoVs) are known to cross-react with SARS-CoV-2, but data on cross-protective effects of prior HCoV infections are conflicting. In a prospective cohort of healthcare workers (HCWs), we studied the association between seasonal HCoV (OC43, HKU1, 229E and NL63) nucleocapsid protein IgG and SARS-CoV-2 infection during the first pandemic wave in the Netherlands (March 2020 - June 2020), by 4-weekly serum sampling. HCW with HCoV-OC43 antibody levels in the highest quartile, were less likely to become SARS-CoV-2 seropositive when compared with those with lower levels (6/32, 18.8%, versus 42/97, 43.3%, respectively: p = 0.019; HR 0.37, 95% CI 0.16-0.88). We found no significant association with HCoV-OC43 spike protein IgG, or with antibodies against other HCoVs. Our results indicate that the high levels of HCoV-OC43-nucleocapsid antibodies, as an indicator of a recent infection, are associated with protection against SARS-CoV-2 infection; this supports and informs efforts to develop pancoronavirus vaccines.
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Affiliation(s)
- A H Ayesha Lavell
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Jonne J Sikkens
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Arthur W D Edridge
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Karlijn van der Straten
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Internal Medicine, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Ferdyansyah Sechan
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Melissa Oomen
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - David T P Buis
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Michiel Schinkel
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Judith A Burger
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Meliawati Poniman
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jacqueline van Rijswijk
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Menno D de Jong
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Godelieve J de Bree
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Internal Medicine, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Edgar J G Peters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Yvo M Smulders
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Rogier W Sanders
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, NY 10021, USA
| | - Marit J van Gils
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Lia van der Hoek
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.,Amsterdam UMC Location University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Laboratory of Experimental Virology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Marije K Bomers
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Internal Medicine, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.,Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
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9
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Burgers JS, Hamming JF, Smulders YM. [Are guidelines still supportive in clinical practice?]. Ned Tijdschr Geneeskd 2022; 166:D6953. [PMID: 36300462] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Clinical practice guidelines are fundamental to support knowledge and decision making of healthcare professionals in many disciplines. They can contribute to reducing undesirable practice variation, educating patients, and monitoring care. However, the burden increases if the number and size of guidelines continues to increase and as more side effects occur due to injudicious use, both in the professional and policy setting. Restricting the scope and finding the right balance between completeness and conciseness are major challenges for guideline developers and stakeholders. Ongoing innovation projects are working on improving accessibility, updating, and applicability in multimorbidity through optimal use of digital technologies. As long as healthcare professionals are in the lead in guideline development and involved in policy making, doctors can continue to rely on guidelines, if used correctly for the right care.
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Affiliation(s)
- Jako S Burgers
- Nederlands Huisartsen Genootschap, Utrecht
- Contact: Jako S. Burgers
| | | | - Yvo M Smulders
- Amsterdam UMC, locatie VUmc, afd. Interne Geneeskunde, Amsterdam
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10
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Visseren FLJ, Smulders YM. [New predictions in prevention guidelines: improved estimation of cardiovascular risks]. Ned Tijdschr Geneeskd 2022; 166:D6798. [PMID: 35899735] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Estimation of 10-year cardiovascular risk has a central role in Cardiovascular Prevention Guidelines in order to identify people at high risk that would benefit from lifestyle modification and risk factor treatment. In the recently issued European Guidelines age-dependent 10-year risk thresholds have been introduced, as well as lifetime risk estimation and estimation of treatment benefit, which all can be used in clinical practice to further individualize treatment of cardiovascular risk factors. Also cardiovascular risk prediction in people with diabetes and patients with already established cardiovascular disease are now available to estimate residual cardiovascular risk after initial lifestyle and risk factor treatment to guide individual intensification of risk factor treatment to further reduce the risk of a first or subsequent cardiovascular event.
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Affiliation(s)
- Frank L J Visseren
- UMC Utrecht, afd. Vasculaire Geneeskunde, Utrecht
- Contact: Frank L.J. Visseren
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11
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van Dam CS, Trappenburg MC, Ter Wee MM, Hoogendijk EO, de Vet R, Smulders YM, Nanayakkara PB, Muller M, Peters ML. The Prognostic Accuracy of Clinical Judgment Versus a Validated Frailty Screening Instrument in Older Patients at the Emergency Department: Findings of the AmsterGEM Study. Ann Emerg Med 2022; 80:422-431. [PMID: 35717270 DOI: 10.1016/j.annemergmed.2022.04.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To compare the prognostic accuracy of clinical judgment for frailty in older patients at the emergency department with a validated screening instrument and patient-perceived frailty. METHODS A prospective cohort study in patients 70 years of age and older in 2 Dutch EDs with a follow-up of 3 months. A dichotomous question was asked to the physician and patient: "Do you consider the patient / yourself to be frail?" The Identification of Seniors At Risk-Hospitalized Patients (ISAR-HP) was used as a validated screening instrument. The primary composite outcome consisted of either functional decline, institutionalization, or mortality. RESULTS A total of 736 patients were included. The physician identified 59% as frail, compared with 49% by ISAR-HP and 43% by patients themselves. The level of agreement was fair (Fleiss Kappa, 0.31). After 3 months, 31% of the patients experienced at least 1 adverse health outcome. The sensitivity was 79% for the physician, 72% for ISAR-HP, 61% for the patient, and 48% for all 3 combined. The specificity was 50% for the physician, 63% for ISAR-HP, 66% for the patient, and 85% for all 3 positive. The highest positive likelihood ratio was 3.03 (physician, ISAR-HP, patient combined), and the lowest negative likelihood ratio was 0.42 (physician). The areas under the receiver operating curves were all poor: 0.68 at best for ISAR-HP. CONCLUSION Clinical judgment for frailty showed fair agreement with a validated screening instrument and patient-perceived frailty. All 3 instruments have poor prognostic accuracy, which does not improve when combined. These findings illustrate the limited prognostic value of clinical judgment as a frailty screener in older patients at the ED.
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Affiliation(s)
- Carmen S van Dam
- Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands.
| | - Marijke C Trappenburg
- Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Marieke M Ter Wee
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Riekie de Vet
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Yvo M Smulders
- Department of Internal Medicine and Vascular Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Prabath B Nanayakkara
- Section General Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Mike L Peters
- Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands; Department of Internal Medicine and Vascular Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands; Department of Internal Medicine and Geriatrics, University Medical Center Utrecht, the Netherlands
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12
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. [2021 ESC Guidelines on cardiovascular disease prevention in clinical practice]. G Ital Cardiol (Rome) 2022; 23:e3-e115. [PMID: 35708476 DOI: 10.1714/3808.37926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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13
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Angelantonio ED, Franco OH, Halvorsen S, Richard Hobbs FD, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Rev Esp Cardiol (Engl Ed) 2022; 75:429. [PMID: 35525570 DOI: 10.1016/j.rec.2022.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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14
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Abstract
OBJECTIVE In this paper, we challenge the premise that patients are capable of accurately predicting their emotional response or quality of life in anticipation of health changes. Our goal was to systematically review the published empirical evidence related to the reliability of affective forecasting in the context of medical conditions. DESIGN Scoping review. SETTING We conducted a search string using both simple search terms as well as MeSH terms and searched the electronic databases of PubMed, Embase, CINAHL and Cochrane up to April 2021. PARTICIPANTS We initially selected 5726 articles. Empirical studies reporting on predicted and/or observed emotions or quality of life concerning deterioration, improvement in health or chronic illnesses were included. Furthermore, empirical studies of healthy individuals predicting emotional response or quality of life compared with patients reflecting on emotions or quality of life concerning deterioration or improvement in health or chronic illnesses were also included. Studies on healthy participants, psychiatric patients and non-English articles were excluded. RESULTS 7 articles were included in this review. We found that patients generally tend to systematically exaggerate both anticipated happiness and sorrow/grief after health improvement and deterioration, respectively. CONCLUSION Patients are less adept in predicting emotional response or quality of life regarding to health changes than we are inclined to assume. We discuss several biases which could explain this phenomenon. Our findings are relevant in the context of treatment decisions, advanced care planning and advanced care directives.
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Affiliation(s)
| | | | - R Otten
- Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Claudi Bockting
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | - Y M Smulders
- Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
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15
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Appelman B, van der Straten K, Lavell AHA, Schinkel M, Slim MA, Poniman M, Burger JA, Oomen M, Tejjani K, Vlaar APJ, Wiersinga WJ, Smulders YM, van Vught LA, Sanders RW, van Gils MJ, Bomers MK, Sikkens JJ. Time since SARS-CoV-2 infection and humoral immune response following BNT162b2 mRNA vaccination. EBioMedicine 2021; 72:103589. [PMID: 34571363 PMCID: PMC8461365 DOI: 10.1016/j.ebiom.2021.103589] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/28/2021] [Accepted: 09/06/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND To optimise the use of available SARS-CoV-2 vaccines, some advocate delaying second vaccination for individuals infected within six months. We studied whether post-vaccination immune response is equally potent in individuals infected over six months prior to vaccination. METHODS We tested serum IgG binding to SARS-CoV-2 spike protein and neutralising capacity in 110 healthcare workers, before and after both BNT162b2 messenger RNA (mRNA) vaccinations. We compared outcomes between participants with more recent infection (n = 18, median two months, IQR 2-3), with infection-vaccination interval over six months (n = 19, median nine months, IQR 9-10), and to those not previously infected (n = 73). FINDINGS Both recently and earlier infected participants showed comparable humoral immune responses after a single mRNA vaccination, while exceeding those of previously uninfected persons after two vaccinations with 2.5 fold (p = 0.003) and 3.4 fold (p < 0.001) for binding antibody levels, and 6.4 and 7.2 fold for neutralisation titres, respectively (both p < 0.001). The second vaccine dose yielded no further substantial improvement of the humoral response in the previously infected participants (0.97 fold, p = 0.92), while it was associated with a 4 fold increase in antibody binding levels and 18 fold increase in neutralisation titres in previously uninfected participants (both p < 0.001). Adjustment for potential confounding of sex and age did not affect these findings. INTERPRETATION Delaying the second vaccination in individuals infected up to ten months prior may constitute a more efficient use of limited vaccine supplies. FUNDING Netherlands Organization for Health Research and Development ZonMw; Corona Research Fund Amsterdam UMC; Bill & Melinda Gates Foundation.
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Affiliation(s)
- Brent Appelman
- Center for Experimental and Molecular Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Karlijn van der Straten
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Department of Internal Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - A H Ayesha Lavell
- Department of Internal Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, the Netherlands
| | - Michiel Schinkel
- Center for Experimental and Molecular Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Department of Internal Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, the Netherlands
| | - Marleen A Slim
- Center for Experimental and Molecular Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Meliawati Poniman
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Judith A Burger
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Melissa Oomen
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Khadija Tejjani
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - W Joost Wiersinga
- Department of Internal Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Yvo M Smulders
- Department of Internal Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, the Netherlands
| | - Lonneke A van Vught
- Center for Experimental and Molecular Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Rogier W Sanders
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Department of Microbiology and Immunology, Weill Medical College of Cornell University, New York, USA
| | - Marit J van Gils
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
| | - Marije K Bomers
- Department of Internal Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, the Netherlands.
| | - Jonne J Sikkens
- Department of Internal Medicine, Amsterdam UMC, Amsterdam Institute for Infection and Immunity, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam 1081 HV, the Netherlands.
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16
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2021; 29:5-115. [PMID: 34558602 DOI: 10.1093/eurjpc/zwab154] [Citation(s) in RCA: 181] [Impact Index Per Article: 60.3] [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] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA).,International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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17
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42:3227-3337. [PMID: 34458905 DOI: 10.1093/eurheartj/ehab484] [Citation(s) in RCA: 2015] [Impact Index Per Article: 671.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA)
- International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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18
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Agca R, Blanken AB, van Sijl AM, Smulders YM, Voskuyl AE, van der Laken C, Boellaard R, Nurmohamed MT. Arterial wall inflammation is increased in rheumatoid arthritis compared with osteoarthritis, as a marker of early atherosclerosis. Rheumatology (Oxford) 2021; 60:3360-3368. [PMID: 33447846 PMCID: PMC8516502 DOI: 10.1093/rheumatology/keaa789] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/10/2020] [Indexed: 11/29/2022] Open
Abstract
Objective RA is associated with higher risk of cardiovascular (CV) disease. Ongoing systemic inflammation is presumed to accelerate atherosclerosis by increasing inflammation in the arterial wall. However, evidence supporting this hypothesis is limited. We aimed to investigate arterial wall inflammation in RA vs OA, and its association with markers of inflammation and CV risk factors. Methods 18-fluorodeoxyglucose PET combined with CT (18F-FDG-PET/CT) was performed in RA (n = 61) and OA (n = 28) to investigate inflammatory activity in the wall of large arteries. Secondary analyses were performed in patients with early untreated RA (n = 30), and established RA, active under DMARD treatment (n = 31) vs OA. Results Patients with RA had significantly higher 18F-FDG uptake in the wall of the carotid arteries (beta 0.27, 95%CI 0.11—0.44, P <0.01) and the aorta (beta 0.47, 95%CI 0.17—0.76, P <0.01) when compared with OA, which persisted after adjustment for traditional CV risk factors. Patients with early RA had the highest 18F-FDG uptake, followed by patients with established RA and OA respectively. Higher ESR and DAS of 28 joints values were associated with higher 18F-FDG uptake in all arterial segments. Conclusion Patients with RA have increased 18F-FDG uptake in the arterial wall compared with patients with OA, as a possible marker of early atherosclerosis. Furthermore, a higher level of clinical disease activity and circulating inflammatory markers was associated with higher arterial 18F-FDG uptake, which may support a role of arterial wall inflammation in the pathogenesis of vascular complications in patients with RA.
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Affiliation(s)
- Rabia Agca
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, Reade.,Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center
| | - Annelies B Blanken
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, Reade
| | - Alper M van Sijl
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, Reade.,Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center
| | | | - Alexandre E Voskuyl
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center
| | - Conny van der Laken
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center
| | - Ronald Boellaard
- Department of Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, Reade.,Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center
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19
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Jaspers NEM, Visseren FLJ, van der Graaf Y, Smulders YM, Damman OC, Brouwers C, Rutten GEHM, Dorresteijn JAN. Communicating personalised statin therapy-effects as 10-year CVD-risk or CVD-free life-expectancy: does it improve decisional conflict? Three-armed, blinded, randomised controlled trial. BMJ Open 2021; 11:e041673. [PMID: 34272216 PMCID: PMC8287608 DOI: 10.1136/bmjopen-2020-041673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether communicating personalised statin therapy-effects obtained by prognostic algorithm leads to lower decisional conflict associated with statin use in patients with stable cardiovascular disease (CVD) compared with standard (non-personalised) therapy-effects. DESIGN Hypothesis-blinded, three-armed randomised controlled trial SETTING AND PARTICIPANTS: 303 statin users with stable CVD enrolled in a cohort INTERVENTION: Participants were randomised in a 1:1:1 ratio to standard practice (control-group) or one of two intervention arms. Intervention arms received standard practice plus (1) a personalised health profile, (2) educational videos and (3) a structured telephone consultation. Intervention arms received personalised estimates of prognostic changes associated with both discontinuation of current statin and intensification to the most potent statin type and dose (ie, atorvastatin 80 mg). Intervention arms differed in how these changes were expressed: either change in individual 10-year absolute CVD risk (iAR-group) or CVD-free life-expectancy (iLE-group) calculated with the SMART-REACH model (http://U-Prevent.com). OUTCOME Primary outcome was patient decisional conflict score (DCS) after 1 month. The score varies from 0 (no conflict) to 100 (high conflict). Secondary outcomes were collected at 1 or 6 months: DCS, quality of life, illness perception, patient activation, patient perception of statin efficacy and shared decision-making, self-reported statin adherence, understanding of statin-therapy, post-randomisation low-density lipoprotein cholesterol level and physician opinion of the intervention. Outcomes are reported as median (25th- 75th percentile). RESULTS Decisional conflict differed between the intervention arms: median control 27 (20-43), iAR-group 22 (11-30; p-value vs control 0.001) and iLE-group 25 (10-31; p-value vs control 0.021). No differences in secondary outcomes were observed. CONCLUSION In patients with clinically manifest CVD, providing personalised estimations of treatment-effects resulted in a small but significant decrease in decisional conflict after 1 month. The results support the use of personalised predictions for supporting decision-making. TRIAL REGISTRATION NTR6227/NL6080.
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Affiliation(s)
- Nicole E M Jaspers
- University Medical Center Utrecht, Department of Vascular Medicine, Utrecht University, Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- University Medical Center Utrecht, Department of Vascular Medicine, Utrecht University, Utrecht, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, Utrecht, The Netherlands
| | - Yvo M Smulders
- University Medical Centre, Department of Internal Medicine, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, North-Holland, The Netherlands
| | - Corline Brouwers
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, North-Holland, The Netherlands
| | - Guy E H M Rutten
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- University Medical Center Utrecht, Department of Vascular Medicine, Utrecht University, Utrecht, Utrecht, The Netherlands
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20
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Sikkens JJ, Buis DTP, Peters EJG, Dekker M, Schinkel M, Reijnders TDY, Schuurman AR, de Brabander J, Lavell AHA, Maas JJ, Koopsen J, Han AX, Russell CA, Schinkel J, Jonges M, Matamoros S, Jurriaans S, van Mansfeld R, Wiersinga WJ, Smulders YM, de Jong MD, Bomers MK. Serologic Surveillance and Phylogenetic Analysis of SARS-CoV-2 Infection Among Hospital Health Care Workers. JAMA Netw Open 2021; 4:e2118554. [PMID: 34319354 PMCID: PMC9437910 DOI: 10.1001/jamanetworkopen.2021.18554] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE It is unclear when, where, and by whom health care workers (HCWs) working in hospitals are infected with SARS-CoV-2. OBJECTIVE To determine how often and in what manner nosocomial SARS-CoV-2 infection occurs in HCW groups with varying exposure to patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This cohort study comprised 4 weekly measurements of SARS-CoV-2-specific antibodies and collection of questionnaires from March 23 to June 25, 2020, combined with phylogenetic and epidemiologic transmission analyses at 2 university hospitals in the Netherlands. Included individuals were HCWs working in patient care for those with COVID-19, HCWs working in patient care for those without COVID-19, and HCWs not working in patient care. Data were analyzed from August through December 2020. EXPOSURES Varying work-related exposure to patients infected with SARS-CoV-2. MAIN OUTCOMES AND MEASURES The cumulative incidence of and time to SARS-CoV-2 infection, defined as the presence of SARS-CoV-2-specific antibodies in blood samples, were measured. RESULTS Among 801 HCWs, there were 439 HCWs working in patient care for those with COVID-19, 164 HCWs working in patient care for those without COVID-19, and 198 HCWs not working in patient care. There were 580 (72.4%) women, and the median (interquartile range) age was 36 (29-50) years. The incidence of SARS-CoV-2 was increased among HCWs working in patient care for those with COVID-19 (54 HCWs [13.2%; 95% CI, 9.9%-16.4%]) compared with HCWs working in patient care for those without COVID-19 (11 HCWs [6.7%; 95% CI, 2.8%-10.5%]; hazard ratio [HR], 2.25; 95% CI, 1.17-4.30) and HCWs not working in patient care (7 HCWs [3.6%; 95% CI, 0.9%-6.1%]; HR, 3.92; 95% CI, 1.79-8.62). Among HCWs caring for patients with COVID-19, SARS-CoV-2 cumulative incidence was increased among HCWs working on COVID-19 wards (32 of 134 HCWs [25.7%; 95% CI, 17.6%-33.1%]) compared with HCWs working on intensive care units (13 of 186 HCWs [7.1%; 95% CI, 3.3%-10.7%]; HR, 3.64; 95% CI, 1.91-6.94), and HCWs working in emergency departments (7 of 102 HCWs [8.0%; 95% CI, 2.5%-13.1%]; HR, 3.29; 95% CI, 1.52-7.14). Epidemiologic data combined with phylogenetic analyses on COVID-19 wards identified 3 potential HCW-to-HCW transmission clusters. No patient-to-HCW transmission clusters could be identified in transmission analyses. CONCLUSIONS AND RELEVANCE This study found that HCWs working on COVID-19 wards were at increased risk for nosocomial SARS-CoV-2 infection with an important role for HCW-to-HCW transmission. These findings suggest that infection among HCWs deserves more consideration in infection prevention practice.
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Affiliation(s)
- Jonne J. Sikkens
- Department of Internal Medicine, Amsterdam
Infection and Immunity Institute, Amsterdam University Medical Centers, Vrije
Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David T. P. Buis
- Department of Internal Medicine, Amsterdam
Infection and Immunity Institute, Amsterdam University Medical Centers, Vrije
Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Edgar J. G. Peters
- Section Infectious Diseases, Department of
Internal Medicine, Amsterdam Infection and Immunity Institute, Amsterdam University
Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mireille Dekker
- Department of Medical Microbiology and Infection
Prevention, Amsterdam Infection and Immunity Institute, Amsterdam University Medical
Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michiel Schinkel
- Center for Experimental Molecular Medicine,
Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers,
University of Amsterdam, Amsterdam, the Netherlands
| | - Tom D. Y. Reijnders
- Center for Experimental Molecular Medicine,
Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers,
University of Amsterdam, Amsterdam, the Netherlands
| | - Alex. R. Schuurman
- Center for Experimental Molecular Medicine,
Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers,
University of Amsterdam, Amsterdam, the Netherlands
| | - Justin de Brabander
- Center for Experimental Molecular Medicine,
Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers,
University of Amsterdam, Amsterdam, the Netherlands
| | - A. H. Ayesha Lavell
- Department of Internal Medicine, Amsterdam
Infection and Immunity Institute, Amsterdam University Medical Centers, Vrije
Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jaap J. Maas
- Department of Occupational Health and Safety,
Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the
Netherlands
| | - Jelle Koopsen
- Department of Medical Microbiology and Infection
Prevention, Amsterdam University Medical Centers, University of Amsterdam,
Amsterdam, the Netherlands
| | - Alvin X. Han
- Department of Medical Microbiology and Infection
Prevention, Amsterdam University Medical Centers, University of Amsterdam,
Amsterdam, the Netherlands
| | - Colin A. Russell
- Department of Medical Microbiology and Infection
Prevention, Amsterdam University Medical Centers, University of Amsterdam,
Amsterdam, the Netherlands
| | - Janke Schinkel
- Department of Medical Microbiology and Infection
Prevention, Amsterdam University Medical Centers, University of Amsterdam,
Amsterdam, the Netherlands
| | - Marcel Jonges
- Department of Medical Microbiology and Infection
Prevention, Amsterdam University Medical Centers, University of Amsterdam,
Amsterdam, the Netherlands
| | - Sébastien Matamoros
- Department of Medical Microbiology and Infection
Prevention, Amsterdam University Medical Centers, University of Amsterdam,
Amsterdam, the Netherlands
| | - Suzanne Jurriaans
- Department of Medical Microbiology and Infection
Prevention, Amsterdam University Medical Centers, University of Amsterdam,
Amsterdam, the Netherlands
| | - Rosa van Mansfeld
- Department of Medical Microbiology and Infection
Prevention, Amsterdam University Medical Centers, University of Amsterdam,
Amsterdam, the Netherlands
| | - W. Joost Wiersinga
- Division of Infectious Diseases, Department of
Internal Medicine, Amsterdam Infection and Immunity Institute, Amsterdam University
Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Yvo M. Smulders
- Department of Internal Medicine, Amsterdam
Infection and Immunity Institute, Amsterdam University Medical Centers, Vrije
Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Menno D. de Jong
- Department of Medical Microbiology and Infection
Prevention, Amsterdam University Medical Centers, University of Amsterdam,
Amsterdam, the Netherlands
| | - Marije K. Bomers
- Section Infectious Diseases, Department of
Internal Medicine, Amsterdam Infection and Immunity Institute, Amsterdam University
Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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21
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Knip JJ, Voskuyl AE, Smulders YM. [Systemic autoimmune diseases; diagnostics versus classification]. Ned Tijdschr Geneeskd 2021; 165:D5744. [PMID: 34346619] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Systemic autoimmune diseases are characterized by their heterogenic clinical presentations and often poorly understood pathogenesis. As such, the diagnosis process may be complex and the final diagnosis is made by an expert, after considering a differential diagnosis. Classification criteria are developed for research purposes to select homogenous populations of already diagnosed patients. In clinical practice, these classification criteria are sometimes misused as diagnostic criteria. We describe three patient histories. Two patients met the classification criteria of several separate diseases, emphasizing the amount of overlap between different sets of criteria and the necessity of making a diagnosis before using classification criteria. A third patient was diagnosed with systemic sclerosis and later developed rheumatoid arthritis; a diagnosis that could have been overlooked if classification criteria were used diagnostically. We describe the correct use of classification criteria in systemic autoimmune diseases and discuss what the diagnostic process is supposed to entail.
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Affiliation(s)
- J J Knip
- Spaarne Gasthuis, afd. Interne Geneeskunde, Haarlem/Hoofddorp
- Contact: J.J. Knip
| | - A E Voskuyl
- Amsterdam UMC, locatie VUmc, afd. Reumatologie en Klinische Immunologie, Amsterdam
| | - Y M Smulders
- Amsterdam UMC, locatie VUmc, afd. Interne Geneeskunde, Amsterdam
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22
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Röttgering JG, de Man AME, Schuurs TC, Wils EJ, Daniels JM, van den Aardweg JG, Girbes ARJ, Smulders YM. Determining a target SpO2 to maintain PaO2 within a physiological range. PLoS One 2021; 16:e0250740. [PMID: 33983967 PMCID: PMC8118260 DOI: 10.1371/journal.pone.0250740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Objective In the context of an ongoing debate on the potential risks of hypoxemia and hyperoxemia, it seems prudent to maintain the partial arterial oxygen pressure (PaO2) in a physiological range during administration of supplemental oxygen. The PaO2 and peripheral oxygen saturation (SpO2) are closely related and both are used to monitor oxygenation status. However, SpO2 values cannot be used as an exact substitute for PaO2. The aim of this study in acutely ill and stable patients was to determine at which SpO2 level PaO2 is more or less certain to be in the physiological range. Methods This is an observational study prospectively collecting data pairs of PaO2 and SpO2 values in patients admitted to the emergency room or intensive care unit (Prospective Inpatient Acutely ill cohort; PIA cohort). A second cohort of retrospective data of patients who underwent pulmonary function testing was also included (Retrospective Outpatient Pulmonary cohort; ROP cohort). Arterial hypoxemia was defined as PaO2 < 60 mmHg and hyperoxemia as PaO2 > 125 mmHg. The SpO2 cut-off values with the lowest risk of hypoxemia and hyperoxemia were determined as the 95th percentile of the observed SpO2 values corresponding with the observed hypoxemic and hyperoxemic PaO2 values. Results 220 data pairs were collected in the PIA cohort. 95% of hypoxemic PaO2 measurements occurred in patients with an SpO2 below 94%, and 95% of hyperoxemic PaO2 measurements occurred in patients with an SpO2 above 96%. Additionally in the 1379 data pairs of the ROP cohort, 95% of hypoxemic PaO2 measurements occurred in patients with an SpO2 below 93%. Conclusion The SpO2 level marking an increased risk of arterial hypoxemia is not substantially different in acutely ill versus stable patients. In acutely ill patients receiving supplemental oxygen an SpO2 target of 95% maximizes the likelihood of maintaining PaO2 in the physiological range.
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Affiliation(s)
- Jantine G. Röttgering
- Department of Intensive Care, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
- Institute for Cardiovascular Research (ICaR-VU), Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
- * E-mail:
| | - Angelique M. E. de Man
- Department of Intensive Care, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
- Institute for Cardiovascular Research (ICaR-VU), Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - Thomas C. Schuurs
- Department of Emergency Medicine, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, Zuid-Holland, The Netherlands
| | - Johannes M. Daniels
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | | | - Armand R. J. Girbes
- Department of Intensive Care, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
- Institute for Cardiovascular Research (ICaR-VU), Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - Yvo M. Smulders
- Institute for Cardiovascular Research (ICaR-VU), Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
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23
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Bakkum MJ, Schouten VL, Smulders YM, Nossent EJ, van Agtmael MA, Tuinman PR. Accelerated treatment with rtPA for pulmonary embolism induced circulatory arrest. Thromb Res 2021; 203:74-80. [PMID: 33971387 DOI: 10.1016/j.thromres.2021.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/17/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
Patients with circulatory arrest due to pulmonary embolism (PE) should be treated with fibrinolytics. Current guidelines do not specify which regimen to apply, and it has been suggested that the regimen of 100 mg rtPA/2 h should be used, because this is recommended for hemodynamic instable PE in the ESC/ERS Guideline. This two hour regimen, however, is incompatible with key principles of cardiopulmonary resuscitation (CPR), such as employment of interventions that allow fast evaluation of effectiveness, and limitation of the total duration of CPR to avoid poor neurological outcomes. Additionally, the low flow-state during CPR has important consequences for the pharmacokinetic properties of rtPA. Arguably, the volume of distribution is lower, the metabolism reduced and the half life time longer. Therefore, these changes largely discard the rationale to use high dosages of rtPA over a prolonged period of time. More importantly, these changes highlight that the guideline recommendations, based on studies in patients without circulatory arrest, cannot be easily translated to the situation of circulatory arrest. An accelerated regimen of rtPA (0.6 mg/kg/15 min., max 50 mg) is mentioned by the 2019 ESC/ERS Guideline. However, empirical support or a rationale is not provided. Due to the rarity of the situation and ethical difficulties associated with randomizing unconscious patients, a randomized head-to-head comparison between the two regimens is unlikely to ever be performed. With this comprehensive overview of the pharmacokinetics of rtPA and current literature, a strong rationale is provided that the accelerated protocol is the regimen of choice for patients with PE-induced circulatory arrest.
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Affiliation(s)
- M J Bakkum
- Amsterdam UMC, Department of Internal Medicine, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - V L Schouten
- Amsterdam UMC, Department of Intensive Care Medicine, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Noordwest Ziekenhuisgroep, Department of Intensive Care, Location Alkmaar and Den Helder, Wilhelminalaan 12, 1815 JD Alkmaar, the Netherlands
| | - Y M Smulders
- Amsterdam UMC, Department of Internal Medicine, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - E J Nossent
- Amsterdam UMC, Department of Pulmonology, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - M A van Agtmael
- Amsterdam UMC, Department of Internal Medicine, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - P R Tuinman
- Amsterdam UMC, Department of Intensive Care Medicine, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
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24
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Blanken AB, Agca R, van Sijl AM, Voskuyl AE, Boellaard R, Smulders YM, van der Laken CJ, Nurmohamed MT. Arterial wall inflammation in rheumatoid arthritis is reduced by anti-inflammatory treatment. Semin Arthritis Rheum 2021; 51:457-463. [PMID: 33770536 DOI: 10.1016/j.semarthrit.2021.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) patients have an increased risk of cardiovascular disease (CVD), partly due to an increased prevalence of cardiovascular risk factors, but also due to chronic systemic inflammation inducing atherosclerotic changes of the arterial wall. The aim of this study was to determine whether anti-inflammatory therapy for the treatment of RA has favorable effects on arterial wall inflammation in RA patients. METHODS Arterial wall inflammation before and after 6 months of anti-inflammatory treatment was assessed in 49 early and established RA patients using 18F-fluorodeoxyglucose-positron emission tomography with computed tomography (18F-FDG-PET/CT). Arterial 18F-FDG uptake was quantified as maximum standardized uptake value (SUVmax) in the thoracic aorta, abdominal aorta, carotid, iliac and femoral arteries. Early RA patients (n = 26) were treated with conventional synthetic disease modifying anti-rheumatic drugs with or without corticosteroids, whereas established RA patients (n = 23) were treated with adalimumab. RESULTS In RA patients, overall SUVmax was over time reduced by 4% (difference -0.06, 95%CI -0.12 to -0.01, p = 0.02), with largest reductions in carotid (-8%, p = 0.001) and femoral arteries (-7%, p = 0.005). There was no difference in arterial wall inflammation change between early and established RA patients (SUVmax difference 0.003, 95%CI -0.11 to 0.12, p = 0.95). Change in arterial wall inflammation significantly correlated with change in serological inflammatory markers (erythrocyte sedimentation rate and C-reactive protein). CONCLUSION Arterial wall inflammation in RA patients is reduced by anti-inflammatory treatment and this reduction correlates with reductions of serological inflammatory markers. These results suggest that anti-inflammatory treatment of RA has favorable effects on the risk of cardiovascular events in RA patients.
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Affiliation(s)
- Annelies B Blanken
- Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemstraat 2, PO box 58271, 1040 HG Amsterdam, the Netherlands; Amsterdam Rheumatology and immunology Center, location Amsterdam UMC, VU University Medical Center, Department of Rheumatology, Amsterdam, the Netherlands.
| | - Rabia Agca
- Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemstraat 2, PO box 58271, 1040 HG Amsterdam, the Netherlands; Amsterdam Rheumatology and immunology Center, location Amsterdam UMC, VU University Medical Center, Department of Rheumatology, Amsterdam, the Netherlands
| | - Alper M van Sijl
- Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemstraat 2, PO box 58271, 1040 HG Amsterdam, the Netherlands; Amsterdam Rheumatology and immunology Center, location Amsterdam UMC, VU University Medical Center, Department of Rheumatology, Amsterdam, the Netherlands
| | - Alexandre E Voskuyl
- Amsterdam Rheumatology and immunology Center, location Amsterdam UMC, VU University Medical Center, Department of Rheumatology, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Amsterdam UMC, location VU University Medical Center, Department of Nuclear Medicine, Amsterdam, the Netherlands
| | - Yvo M Smulders
- Amsterdam UMC, location VU University Medical Center, Department of Internal Medicine, Amsterdam, the Netherlands
| | - Conny J van der Laken
- Amsterdam Rheumatology and immunology Center, location Amsterdam UMC, VU University Medical Center, Department of Rheumatology, Amsterdam, the Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and immunology Center, location Reade, Department of Rheumatology, Dr. Jan van Breemstraat 2, PO box 58271, 1040 HG Amsterdam, the Netherlands; Amsterdam Rheumatology and immunology Center, location Amsterdam UMC, VU University Medical Center, Department of Rheumatology, Amsterdam, the Netherlands
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25
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de Vries TI, Westerink J, Bots ML, Asselbergs FW, Smulders YM, Visseren FLJ. Relationship between classic vascular risk factors and cumulative recurrent cardiovascular event burden in patients with clinically manifest vascular disease: results from the UCC-SMART prospective cohort study. BMJ Open 2021; 11:e038881. [PMID: 34006017 PMCID: PMC7942272 DOI: 10.1136/bmjopen-2020-038881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The aim of the current study was to assess the relationship between classic cardiovascular risk factors and risk of not only the first recurrent atherosclerotic cardiovascular event, but also the total number of non-fatal and fatal cardiovascular events in patients with recently clinically manifest cardiovascular disease (CVD). DESIGN Prospective cohort study. SETTING Tertiary care centre. PARTICIPANTS 7239 patients with a recent first manifestation of CVD from the prospective UCC-SMART (Utrecht Cardiovascular Cohort - Second Manifestations of ARTerial disease) cohort study. OUTCOME MEASURES Total cardiovascular events, including myocardial infarction, stroke, vascular interventions, major limb events and cardiovascular mortality. RESULTS During a median follow-up of 8.9 years, 1412 patients had one recurrent cardiovascular event, while 1290 patients had two or more recurrent events, with a total of 5457 cardiovascular events during follow-up. The HRs for the first recurrent event and cumulative event burden using Prentice-Williams-Peterson models, respectively, were 1.36 (95% CI 1.25 to 1.48) and 1.26 (95% CI 1.17 to 1.35) for smoking, 1.14 (95% CI 1.11 to 1.18) and 1.09 (95% CI 1.06 to 1.12) for non-high-density lipoprotein (HDL) cholesterol, and 1.05 (95% CI 1.03 to 1.07) and 1.04 (95% CI 1.03 to 1.06) for systolic blood pressure per 10 mm Hg. CONCLUSIONS In a cohort of patients with established CVD, systolic blood pressure, non-HDL cholesterol and current smoking are important risk factors for not only the first, but also subsequent recurrent events during follow-up. Recurrent event analysis captures the full cumulative burden of CVD in patients.
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Affiliation(s)
- Tamar Irene de Vries
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jan Westerink
- UMC Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, ICIN-Netherlands Heart Institute, Durrer Center for Cardiogenetic Research, University Medical Centre Utrecht, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Yvo M Smulders
- Department of Internal Medicine, Amsterdam UMC, Location VU University, Amsterdam, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, Utrecht University, Utrecht, The Netherlands
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26
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Affiliation(s)
| | - Frank H Bosch
- Radboudumc and Rijnstate Hospital, Nijmegen and Arnhem, the Netherlands (F.H.B.)
| | - Yvo M Smulders
- Amsterdam University Medical Center, Amsterdam, the Netherlands (Y.M.S.)
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27
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van Diemen JJK, Madsen MC, Vrancken P, de Bie K, van der Bom JG, Veen G, Bonten TN, Fuijkschot WW, Smulders YM, Thijs A. Evening aspirin intake results in higher levels of platelet inhibition and a reduction in reticulated platelets - a window of opportunity for patients with cardiovascular disease? Platelets 2020; 32:821-827. [PMID: 32838616 DOI: 10.1080/09537104.2020.1809643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiovascular events occur most frequently in the early morning. Similarly, the release of reticulated platelets (RP) by megakaryocytes has a peak in the late night and early morning. Which aspirin regimen most effectively inhibits platelets during these critical hours is unknown. Hence, the primary objective of this trial was to assess platelet function and RP levels at 8.00 AM, in stable cardiovascular (CVD) patients, during three different aspirin regimens. In this open-label randomized cross-over study subjects were allocated to three sequential aspirin regimens: once-daily (OD) 80 mg morning; OD-evening, and twice-daily (BID) 40 mg. Platelet function was measured at 8.00 AM & 8.00 PM by serum Thromboxane B2 (sTxB2) levels, the Platelet Function Analyzer (PFA)-200® Closure Time (CT), Aspirin Reaction Units (ARU, VerifyNow®), and RP levels. In total, 22 patients were included. At 8.00 AM, sTxB2 levels were the lowest after OD-evening in comparison with OD-morning (p = <0.01), but not in comparison with BID. Furthermore, RP levels were similar at 8.00 AM, but statistically significantly reduced at 8.00 PM after OD-evening (p = .01) and BID (p = .02) in comparison with OD-morning. OD-evening aspirin intake results in higher levels of platelet inhibition during early morning hours and results in a reduction of RP levels in the evening. These findings may, if confirmed by larger studies, be relevant to large groups of patients taking aspirin to reduce cardiovascular risk.
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Affiliation(s)
- J J K van Diemen
- Department of Internal Medicine, Amsterdam UMC, Location VU University, Amsterdam, The Netherlands
| | - M C Madsen
- Department of Internal Medicine, Amsterdam UMC, Location VU University, Amsterdam, The Netherlands
| | - P Vrancken
- Department of Internal Medicine, Amsterdam UMC, Location VU University, Amsterdam, The Netherlands
| | - K de Bie
- Department of Internal Medicine, Amsterdam UMC, Location VU University, Amsterdam, The Netherlands
| | - J G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,JJ Van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - G Veen
- Department of Cardiology, Amsterdam UMC, Location VU University, Amsterdam, The Netherlands
| | - T N Bonten
- Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - W W Fuijkschot
- Department of Internal Medicine, Amsterdam UMC, Location VU University, Amsterdam, The Netherlands
| | - Y M Smulders
- Department of Internal Medicine, Amsterdam UMC, Location VU University, Amsterdam, The Netherlands
| | - A Thijs
- Department of Internal Medicine, Amsterdam UMC, Location VU University, Amsterdam, The Netherlands
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28
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van den Oever IAM, Baniaamam M, Simsek S, Raterman HG, van Denderen JC, van Eijk IC, Peters MJL, van der Horst-Bruinsma IE, Smulders YM, Nurmohamed MT. The effect of anti-TNF treatment on body composition and insulin resistance in patients with rheumatoid arthritis. Rheumatol Int 2020; 41:319-328. [PMID: 32776224 PMCID: PMC7835149 DOI: 10.1007/s00296-020-04666-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
Given the link between systemic inflammation, body composition and insulin resistance (IR), anti-inflammatory therapy may improve IR and body composition in inflammatory joint diseases. This study assesses the IR and beta cell function in rheumatoid arthritis (RA) patients with active disease compared to osteoarthritis (OA) patients and investigates the effect of anti-TNF treatment on IR, beta cell function and body composition in RA. 28 Consecutive RA patients starting anti-TNF treatment (adalimumab), and 28 age, and sex-matched patients with OA were followed for 6 months. Exclusion criteria were use of statins, corticosteroids, and cardiovascular or endocrine co-morbidity. Pancreatic beta cell function and IR, using the homeostasis model assessment (HOMA2), and body composition, using dual-energy X-ray absorptiometry (DXA) were measured at baseline and 6 months. At baseline, IR [1.5 (1.1–1.8) vs. 0.7 (0.6–0.9), 100/%S] and beta cell function (133% vs. 102%) were significantly (p < 0.05) higher in RA patients with active disease as compared to OA patients. After 6 months of anti-TNF treatment, IR [1.5 (1.1–1.8) to 1.4 (1.1–1.7), p = 0.17] slightly improved and beta cell function [133% (115–151) to 118% (109–130), p <0.05] significantly improved. Improvement in IR and beta cell function was most pronounced in RA patients with highest decrease in CRP and ESR. Our observations indicate that IR and increased beta cell function are more common in RA patients with active disease. Anti-TNF reduced IR and beta cell function especially in RA patients with highest decrease in systemic inflammation and this effect was not explained by changes in body composition.
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Affiliation(s)
- I A M van den Oever
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Baniaamam
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands. .,Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - S Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - H G Raterman
- Department of Rheumatology, Northwest Clinics, Alkmaar, The Netherlands
| | - J C van Denderen
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - I C van Eijk
- Department of Rheumatology, Northwest Clinics, Alkmaar, The Netherlands
| | - M J L Peters
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - I E van der Horst-Bruinsma
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Y M Smulders
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
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29
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Turaihi AH, Serné EH, Molthoff CFM, Koning JJ, Knol J, Niessen HW, Goumans MJTH, van Poelgeest EM, Yudkin JS, Smulders YM, Jimenez CR, van Hinsbergh VWM, Eringa EC. Perivascular Adipose Tissue Controls Insulin-Stimulated Perfusion, Mitochondrial Protein Expression, and Glucose Uptake in Muscle Through Adipomuscular Arterioles. Diabetes 2020; 69:603-613. [PMID: 32005705 DOI: 10.2337/db18-1066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/24/2020] [Indexed: 11/13/2022]
Abstract
Insulin-mediated microvascular recruitment (IMVR) regulates delivery of insulin and glucose to insulin-sensitive tissues. We have previously proposed that perivascular adipose tissue (PVAT) controls vascular function through outside-to-inside communication and through vessel-to-vessel, or "vasocrine," signaling. However, direct experimental evidence supporting a role of local PVAT in regulating IMVR and insulin sensitivity in vivo is lacking. Here, we studied muscles with and without PVAT in mice using combined contrast-enhanced ultrasonography and intravital microscopy to measure IMVR and gracilis artery diameter at baseline and during the hyperinsulinemic-euglycemic clamp. We show, using microsurgical removal of PVAT from the muscle microcirculation, that local PVAT depots regulate insulin-stimulated muscle perfusion and glucose uptake in vivo. We discovered direct microvascular connections between PVAT and the distal muscle microcirculation, or adipomuscular arterioles, the removal of which abolished IMVR. Local removal of intramuscular PVAT altered protein clusters in the connected muscle, including upregulation of a cluster featuring Hsp90ab1 and Hsp70 and downregulation of a cluster of mitochondrial protein components of complexes III, IV, and V. These data highlight the importance of PVAT in vascular and metabolic physiology and are likely relevant for obesity and diabetes.
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Affiliation(s)
- Alexander H Turaihi
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Erik H Serné
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Carla F M Molthoff
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jasper J Koning
- Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jaco Knol
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Hans W Niessen
- Department of Pathology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marie Jose T H Goumans
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik M van Poelgeest
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, U.K
| | - Yvo M Smulders
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Connie R Jimenez
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Victor W M van Hinsbergh
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Etto C Eringa
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
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30
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Msoka TF, Van Guilder GP, Smulders YM, van Furth M, Bartlett JA, van Agtmael MA. Correction to: Association of HIV-infection, antiretroviral treatment and metabolic syndrome with large artery stiffness: a cross-sectional study. BMC Infect Dis 2019; 19:187. [PMID: 30795748 PMCID: PMC6387487 DOI: 10.1186/s12879-019-3728-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 11/11/2022] Open
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31
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Kleipool EE, Dorresteijn JA, Smulders YM, Visseren FL, Peters MJ, Muller M. Treatment of hypercholesterolaemia in older adults calls for a patient-centred approach. Heart 2019; 106:261-266. [PMID: 31780523 PMCID: PMC7027025 DOI: 10.1136/heartjnl-2019-315600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/01/2019] [Accepted: 10/16/2019] [Indexed: 12/21/2022] Open
Abstract
Due to an increasing number of older adults with (risk factors for) cardiovascular disease (CVD), the sum of older adults eligible for lipid-lowering drugs will increase. This has risen questions about benefits and harms of lipid-lowering therapy in older adults with a varying number of (cardiovascular) comorbidities and functional status. The heterogeneity in physical and functional health increases with age, leading to a much wider variety in cardiovascular risk and life expectancy than in younger adults. We suggest treatment decisions on hypercholesterolaemia in adults aged ≥75 years should shift from a strictly 10-year cardiovascular risk-driven approach to a patient-centred and lifetime benefit-based approach. With this, estimated 10-year risk of CVD should be placed into the perspective of life expectancy. Moreover, frailty and safety concerns must be taken into account for a risk–benefit discussion between clinician and patient. Based on the Dutch addendum ‘Cardiovascular Risk Management in (frail) older adults’, our approach offers more detailed information on when not to initiate or deprescribe therapy than standard guidelines. Instead of using traditional risk estimating tools which tend to overestimate risk of CVD in older adults, use a competing risk adjusted, older adults-specific risk score (available at https://u-prevent.com). By filling in a patient’s (cardiovascular) health profile (eg, cholesterol, renal function), the tool estimates risk of CVD and models the effect of medication in terms of absolute risk reduction for an individual patient. Using this tool can guide doctors and patients in making shared decisions on initiating, continuing or deprescribing lipid-lowering therapy.
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Affiliation(s)
- Emma Ef Kleipool
- Internal medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Yvo M Smulders
- Internal medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lj Visseren
- Vascular medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mike Jl Peters
- Internal medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Majon Muller
- Internal medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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32
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Jaspers NEM, Visseren FLJ, Van Der Graaf Y, Damman OC, Smulders YM, Dorresteijn JAN. P646Effects of personalized therapy-effect predictions on statin treatment decisions by patients and physicians: a three-armed, blinded, randomized controlled trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Several online tools express an individual's therapy-benefit for various cardiovascular disease (CVD) prevention strategies. The benefit can be expressed in multiple formats, such as absolute 10-year CVD risk reduction or gain in CVD-free life-years. It is increasingly suggested that these estimates can be used in doctor-patient communication to support shared decision-making. However, the actual therapy-benefit to be expected from preventive therapy might be small from the perspective of patients, and it remains unclear how the estimates affect patient and physician decision-making.
Purpose
The primary objective was to determine whether communicating personalized predictions of prognosis and treatment-effects (compared to non-personalized standard practice) leads to lower decisional conflict among patients with stable CVD and prescribed statin medication.
Methods
A hypothesis-blinded, three-armed randomized controlled trial was performed in which 303 patients were randomized in a 1:1:1 ratio to either standard practice (control-group) or to one of two intervention arms. Intervention arms received personalized estimates of prognostic changes associated with both discontinuation of current statin and intensification to the most potent statin type and dose (atorvastatin 80 mg). Intervention arms differed only in the format of the treatment effect estimates: change in personal 10-year absolute CVD risk (iAR-group) or CVD-free life-expectancy (iLE-group). Primary outcome was patient decisional conflict score (DCS) after one-month, which varies from 0 (no conflict) to 100 (high conflict). Secondary outcomes were collected at one or six months: DCS, quality of life, illness perception, patient activation, patient perception of statin efficacy and shared decision-making, self-reported statin adherence, understanding of statin-therapy, post-randomization low-density lipoprotein cholesterol levels, and physician opinion of statin therapy decisions and the intervention. Outcomes are reported as median (25th–75th percentile).
Results
In the iAR group, the change in 10-year absolute CVD-risk was −2.4 (−1.2 to −3.9%) from intensification and +10.2% (+7.7 to +13.5) from discontinuation. In the iLE group, the change in CVD-free life-expectancy was +0.5 years (+0.3 to +0.8) from intensification and −2.0 years (−1.3 to −2.8) from discontinuation. Decisional conflict differed between the intervention arms: median control 27 (20–43), iAR-group 22 (11–30; p-value versus control 0.002), and iLE-group 25 (10–31; p-value versus control 0.02). No differences in secondary outcomes were observed.
Figure 1. Part of the personalized information received by iAR-group (left) and iLE-group (right).
Conclusion
In patients with clinically manifest CVD, providing personalized estimations of treatment-effects lowers decisional conflict associated with statin use. The results support the use of personalized predictions for patient decision making.
Acknowledgement/Funding
Partially funded by a Netherlands Heart Foundation grant (2016T026)
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Affiliation(s)
- N E M Jaspers
- University Medical Center Utrecht, Vascular Medicine, Utrecht, Netherlands (The)
| | - F L J Visseren
- University Medical Center Utrecht, Vascular Medicine, Utrecht, Netherlands (The)
| | - Y Van Der Graaf
- Julius Health Center - Julius Gezondheidscentra, Utrecht, Netherlands (The)
| | - O C Damman
- VU University Amsterdam, Amsterdam, Netherlands (The)
| | - Y M Smulders
- VU University Medical Center, Amsterdam, Netherlands (The)
| | - J A N Dorresteijn
- University Medical Center Utrecht, Vascular Medicine, Utrecht, Netherlands (The)
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33
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van Diemen JJK, van Dijk A, Racca C, Knol T, Bonten TN, Numans ME, Fuijkschot WW, Smulders YM, Thijs A. The viewing of a 'Bloodcurdling' horror movie increases platelet reactivity: A randomized cross-over study in healthy volunteers. Thromb Res 2019; 182:27-32. [PMID: 31442695 DOI: 10.1016/j.thromres.2019.07.028] [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: 03/25/2019] [Revised: 07/12/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Epidemiological studies have suggested an increased risk of cardiovascular events (CVE) during acute stressful and/or frightful moments. A possible explanation for this could be an effect of acute stress on hemostasis. A recent study demonstrated an increase in factor VIII after watching a horror movie. Primary hemostasis, however, is thought to play a more prominent role in the etiology of CVE. The objective of this study was therefore to assess the influence of viewing a 'bloodcurdling' horror movie on platelet reactivity in healthy volunteers. METHODS We performed a randomized cross-over study in healthy adults. Subjects were allocated to two movies in random sequence: a horror and a control movie. Blood was drawn at baseline and after 24 min of viewing time. The primary endpoint was the change in Platelet Function Analyzer® Closure Time (Δ PFA-CT) after watching the movie. RESULTS In total, 20 participants, aged 18-30 years, completed the study protocol. The delta PFA-CT was statistically significantly shorter with a mean in the delta difference of -9.7 s (SEM 4.0, 95% C.I. -18.0 to -1.3) during the horror movie versus the control movie. The Light Transmission Aggregometry endpoints were in line with the PFA-CT, albeit only the highest level of Arachidonic Acid agonist demonstrated a statistically significant mean difference in the delta of aggregation of 13.15% (SEM 7.0, 95% C.I. 1.6-27.9). CONCLUSION A 'blood curdling' horror movie increases platelet reactivity. These data are supportive of a role of platelet reactivity in acute stress induced cardiovascular event risk.
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Affiliation(s)
- J J K van Diemen
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, the Netherlands.
| | - A van Dijk
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, the Netherlands
| | - C Racca
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, the Netherlands
| | - T Knol
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, the Netherlands
| | - T N Bonten
- Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - M E Numans
- Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - W W Fuijkschot
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, the Netherlands
| | - Y M Smulders
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, the Netherlands
| | - A Thijs
- Department of Internal Medicine, Amsterdam University Medical Center, Location VU University Medical Center, Amsterdam, the Netherlands
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34
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Kleipool EEF, Nielen MMJ, Korevaar JC, Harskamp RE, Smulders YM, Serné E, Thijs A, Peters MJL, Muller M. Prescription patterns of lipid lowering agents among older patients in general practice: an analysis from a national database in the Netherlands. Age Ageing 2019; 48:577-582. [PMID: 31074492 DOI: 10.1093/ageing/afz034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/10/2019] [Accepted: 03/25/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Dutch cardiovascular risk management guidelines state almost every older adult (≥70 years) is eligible for a lipid lowering drug (LLD). However, life expectancy, frailty or comorbidities may influence this treatment decision. OBJECTIVE investigate how many older adults, according to age, frailty (Drubbel-frailty index) and comorbidities were prescribed LLDs. METHODS data of 244,328 adults ≥70 years from electronic health records of 415 Dutch general practices from 2011-15 were used. Number of LLD prescriptions in patients with (n = 55,309) and without (n = 189,019) cardiovascular disease (CVD) was evaluated according to age, frailty and comorbidities. RESULTS about 69% of adults ≥70 years with CVD and 36% without CVD were prescribed a LLD. LLD prescriptions decreased with age; with CVD: 78% aged 70-74 years and 29% aged ≥90 years were prescribed a LLD, without CVD: 37% aged 70-74 years and 12% aged ≥90 years. In patients with CVD and within each age group, percentage of LLD prescriptions was 20% point(pp) higher in frail compared with non-frail. In patients without CVD, percentage of LLD prescriptions in frail patients was 11pp higher in adults aged 70-74 years and 40pp higher in adults aged ≥90 years compared to non-frail. Similar trends were seen in the analyses with number of comorbidities. CONCLUSION in an older population, LLD prescriptions decreased with age but-contrary to our expectations-LLD prescriptions increased with higher frailty levels.
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Affiliation(s)
- E E F Kleipool
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M M J Nielen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - J C Korevaar
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - R E Harskamp
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam, The Netherlands
| | - Y M Smulders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - E Serné
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - A Thijs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M J L Peters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M Muller
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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35
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van Broekhoven A, Krijnen PAJ, Fuijkschot WW, Morrison MC, Zethof IPA, van Wieringen WN, Smulders YM, Niessen HWM, Vonk ABA. Short-term LPS induces aortic valve thickening in ApoE*3Leiden mice. Eur J Clin Invest 2019; 49:e13121. [PMID: 31013351 DOI: 10.1111/eci.13121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Received: 10/22/2018] [Revised: 04/16/2019] [Accepted: 04/19/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recently, it was shown that 12 weeks of lipopolysaccharide (LPS) administration to nonatherosclerotic mice induced thickening of the aortic heart valve (AV). Whether such effects may also occur even earlier is unknown. As most patients with AV stenosis also have atherosclerosis, we studied the short-term effect of LPS on the AVs in an atherosclerotic mouse model. METHODS ApoE*3Leiden mice, on an atherogenic diet, were injected intraperitoneally with either LPS or phosphate buffered saline (PBS), and sacrificed 2 or 15 days later. AVs were assessed for size, fibrosis, glycosaminoglycans (GAGs), lipids, calcium deposits, iron deposits and inflammatory cells. RESULTS LPS injection caused an increase in maximal leaflet thickness at 2 days (128.4 µm) compared to PBS-injected mice (67.8 µm; P = 0.007), whereas at 15 days this was not significantly different. LPS injection did not significantly affect average AV thickness on day 2 (37.8 µm), but did significantly increase average AV thickness at day 15 (41.6 µm; P = 0.038) compared to PBS-injected mice (31.7 and 32.3 µm respectively). LPS injection did not affect AV fibrosis, GAGs and lipid content. Furthermore, no calcium deposits were found. Iron deposits, indicative for valve haemorrhage, were observed in one AV of the PBS-injected group (a day 2 mouse; 9.1%) and in five AVs of the LPS-injected group (both day 2- and 15 mice; 29.4%). No significant differences in inflammatory cell infiltration were observed upon LPS injection. CONCLUSION Short-term LPS apparently has the potential to increase AV thickening and haemorrhage. These results suggest that systemic inflammation can acutely compromise AV structure.
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Affiliation(s)
- Amber van Broekhoven
- Department of Pathology, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiac Surgery, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands
| | - Paul A J Krijnen
- Department of Pathology, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Wessel W Fuijkschot
- Department of Pathology, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands
| | - Martine C Morrison
- Department of Metabolic Health Research, The Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands
| | - Ilse P A Zethof
- Department of Pathology, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Wessel N van Wieringen
- Department of Epidemiology and Biostatistics, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands.,Department of Mathematics, VU University, Amsterdam, The Netherlands
| | - Yvo M Smulders
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands
| | - Hans W M Niessen
- Department of Pathology, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiac Surgery, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands
| | - Alexander B A Vonk
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiac Surgery, Amsterdam UMC-Location VUmc, Amsterdam, The Netherlands
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36
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Haven TL, Bouter LM, Smulders YM, Tijdink JK. Perceived publication pressure in Amsterdam: Survey of all disciplinary fields and academic ranks. PLoS One 2019; 14:e0217931. [PMID: 31216293 PMCID: PMC6583945 DOI: 10.1371/journal.pone.0217931] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 01/15/2019] [Accepted: 05/21/2019] [Indexed: 11/19/2022] Open
Abstract
Publications determine to a large extent the possibility to stay in academia ("publish or perish"). While some pressure to publish may incentivise high quality research, too much publication pressure is likely to have detrimental effects on both the scientific enterprise and on individual researchers. Our research question was: What is the level of perceived publication pressure in the four academic institutions in Amsterdam and does the pressure to publish differ between academic ranks and disciplinary fields? Investigating researchers in Amsterdam with the revised Publication Pressure Questionnaire, we find that a negative attitude towards the current publication climate is present across academic ranks and disciplinary fields. Postdocs and assistant professors (M = 3.42) perceive the greatest publication stress and PhD-students (M = 2.44) perceive a significant lack of resources to relieve publication stress. Results indicate the need for a healthier publication climate where the quality and integrity of research is rewarded.
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Affiliation(s)
- Tamarinde L. Haven
- Department of Philosophy, Vrije Universiteit, Amsterdam, North Holland, The Netherlands
| | - Lex M. Bouter
- Department of Philosophy, Vrije Universiteit, Amsterdam, North Holland, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUmc, Amsterdam, North Holland, The Netherlands
| | - Yvo M. Smulders
- Department of Internal Medicine, Amsterdam UMC, location VUmc, Amsterdam, North Holland, The Netherlands
| | - Joeri K. Tijdink
- Department of Philosophy, Vrije Universiteit, Amsterdam, North Holland, The Netherlands
- Department of Medical Humanities, Amsterdam UMC, location VUmc, Amsterdam, North Holland, The Netherlands
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37
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Heslinga M, Van Den Oever I, Jonker DL, Griep EN, Griep-Wentink H, Smulders YM, Lems WF, Boers M, Voskuyl AE, Peters M, Van Schaardenburg D, Nurmohamed MT. Suboptimal cardiovascular risk management in rheumatoid arthritis patients despite an explicit cardiovascular risk screening programme. Scand J Rheumatol 2019; 48:345-352. [PMID: 31210083 DOI: 10.1080/03009742.2019.1600718] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: In 2011, we started to offer cardiovascular (CV) risk screening to rheumatoid arthritis (RA) patients with a high CV risk. After 1 year, we assessed whether patients labelled as high CV risk had started preventive treatment when indicated, and whether the CV risk score had changed. Methods: CV risk screening was performed in both a large outpatient rheumatology clinic and a general hospital in the Netherlands, and the general practitioner or the internist was informed about the results of the CV screening, including specific advice on the initiation or adjustment of cardiopreventive drugs. National guidelines were used to assess how many patients were eligible for preventive treatment. After 1 year, CV risk, lifestyle, and treatment were re-evaluated. Patients with a history of CV disease at baseline or who experienced a CV event during follow-up were excluded from the analyses. Results: A high 10 year CV risk (> 20%) was present in 58%, and 55% had an indication for anti-hypertensives, statins, or both. At follow-up, cardiopreventive drug treatment had been started or adjusted in only one-third of patients with an indication for treatment. After screening, 42% of patients reported having changed their lifestyle, through more exercise (24%), diet adaption (20%), and weight loss (11%). Conclusion: Despite clear guidelines to improve CV risk, the results of a programme comprising active screening, targeted advice, and referral to the general practitioner or internist prove that primary prevention remains a major challenge in high-risk RA patients.
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Affiliation(s)
- M Heslinga
- Amsterdam Rheumatology and Immunology Center/Reade , Amsterdam , The Netherlands
| | - Iam Van Den Oever
- Amsterdam Rheumatology and Immunology Center/Reade , Amsterdam , The Netherlands
| | - D L Jonker
- Department of Rheumatology, Antonius Hospital , Sneek , The Netherlands
| | - E N Griep
- Department of Rheumatology, Antonius Hospital , Sneek , The Netherlands
| | - Hrm Griep-Wentink
- Department of Rheumatology, Antonius Hospital , Sneek , The Netherlands
| | - Y M Smulders
- Department of Internal Medicine, VU University Medical Center , Amsterdam , The Netherlands
| | - W F Lems
- Amsterdam Rheumatology and Immunology Center/Reade , Amsterdam , The Netherlands.,Amsterdam Rheumatology and Immunology Center/VU University Medical Center , Amsterdam , The Netherlands
| | - M Boers
- Amsterdam Rheumatology and Immunology Center/VU University Medical Center , Amsterdam , The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center , Amsterdam , The Netherlands
| | - A E Voskuyl
- Amsterdam Rheumatology and Immunology Center/VU University Medical Center , Amsterdam , The Netherlands
| | - Mjl Peters
- Department of Internal Medicine, VU University Medical Center , Amsterdam , The Netherlands
| | - D Van Schaardenburg
- Amsterdam Rheumatology and Immunology Center/Reade , Amsterdam , The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center , Amsterdam , The Netherlands
| | - M T Nurmohamed
- Amsterdam Rheumatology and Immunology Center/Reade , Amsterdam , The Netherlands.,Amsterdam Rheumatology and Immunology Center/VU University Medical Center , Amsterdam , The Netherlands.,Amsterdam Rheumatology and Immunology Center/AMC , Amsterdam , The Netherlands
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38
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Opstelten W, van der Valk PGM, Smulders YM. [Paraneoplastic syndromes]. Ned Tijdschr Geneeskd 2019; 163:D4143. [PMID: 31283129] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A paraneoplastic syndrome is a phenomenon or complex of symptoms that can occur with malignancy, without this being the result of tumour cells in the affected area. In this article, we describe the following paraneoplastic syndromes: thrombophlebitis migrans, clubbing, pemphigus, acanthosis nigricans, blue fingers, dermatomyositis, and myasthenia gravis.
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Affiliation(s)
- Wim Opstelten
- Huisartsenpraktijk Vondelplein, Amersfoort
- Contact: W. Opstelten
| | | | - Yvo M Smulders
- Amsterdam UMC, locatie VUmc, afd. Interne Geneeskunde, Amsterdam
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39
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Demirkiran A, Everaars H, Elitok A, van de Ven PM, Smulders YM, Dreijerink KM, Tanakol R, Ozcan M. Hypertension with primary aldosteronism is associated with increased carotid intima-media thickness and endothelial dysfunction. J Clin Hypertens (Greenwich) 2019; 21:932-941. [PMID: 31187936 PMCID: PMC6771730 DOI: 10.1111/jch.13585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 01/22/2023]
Abstract
Patients with primary aldosteronism induced hypertension are more likely to experience cardiovascular events compared to patients with essential hypertension. Primary aldosteronism may therefore have distinct adverse effects on cardiovascular structure and function, independent of hypertension. However, current data on such effects of primary aldosteronism are conflicting. The aim of the present study was to investigate the influence of primary aldosteronism on vascular structure and endothelial function, using intima‐media thickness as a vascular remodeling index and flow‐mediated dilation as a functional parameter. In total, 70 participants were recruited from patients with resistant hypertension. Twenty‐nine patients diagnosed with primary aldosteronism and 41 patients with essential hypertension were prospectively enrolled. Primary aldosteronism was due to aldosterone‐producing adenoma in 10 cases and due to idiopathic adrenal hyperplasia in 19 cases. All patients underwent ultrasound of the common carotid intima‐media thickness and flow‐mediated dilation of the brachial artery. Primary aldosteronism patients had significantly lower flow‐mediated dilation (3.3 [2.4‐7.4] % vs 14.7 [10.3‐19.9] %, P < 0.01) and significantly higher carotid intima‐media thickness (0.9 [0.7‐1.0] mm vs 0.8 [0.6‐0.9] mm, P = 0.02) compared to patients with essential hypertension. These differences remained significant after adjusting for age, sex, diabetes mellitus, 24‐hours systolic blood pressure, and smoking (P < 0.01). No differences in either outcome were observed between the adenoma and adrenal hyperplasia groups (both P > 0.05). Hypertensive patients with hyperaldosteronism appear to exhibit deteriorative effects on both vascular structure and function, independent of hypertension.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ali Elitok
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Yvo M Smulders
- Division of Vascular Medicine, Department of Internal Medicine, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Koen M Dreijerink
- Division of Endocrinology, Department of Internal Medicine, Amsterdam University Medical Center - Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Refik Tanakol
- Division of Endocrinology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Ozcan
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Abstract
OBJECTIVES Electronic dance music (EDM) concerts are becoming increasingly popular. Strong stroboscopic light effects are commonly part of these shows, and may provoke seizures in individuals with photosensitive epilepsy. This study aims to examine the risk of epileptic seizures during EDM concerts. SETTING 28 EDM concerts taking place in The Netherlands. PARTICIPANTS We describe a young man who experienced a seizure during an EDM concert, and who later showed a positive electroencephalographic provocation test during exposure to video footage of the same concert. Subsequently, we performed a cohort study of 400 343 visitors to EDM concerts, divided in those exposed (concert occurring in darkness) versus unexposed (concert in daylight) to stroboscopic light effects. RESULTS In total, 400 343 EDM concert visitors were included: 241 543 (representing 2 222 196 person hours) in the exposed group and 158 800 (representing 2 334 360 person hours) in the control group. The incidence density ratio of epileptic seizures in exposed versus unexposed individuals was 3.5 (95% CI: 1.7 to 7.8; p<0.0005). Less than one-third of cases occurred during use of ecstasy or similar stimulant drugs. CONCLUSION Stroboscopic light effects during EDM concerts occurring in darkness probably more than triple the risk of epileptic seizures. Concert organisers and audience should warn against the risk of seizures and promote precautionary measures in susceptible individuals.
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Affiliation(s)
- Newel Salet
- Department of Internal Medicine, VU Medisch Centrum, Amsterdam, Noord-Holland, The Netherlands
| | - Marieke Visser
- Neurology, VUmc University Medical Centre, Amsterdam, The Netherlands
| | - Cornelis Stam
- Department of Clinical Neurophysiology and MEG Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Yvo M Smulders
- Internal Medicine, VUmc University Medical Centre, Amsterdam, The Netherlands
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41
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Meijer RI, Hoevenaars FPM, Serné EH, Yudkin JS, Kokhuis TJA, Weijers EM, van Hinsbergh VWM, Smulders YM, Eringa EC. JNK2 in myeloid cells impairs insulin's vasodilator effects in muscle during early obesity development through perivascular adipose tissue dysfunction. Am J Physiol Heart Circ Physiol 2019; 317:H364-H374. [PMID: 31149833 DOI: 10.1152/ajpheart.00663.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Reduced vasodilator properties of insulin in obesity are caused by changes in perivascular adipose tissue and contribute to microvascular dysfunction in skeletal muscle. The causes of this dysfunction are unknown. The effects of a short-term Western diet on JNK2-expressing cells in perivascular adipose tissue (PVAT) on insulin-induced vasodilation and perfusion of skeletal muscle were assessed. In vivo, 2 wk of Western diet (WD) reduced whole body insulin sensitivity and insulin-stimulated muscle perfusion, determined using contrast ultrasonography during the hyperinsulinemic clamp. Ex vivo, WD triggered accumulation of PVAT in skeletal muscle and blunted its ability to facilitate insulin-induced vasodilation. Labeling of myeloid cells with green fluorescent protein identified bone marrow as a source of PVAT in muscle. To study whether JNK2-expressing inflammatory cells from bone marrow were involved, we transplanted JNK2-/- bone marrow to WT mice. Deletion of JNK2 in bone marrow rescued the vasodilator phenotype of PVAT during WD exposure. JNK2 deletion in myeloid cells prevented the WD-induced increase in F4/80 expression. Even though WD and JNK2 deletion resulted in specific changes in gene expression of PVAT; epididymal and subcutaneous adipose tissue; expression of tumor necrosis factor-α, interleukin-1β, interleukin-6, or protein inhibitor of STAT1 was not affected. In conclusion, short-term Western diet triggers infiltration of JNK2-positive myeloid cells into PVAT, resulting in PVAT dysfunction, nonclassical inflammation, and loss of insulin-induced vasodilatation in vivo and ex vivo.NEW & NOTEWORTHY We demonstrate that in the earliest phase of weight gain, changes in perivascular adipose tissue in muscle impair insulin-stimulated muscle perfusion. The hallmark of these changes is infiltration by inflammatory cells. Deletion of JNK2 from the bone marrow restores the function of perivascular adipose tissue to enhance insulin's vasodilator effects in muscle, showing that the bone marrow contributes to regulation of muscle perfusion.
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Affiliation(s)
- Rick I Meijer
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Femke P M Hoevenaars
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Erik H Serné
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - John S Yudkin
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands.,Department of Medicine, University College London, London, United Kingdom
| | - Tom J A Kokhuis
- Biomedical Engineering, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ester M Weijers
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Victor W M van Hinsbergh
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Yvo M Smulders
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Etto C Eringa
- Department of Physiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
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42
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Agca R, Hopman LHGA, Laan KJC, van Halm VP, Peters MJL, Smulders YM, Dekker JM, Nijpels G, Stehouwer CDA, Voskuyl AE, Boers M, Lems WF, Nurmohamed MT. Cardiovascular Event Risk in Rheumatoid Arthritis Compared with Type 2 Diabetes: A 15-year Longitudinal Study. J Rheumatol 2019; 47:316-324. [PMID: 31092721 DOI: 10.3899/jrheum.180726] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Cardiovascular (CV) disease (CVD) risk is increased in rheumatoid arthritis (RA). However, longterm followup studies investigating this risk are scarce. METHODS The CARRÉ (CARdiovascular research and RhEumatoid arthritis) study is a prospective cohort study investigating CVD and its risk factors in 353 patients with longstanding RA. CV endpoints were assessed at baseline and 3, 10, and 15 years after the start of the study and are compared to a reference cohort (n = 2540), including a large number of patients with type 2 diabetes (DM). RESULTS Ninety-five patients with RA developed a CV event over 2973 person-years, resulting in an incidence rate of 3.20 per 100 person-years. Two hundred fifty-seven CV events were reported in the reference cohort during 18,874 person-years, resulting in an incidence rate of 1.36 per 100 person-years. Age- and sex-adjusted HR for CV events were increased for RA (HR 2.07, 95% CI 1.57-2.72, p < 0.01) and DM (HR 1.51, 95% CI 1.02-2.22, p = 0.04) compared to the nondiabetic participants. HR was still increased in RA (HR 1.82, 95% CI 1.32-2.50, p < 0.01) after additional adjustment for CV risk factors. Patients with both RA and DM or insulin resistance had the highest HR for developing CVD (2.21, 95% CI 1.01-4.80, p = 0.046 and 2.67, 95% CI 1.30-5.46, p < 0.01, respectively). CONCLUSION The incidence rate of CV events in established RA was more than double that of the general population. Patients with RA have an even higher risk of CVD than patients with DM. This risk remained after adjustment for traditional CV risk factors, suggesting that systemic inflammation is an independent contributor to CV risk.
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Affiliation(s)
- Rabia Agca
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands. .,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam.
| | - Luuk H G A Hopman
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Koen J C Laan
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Vokko P van Halm
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Mike J L Peters
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Yvo M Smulders
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Jacqueline M Dekker
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Giel Nijpels
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Coen D A Stehouwer
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Alexandre E Voskuyl
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Maarten Boers
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Willem F Lems
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Michael T Nurmohamed
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
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Smulders YM. [Lifestyle intervention in the consulting room: high-hanging fruit]. Ned Tijdschr Geneeskd 2019; 163:D3809. [PMID: 30816661] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The attributable risk of lifestyle factors for the development of diabetes, hypertension, and related disorders is very large. To what extent this attributable risk translates into potential for prevention and treatment in the consulting room in much less clear. Previous trials showing effects of lifestyle interventions have often been characterized by intensive patient education and stimulation programmes, which may be difficult to implement in everyday practice. Also, the effectiveness of interventions decreases as the intensity of patient support decreases. Unless intensive patient support programmes are developed and financed in general practitioners' practices, population-based strategies may be more effective in terms of reducing the disease load of lifestyle-associated diseases.
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Affiliation(s)
- Yvo M Smulders
- Amsterdam UMC, locatie VUmc, afdeling Interne Geneekunde
- Contact: Y. Smulders
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Smit B, Smulders YM, Eringa EC, Gelissen HPMM, Girbes ARJ, de Grooth HJS, Schotman HHM, Scheffer PG, Oudemans-van Straaten HM, Spoelstra-de Man AME. Hyperoxia does not affect oxygen delivery in healthy volunteers while causing a decrease in sublingual perfusion. Microcirculation 2018; 25. [PMID: 29210137 PMCID: PMC5838560 DOI: 10.1111/micc.12433] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/27/2017] [Indexed: 12/17/2022]
Abstract
Objective To determine the human dose‐response relationship between a stepwise increase in arterial oxygen tension and its associated changes in DO2 and sublingual microcirculatory perfusion. Methods Fifteen healthy volunteers breathed increasing oxygen fractions for 10 minutes to reach arterial oxygen tensions of baseline (breathing air), 20, 40, 60 kPa, and max kPa (breathing oxygen). Systemic hemodynamics were measured continuously by the volume‐clamp method. At the end of each period, the sublingual microcirculation was assessed by SDF. Results Systemic DO2 was unchanged throughout the study (Pslope = .8). PVD decreased in a sigmoidal fashion (max −15% while breathing oxygen, SD18, Pslope = .001). CI decreased linearly (max −10%, SD10, Pslope < .001) due to a reduction in HR (max −10%, SD7, Pslope = .009). There were no changes in stroke volume or MAP. Most changes became apparent above an arterial oxygen tension of 20 kPa. Conclusions In healthy volunteers, supraphysiological arterial oxygen tensions have no effect on systemic DO2. Sublingual microcirculatory PVD decreased in a dose‐dependent fashion. All hemodynamic changes appear negligible up to an arterial oxygen tension of 20 kPa.
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Affiliation(s)
- Bob Smit
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Yvo M Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Etto C Eringa
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Harry P M M Gelissen
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Armand R J Girbes
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Harm-Jan S de Grooth
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Hans H M Schotman
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter G Scheffer
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
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van Lieshout CT, Tijdink JK, Smulders YM. Conflict of interest disclosure slides at the European Society of Cardiology Congress 2016 in Rome: are they displayed long enough to assess their content? A cross-sectional study. BMJ Open 2018; 8:e023534. [PMID: 30413513 PMCID: PMC6231600 DOI: 10.1136/bmjopen-2018-023534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To assess the duration of display of conflict of interest (COI) disclosure slides of presentations at the European Society of Cardiology (ESC) Congress 2016, and to identify factors associated with the duration of display of the disclosure slide. DESIGN Cross-sectional observational study. OUTCOME MEASURES Display duration of the COI disclosure slide and display duration per disclosure. RESULTS Analysis of official video recordings of all oral presentations, viewed on the ESC website. 1673 oral presentations were analysed. In 706 presentations (42.2%), COIs were present on the disclosure slide. The median display duration of the disclosure slide was 2.49 s (minimum value: 0.16 s; IQR 1.47-4.08). In multivariable analysis, time spent on COI disclosures was positively related to the number of COIs (+0.11 s per extra COI), older estimated age of the speaker (+3.92 s for 75-85 years compared with <25 years), verbally commenting on disclosures (up to +8.25 s) and disclosures being of a non-commercial nature (+2.83 s). In addition, speakers from Eastern, Southern and Western Europe, Africa+East Asia and Asia showed their disclosures significantly shorter than the reference group (Northern Europe). CONCLUSION COI disclosure slides are often displayed too briefly to reasonably assess their content. Several factors appear to influence the duration of display of the COI disclosure slides, but none do so to the degree that the display duration becomes sufficiently long.
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Affiliation(s)
| | - Joeri K Tijdink
- Department of Philosophy, VU University, Amsterdam, The Netherlands
| | - Yvo M Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Ruiter-Visser R, Dols A, Smulders YM, Jacobs GE, Nauta KJ. [Valproic acid toxicity due to misinterpretation of plasma levels: increase in unbound fraction caused by hypoalbuminaemia and renal dysfunction]. Ned Tijdschr Geneeskd 2018; 162:D2719. [PMID: 30212012] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Valproic acid is one of the most widely prescribed drugs for the treatment of epilepsy and bipolar disorder. As only the unbound fraction of a medicinal product is pharmacologically active, in some strong protein-bound psychotropic drugs such as valproic acid and phenytoin, a rise in this fraction can lead to severe toxicity. CASE DESCRIPTION A 65-year-old male with a type 1 bipolar disorder developed a number of neurological symptoms including sluggishness, muscle weakness, difficulty in walking and disorders of micturition after his mood stabiliser was changed to valproic acid. Recognition of drug toxicity was delayed as his total plasma valproic acid levels were within the therapeutic range. Later it became apparent that the patient had toxic unbound valproic acid levels due to hypoalbuminaemia and impaired renal function. CONCLUSION Clinicians should always consider drug toxicity in patients who show neurological symptoms and use highly protein-bound psychotropic drugs, even if the total plasma concentration of the drug is in the therapeutic range.
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Affiliation(s)
- Roos Ruiter-Visser
- GGZ inGeest, polikliniek Ouderen- en neuropsychiatrie, Amsterdam
- Contact: R. Ruiter-Visser
| | - Annemieke Dols
- GGZ inGeest, polikliniek Ouderen- en neuropsychiatrie, Amsterdam
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Smit B, Smulders YM, Eringa EC, Oudemans - van Straaten HM, Girbes ARJ, Wever KE, Hooijmans CR, Spoelstra - de Man AME. Effects of hyperoxia on vascular tone in animal models: systematic review and meta-analysis. Crit Care 2018; 22:189. [PMID: 30075723 PMCID: PMC6091089 DOI: 10.1186/s13054-018-2123-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/09/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Arterial hyperoxia may induce vasoconstriction and reduce cardiac output, which is particularly undesirable in patients who already have compromised perfusion of vital organs. Due to the inaccessibility of vital organs in humans, vasoconstrictive effects of hyperoxia have primarily been studied in animal models. However, the results of these studies vary substantially. Here, we investigate the variation in magnitude of the hyperoxia effect among studies and explore possible sources of heterogeneity, such as vascular region and animal species. METHOD Pubmed and Embase were searched for eligible studies up to November 2017. In vivo and ex vivo animal studies reporting on vascular tone changes induced by local or systemic normobaric hyperoxia were included. Experiments with co-interventions (e.g. disease or endothelium removal) or studies focusing on lung, brain or fetal vasculature or the ductus arteriosus were not included. We extracted data pertaining to species, vascular region, blood vessel characteristics and method of hyperoxia induction. Overall effect sizes were estimated with a standardized mean difference (SMD) random effects model. RESULTS We identified a total of 60 studies, which reported data on 67 in vivo and 18 ex vivo experiments. In the in vivo studies, hyperoxia caused vasoconstriction with an SMD of - 1.42 (95% CI - 1.65 to - 1.19). Ex vivo, the overall effect size was SMD - 0.56 (95% CI - 1.09 to - 0.03). Between-study heterogeneity (I2) was high for in vivo (72%, 95% CI 62 to 85%) and ex vivo studies (86%, 95% CI 78 to 98%). In vivo, in comparison to the overall effect size, hyperoxic vasoconstriction was less pronounced in the intestines and skin (P = 0.03) but enhanced in the cremaster muscle region (P < 0.001). Increased constriction was seen in vessels 15-25 μm in diameter. Hyperoxic constriction appeared to be directly proportional to oxygen concentration. For ex vivo studies, heterogeneity could not be explained with subgroup analysis. CONCLUSION The effect of hyperoxia on vascular tone is substantially higher in vivo than ex vivo. The magnitude of the constriction is most pronounced in vessels ~ 15-25 μm in diameter and is proportional to the level of hyperoxia. Relatively increased constriction was seen in muscle vasculature, while reduced constriction was seen in the skin and intestines.
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Affiliation(s)
- Bob Smit
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands
| | - Yvo M. Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Etto C. Eringa
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Armand R. J. Girbes
- Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands
| | - Kimberley E. Wever
- SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE), Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carlijn R. Hooijmans
- SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE), Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Jaspers NEM, Visseren FLJ, Numans ME, Smulders YM, van Loenen Martinet FA, van der Graaf Y, Dorresteijn JAN. Variation in minimum desired cardiovascular disease-free longevity benefit from statin and antihypertensive medications: a cross-sectional study of patient and primary care physician perspectives. BMJ Open 2018; 8:e021309. [PMID: 29804065 PMCID: PMC5988148 DOI: 10.1136/bmjopen-2017-021309] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Expressing therapy benefit from a lifetime perspective, instead of only a 10-year perspective, is both more intuitive and of growing importance in doctor-patient communication. In cardiovascular disease (CVD) prevention, lifetime estimates are increasingly accessible via online decision tools. However, it is unclear what gain in life expectancy is considered meaningful by those who would use the estimates in clinical practice. We therefore quantified lifetime and 10-year benefit thresholds at which physicians and patients perceive statin and antihypertensive therapy as meaningful, and compared the thresholds with clinically attainable benefit. DESIGN Cross-sectional study. SETTINGS (1) continuing medical education conference in December 2016 for primary care physicians;(2) information session in April 2017 for patients. PARTICIPANTS 400 primary care physicians and 523 patients in the Netherlands. OUTCOME Months gain of CVD-free life expectancy at which lifelong statin therapy is perceived as meaningful, and months gain at which 10 years of statin and antihypertensive therapy is perceived as meaningful. Physicians were framed as users for lifelong and prescribers for 10-year therapy. RESULTS Meaningful benefit was reported as median (IQR). Meaningful lifetime statin benefit was 24 months (IQR 23-36) in physicians (as users) and 42 months (IQR 12-42) in patients willing to consider therapy. Meaningful 10-year statin benefit was 12 months (IQR 10-12) for prescribing (physicians) and 14 months (IQR 10-14) for using (patients). Meaningful 10-year antihypertensive benefit was 12 months (IQR 8-12) for prescribing (physicians) and 14 months (IQR 10-14) for using (patients). Women desired greater benefit than men. Age, CVD status and co-medication had minimal effects on outcomes. CONCLUSION Both physicians and patients report a large variation in meaningful longevity benefit. Desired benefit differs between physicians and patients and exceeds what is clinically attainable. Clinicians should recognise these discrepancies when prescribing therapy and implement individualised medicine and shared decision-making. Decision tools could provide information on realistic therapy benefit.
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Affiliation(s)
- Nicole E M Jaspers
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Yvo M Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
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Turaihi AH, Bakker W, van Hinsbergh VWM, Serné EH, Smulders YM, Niessen HWM, Eringa EC. Insulin Receptor Substrate 2 Controls Insulin-Mediated Vasoreactivity and Perivascular Adipose Tissue Function in Muscle. Front Physiol 2018; 9:245. [PMID: 29628894 PMCID: PMC5876319 DOI: 10.3389/fphys.2018.00245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/06/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction: Insulin signaling in adipose tissue has been shown to regulate insulin's effects in muscle. In muscle, perivascular adipose tissue (PVAT) and vascular insulin signaling regulate muscle perfusion. Insulin receptor substrate (IRS) 2 has been shown to control adipose tissue function and glucose metabolism, and here we tested the hypothesis that IRS2 mediates insulin's actions on the vessel wall as well as the vasoactive properties of PVAT. Methods: We studied PVAT and muscle resistance arteries (RA) from littermate IRS2+/+ and IRS2−/− mice and vasoreactivity by pressure myography, vascular insulin signaling, adipokine expression, and release and PVAT morphology. As insulin induced constriction of IRS2+/+ RA in our mouse model, we also exposed RA's of C57/Bl6 mice to PVAT from IRS2+/+ and IRS2−/− littermates to evaluate vasodilator properties of PVAT. Results: IRS2−/− RA exhibited normal vasomotor function, yet a decreased maximal diameter compared to IRS2+/+ RA. IRS2+/+ vessels unexpectedly constricted endothelin-dependently in response to insulin, and this effect was absent in IRS2−/− RA due to reduced ERK1/2activation. For evaluation of PVAT function, we also used C57/Bl6 vessels with a neutral basal effect of insulin. In these experiments insulin (10.0 nM) increased diameter in the presence of IRS2+/+ PVAT (17 ± 4.8, p = 0.014), yet induced a 10 ± 7.6% decrease in diameter in the presence of IRS2−/− PVAT. Adipocytes in IRS2−/− PVAT (1314 ± 161 μm2) were larger (p = 0.0013) than of IRS2+/+ PVAT (915 ± 63 μm2). Adiponectin, IL-6, PAI-1 secretion were similar between IRS2+/+ and IRS2−/− PVAT, as were expression of pro-inflammatory genes (TNF-α, CCL2) and adipokines (adiponectin, leptin, endothelin-1). Insulin-induced AKT phosphorylation in RA was similar in the presence of IRS2−/− and IRS2+/+ PVAT. Conclusion: In muscle, IRS2 regulates both insulin's vasoconstrictor effects, mediating ERK1/2-ET-1 activation, and its vasodilator effects, by mediating the vasodilator effect of PVAT. The regulatory role of IRS2 in PVAT is independent from adiponectin secretion.
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Affiliation(s)
- Alexander H Turaihi
- Department of Physiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, Netherlands
| | - Wineke Bakker
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, Netherlands
| | - Victor W M van Hinsbergh
- Department of Physiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, Netherlands
| | - Erik H Serné
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, Netherlands
| | - Yvo M Smulders
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, Netherlands
| | - Hans W M Niessen
- Department of Pathology and Cardiac Surgery, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, Netherlands
| | - Etto C Eringa
- Department of Physiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, Netherlands
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Kaasenbrood L, Ray KK, Boekholdt SM, Smulders YM, LaRosa JC, Kastelein JJP, van der Graaf Y, Dorresteijn JAN, Visseren FLJ. Estimated individual lifetime benefit from PCSK9 inhibition in statin-treated patients with coronary artery disease. Heart 2018; 104:1699-1705. [DOI: 10.1136/heartjnl-2017-312510] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 01/24/2023] Open
Abstract
ObjectiveIn statin-treated patients with stable coronary artery disease (CAD), residual risk of cardiovascular events is partly explained by plasma levels of low-density lipoprotein cholesterol (LDL-C). This study aimed to estimate individual benefit of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition in CAD patients already treated with high-dose statin.MethodsIndividual lifetime benefit was estimated in months gain free of stroke or myocardial infarction (MI) until age 80 years. Predictions were based on two competing risk models developed in data from 4853 patients with CAD originating from the atorvastatin 80 mg arm of the Treating to New Targets (TNT) trial. The relative effect of PCSK9 inhibition was added to the models and was assumed based on average estimates from large clinical trials. We accounted for individual LDL-C levels, assuming 50% LDL-C reduction by PCSK9 inhibition and 21% cardiovascular risk reduction per mmol/L (39 mg/dL) LDL-C lowering.ResultsEstimated individual gain was <6 months in 61% of the patients, 6–12 months in 28% of the patients and ≥12 months in 10% of the patients (median 5, quartiles 2–8 months). Highest estimated benefit was observed in younger patients (aged 40–60 years) with high risk factor burden, particularly if LDL-C levels were >1.8 mmol/L (>70 mg/dL). Estimated benefit was lowest (≤5 months) in older patients (≥70 years), in particular if LDL-C and other risk factors levels were low.ConclusionThe individual estimated lifetime benefit from PCSK9 inhibition in patients with stable CAD on high-dose statin varied from <6 to ≥12 months free of stroke or MI. Highest benefit is expected in younger patients (age 40–60 years) with high risk factor burden and relatively high LDL-C levels.Trial registration numberNCT00327691; Post-results
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