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Bergstrand S, Jonasson H, Fredriksson I, Larsson M, Östgren CJ, Strömberg T. Association between cardiovascular risk profile and impaired microvascular function in a Swedish middle-aged cohort (the SCAPIS study). Eur J Prev Cardiol 2024:zwae052. [PMID: 38333959 DOI: 10.1093/eurjpc/zwae052] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/04/2024] [Accepted: 02/06/2024] [Indexed: 02/10/2024]
Abstract
AIM The aim was to investigate the relationship between microvascular function, cardiovascular risk profile, and subclinical atherosclerotic burden. METHODS The study enrolled 3809 individuals, 50-65 years old, participating in the population-based observational cross-sectional Swedish CArdioPulmonary bioImage Study (SCAPIS). Microvascular function was assessed in forearm skin using an arterial occlusion and release protocol determining peak blood oxygen saturation (OxyP). Cardiovascular risk was calculated using the updated Systematic Coronary Risk Evaluation (SCORE2; 10-year risk of fatal and non-fatal CVD events). OxyP was compared with Coronary Artery Calcification Score (CACS) and to plaques in the carotid arteries. RESULTS Individuals with OxyP values in the lowest quartile (Q1; impaired microvascular function), had a mean SCORE2 of 5.8% compared to 3.8% in those with the highest values of OxyP (Q4), a relative risk increase of 53%. The risk of having a SCORE2 > 10% was 5 times higher for those in Q1 (OR: 4.96 95% CI: 2.76-8.93) vs. Q4 when adjusting for BMI and hsCRP. OxyP was lower in individuals with CACS > 0, and in those with both carotid plaques and CACS >0, =compared with individuals without subclinical atherosclerotic burdens (87.5 ± 5.6% and 86.9 ± 6.0%, vs 88.6 ± 5.8%, p < 0.01). CONCLUSION In a population without cardiovascular disease or diabetes mellitus, impaired microvascular function is associated with cardiovascular risk profiles such as higher SCORE2 risk and CACS. We suggest that OxyP may serve as a microcirculatory functional marker of subclinical atherosclerosis and CVD risk, that is not detected by structural assessments.
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Affiliation(s)
- Sara Bergstrand
- Department of Health, Medicine and Caring and Sciences, Linköping University, Linköping, Sweden
| | - Hanna Jonasson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Ingemar Fredriksson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Perimed AB, Järfälla, Stockholm, Sweden
| | - Marcus Larsson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring and Sciences, Linköping University, Linköping, Sweden
- Centre of Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tomas Strömberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
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Drvendžija Z, Galić BS, Vujanović M, Marić D, Jovanović NB, Brkić S, Turkulov V, Ilić D. Sagittal Abdominal Diameter as the Best Predictor of Metabolic Syndrome in HIV-Infected Men on Antiretroviral Therapy. Curr HIV Res 2024; 22:CHR-EPUB-138361. [PMID: 38323612 DOI: 10.2174/011570162x270929240125055222] [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: 07/31/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The interaction of human immunodeficiency virus (HIV), host and antiretroviral therapy causes a range of metabolic disorders that can be characterized as a metabolic syndrome (MetS) that increases the cardiovascular risk. MetS involves central obesity, which can be detected using different anthropometric parameters. OBJECTIVE To assess the abilities of different anthropometric parameters in the prediction of MetS in HIV-infected men on ART. METHOD The study involved 92 male participants (mean age 44.46±10.38 years), divided into two groups: with and without MetS. All subjects underwent biochemical evaluation (triglycerides, HDL-cholesterol, fasting glucose), blood pressure measurement and anthropometric assessment: body mass, body height, body mass index (BMI), body fat mass, body circumferences (chest, upper arm, forearm, waist, hip, proximal and middle thigh and calf), sagittal abdominal diameter (SAD), skinfold thicknesses (subscapular, anterior and posterior upper arm, anterior and lateral forearm, abdominal, supraspinal, thigh and calf), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist-to-thigh ratio (WTR), sagittal abdominal diameter-to-body height ratio (SADH), body adiposity index (BAI) and conicity index. MetS was specified according to IDF criteria. RESULTS Subjects with MetS had statistically significant higher values of all anthropometric parameters except middle thigh circumference, calf skinfold and body height. According to ROC analysis and Binary Logistic Regression, SAD has been shown as the best predictor of MetS with a predictive value of 21.40 cm (AUC:0.91), followed by WHR with a predictive value of 0.93. CONCLUSION Sagittal abdominal diameter is the strongest anthropometric indicator of MetS in HIV-infected patients on ART.
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Affiliation(s)
- Zorka Drvendžija
- Department of Anatomy, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Biljana Srdić Galić
- Department of Anatomy, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Miloš Vujanović
- Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Germany
| | - Daniela Marić
- Department of Infectious Diseases, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
- Clinic for Infectious Diseases, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Nina Brkić Jovanović
- Department of Psychology, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Snežana Brkić
- Department of Infectious Diseases, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
- Clinic for Infectious Diseases, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Vesna Turkulov
- Department of Infectious Diseases, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
- Clinic for Infectious Diseases, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Dalibor Ilić
- Center for Radiology, University Clinical Center of Vojvodina, Novi Sad, Serbia
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Al Fatly M, Mulder MT, Roeters van Lennep J, Blom HJ, Berk KAC. The effect of diet-induced weight loss on circulating homocysteine levels in people with obesity and type 2 diabetes. Nutr J 2024; 23:2. [PMID: 38167024 PMCID: PMC10763019 DOI: 10.1186/s12937-023-00908-y] [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: 06/29/2022] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND/AIMS Having type 2 diabetes (T2D) in combination with being overweight results in an additional increase in cardiovascular disease (CVD) risk. In addition, T2D and obesity are associated with increased levels of total homocysteine (tHcy), possibly contributing to the CVD risk. Weight loss dieting has positive effects on several CVD risk factors, but whether it affects tHcy remains unclear. Therefore, the aim of this study was to determine the effect of a calorie restricted diet on tHcy in overweight people with T2D. METHODS In this post-hoc analysis of the POWER study, adults with T2D and a BMI greater than 27 kg/m² were included from the outpatient diabetes clinic of the Erasmus Medical Center, Rotterdam. The patients were subjected to a very low-calorie diet with fortified meal replacements for 20 weeks. Before and after this intervention, blood samples were collected to measure tHcy and other CVD risk factors like glycaemic and lipid parameters. RESULTS 161 overweight participants with T2D were included, with a mean age of 54 years (range 26-74), mean weight of 104.6 ± 19.9 kg and mean HbA1c of 62.7 ± 14.3 mmol/mol. At baseline, men displayed higher tHcy than women, and tHcy level was positively correlated with body weight and triglyceride levels, while it was negatively correlated with renal function and HDL cholesterol. During the intervention, bodyweight was reduced by a mean of 9.7% (from 104.6 ± 19.9 to 94.5 ± 18.1 kg p < 0.001), and all measured glycaemic and lipid blood parameters improved significantly. However, tHcy remained unchanged (from 12.1 ± 4.1 to 12.1 ± 4.2 umol/L, p = 0.880). The change in tHcy during the intervention was negatively associated with the change in weight and BMI (p = 0.01 and p = 0.008, respectively). People who lost < 10 kg (n = 92) had a mean tHcy change of -0.47 umol/L, while people who lost more than ≥ 10 kg (n = 69) had a mean tHcy change of 0.60 umol/L (p = 0.021). CONCLUSION In conclusion, our data show that a calorie restricted diet does not affect tHcy in people with T2D and obesity, despite the use of meal replacements fortified with folic acid and vitamin B12. Our data showed a negative correlation between change in tHcy levels and weight loss, suggesting that people who lost more weight (> 10 kg) showed an increase in tHcy. Future studies should explore the potential increase in tHcy induced by weight loss dieting and target the question if tHcy reduction strategies during weight loss could be clinically beneficial.
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Affiliation(s)
- Meryem Al Fatly
- Department of Internal Medicine, section of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique T Mulder
- Department of Internal Medicine, section of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jeanine Roeters van Lennep
- Department of Internal Medicine, section of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henk J Blom
- Laboratory of Genetic Metabolic Diseases, Department of Clinical Genetics, Center of lysosomal and metabolic disorders, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kirsten A C Berk
- Department of Internal Medicine, section of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands.
- Department of Internal Medicine, section of Dietetics, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Gerganov G, Georgiev T, Dimova M, Shivacheva T. Vascular effects of biologic and targeted synthetic antirheumatic drugs approved for rheumatoid arthritis: a systematic review. Clin Rheumatol 2023; 42:2651-2676. [PMID: 36991244 DOI: 10.1007/s10067-023-06587-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/01/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) increases the risk of cardiovascular disease (CVD), with inflammation playing a key role. Biologic and targeted synthetic drugs used to treat RA can induce systemic immunomodulation and may have pleiotropic effects on vascular function, making it crucial to investigate their impact on CVD risk in RA patients. METHODS A systematic review of the literature was conducted to investigate the impact of biologic and targeted synthetic treatments approved for RA on various cardiovascular markers, including endothelial function, arterial stiffness, and subclinical atherosclerosis. Our analysis included a search of the MedLine (via PubMed) and Web of Science databases using a pre-determined search strategy. We conducted a narrative synthesis of the included studies due to heterogeneity in study design and outcome measures. RESULTS From an initial pool of 647 records, we excluded 327 studies based on their titles and abstracts, and we selected 182 studies for final examination. Ultimately, 58 articles met our inclusion criteria and were included in our systematic review. Our analysis of these studies revealed a positive effect of biologic and targeted synthetic therapies on vascular dysfunction associated with RA. However, the impact of these treatments on subclinical atherosclerosis was inconsistent. CONCLUSION Overall, our systematic review provides important insights into the potential cardiovascular benefits of biologic and targeted synthetic treatments for RA by a still unknown mechanism. These findings can inform clinical practice and contribute to our understanding of their possible effects on early vascular pathology. Key Points • Great heterogeneity of methods are used to evaluate the endothelial function and arterial stiffness in patients with RA on biologic and targeted synthetic antirheumatic drugs. • Most studies have shown a considerable improvement in endothelial function and arterial stiffness with TNFi, despite some studies reporting only transient or no improvement. • Anakinra and tocilizumab may have a beneficial effect on vascular function and endothelial injury, as indicated by increased FMD, coronary flow reserve, and reduced levels of biomarkers of endothelial function, while the overall impact of JAKi and rituximab remains inconclusive based on the reviewed studies. • To fully comprehend the distinctions between biologic therapies, more long-term, well-designed clinical trials are necessary using a homogeneous methodology.
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Affiliation(s)
- Georgi Gerganov
- Department of Propedeutics of Internal Medicine, Faculty of Medicine, Medical University - Varna, 9002, Varna, Bulgaria
- Clinic of Rheumatology, University Hospital St. Marina - Varna, 9010, Varna, Bulgaria
| | - Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital St. Marina - Varna, 9010, Varna, Bulgaria.
- First Department of Internal Medicine, Faculty of Medicine, Medical University - Varna, 9002, Varna, Bulgaria.
| | - Maria Dimova
- Department of Propedeutics of Internal Medicine, Faculty of Medicine, Medical University - Varna, 9002, Varna, Bulgaria
- Clinic of Internal Medicine, University Hospital St. Marina - Varna, 9010, Varna, Bulgaria
| | - Tanya Shivacheva
- Clinic of Rheumatology, University Hospital St. Marina - Varna, 9010, Varna, Bulgaria
- First Department of Internal Medicine, Faculty of Medicine, Medical University - Varna, 9002, Varna, Bulgaria
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Dheyriat L, Ward D, Beaugerie L, Jess T, Kirchgesner J. Risk of Recurrent Acute Arterial Events Associated With Thiopurines and Anti-Tumor Necrosis Factor in Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2023; 21:164-172.e11. [PMID: 35842123 DOI: 10.1016/j.cgh.2022.06.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/25/2022] [Accepted: 06/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with inflammatory bowel disease (IBD) are at increased risk of acute arterial events. Treatment with anti-tumor necrosis factor (anti-TNF) agents has been associated with a protective effect against the first occurrence of acute arterial events, but the impact of treatment with anti-TNF in patients with a previous history of acute arterial events remains unclear. We assessed the effect of anti-TNF and thiopurines on the risk of recurrent acute arterial events in patients with IBD in a nationwide cohort. METHODS Based on the French nationwide health insurance database, patients with IBD and a previous history of an acute arterial event were followed up from January 1, 2009, until December 31, 2018. The risk of acute arterial event recurrence associated with anti-TNF and thiopurine exposure was assessed using marginal structural Cox proportional hazard models adjusted for baseline and time-varying covariates. RESULTS A total of 27,185 patients were included. During 121,822 person-years (median follow-up period, 4.0 y), 6865 recurrent acute arterial events occurred (incidence rate per 1000 person-years, 56.4; 95% CI, 55.0-57.7). Exposure to both anti-TNF and thiopurines were associated with a decreased risk of recurrent acute arterial events compared with the absence of exposure to either treatment (hazard ratio, 0.75; 95% CI, 0.63-0.90 and hazard ratio, 0.76; 95% CI, 0.66-0.88, respectively). CONCLUSIONS In a nationwide cohort study of patients with IBD and a previous history of an acute arterial event, exposure to both anti-TNF and thiopurines were associated with a decreased risk of recurrent acute arterial events.
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Affiliation(s)
- Lucile Dheyriat
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Daniel Ward
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France; Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Laurent Beaugerie
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France; Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Julien Kirchgesner
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France; Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Grunvald E, Shah R, Hernaez R, Chandar AK, Pickett-Blakely O, Teigen LM, Harindhanavudhi T, Sultan S, Singh S, Davitkov P. AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Gastroenterology 2022; 163:1198-1225. [PMID: 36273831 DOI: 10.1053/j.gastro.2022.08.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND & AIMS Pharmacological management of obesity improves outcomes and decreases the risk of obesity-related complications. This American Gastroenterological Association guideline is intended to support practitioners in decisions about pharmacological interventions for overweight and obesity. METHODS A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation framework to prioritize clinical questions, identify patient-centered outcomes, and conduct an evidence synthesis of the following agents: semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate extended-release (ER), naltrexone-bupropion ER, orlistat, phentermine, diethylpropion, and Gelesis100 oral superabsorbent hydrogel. The guideline panel used the evidence-to-decision framework to develop recommendations for the pharmacological management of obesity and provided implementation considerations for clinical practice. RESULTS The guideline panel made 9 recommendations. The panel strongly recommended the use of pharmacotherapy in addition to lifestyle intervention in adults with overweight and obesity (body mass index ≥30 kg/m2, or ≥27 kg/m2 with weight-related complications) who have an inadequate response to lifestyle interventions. The panel suggested the use of semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER (based on moderate certainty evidence), and phentermine and diethylpropion (based on low certainty evidence), for long-term management of overweight and obesity. The guideline panel suggested against the use of orlistat. The panel identified the use of Gelesis100 oral superabsorbent hydrogel as a knowledge gap. CONCLUSIONS In adults with overweight and obesity who have an inadequate response to lifestyle interventions alone, long-term pharmacological therapy is recommended, with multiple effective and safe treatment options.
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Affiliation(s)
- Eduardo Grunvald
- Department of Medicine, University of California San Diego, La Jolla, California.
| | - Raj Shah
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruben Hernaez
- Division of Gastroenterology and Hepatology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Octavia Pickett-Blakely
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Levi M Teigen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Tasma Harindhanavudhi
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Siddharth Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Perica Davitkov
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
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Helleputte S, Van Bortel L, Verbeke F, Op 't Roodt J, Calders P, Lapauw B, De Backer T. Arterial stiffness in patients with type 1 diabetes and its comparison to cardiovascular risk evaluation tools. Cardiovasc Diabetol 2022; 21:97. [PMID: 35681143 PMCID: PMC9185867 DOI: 10.1186/s12933-022-01537-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background Arterial stiffness is a potential biomarker for cardiovascular disease (CVD) risk in patients with type 1 diabetes (T1D). However, its relation with other CV risk evaluation tools in T1D has not been elucidated yet. This study aimed to evaluate arterial stiffness in T1D patients free from known CVD, and compare it to other CV risk evaluation tools used in T1D. Methods Cross-sectional study in adults with a T1D duration of at least 10 years and without established CVD. Patients were categorized in CVD risk groups based on 2019 European Society of Cardiology (ESC) guidelines, and the STENO T1D risk engine was used to estimate 10-year risk for CV events. Arterial stiffness was evaluated with carotid-femoral pulse wave velocity (cf-PWV). Coronary artery calcium (CAC) score was assessed and carotid ultrasound was performed. Ambulatory 24-h blood pressure and central hemodynamic parameters were evaluated. Data on renal function and diabetic kidney disease was retrieved. Results 54 patients (age: 46 ± 9.5 years; T1D duration: 27 ± 8.8 years) were included. One-fourth of patients showed prematurely increased aortic stiffness based on cf-PWV (24%). Cf-PWV was significantly associated with CAC score, carotid intima-media thickness, central hemodynamic parameters and diabetic kidney disease. Based on STENO, 20 patients (37%) were at low, 20 patients (37%) at moderate, and 14 patients (26%) at high 10-year risk for CV event. Cf-PWV was strongly associated with the STENO score (rs = + 0.81; R2 = 0.566, p < 0.001), increasing with each higher STENO group (p < 0.01). However, cf-PWV was not significantly different between the two CV risk groups (high versus very high) based on ESC criteria, and ESC criteria compared to STENO classified 10 patients more as having > 10% 10-year risk for CV events (n = 44/54; 81.5% versus n = 34/54; 63%). Conclusions This study demonstrated that a substantial proportion of long-standing T1D patients free from known CVD show premature arterial stiffening. Cf-PWV strongly associates with the STENO risk score for future CV events and with cardiovascular imaging and function outcomes, thereby illustrating the clinical importance of arterial stiffness. The data, however, also show considerable heterogeneity in CV risk and differences in risk categorisation between the STENO tool and ESC criteria.There is a need for refinement of CV risk classification in T1D, and future studies should investigate if evaluation of arterial stiffness should be implemented in T1D clinical practice and which patients benefit the most from its assessment.
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Affiliation(s)
- Simon Helleputte
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Fonds Wetenschappelijk Onderzoek (FWO) Vlaanderen, Ghent, Belgium.
| | - Luc Van Bortel
- Unit of Clinical Pharmacology, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Francis Verbeke
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Jos Op 't Roodt
- Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Patrick Calders
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Bruno Lapauw
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Tine De Backer
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Unit of Clinical Pharmacology, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium.,Department of Cardiology, Ghent University Hospital, Ghent, Belgium
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Tasca J, Bianchi G, Girardello A, Lucchini A, Cappelli C. Cardiac involvement in athletes infected by SARS COV-2 disease. Sci Sports 2022; 37:167-175. [PMID: 35153372 PMCID: PMC8818378 DOI: 10.1016/j.scispo.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 01/17/2023]
Abstract
Objectives The aim of the present study was to conduct a review of the current literature evaluating the available evidence to date in terms of epidemiology, pathophysiology and clinical presentation of COVID-19 in relation to cardiovascular involvement, with a special focus on the myocarditis model, in the population of athletes (professional and recreational) who are preparing to return to competitions, with the ultimate aim of guaranteeing maximum safety for resuming sports activities. News The COVID-19 pandemic has resulted in the inevitable cancellation of most sports activities, practiced at both a professional and amateur level, in order to minimize the risk of spreading the infection. Since the number of athletes who tested positive was rather high, the potential cardiac involvement in this peculiar population of subjects contracting the disease in a mild (asymptomatic, slightly symptomatic) or moderate form, has recently raised concerns following the observation of cases of recorded myocardial damage, myocarditis, arrhythmias and a first reported case of Sudden Cardiac Death (SCD) in a 27-year-old professional basketball player. Several studies even seem to confirm the possibility of permanent impairment of the cardiorespiratory system following the infection. Medical history, biomarkers, electrocardiographical and cardiac imaging features appear to be crucial in distinguishing cardiovascular alterations related to COVID-19 infection from typical adaptations to exercise related to athletes' heart. Prospects and Projects Clarifications and prospective data based on long-term follow-ups on larger populations of athletes are still needed to exclude the development of myocardial damage capable of negatively affecting prognosis and increasing cardiovascular risk in athletes recovered from COVID-19 in asymptomatic (simple positivity to SARS-COV-2) or in a mild form. Conclusion From a clinical point of view extreme caution is necessary when planning the return to sport (Return To Play-RTP) of athletes recovered from a mild or asymptomatic form of COVID-19: a careful preliminary medical-sports evaluation should be carried out in order to assess the potential development of myocardial damage that would increase their cardiovascular risk.
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Janić M, Rizzo M, Cosentino F, Pantea Stoian A, Lunder M, Šabović M, Janež A. Effect of Oral Semaglutide on Cardiovascular Parameters and Their Mechanisms in Patients with Type 2 Diabetes: Rationale and Design of the Semaglutide Anti-Atherosclerotic Mechanisms of Action Study (SAMAS). Diabetes Ther 2022; 13:795-810. [PMID: 35258841 PMCID: PMC8989913 DOI: 10.1007/s13300-022-01226-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) management has reached a point where not only optimal glycaemic control is necessary, but also additional interventions with proven cardiovascular risk reduction benefit. Subcutaneous semaglutide has been shown to provide cardiovascular protection, but its use may be limited by its injection formulation. To overcome this limitation, an oral semaglutide tablet has been developed, which could potentially be of the same value as its injection counterpart, but in a much wider group of patients with T2D, thereby allowing for broader cardiovascular risk reduction in this vulnerable patient population. METHODS A total of 100 consecutive patients with T2D and a disease duration of up to 10 years, without manifest cardiovascular disease, who are treated with metformin (± sulphonylurea) and optimal cardioprotective therapy, will be recruited in a single-blinded, randomized trial named "Semaglutide Anti-atherosclerotic Mechanisms of Action Study (SAMAS)." After 1:1 randomization, patients will receive either oral semaglutide 14 mg daily or placebo for 1 year. The primary outcome comprises changes in atherosclerosis-related structural and functional characteristics of the arterial wall, namely: reduction of the carotid intima-media thickness, improvement of endothelial function and decrease in arterial stiffness. Secondary outcomes are changes in atherogenic small dense low-density lipoproteins, glucose control (HbA1c) and inflammatory markers (hsCRP). Possible correlations between primary endpoints and changes in lipids, HbA1c and high-sensitivity C-reactive protein will be sought. DISCUSSION This is the first study to investigate the direct and indirect anti-atherosclerotic mechanisms of oral semaglutide. The results are expected to confirm the position of oral semaglutide in the multifactorial management of T2D with an emphasis on cardiovascular disease prevention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05147896.
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Affiliation(s)
- Miodrag Janić
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
- Medical Faculty, University of Ljubljana, 1000, Ljubljana, Slovenia.
| | - Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, 90100, Palermo, Italy
| | - Francesco Cosentino
- Unit of Cardiology, Karolinska Institute and Karolinska University Hospital, University of Stockholm, Stockholm, Sweden
| | - Anca Pantea Stoian
- Faculty of Medicine, Diabetes, Nutrition and Metabolic Diseases, Carol Davila University, Bucharest, Romania
| | - Mojca Lunder
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000, Ljubljana, Slovenia
| | - Mišo Šabović
- Medical Faculty, University of Ljubljana, 1000, Ljubljana, Slovenia
- Clinical Department of Vascular Diseases, University Medical Centre Ljubljana, 1000, Ljubljana, Slovenia
| | - Andrej Janež
- Clinical Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000, Ljubljana, Slovenia
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10
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van Heesewijk JO, Dreijerink KMA, Wiepjes CM, Kok AAL, van Schoor NM, Huisman M, den Heijer M, Kreukels BPC. Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men. J Sex Med 2021; 18:1434-1443. [PMID: 37057450 DOI: 10.1016/j.jsxm.2021.05.013] [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: 10/19/2020] [Revised: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Long-term gender-affirming hormone therapy (GHT) in older transgender individuals could have beneficial effects on cognitive functioning. Cardiovascular risk factors and psychological factors are known determinants of cognition. Despite the rising number of older transgender individuals, only few studies have examined cognitive functioning in this population. AIM We aimed to assess differences in cognitive functioning between transgender women, and non-transgender (cisgender) women and men, and investigated the contribution of cardiovascular risk factors and psychological factors on these differences. METHODS In this study, 37 transgender women (age range 55 to 69) receiving GHT for at least ten years (range 10.2 to 41.6) were examined, and their cognitive functioning was compared to an age and education level matched cohort consisting of 222 cisgender women and men from the Longitudinal Aging Study Amsterdam. Linear regression analyses were performed. OUTCOMES Cognitive functioning was assessed by neuropsychological tests including Mini-Mental State Examination (MMSE), Category Fluency animals, Letter Fluency D, 15-Word test (15WT) immediate and delayed recall. Additionally, cardiovascular risk factors and psychological factors such as cardiovascular disease, hypertension, antihypertensive use, statin use, diabetes mellitus, overweight, smoking, alcohol consumption, psychopharmaceutical use, anxiety and depression symptoms were collected. RESULTS Transgender women had higher MMSE scores compared with cisgender women (+0.9, 95% CI 0.4 to 1.5), and cisgender men (+1.1, 95% CI 0.4 to 1.8). On all other tests transgender women performed similar to cisgender men. Transgender women performed at a lower level than cisgender women on 15WT immediate recall, -5.5, 95% CI -7.6 to -3.4, and 15WT delayed recall, -2.7, 95% CI -3.7 to -1.7, and equal to cisgender women on Fluency animals and Fluency D. Cardiovascular and psychological factors (i.e., cardiovascular disease and depression symptoms) partly explained differences on MMSE score between transgender women and cisgender-control groups. CLINICAL IMPLICATIONS The results of this study do not indicate a need for tailored hormone treatment strategies for older transgender women, based on cognitive aspects after long-term GHT. STRENGTHS & LIMITATIONS As one of the first studies, this study compared older transgender women to a large cohort of cisgender men and women regarding cognitive functioning and took into account numerous potential influencing factors. Limitations include difference in test procedures and the cross-sectional design of the study. CONCLUSION Cognitive differences between transgender women and cisgender women and men were small, albeit significant. This may suggest that long-term GHT effects on cognitive functioning in older transgender women are minimal. van Heesewijk JO, Dreijerink KMA, Wiepjes CM, et al. Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men. J Sex Med 2021;18:1434-1443.
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Affiliation(s)
- Jason O van Heesewijk
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Koen M A Dreijerink
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Chantal M Wiepjes
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Almar A L Kok
- Amsterdam University Medical Centers, location VUmc, Department of Epidemiology and Data Science, , Amsterdam, the Netherlands
| | - Natasja M van Schoor
- Amsterdam University Medical Centers, location VUmc, Department of Epidemiology and Data Science, , Amsterdam, the Netherlands
| | - Martijn Huisman
- Amsterdam University Medical Centers, location VUmc, Department of Epidemiology and Data Science, , Amsterdam, the Netherlands
| | - Martin den Heijer
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Baudewijntje P C Kreukels
- Amsterdam University Medical Centers, location VUmc, Department of Medical Psychology, , Amsterdam, the Netherlands
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11
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Schrempf M, Kramer D, Jauk S, Veeranki SPK, Leodolter W, Rainer PP. Machine Learning Based Risk Prediction for Major Adverse Cardiovascular Events. Stud Health Technol Inform 2021; 279:136-143. [PMID: 33965930 DOI: 10.3233/shti210100] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with major adverse cardiovascular events (MACE) such as myocardial infarction or stroke suffer from frequent hospitalizations and have high mortality rates. By identifying patients at risk at an early stage, MACE can be prevented with the right interventions. OBJECTIVES The aim of this study was to develop machine learning-based models for the 5-year risk prediction of MACE. METHODS The data used for modelling included electronic medical records of more than 128,000 patients including 29,262 patients with MACE. A feature selection based on filter and embedded methods resulted in 826 features for modelling. Different machine learning methods were used for modelling on the training data. RESULTS A random forest model achieved the best calibration and discriminative performance on a separate test data set with an AUROC of 0.88. CONCLUSION The developed risk prediction models achieved an excellent performance in the test data. Future research is needed to determine the performance of these models and their clinical benefit in prospective settings.
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Affiliation(s)
- Michael Schrempf
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
| | - Diether Kramer
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
| | - Stefanie Jauk
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria.,Medical University of Graz, Graz, Austria
| | - Sai P K Veeranki
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
| | - Werner Leodolter
- Steiermärkische Krankenanstaltengesellschaft m. b. H., Graz, Austria
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12
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Cocchetti C, Castellini G, Iacuaniello D, Romani A, Maggi M, Vignozzi L, Schreiner T, den Heijer M, T'Sjoen G, Fisher AD. Does Gender-Affirming Hormonal Treatment Affect 30-Year Cardiovascular Risk in Transgender Persons? A Two-Year Prospective European Study (ENIGI). J Sex Med 2021; 18:821-829. [PMID: 33745831 DOI: 10.1016/j.jsxm.2021.01.185] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/17/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cardiovascular (CV) implications of long-term gender affirming hormonal treatment (GAHT) in transgender individuals still remain largely unknown. AIM To evaluate changes in the 30-year Framingham cardiovascular disease (CVD) risk in a large cohort of transgender individuals after the start of GAHT. METHODS In a multicenter prospective study, a consecutive series of 309 participants (165 transmen and 144 transwomen) was evaluated during a 2-year follow-up. Prospectively, after the start of GAHT a physical examination was performed and blood samples were drawn. CVD risk was calculated for each person, according to the Framingham 30-year CVD risk estimate. MAIN OUTCOME MEASURE Changes in CV risk factors and 30-year Framingham CVD risk during GAHT. CLINICAL IMPLICATIONS In transmen testosterone-induced lipid profile alterations may have a clinical relevance on the individual long-term CVD risk. STRENGTHS & LIMITATIONS The strength of the present study is the possibility to predict long-term CV outcomes in transgender individuals receiving GAHT based on a short observation; whereas the main limitation is that CVD risk prospective changes mainly represent the expression of risk factors changes during GAHT. RESULTS In transwomen a significant decrease in triglycerides, total cholesterol and LDL-cholesterol was observed during the 2-year follow-up (P < .05), whereas unfavorable lipid changes - such as increased total cholesterol, triglycerides, and LDL cholesterol levels and decreased HDL cholesterol levels (P < .05)- occurred after the start of GAHT in transmen. These changes in risk factors led to an increase in the risk of general and hard CVD events based on lipid profile over time in transmen (P = .001 and P = .005, respectively). No significant changes in general and hard CVD risk based on lipid profile were observed in transwomen over time. CONCLUSIONS Our findings confirmed the unfavorable lipid changes in transmen after the start of GAHT even during a longer follow-up, empathizing the potential clinical impact of these modifications on individual long-term CVD risk. Cocchetti C, Castellini G, Iacuaniello D, et al. Does Gender-Affirming Hormonal Treatment Affect 30-Year Cardiovascular Risk in Transgender Persons? A Two-Year Prospective European Study (ENIGI). J Sex Med 2021;18:821-829.
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Affiliation(s)
- Carlotta Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Giovanni Castellini
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Davide Iacuaniello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Napoli, Italy
| | - Alessia Romani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Mario Maggi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Thomas Schreiner
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Martin den Heijer
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, VUmc, Amsterdam, The Netherlands
| | - Guy T'Sjoen
- Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Alessandra Daphne Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy.
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13
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Fini NA, Bernhardt J, Churilov L, Clark R, Holland AE. A 2-Year Longitudinal Study of Physical Activity and Cardiovascular Risk in Survivors of Stroke. Phys Ther 2021; 101:6029080. [PMID: 33305804 DOI: 10.1093/ptj/pzaa205] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/08/2020] [Accepted: 08/18/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this study was to explore associations between physical activity, cardiovascular risk factors, mobility, mood, fatigue, and cognition over 2 years following stroke rehabilitation discharge. METHODS In this longitudinal observational study, survivors of first-ever stroke were evaluated at rehabilitation discharge and 6, 12, and 24 months later. Moderate to vigorous physical activity (MVPA) duration (minutes/day) assessed with an electronic monitor was the primary outcome. Further outcomes included step count, the number and duration of MVPA and sedentary bouts, cardiovascular risk factors (eg, blood pressure, fasting lipid profile, body mass index [BMI]), gait speed and endurance, mood, fatigue, and cognition. Associations between physical activity and cardiovascular risk factors over time were assessed with random-effects regression modeling. Associations between baseline characteristics and physical activity at 2 years were explored using regression modeling. RESULTS Seventy-nine participants (68.4% men) with a mean age of 65 years (SD = 14) and a median gait speed of 1.2 m/s (interquartile range = 0.8 to 1.4) were included at baseline. Associations were found between higher physical activity (MVPA duration, number and duration of MVPA bouts) and lower BMI. Better gait speed, endurance, and cognition at baseline were associated with higher MVPA and step count at 2 years. CONCLUSIONS Duration and bouts of MVPA are associated with BMI. Increasing MVPA and bouts of MVPA may be a valuable treatment goal to reduce cardiovascular risk in survivors of stroke. IMPACT This 2-year study found that MVPA is associated with important cardiovascular risk factors in people who have survived stroke. Understanding these associations could be useful for developing effective treatments to prevent recurrent stroke. LAY SUMMARY Performing MVPA and accumulating in bouts of at least 10 minutes might be challenging, but it could be an important component of treatments to reduce cardiovascular risk after stroke.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, Alfred Health, Melbourne, Australia.,Physiotherapy Department, La Trobe University, Melbourne, Australia.,Physiotherapy Department, The University of Melbourne, Parkville, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neurosciences and Mental Health, Heidelberg, Australia
| | - Leonid Churilov
- Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Rebecca Clark
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne, Australia.,Physiotherapy Department, La Trobe University, Melbourne, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
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14
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Chalegre ST, Lins-Filho OL, Lustosa TC, França MV, Couto TLG, Drager LF, Lorenzi-Filho G, Bittencourt MS, Pedrosa RP. Impact of CPAP on arterial stiffness in patients with obstructive sleep apnea: a meta-analysis of randomized trials. Sleep Breath 2020; 25:1195-1202. [PMID: 33094411 DOI: 10.1007/s11325-020-02226-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE This study aimed to perform a systematic review and meta-analysis of randomized trials investigating the effect of continuous positive airway pressure (CPAP) on non-invasive markers of arterial stiffness in patients with OSA. METHODS The purpose of the study was to evaluate the effect of CPAP on markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix)) in patients with OSA. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically reviewed MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, and LILACS databases for randomized trials (RT) evaluating the changes in markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix) comparing CPAP vs. controls in patients with OSA. Reviewer Manager version 5.3 (R Foundation for Statistical Computing, Vienna, Austria) was used to perform meta-analysis. Risk of bias analysis was performed using the Cochrane tool. RESULTS Of the 464 studies initially retrieved, 9 relevant studies with 685 participants were included in the analysis. The studies presented moderate risk of bias. CPAP did not significantly reduce Aix (mean difference, - 1.96 (95% confidence interval (CI) - 5.25 to 1.33), p = 0.24), whereas it significantly changed PWV (mean difference, - 0.44 (95% confidence interval (CI) - 0.76 to - 0.12), p = 0.00). CONCLUSION CPAP treatment was effective in improving arterial stiffness by reducing PWV in patients with OSA. Additional randomized trials, however, should be performed to confirm these findings.
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Affiliation(s)
- Sintya T Chalegre
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil
| | - Ozeas L Lins-Filho
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil.
| | - Thais C Lustosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil
| | - Marcus V França
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil
| | - Tarcya L G Couto
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil
| | - Luciano F Drager
- Hypertension Unit, Heart Institute (InCor) and Renal Division, University Hospital, Faculdade de Medicina, University of São Paulo, Sao Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University Hospital, University of São Paulo, Sao Paulo, Brazil
| | - Marcio S Bittencourt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil.,Hospital Israelita Albert Einstein & Faculdade Israelita de Ciências da Saúde Albert Einstein, Sao Paulo, Brazil
| | - Rodrigo P Pedrosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Rua dos Palmares, SN, Recife, Pernambuco, Brazil
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15
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Egan BM, Li J, Sutherland SE, Jones DW, Ferdinand KC, Hong Y, Sanchez E. Sociodemographic Determinants of Life's Simple 7: Implications for Achieving Cardiovascular Health and Health Equity Goals. Ethn Dis 2020; 30:637-650. [PMID: 32989364 DOI: 10.18865/ed.30.4.637] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Life's Simple 7 (LS7; nutrition, physical activity, cigarette use, body mass index, blood pressure, cholesterol, glucose) predicts cardiovascular health. The principal objective of our study was to define demographic and socioeconomic factors associated with LS7 to better inform programs addressing cardiovascular health and health equity. Methods National Health and Nutrition Examination Surveys 1999-2016 data were analyzed on non-Hispanic White [NHW], NH Black [NHB], and Hispanic adults aged ≥20 years without cardiovascular disease. Each LS7 variable was assigned 0, 1, or 2 points for poor, intermediate, and ideal levels, respectively. Composite LS7 scores were grouped as poor (0-4 points), intermediate (5-9), and ideal (10-14). Results 32,803 adults were included. Mean composite LS7 scores were below ideal across race/ethnicity groups. After adjusting for confounders, NHBs were less likely to have optimal LS7 scores than NHW (multivariable odds ratios (OR .44; 95% CI .37-.53), whereas Hispanics tended to have better scores (1.18; .96-1.44). Hispanics had more ideal LS7 scores than NHBs, although Hispanics had lower incomes and less education, which were independently associated with fewer ideal LS7 scores. Adults aged ≥45 years were less likely to have ideal LS7 scores (.11; .09-.12) than adults aged <45 years. Conclusions NHBs were the least likely to have optimal scores, despite higher incomes and more education than Hispanics, consistent with structural racism and Hispanic paradox. Programs to optimize lifestyle should begin in childhood to mitigate precipitous age-related declines in LS7 scores, especially in at-risk groups. Promoting higher education and reducing poverty are also important.
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Affiliation(s)
- Brent M Egan
- American Medical Association, Improving Health Outcomes, Greenville, SC.,University of South Carolina School of Medicine-Greenville, SC
| | - Jiexiang Li
- College of Charleston, Department of Mathematics, Charleston, SC
| | - Susan E Sutherland
- American Medical Association, Improving Health Outcomes, Greenville, SC.,University of South Carolina School of Medicine-Greenville, SC
| | - Daniel W Jones
- University of Mississippi Medical Center, Center for Obesity Research, Jackson, MS
| | - Keith C Ferdinand
- Tulane University School of Medicine, Tulane Heart and Vascular Institute, New Orleans, LA
| | - Yuling Hong
- Centers for Disease Control, Division of Heart Disease and Stroke Prevention, Atlanta, GA
| | - Eduardo Sanchez
- American Heart Association, Center for Health Metrics and Evaluation, Dallas, TX
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16
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Brunham LR, Mancini GBJ. Editorial Commentary: What Determines the Risk of Cardiovascular Disease in Familial Hypercholesterolemia? Trends Cardiovasc Med 2020; 31:216-217. [PMID: 32407995 DOI: 10.1016/j.tcm.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Liam R Brunham
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - G B John Mancini
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Hwang CL, Bian JT, Thur LA, Peters TA, Piano MR, Phillips SA. Tetrahydrobiopterin Restores Microvascular Dysfunction in Young Adult Binge Drinkers. Alcohol Clin Exp Res 2020; 44:407-414. [PMID: 31782159 PMCID: PMC10284099 DOI: 10.1111/acer.14254] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/19/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Repeated binge drinking is associated with reduced microvascular function. However, microvascular responses to pathophysiological stimulus such as high pressure as well as potential mechanisms that underlie binge-induced microvascular dysfunction are unknown. Therefore, using an ex vivo experimental model, we examined microvascular responses following a brief period of high intraluminal pressure in isolated arterioles from young adults who have a history of repeated binge drinking. In addition, we examined whether the application of the endothelial nitric oxide synthase cofactor, tetrahydrobiopterin, would restore microvascular function in response to flow and high intraluminal pressure in young adult binge drinkers. METHODS Isolated subcutaneous adipose arterioles were obtained from young adult binge drinkers (BD; n = 14), moderate drinkers (MODs; n = 10), and alcohol abstainers (ABs; n = 12; mean age: 23.7 ± 0.5 years; and body mass index: 23.4 ± 0.4 kg/m2 ). Arteriolar flow-induced dilation (FID, pressure gradient: ∆10 to 100 cm H2 O) was measured before and after acute high intraluminal pressure with and without tetrahydrobiopterin. RESULTS Before high pressure, FID at Δ60 and Δ100 cm H2 O pressure gradient in BDs was 14% lower and 18% lower, respectively, than ABs (p < 0.05), while MODs and ABs had similar FID across all pressure gradients (p ≥ 0.2). After high pressure, FID in BDs was further reduced by 10% (p < 0.0005) and this impairment was ameliorated by the treatment of tetrahydrobiopterin (4 to 26% higher, p < 0.005). In contrast, FID after high pressure did not change in MODs and ABs (p ≥ 0.5). CONCLUSIONS Microvascular dysfunction in young adult binge drinkers may be exacerbated with acute pathophysiological stimulus. These binge-induced dysfunctions may be reversed by tetrahydrobiopterin, which suggests a role of oxidative stress and/or uncoupled endothelial nitric oxide synthase in binge drinking.
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Affiliation(s)
- Chueh-Lung Hwang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL
| | - Jing-Tan Bian
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL
| | - Laurel A. Thur
- Center for Research Development and Scholarship, Vanderbilt University School of Nursing, Nashville, TN
| | - Tara A. Peters
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL
| | - Mariann R. Piano
- Center for Research Development and Scholarship, Vanderbilt University School of Nursing, Nashville, TN
| | - Shane A. Phillips
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
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Barranco-Ruiz Y, Ramírez-Vélez R, Martínez-Amat A, Villa-González E. Effect of Two Choreographed Fitness Group-Workouts on the Body Composition, Cardiovascular and Metabolic Health of Sedentary Female Workers. Int J Environ Res Public Health 2019; 16:ijerph16244986. [PMID: 31817936 PMCID: PMC6950037 DOI: 10.3390/ijerph16244986] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 01/08/2023]
Abstract
Daily sedentary working hours contribute negatively to body composition, cardiovascular and metabolic health, especially in women, who are usually less active than men. The objective of this study was to analyze the effect of two trending choreographed fitness group-workouts on the body composition and cardiovascular and metabolic health of sedentary female workers. A total of 98 physically inactive and working women (38.9 ± 6.4 years of age) were randomly assigned to three study groups: Control group (CG) = 31, Zumba Fitness® with three one-hour classes per week (ZF) = 39, and Zumba Fitness with 20 min of additional Bodyweight strength training (ZF + BW) = 28. Measurements included body composition, blood pressure, cardiovascular risk by the Framingham Heart Study tools (10 yr cardiovascular risk and vascular age) and a metabolic blood panel. Post-intervention, both choreographed fitness group-workouts reached a similar significant loss of fat mass (ZF = 2.805 ± 0.48, p < 0.0001; ZF + BW = 3.540 ± 0.04, p < 0.0001), an increase in muscle mass (ZF = 1.70 ± 0.581, p = 0.005; ZF + BW = 3.237 ± 0.657, p < 0.0001) and a decrease in SBP (ZF= 6.454 ± 1.70, p < 0.0001; ZF + BW = 4.12 ± 1.95, p = 0.039). Only the ZF group significantly improved the 10 yr cardiovascular risk (p = 0.032) and metabolic age (p = 0.0025) post-intervention. No significant improvement was observed in the metabolic panel for both choreographed fitness group-workouts. In conclusion, the ZF program generated improvements in cardiovascular and metabolic risk variables compared to ZF + BW or CG. Both choreographed fitness group-workouts contributed similarly to the improvement in systolic blood pressure, fat mass, muscle mass, and also engendered a great adherence to exercise.
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Affiliation(s)
- Yaira Barranco-Ruiz
- Department of Physical and Sports Education, PROFITH “PROmoting FITness and Health through physical activity” Research Group, Sport and Health University Research Institute (iMUDS), Faculty of Education and Sport Sciences, University of Granada, 52071 Melilla, Spain;
- Correspondence: ; Tel.: +34-958-241-000 (ext. 28861)
| | - Robinson Ramírez-Vélez
- Navarrabiomed-Universidad Pública de Navarra (UPNA)-Complejo Hospitalario de Navarra (CHN), Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Navarra, Spain;
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Science, University of Jaen, 23071 Jaen, Spain;
| | - Emilio Villa-González
- Department of Physical and Sports Education, PROFITH “PROmoting FITness and Health through physical activity” Research Group, Sport and Health University Research Institute (iMUDS), Faculty of Education and Sport Sciences, University of Granada, 52071 Melilla, Spain;
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Corona G, Rastrelli G, Di Pasquale G, Sforza A, Mannucci E, Maggi M. Testosterone and Cardiovascular Risk: Meta-Analysis of Interventional Studies. J Sex Med 2019; 15:820-838. [PMID: 29803351 DOI: 10.1016/j.jsxm.2018.04.641] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND The relationship between testosterone (T) and cardiovascular (CV) risk in men is conflicting. AIM To verify whether T therapy (TTh) represents a possible risk factor for CV morbidity and mortality. METHODS We conducted a random effect meta-analysis considering all available data from pharmaco-epidemiological studies as well as randomized placebo-controlled trials (RCTs). OUTCOMES CV mortality and morbidity were investigated. RESULTS After screening, 15 pharmaco-epidemiological and 93 RCT studies were considered. The analysis of pharmaco-epidemiological studies documented that TTh reduces overall mortality and CV morbidity. Conversely, in RCTs, TTh had no clear effect, either beneficial or detrimental, on the incidence of CV events. However, a protective role of TTh on CV morbidity was observed when studies enrolling obese (body mass index >30 kg/m2) patients were scrutinized (Mantel-Haenszel odds ratio 0.51 [95% CI 0.27-0.96]; P = .04), although this association disappeared when only high-quality RCTs were considered (Mantel-Haenszel odds ratio 0.64 [95% CI 0.22-1.88]; P = .42). Finally, an increased risk of CV diseases was observed in RCTs when T preparations were prescribed at dosages above those normally recommended, or when frail men were considered. CLINICAL IMPLICATIONS Pharmaco-epidemiological studies showed that TTh might reduce CV risk, but this effect was not confirmed when RCTs were considered. STRENGTHS & LIMITATIONS Meta-analysis of pharmaco-epidemiological studies indicates that TTh reduces overall mortality and CV morbidity. In addition, even in RCTs, a protective role of TTh on CV morbidity was envisaged when studies enrolling obese (body mass index >30 kg/m2) patients were considered. Pharmaco-epidemiological studies should be considered with caution due to the lack of completeness of follow-up and of the management of missing data. In addition, properly powered placebo-controlled RCTs with a primary CV end point, in men with late-onset hypo-gonadism, are not yet available. Finally, the duration of all studies evaluated in the present meta-analysis is relatively short, reaching a maximum of 3 years. CONCLUSIONS Data from RCTs suggest that treatment with T is not effective in reducing CV risk, however, when TTh is correctly applied, it is not associated with an increase in CV risk and it may have a beneficial effect in some sub-populations. Corona G, Rastrelli G, Di Pasquale G, et al. Testosterone and Cardiovascular Risk: Meta-Analysis of Interventional Studies. J Sex Med 2018;15:820-838.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence, Italy
| | - Giuseppe Di Pasquale
- Cardiology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Alessandra Sforza
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Edoardo Mannucci
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence, Italy; Diabetes Agency, Careggi Hospital, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical, and Biomedical Sciences, University of Florence, Florence, Italy.
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20
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Cioffi G, Ognibeni F, Dalbeni A, Giollo A, Orsolini G, Gatti D, Rossini M, Viapiana O. High prevalence of occult heart disease in normotensive patients with rheumatoid arthritis. Clin Cardiol 2018; 41:736-743. [PMID: 29869800 DOI: 10.1002/clc.22926] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/01/2018] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Due to chronic inflammatory status, rheumatoid arthritis (RA) patients are exposed to changes in left ventricular (LV) geometry and function. We assessed prevalence, factors associated with, and prognostic role of concentric LV geometry and systolic dysfunction (LVSD) detected by echocardiography in a large cohort of patients with RA and normal blood pressure. HYPOTHESIS Changes in LV geometry and function are widely detectable in normotensive patients with RA analyzed in primary prevention. METHODS We prospectively analyzed 194 normotensive RA patients without overt cardiac disease recruited between March 2014 and May 2016, compared with 194 non-RA matched controls. Relative wall thickness >0.43 defined concentric LV geometry. LVSD was defined as impaired global longitudinal strain (GLS). The prespecified study endpoints were all-cause hospitalization and hospitalization for cardiovascular cause. RESULTS The 194 normotensive subjects (mean age, 54 years; 63% female; RA duration 13 years) had a prevalence of LV concentric geometry 5-fold higher and LVSD 5-fold higher than non-RA matched controls. Body mass index, LVSD, and diastolic dysfunction were associated with concentric LV geometry, while worsening renal function and older age were associated with LVSD. LVSD was independently related to the study endpoints (HR 2.37 [1.24-4.53], p = 0.009, for all-causes hospitalization and HR 6.60 [1.47-29.72], p = 0.01 for cardiovascular hospitalization). CONCLUSIONS Despite normotensive status, a consistent proportion of RA patients analyzed in primary prevention have cardiac abnormalities detectable by echocardiography. LVSD is a strong prognosticator of adverse outcome at midterm period in these patients.
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Affiliation(s)
- Giovanni Cioffi
- Department of Cardiology, Villa Bianca Hospital, Trento, Italy
| | - Federica Ognibeni
- Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Andrea Dalbeni
- Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Alessandro Giollo
- Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Orsolini
- Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Davide Gatti
- Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Maurizio Rossini
- Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Ombretta Viapiana
- Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Abstract
Objective: Protection against cardiovascular diseases is provided by the dynamics of risk screening and counseling of primary health care services. Depression is known to pose a risk for cardiovascular diseases. The aim of our study was to determine which specific features of well-known depressed people who had not yet experienced a cardiovascular event were associated with cardiovascular risk. Methods: This study was conducted in patients at the Corum Gulabibey Family Health Center between June 2016 and June 2017. Patients without a known cardiovascular disease were subjected to Beck Depression Inventory (BDI) and Framingham risk scale. Framingham risk scores were compared by dividing the participants into two groups according to having Beck depression scores of equal/above 10 points (high BDI = HBDI) and below 10 points (low BDI = LBDI). Results: Age, LDL, total cholesterol, triglyceride, and blood pressure were all correlated with risk scores. In contrast, HDL and body mass index were only correlated with the risk scores in HBDI participants. From the HBDI patients, those who were obese had higher risk scores than those without obesity. Conclusion: Obesity is a high cardiovascular risk predictor that can be screened at one site in depression. While the body mass index of depressed individuals was correlated with the cardiovascular risk, this index being above 30 was indicative of high cardiovascular risk.
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Affiliation(s)
- Burkay Yakar
- Dr. Burkay Yakar, Department of Family Medicine, Firat University School of Medicine, Elazig, Turkey
| | - Yusuf Haydar Ertekin
- Dr. Yusuf Haydar Ertekin, Department of Family Medicine, Canakkale Onsekiz Mart University School of Medicine, Canakkale, Turkey
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22
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van den Munckhof ICL, Jones H, Hopman MTE, de Graaf J, Nyakayiru J, van Dijk B, Eijsvogels TMH, Thijssen DHJ. Relation between age and carotid artery intima-medial thickness: a systematic review. Clin Cardiol 2018; 41:698-704. [PMID: 29752816 DOI: 10.1002/clc.22934] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 12/29/2022] Open
Abstract
Carotid artery intima-medial thickness (cIMT) represents a popular measure of atherosclerosis and is predictive of future cardiovascular and cerebrovascular events. Although older age is associated with a higher cIMT, little is known about whether this increase in cIMT follows a linear relationship with age or it is affected under influence of cardiovascular diseases (CVD) or CVD risk factors. We hypothesize that the relationship between cIMT and age is nonlinear and is affected by CVD or risk factors. A systematic review of studies that examined cIMT in the general population and human populations free from CVD/risk factors was undertaken. The literature search was conducted in PubMed, Scopus, and Web of Science. Seventeen studies with 32 unique study populations, involving 10,124 healthy individuals free from CVD risk factors, were included. Furthermore, 58 studies with 115 unique study populations were included, involving 65,774 individuals from the general population (with and without CVD risk factors). A strong positive association was evident between age and cIMT in the healthy population, demonstrating a gradual, linear increase in cIMT that did not differ between age decades (r = 0.91, P < 0.001). Although populations with individuals with CVD demonstrated a higher cIMT compared to populations free of CVD, a linear relation between age and cIMT was also present in this population. Our data suggest that cIMT is strongly and linearly related to age. This linear relationship was not affected by CVD or risk factors.
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Affiliation(s)
| | - Helen Jones
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Maria T E Hopman
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Jacqueline de Graaf
- Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Jean Nyakayiru
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Bart van Dijk
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Thijs M H Eijsvogels
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.,Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Dick H J Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.,Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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23
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Chester RC, Kling JM, Manson JE. What the Women's Health Initiative has taught us about menopausal hormone therapy. Clin Cardiol 2018; 41:247-252. [PMID: 29493798 DOI: 10.1002/clc.22891] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/05/2018] [Indexed: 11/06/2022] Open
Abstract
Our understanding of the complex relationship between menopausal hormone therapy (MHT) and cardiovascular disease (CVD) risk has been informed by detailed analyses in the Women's Health Initiative (WHI), the largest randomized, placebo-controlled trial evaluating MHT in postmenopausal women. Although the WHI demonstrated increased risk of CVD events with MHT in the overall cohort, subsequent secondary analyses demonstrated that these risks were influenced by the woman's age and time since menopause, with lower absolute risks and hazard ratios for younger than older women. As MHT is the most effective treatment for the vasomotor symptoms of menopause, it is important to understand its risks and how to conduct risk stratification for symptomatic women. In addition to reviewing the WHI findings, studies pre- and post-WHI are reviewed to describe the relationship between MHT and CVD risk in menopausal women. The absolute risks of adverse cardiovascular events for MHT initiated in women close to menopause are low, and all-cause mortality effects are neutral or even favorable for younger menopausal women. The WHI has advanced and refined our understanding of the relationship between MHT and CVD risk. Although MHT should not be used for CVD prevention, absolute risks of CVD are low when MHT is started close to menopause in healthy women and hazard ratios tend to be lower for younger than older women. For women in early menopause and without contraindications to treatment, the benefits of MHT are likely to outweigh the risks when used for menopausal symptom management.
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Affiliation(s)
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School
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24
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Hauspurg A, Ying W, Hubel CA, Michos ED, Ouyang P. Adverse pregnancy outcomes and future maternal cardiovascular disease. Clin Cardiol 2018; 41:239-246. [PMID: 29446836 DOI: 10.1002/clc.22887] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 01/03/2018] [Indexed: 12/25/2022] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death in women. Although traditional risk factors increase later-life CVD, pregnancy-associated complications additionally influence future CVD risk in women. Recent guidelines for the prevention of CVD in women have added adverse pregnancy outcomes as major CVD risk factors. Studies have shown that women with a history of preeclampsia, gestational diabetes, preterm delivery, and delivery of a small-for-gestational-age infant have an increased risk of developing cardiometabolic risk factors and subsequent CVD. A history of multiple adverse pregnancy outcomes further increases this risk. It has been suggested that these pregnancy complications may unmask preexisting elevated CVD risk; however, whether the pathophysiologic changes underlying these conditions directly result in long-term cardiovascular damage is unclear. The purpose of this review was to highlight the associations between adverse pregnancy outcomes and future CVD, and to emphasize the importance of considering pregnancy history in assessing a woman's CVD risk. Targeted efforts to initiate screening and risk-reduction strategies in women with prior history of pregnancy complications, particularly lifestyle modification, may help decrease the burden of CVD in women.
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Affiliation(s)
- Alisse Hauspurg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Wendy Ying
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carl A Hubel
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela Ouyang
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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25
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Nemani KL, Greene MC, Ulloa M, Vincenzi B, Copeland PM, Al-Khadari S, Henderson DC. Clozapine, Diabetes Mellitus, Cardiovascular Risk and Mortality: Results of a 21-Year Naturalistic Study in Patients with Schizophrenia and Schizoaffective Disorder. ACTA ACUST UNITED AC 2017; 12:168-176. [PMID: 29164928 DOI: 10.3371/csrp.knmg.111717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The goal of this 21-year naturalistic study of clozapine-treated patients was to examine the cardiovascular risk factors following clozapine initiation and resultant mortality estimates from cardiovascular disease. Data were collected from January 1992 to February 2012 medical records from clozapine-treated patients with schizophrenia or schizoaffective disorder. Demographics, clozapine dosage and laboratory results were extracted at 12-month intervals. At clozapine initiation, the mean age of the 96 patients was 36.4 years±7.6 years; n=27 (28%) were women. The mean duration of clozapine use was 13 years. The Kaplan-Meier estimate for 21-year cardiovascular events was 29%, while the Kaplan-Meier estimate for 21-year mortality from cardiovascular disease was 10%. The mean cardiovascular risk increased during the first ten years (p<.01), while a slight decrease occurred beyond ten years (p<.01). Patients involved in cardiometabolic research showed a greater decrease in cardiovascular risk factors over 21 years (p=.05). The Kaplan-Meier estimate for 21-year all-cause mortality was 22%. Forty-one patients were diagnosed with diabetes (42.7%), compared to a nationwide prevalence of 13.7% in a similar age group. These results support the hypothesis that clozapine-treated patients are at risk for cardiovascular events and death secondary to an increased risk of medical disorders. Interventions that target weight loss, smoking cessation, and lipid profile improvement may alleviate the increased risk of cardiovascular mortality.
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26
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Zagaceta J, Bastarrika G, Zulueta JJ, Colina I, Alcaide AB, Campo A, Divo M, Casanova C, Marin JM, Pinto-Plata VM, Celli BR, de-Torres JP. Prospective comparison of non-invasive risk markers of major cardiovascular events in COPD patients. Respir Res 2017; 18:175. [PMID: 28962654 PMCID: PMC5622585 DOI: 10.1186/s12931-017-0658-y] [Citation(s) in RCA: 9] [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: 07/03/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients. The goal of the present study was to evaluate the prognostic value of non-invasive CV risk markers in COPD patients. Methods CV risk was prospectively evaluated in 287 COPD patients using non-invasive markers including the Framingham score, the Systematic Coronary Risk Evaluation (SCORE) charts, coronary arterial calcium (CAC), epicardial adipose tissue (EAT), as well as clinical, biochemical and physiological variables. The predictive power of each parameter was explored using CV events as the main outcome. Results During a median follow up of 65 months (ICR: 36–100), 44 CV events were recorded, 12 acute myocardial infarctions (27.3%), 10 ischemic heart disease/angina (22.7%), 12 peripheral artery disease events requiring surgery (27.3%) and 10 strokes (22.7%). A total of 35 CV deaths occurred during that period. Univariable analysis determined that age, hypertension, CRP, total Cholesterol, LDL-Cholesterol, Framingham score and CAC were independently associated with CV events. Multivariable analysis identified CAC as the best predictor of CV events (HR; 95%CI: 1.32; 1.19–1.46, p < 001). Conclusions In COPD patients attending pulmonary clinics, CAC was the best independent non-invasive predictor of CV events. This tool may help evaluate the risk for a CV event in patients with COPD. Larger studies should reproduce and validate these findings.
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Affiliation(s)
- Jorge Zagaceta
- Pulmonary Department, Clinica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Spain.,Universidad de Piura, Piura, Peru.,Clínica Angloamericana, Lima, Peru
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier J Zulueta
- Pulmonary Department, Clinica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Spain
| | - Inmaculada Colina
- Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ana B Alcaide
- Pulmonary Department, Clinica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Spain
| | - Arantza Campo
- Pulmonary Department, Clinica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Spain
| | - Miguel Divo
- Pulmonary Division, Brigham and Women's Hospital, Boston, USA
| | - Ciro Casanova
- Pulmonary Department, Hospital Universitario La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - José M Marin
- Respiratory Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Juan P de-Torres
- Pulmonary Department, Clinica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Spain.
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27
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Fatima S, Jameel A, Ayesha F, Menzies DJ. The shifting paradigm in the treatment of type 2 diabetes mellitus-A cardiologist's perspective. Clin Cardiol 2017; 40:970-973. [PMID: 28841228 DOI: 10.1002/clc.22781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/09/2017] [Accepted: 07/28/2017] [Indexed: 01/16/2023] Open
Abstract
In patients with diabetes mellitus, cardiovascular (CV) disease is the leading cause of morbidity and mortality. A multitude of contemporary antidiabetic agents presents different CV safety profiles. Metformin forms the cornerstone agent to reduce CV events. Newer agents, such as glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors, have appealing CV benefits. Insulin, dipeptidyl peptidase-4 inhibitors, and sulfonylureas have neutral CV effects. Cardiologists should familiarize themselves with these agents to promote comprehensive CV care in patients with diabetes mellitus.
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Affiliation(s)
- Saeeda Fatima
- Department of Internal Medicine, Bassett Medical Center, New York
| | - Ayesha Jameel
- Department of Internal Medicine, Bassett Medical Center, New York
| | - Fnu Ayesha
- Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Dhananjai J Menzies
- Interventional Cardiology and Catheterization Laboratories, Bassett Medical Center, New York
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28
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Gulayin P, Irazola V, Lozada A, Chaparro M, Santero M, Gutierrez L, Poggio R, Beratarrechea A, Rubinstein A. Educational intervention to improve effectiveness in treatment and control of patients with high cardiovascular risk in low-resource settings in Argentina: study protocol of a cluster randomised controlled trial. BMJ Open 2017; 7:e014420. [PMID: 28143840 PMCID: PMC5293870 DOI: 10.1136/bmjopen-2016-014420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 02/06/2023] Open
Abstract
INTRODUCTION Hypercholesterolaemia is estimated to cause 2.6 million deaths annually and one-third of the cases of ischaemic heart disease. In Argentina, the prevalence of hypercholesterolaemia increased between 2005 and 2013 from 27.9% to 29.8%. Only one out of four subjects with a self-reported diagnosis of coronary heart disease is taking statins. Since 2014, statins (simvastatin 20 mg) are part of the package of drugs provided free-of-charge for patients according to cardiovascular disease (CVD) risk stratification. The goal of this study is to test whether a complex intervention targeting physicians and pharmacist assistants improves treatment and control of hypercholesterolaemia among patients with moderate-to-high cardiovascular risk in Argentina. METHODS AND ANALYSIS This is a cluster trial of 350 patients from 10 public primary care centres in Argentina to be randomised to either the intervention or usual care. The study is designed to have 90% statistical power to detect a 0.7 mmol/L reduction in low-density lipoproteins cholesterol from baseline to 12 months. The physician education programme consists of a 2-day initial intensive training and certification workshop followed by educational outreach visits (EOVs) conducted at 3, 6 and 9 months from the outset of the study. An on-site training to pharmacist assistants during the first EOV is performed at each intervention clinic. In addition, two intervention support tools are used: an app installed in physician's smartphones to serve as a decision aid to improve prescription of statins according to patient's CVD risk and a web-based platform tailored to send individualised SMS messages to patients. ETHICS AND DISSEMINATION Ethical approval was obtained from an independent ethics committee. Results of this study will be presented to the Ministry of Health of Argentina for potential dissemination and scale-up of the intervention programme to the entire national public primary care network in Argentina. TRIAL REGISTRATION NUMBER NCT02380911.
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Affiliation(s)
- Pablo Gulayin
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Martin Chaparro
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Laura Gutierrez
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrea Beratarrechea
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Woudberg NJ, Goedecke JH, Lecour S. Protection from Cardiovascular Disease Due to Increased High-Density Lipoprotein Cholesterol in African Black Populations: Myth or Reality? Ethn Dis 2016; 26:553-560. [PMID: 27773983 DOI: 10.18865/ed.26.4.553] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The burden of cardiovascular disease (CVD) in sub-Saharan Africa has increased over the last decade. Despite this, African Black populations present with relatively low incidences of coronary heart disease and ischemic heart disease, which may be attributed to their lower total cholesterol, triglycerides and low-density lipoprotein cholesterol concentrations, compared with White populations. Commensurate with these lower lipid levels, it was believed that high-density lipoprotein cholesterol (HDL-C) concentrations would be higher in Black populations compared with their White counterparts. This is based on data from previous studies of African and African American populations; however, recent studies conducted in Africa found similar or lower HDL-C concentrations in Black compared with White individuals. Current research, therefore, suggests that HDL-C may not be a good indicator of cardiovascular risk and future research should focus on HDL quality (vs quantity), by measuring HDL functionality and subclass.
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Affiliation(s)
- Nicholas J Woudberg
- Hatter Institute for Cardiovascular Research in Africa and South African Medical Research Council Inter-University Cape Heart Group, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julia H Goedecke
- Non-Communicable Disease Research Unit, South African Medical Research Council
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa and South African Medical Research Council Inter-University Cape Heart Group, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Patel RS, Lagord C, Waterall J, Moth M, Knapton M, Deanfield JE. Online self-assessment of cardiovascular risk using the Joint British Societies (JBS3)-derived heart age tool: a descriptive study. BMJ Open 2016; 6:e011511. [PMID: 27683512 PMCID: PMC5051389 DOI: 10.1136/bmjopen-2016-011511] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE A modified version of the Joint British Societies (JBS3) 'heart age' tool was introduced online to broaden access to personalised risk assessment to the general population and encourage participation in the National Health Service (NHS) Health Check programme. This study reports on its early uptake and the profiles of those who used the self-assessment tool to determine their own cardiovascular risk. DESIGN Observational, retrospective analysis of online tool use. SETTING Between February and July 2015, user data collected from the NHS Choices website, where the tool was hosted, were analysed anonymously using standard analytic packages. RESULTS The online tool landing page was viewed 1.4 million times in the first 5 months, with increased activity following limited media coverage. Of the 575 782 users completing the data journey with a valid 'heart age' result, their demographic and risk factor profiles broadly resembled the population of England, although both younger users and males (60%) were over-represented. Almost 50% and 79% did not know or enter their blood pressure or total cholesterol values, respectively. Estimated heart age was higher than chronological age for 79% of all users, and also for 69% of younger users under 40 years who are at low 10-year risk and not invited for NHS Health Checks. CONCLUSIONS These data suggest a high level of public interest in self-assessment of cardiovascular risk when an easily understood metric is used, although a large number of users lack awareness of their own risk factors. The heart age tool was accessed by a group not easily reached by conventional approaches yet is at high cardiovascular risk and would benefit most from early and sustained risk reduction. These are both important opportunities for interventions to educate and empower the public to manage better their cardiovascular risk and promote population-level prevention.
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Affiliation(s)
- Riyaz S Patel
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, University College London, London, UK
- Bart's Heart Centre, St Bartholomew's Hospital, London, UK
| | | | | | | | | | - John E Deanfield
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, University College London, London, UK
- Bart's Heart Centre, St Bartholomew's Hospital, London, UK
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Maseroli E, Fanni E, Cipriani S, Scavello I, Pampaloni F, Battaglia C, Fambrini M, Mannucci E, Jannini EA, Maggi M, Vignozzi L. Cardiometabolic Risk and Female Sexuality: Focus on Clitoral Vascular Resistance. J Sex Med 2016; 13:1651-1661. [PMID: 27692844 DOI: 10.1016/j.jsxm.2016.09.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/17/2016] [Accepted: 09/02/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. AIM To investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image. METHODS Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. MAIN OUTCOME MEASURES Patients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT). RESULTS Clitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = -0.321, P = .014) and satisfaction (β = -0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast). CONCLUSION Clitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.
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Affiliation(s)
- Elisa Maseroli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Egidia Fanni
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sarah Cipriani
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Irene Scavello
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesca Pampaloni
- Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Cesare Battaglia
- Department of Gynecology and Pathophysiology of Human Reproduction, University of Bologna, Bologna, Italy
| | - Massimiliano Fambrini
- Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Edoardo Mannucci
- Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Florence, Italy
| | | | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy.
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Rastrelli G, Corona G, Mannucci E, Maggi M. Vascular and Chronological Age in Men With Erectile Dysfunction: A Longitudinal Study. J Sex Med 2016; 13:200-8. [PMID: 26953832 DOI: 10.1016/j.jsxm.2015.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/13/2015] [Accepted: 11/18/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Impaired penile color Doppler ultrasound predicts major adverse cardiovascular (CV) events (MACE), particularly in men at low-risk. However, penile color Doppler ultrasound is not recommended in routine clinical checkups. AIM To evaluate whether the difference between vascular and chronological age (Δage), as derived from the SCORE algorithm, is a predictor of MACE in subjects consulting for erectile dysfunction (ED) independently from other CV risk factors, including penile color Doppler ultrasound parameters. METHODS A consecutive series of 1687 male patients attending the Outpatient Clinic for ED for the first time was retrospectively studied. Among them, the SCORE was applicable in 49.9% (n = 841) men, of whom 87.9% (n = 739) were free from previous MACE and were analyzed. MAIN OUTCOME MEASURES Vascular age was derived from the SCORE algorithm and the Δage was considered. Information on MACE was obtained through the City of Florence Registry Office. MACE were identified using the International Classification of Diseases, and fatal and nonfatal MACE were coded as 410-414 (ischemic heart disease), 420-429 (other heart diseases), or 798-799 (sudden death from cardiac diseases), 430-434 or 436-438 (cerebrovascular disease), and 440 (peripheral arterial disease). RESULTS Δage was associated with incident MACE. When dividing the population according to the median age (56 years), family history of CV diseases, and the presence of metabolic syndrome, the association between Δage and MACE was maintained only in low-risk subjects, even after adjusting for confounders [HR = 1.09(1.03-1.16), 1.05(1.01-1.10) and 1.08(1.01-1.16) for younger men, without CV family history or metabolic syndrome, respectively, all P < .05], including penile color Doppler ultrasound parameters. CONCLUSION In subjects consulting for ED, Δage is associated with incident MACE, in particular in low-risk men. The prediction of MACE by Δage is independent from other risk factors including penile color Doppler ultrasound parameters, so it can be used as a costless and safe surrogate marker of penile vascular damage.
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Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Giovanni Corona
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy; Endocrinology Section, Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - Edoardo Mannucci
- Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Via delle Oblate 1, 50139 Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
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Abstract
With more effective and widespread antiretroviral treatment, the overall incidence of AIDS- or HIV-related death has decreased dramatically. Consequently, as patients are aging, cardiovascular disease (CVD) has emerged as an important cause of morbidity and mortality in the HIV population. The incidence of CVD overall in HIV is relatively low, but it is approximately 1.5-2-fold higher than that seen in age-matched HIV-uninfected individuals. Multiple factors are believed to explain this excess in risk such as overrepresentation of traditional cardiovascular risk factors (particularly smoking), toxicities associated with cumulative exposure to some antiretroviral agents, together with persistent chronic inflammation, and immune activation associated with HIV infection. Tools are available to calculate an individual's predicted risk of CVD and should be incorporated in the regular follow-up of HIV-infected patients. Targeted interventions to reduce this risk must be recommended, including life-style changes and medical interventions that might include changes in antiretroviral therapy.
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Affiliation(s)
- R Martin-Iguacel
- Infectious Diseases Department, Odense University Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark.
| | - J M Llibre
- HIV Unit and "Lluita contra la SIDA" Foundation, Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - N Friis-Moller
- Infectious Diseases Department, Odense University Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark.
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Minhas JS, Patel P, Gupta PK. Limitations of a Cardiac Risk (QRISK2) Calculator in Patients with High Density Lipoprotein (HDL). High Blood Press Cardiovasc Prev 2016; 23:47-50. [PMID: 26905417 DOI: 10.1007/s40292-016-0131-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/06/2015] [Accepted: 02/09/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION There is existing debate as to the relationship between blood concentration of HDL (high density lipoprotein) and cardiovascular outcomes. Patients with hyperalphalipoproteinaemia (HALP) have high HDL levels and this can be attributed to a variety of factors. AIM AND METHODS This study aims for the first time to examine the HALP cohort and understand demographics, relationship with cardiovascular disease (CVD) risk and scoring with a cardiac risk calculator (QRISK 2 calculator). RESULTS The study found 42 patients had a statistically significant difference (p = 0.001) between CVD risk estimated using actual measured HDL (Score 1) versus CVD risk calculated using standard population mean HDL values (Score 2). Furthermore, in the CVD event group (n = 6) a significant difference was also seen between Score 1 and Score 2 (p = 0.027). CONCLUSION The study highlights issues with underestimation of CVD risk in this population and strongly advocates use of standard population mean values in assessment of CVD risk.
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Affiliation(s)
- Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK
| | - Prashanth Patel
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pankaj K Gupta
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
- NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester, UK.
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK.
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Liu LL, Kahn HS, Pettitt DJ, Fino NF, Morgan T, Maahs DM, Crimmins NA, Lamichhane AP, Liese AD, D’Agostino RB, Bell RA. Comparing Two Waist-to-Height Ratio Measurements with Cardiometabolic Risk Factors among Youth with Diabetes. Int J Child Health Nutr 2016; 5:87-94. [PMID: 28232855 PMCID: PMC5319429] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Waist circumference (WC) is commonly measured by either the World Health Organization (WHO) or National Health and Nutrition Examination Survey (NHANES) protocol. OBJECTIVE Compare the associations of WHO vs. NHANES WC-to-height ratio (WHtR) protocols with cardiometabolic risk factors (CMRFs) in a sample of youth with diabetes. METHODS For youth (10-19 years old with type 1 [N=3082] or type 2 [N=533] diabetes) in the SEARCH for Diabetes in Youth Study, measurements were obtained of WC (by two protocols), weight, height, fasting lipids (total cholesterol, triglycerides, HDL cholesterol, Non-HDL cholesterol) and blood pressures. Associations of CMRFs with WHO and NHANES WHtR were modeled stratified by body mass index (BMI) percentiles for age/sex: lower BMI (<85th BMI percentile; N=2071) vs. higher BMI (≥85th percentile; N=1594). RESULTS Among lower-BMI participants, both NHANES and WHO WHtR were associated (p<0.005) with all CMRFs except blood pressure. Among higher-BMI participants, both NHANES and WHO WHtR were associated (p<0.05) with all CMRFs. WHO WHtR was more strongly associated (p<0.05) than NHANES WHtR with triglycerides, non-HDL cholesterol, and systolic blood pressure in lower-BMI participants. Among high-BMI participants, WHO WHtR was more strongly associated (p<0.05) than NHANES WHtR with triglycerides and systolic blood pressure. CONCLUSION Among youth with diabetes, WHtR calculated from either WC protocol captures cardiometabolic risk. The WHO WC protocol may be preferable to NHANES WC.
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Affiliation(s)
- Lenna L. Liu
- University of Washington and Seattle Children’s Hospital, Seattle, WA 98122, USA
| | - Henry S. Kahn
- Centers for Disease Control and Prevention, Mail Stop K-10, 4770 Buford Highway, NE Atlanta, GA 30341-3717, USA
| | | | - Nora F. Fino
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Tim Morgan
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - David M. Maahs
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, P. O. Box 6511, Mail Stop A140, Aurora, CO 80045, USA
| | - Nancy A. Crimmins
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Mail Location 7012, Cincinnati, OH 45229, USA
| | - Archana P. Lamichhane
- Department of Nutrition, University of North Carolina at Chapel Hill, 2211 McGavran Greenberg, CB 7461, Chapel Hill, NC 27599-7461, USA
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA
| | - Ralph B. D’Agostino
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Ronny A. Bell
- Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Negro F, Forton D, Craxì A, Sulkowski MS, Feld JJ, Manns MP. Extrahepatic morbidity and mortality of chronic hepatitis C. Gastroenterology 2015; 149:1345-60. [PMID: 26319013 DOI: 10.1053/j.gastro.2015.08.035] [Citation(s) in RCA: 262] [Impact Index Per Article: 29.1] [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: 11/15/2014] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 12/17/2022]
Abstract
Chronic hepatitis C virus (HCV) infection is associated with several extrahepatic manifestations. Patients with HCV may develop mixed cryoglobulinemia and its sequelae, ranging from cutaneous and visceral vasculitis to glomerulonephritis and B-cell non-Hodgkin lymphoma. HCV-infected patients have increased rates of insulin resistance, diabetes, and atherosclerosis, which may lead to increased cardiovascular morbidity and mortality. Neurological manifestations of HCV infection include fatigue and cognitive impairment. The mechanisms causing the extrahepatic effects of HCV infection are likely multifactorial and may include endocrine effects, HCV replication in extrahepatic cells, or a heightened immune reaction with systemic effects. Successful eradication of HCV with interferon alfa and ribavirin was shown to improve some of these extrahepatic effects; sustained virological response is associated with resolution of complications of cryoglobulinemia, reduced levels of insulin resistance, reduced incidence of diabetes and stroke, and improved fatigue and cognitive functioning. The availability of new interferon-free, well-tolerated anti-HCV treatment regimens is broadening the spectrum of patients available for therapy, including those in whom interferon was contraindicated, and will likely result in greater improvements in the extrahepatic manifestations of HCV. If these regimens are shown to confer significant benefit in the metabolic, cardiovascular, or neuropsychiatric conditions associated with HCV infection, extrahepatic manifestations of HCV may become a major indication for treatment even in the absence of liver disease.
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Affiliation(s)
- Francesco Negro
- Division of Gastroenterology and Hepatology and Division of Clinical Pathology, University Hospital, Geneva, Switzerland
| | - Daniel Forton
- Department of Gastroenterology and Hepatology, St George's Hospital, London, England
| | - Antonio Craxì
- Gastroenterology and Internal Medicine, University of Palermo, Palermo, Italy
| | - Mark S Sulkowski
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Hannover, Germany.
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Hill LK, Sims Wright R, Aiken-Morgan AT, Gamaldo A, Edwards CL, Whitfield KE. Perceived Control Predicts Pulse Pressure in African American Men: The Baltimore Study of Black Aging. Ethn Dis 2015; 25:263-70. [PMID: 26676156 DOI: 10.18865/ed.25.3.263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Poorer health profiles among African American men throughout the life course evince greater rates of cardiovascular disease (CVD) and significantly earlier mortality compared with other groups. Despite growing emphasis on identifying how psychosocial factors influence disparate disease risk, little of this research has focused intently on African American men. METHODOLOGY Using hierarchical linear regression, we explored the additive influence of stress, depression, and perceived control on pulse pressure, an established marker of CVD risk, in a sample (N = 153) of African American men (mean age = 66.73 ± 9.29) from the Baltimore Study of Black Aging (BSBA). RESULTS After accounting for age and health status indicators, perceived control emerged as a significant predictor of pulse pressure. DISCUSSION These findings suggest that greater belief in one's own efficacy is a protective factor for cardiovascular health among African American men. Future research should examine whether enhancing perceived control can have an appreciable impact on the immense CVD burden in this and other at-risk populations.
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Affiliation(s)
- LaBarron K Hill
- 1. Duke University Medical Center - Center for the Study of Aging and Human Development ; 2. Duke University - Department of Psychiatry and Behavioral Sciences ; 3. Duke University - Center on Biobehavioral Health Disparities Research
| | | | | | | | - Christopher L Edwards
- 2. Duke University - Department of Psychiatry and Behavioral Sciences ; 3. Duke University - Center on Biobehavioral Health Disparities Research
| | - Keith E Whitfield
- 3. Duke University - Center on Biobehavioral Health Disparities Research ; 4. Duke University - Department of Psychology and Neuroscience
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Bruce MA, Beech BM, Griffith DM, Thorpe RJ. Weight Status and Blood Pressure among Adolescent African American Males: The Jackson Heart KIDS Pilot Study. Ethn Dis 2015; 25:305-12. [PMID: 26672894 DOI: 10.18865/ed.25.3.305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/13/2023] Open
Abstract
BACKGROUND Obesity had not been considered a significant factor contributing to high levels of hypertension among African American males until recently. Epidemiologic research on heart disease among males has primarily focused on adults; however, the significant rise in obesity and hypertension prevalence among African American boys indicates that studies examining the relationship between excess body weight and elevated blood pressure among this high-risk population are critically needed. The purpose of our study was to examine the degree to which weight status has implications for elevated blood pressure among young African American males. METHODS The data for this cross-sectional study were drawn from adolescent males (N=105), aged 12-19 years and who participated in the Jackson Heart KIDS Pilot Study - an offspring cohort study examining cardiovascular disease risks among adolescent descendants of Jackson Heart Study participants. Blood pressure was the primary outcome of interest and weight status was a key independent variable. Other covariates were fruit and vegetable consumption, physical activity, sleep, and stress. RESULTS Approximately 49% of adolescent males in the study were overweight or obese. Bivariate and multiple variable analyses suggest that obesity may be correlated with elevated diastolic blood pressure (DBP) levels among African American boys. Results from ordinary least squared regression analysis indicate that the DBP for boys carrying excess weight was 4.2 mm Hg (P<.01) higher than the corresponding DBP for their normal weight counterparts, after controlling for age, fruit and vegetable consumption, physical activity, and sleep. CONCLUSIONS Additional studies are needed to specify the manner through which excess weight and weight gain can accelerate the development and progression of CVD-related diseases among African American males over the life course, thereby providing evidenced-based information for tailored interventions that can reduce risks for premature morbidity, disability, and mortality among this group.
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Affiliation(s)
- Marino A Bruce
- 1. Center for Health of Minority Males, Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson, Miss. ; 2. Department of Sociology and Criminal Justice, Jackson State University, Jackson, Miss
| | - Bettina M Beech
- 1. Center for Health of Minority Males, Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson, Miss. ; 3. Departments of Pediatrics and Family Medicine, University of Mississippi Medical Center, Jackson, Miss
| | - Derek M Griffith
- 4. Institute for Research on Men's Health, Vanderbilt University, Nashville, Tenn. ; 5. Center for Medicine, Health, and Society, Vanderbilt University, Nashville, Tenn
| | - Roland J Thorpe
- 6. Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Baltimore, Md. ; 7. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
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Arulanandan A, Ang B, Bettencourt R, Hooker J, Behling C, Lin GY, Valasek MA, Ix JH, Schnabl B, Sirlin CB, Loomba R. Association Between Quantity of Liver Fat and Cardiovascular Risk in Patients With Nonalcoholic Fatty Liver Disease Independent of Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol 2015; 13:1513-20.e1. [PMID: 25661453 DOI: 10.1016/j.cgh.2015.01.027] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [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: 10/14/2014] [Revised: 12/30/2014] [Accepted: 01/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The association between quantity of liver fat and the presence of metabolic syndrome needs to be assessed systematically. We aimed to determine the association between the quantity of liver fat and the presence of the metabolic syndrome in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD), independent of nonalcoholic steatohepatitis (NASH). METHODS We recruited 146 patients with well-characterized biopsy-proven NAFLD and 50 individuals without NAFLD (controls) to participate in a case-control study at the NAFLD Translational Research Unit at the University of California San Diego. Liver fat was quantified in patients with NAFLD and controls using an advanced magnetic resonance imaging-based biomarker, the proton-density-fat-fraction (MRI-PDFF). Patients with NAFLD were divided into groups based on whether they were above or below the median MRI-PDFF value (15.4% in patients with NAFLD); the MRI-PDFF value for controls was less than 5%. The primary outcome was the presence of the metabolic syndrome using Adult Treatment Panel III criteria without and with adjustment for the presence of NASH. RESULTS Compared with NAFLD patients with MRI-PDFF values below the median, and compared with controls, NAFLD patients with MRI-PDFF values above the median were more likely to have abdominal obesity (P < .0001), lower levels of high-density cholesterol (P < .0001), higher levels of triglycerides (P < .0001), and higher fasting glucose levels (P < .001). Compared with NAFLD patients with MRI-PDFF values below the median, NAFLD patients with MRI-PDFF above the median were more likely to have the metabolic syndrome (60.3% vs. 44.4%; P < .04), independent of biopsy-detected NASH. CONCLUSIONS Increased liver fat content in patients with NAFLD is associated with increased rates of the metabolic syndrome, independent of NASH. There appears to be an association between the quantity of liver fat and the risk for cardiovascular disease in patients with NAFLD.
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Affiliation(s)
- Ahilan Arulanandan
- Division of Internal Medicine, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - Brandon Ang
- NAFLD Translational Research Unit, Division of Gastroenterology, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - Ricki Bettencourt
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - Jonathan Hooker
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California
| | - Cynthia Behling
- Department of Pathology, University of California San Diego School of Medicine, La Jolla, California
| | - Grace Y Lin
- Department of Pathology, University of California San Diego School of Medicine, La Jolla, California
| | - Mark A Valasek
- Department of Pathology, University of California San Diego School of Medicine, La Jolla, California
| | - Joachim H Ix
- Division of Nephrology, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - Bernd Schnabl
- NAFLD Translational Research Unit, Division of Gastroenterology, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California
| | - Rohit Loomba
- NAFLD Translational Research Unit, Division of Gastroenterology, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California; Division of Epidemiology, Department of Family and Preventive Medicine, University of California San Diego School of Medicine, La Jolla, California.
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Rostami A, Khalili M, Haghighat N, Eghtesadi S, Shidfar F, Heidari I, Ebrahimpour-Koujan S, Eghtesadi M. High-cocoa polyphenol-rich chocolate improves blood pressure in patients with diabetes and hypertension. ARYA Atheroscler 2015; 11:21-9. [PMID: 26089927 PMCID: PMC4460349] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 10/18/2014] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim was to examine the effects of high-cocoa polyphenol-rich chocolate on lipid profiles, weight, blood pressure, glycemic control, and inflammation in individuals with Type 2 diabetes and hypertension. METHODS Sixty individuals [32 in dark chocolate group (DCG) and 28 in white chocolate group (WCG)] with Type 2 diabetes on stable medication were enrolled in a randomized, placebo-controlled double-blind study. Subjects were randomized to consume 25 g DCG or WCG for 8 weeks. Changes in weight, blood pressure, glycemic control, lipid profile, and high sensitive C-reactive protein (hsCRP) were measured at the beginning and end of the intervention. This clinical trial was registered at the Iranian registry of clinical trials. RESULTS In DCC group, compared with baseline, serum levels of Apo A-1 (P = 0.045) was increased and fasting blood sugar (FBS) (P = 0.027), hemoglobin A1c (HbA1c) (P = 0.025), Apo B (P = 0.012) and Log of hsCRP (P = 0.043) levels were decreased at the end of study. No changes were seen within the WCG in studied parameters. High polyphenol chocolate consumption compared to white chocolate resulted in significant decrease in of systolic (-5.93 ± 6.25 vs. -1.07 ± 7.97 mmHg, P = 0.004) and diastolic blood pressure (-6.4 ± 6.25 vs. 0.17 ± 7.9 mmHg, P = 0.002), FBS (-7.84 ± 19.15 vs. 4.00 ± 20.58 mg/dl, P = 0.019) over the course of 8 weeks of daily chocolate consumption neither weight nor body mass index and TG levels altered from baseline. CONCLUSION High polyphenol chocolate is effective in improving TG levels in hypertensive patients with diabetes and decreasing blood pressure and FBS without affecting weight, inflammatory markers, insulin resistance or glycemic control.
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Affiliation(s)
- Ali Rostami
- Department of Clinical Nutrition, School of Nutrition and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Khalili
- Assistant Professor, Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Haghighat
- PhD Candidate, Department of Nutrition, School of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahryar Eghtesadi
- Professor, Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran,Correspondence to: Shahryar Eghtesadi,
| | - Farzad Shidfar
- Professor, Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Iraj Heidari
- Associate Professor, Department of Endocrinology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Soraiya Ebrahimpour-Koujan
- Department of Biochemistry and Diet Therapy, School of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Eghtesadi
- Research Assistant, Department of Research, School of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
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Abstract
OBJECTIVE Non-steroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly used medications due to their well-known analgesic, anti-inflammatory, and antipyretic actions. Due to their known benefits and inherent risks, there have been multiple guidelines from national professional societies that suggest appropriate use to provide both maximum benefit and mitigate risk of adverse events, particularly in older individuals. DESIGN A literature search was undertaken using PubMed and search terms including pain, aging, treatment, non-steroidal anti-inflammatory drugs, arthritis, older patient, and guidelines. Practice guideline reviews were conducted from the following sources: American Geriatric Society, American College of Rheumatology, and the European League Against Rheumatism suggesting the appropriate and safer use of NSAIDs, along with references to guidelines product by Osteoarthritis Research International, the American Gastroenterological Association. CONCLUSIONS Literature-based and professional society guidelines provides clinicians with means optimize efficacy and safety of NSAIDs in clinical practice. Summary recommendations are provided in this review.
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Affiliation(s)
- Alexa Simon Meara
- Division of Immunology and Rheumatology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Internal Medicine Residency, East Carolina University/Brody School of Medicine, Greenville, North Carolina, USA
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Abstract
INTRODUCTION A public outcry against testosterone (T) therapy has suddenly occurred based on two reports suggesting treatment was associated with increased cardiovascular (CV) risks. AIM To analyze scientific and social bases for concerns regarding T therapy. METHODS Analysis of recent articles regarding CV risks with T and comparison with events surrounding publication of results of the Women's Health Initiative in 2002. RESULTS In the first study, the percentage of individuals with an adverse event was lower by half in men who received T compared with untreated men (10.1% vs. 21.2%). However, an opposite conclusion was reached via complex statistics. The second study reported minor increased rate of nonfatal myocardial infarction (MI) up to 90 days after receiving a T prescription compared with the prior 12 months. However, there was no control group, so it is unknown whether this MI rate was increased, reduced, or unchanged compared with untreated men. Neither study provided substantive evidence of risk, yet these were lauded as proof of dangers, despite a substantial literature to the contrary. Similar events followed the publication of the Women's Health Initiative in 2002 when a media frenzy over increased risks with female hormone replacement therapy obscured the fact that the reported excess risk was clinically meaningless, at two events per 1,000 person-years. Stakeholders driving concerns regarding hormone risks are unlikely to be clinicians with real-world patient experience. CONCLUSIONS The use of weak studies as proof of danger indicates that cultural (i.e., nonscientific) forces are at play. Negative media stories touting T's risks appear fueled by antipharma sentiment, anger against aggressive marketing, and antisexuality. This stance is best described as "hormonophobia." As history shows, evidence alone may be insufficient to alter a public narrative. The true outrage is that social forces and hysteria have combined to deprive men of a useful treatment without regard for medical science.
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Stamatiou K, Stamatopoulou E, Christopoulos G. Is bilateral orchiectomy for metastatic prostate cancer treatment associated with high cardiovascular risk? Aging Dis 2013; 4:381-4. [PMID: 24307970 DOI: 10.14336/ad.2013.0400381] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/01/2022] Open
Abstract
Cardiovascular disease is one of the most common causes of death worldwide and the most usual in the western populations. Although it affects both sexes, it is more frequent in males in whom it shortens the average life expectancy. This difference has been attributed to the negative effects of testosterone; however, recent research showed that this hormone may have protective effects on the cardiovascular system. In confirmation to the above current evidence suggests that the low levels of testosterone could be associated with an increased CVD risk and with an augmentation of morbidity and mortality in males. In the present article, we present 2 cases of men with CVD and metastatic prostate cancer treated with bilateral orchiectomy who died of acute stroke during the perioperational period. The possible association of androgen deprivation with cardiovascular disease progression and the consequent risk of stroke are briefly discussed.
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Millán J, Alegría E, Guijarro C, Lozano JV, Vitale GC, González-Timón B, González-Juanatey JR. [Dyslipemia in diabetics treated with statins. Results of the DYSIS study in Spian]. Med Clin (Barc) 2013; 141:430-6. [PMID: 23246165 DOI: 10.1016/j.medcli.2012.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 08/30/2012] [Accepted: 09/06/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Type 2 diabetes mellitus (DM2) is characterized by carrying a high cardiovascular risk. This situation underscores the importance of intensively treating the risk factors present in diabetic patients, notably dyslipemia. The treatment with cholesterol-lowering drugs may be especially effective to reduce the cardiovascular risk in diabetic patients. Therefore, LDL-cholesterol is a priority target in the lipid management of these patients. This study analyzes the alterations in the lipid profile of diabetic patients receiving treatment with statins, which therefore may contribute to persistent cardiovascular risk in such individuals. PATIENTS AND METHODS The DYSIS (Dyslipidemia International Study) is an international, observational trial analyzing the lipid profile of patients treated with statins and followed-up on in outpatient clinics by primary care physicians and specialists. This study is referred to the data on the diabetic patients. RESULTS Of the total patients enrolled in the DYSIS, the present study included 3703 patients, 39% being diabetics. A total of 59.2% of diabetics showed LDL-C out of goal; triglyceride elevation was observed in 43.6% and 36.4% showed low HDL-C. In diabetics patients with coronary heart disease, 31% had uncontrolled levels of all three lipid parameters. The prevalence of out of goal LDL-C in diabetic patients with metabolic syndrome was close to 60%; 39.8% had low levels of HDL-C and 46,6% high levels of triglycerides. In addition, 57% of diabetic patients with obesity showed LDL-C out of control, despite statins treatment. CONCLUSIONS Cardiovascular diseases remain the main cause of morbidity-mortality in patients with DM2. The results of the present study show that in diabetic patients the degree of control is very limited with regard to LDL-cholesterol. More than half of diabetic patients treated with statins had LDL-cholesterol out of goal. The level of dyslipidemia control was low, despite statins treatment. Therefore, the detection of atherogenic dyslipidemia may point to the advisability of using combination therapy for dyslipidemia in diabetic patients.
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VanWormer JJ, Acharya A, Greenlee RT, Nieto FJ. Oral hygiene and cardiometabolic disease risk in the survey of the health of Wisconsin. Community Dent Oral Epidemiol 2012; 41:374-84. [PMID: 23106415 DOI: 10.1111/cdoe.12015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 10/10/2011] [Accepted: 09/18/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Poor oral health is an increasingly recognized risk factor for cardiovascular disease (CVD) and type 2 diabetes (T2D), but little is known about the association between toothbrushing or flossing and cardiometabolic disease risk. The purpose of this study was to examine the degree to which an oral hygiene index was associated with CVD and T2D risk scores among disease-free adults in the Survey of the Health of Wisconsin. METHODS All variables were measured in 2008-2010 in this cross-sectional design. Based on toothbrushing and flossing frequency, an oral hygiene index (poor, fair, good, excellent) was created as the primary predictor variable. The outcomes, CVD and T2D risk score, were based on previous estimates from large cohort studies. There were 712 and 296 individuals with complete data available for linear regression analyses in the CVD and T2D samples, respectively. RESULTS After covariate adjustment, the final model indicated that participants in the excellent (β ± SE = -0.019 ± 0.008, P = 0.020) oral hygiene category had a significantly lower CVD risk score as compared to participants in the poor oral hygiene category. Sensitivity analyses indicated that both toothbrushing and flossing were independently associated with CVD risk score, and various modifiable risk factors. Oral hygiene was not significantly associated with T2D risk score. CONCLUSIONS Regular toothbrushing and flossing are associated with a more favorable CVD risk profile, but more experimental research is needed in this area to precisely determine the effects of various oral self-care maintenance behaviors on the control of individual cardiometabolic risk factors. These findings may inform future joint medical-dental initiatives designed to close gaps in the primary prevention of oral and systemic diseases.
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Affiliation(s)
- Jeffrey J VanWormer
- Epidemiology Research Center, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA.
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Scicchitano P, Dentamaro I, Carbonara R, Bulzis G, Dachille A, Caputo P, Riccardi R, Locorotondo M, Mandurino C, Matteo Ciccone M. Cardiovascular Risk in Women With PCOS. Int J Endocrinol Metab 2012; 10:611-8. [PMID: 23843832 PMCID: PMC3693634 DOI: 10.5812/ijem.4020] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 03/07/2012] [Accepted: 03/18/2012] [Indexed: 12/30/2022] Open
Abstract
Polycystic ovary syndrome (PCOS), or Stein-Leventhal syndrome, is a common endocrine disorder defined by two of the three following features: i) oligoovulation or anovulation, ii) clinical and/or biochemical signs of hyperandrogenism, or iii) polycystic ovaries, once the related endocrinological and gynaecological disorders have been excluded. PCOS does not exclusively involve the reproductive apparatus , it has a complex number of systemic relevancy symptoms. It leads to Metabolic Syndrome, with severe consequences on the cardiovascular apparatus. Many clinical studies have underlined the connection between PCOS and the cardiovascular risk profile of such female patients, due to a lipid/glucose altered metabolism, hypertension, systemic inflammatory condition (assessable by markers such as VES, TNF-alfa, citokines and C-reactive protein (hsPCR) levels), and vascular injuries. Considering the early onset of the disease, PCOS could be considered as a real cardiovascular risk factor which affects the quality of life seriously. The current review aimed to point out the main connections between PCOS and cardiovascular risk factors according to the latest findings coming from literature data analysis, and try to depict the great influences that such a common disease can have on the patients' health integrity.
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Affiliation(s)
- Pietro Scicchitano
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Ilaria Dentamaro
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Rosa Carbonara
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Gabriella Bulzis
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Annamaria Dachille
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Paola Caputo
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Roberta Riccardi
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Manuela Locorotondo
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Cosimo Mandurino
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy
- Corresponding author: Marco Matteo Ciccone, Section of Cardiovascular Diseases, DETO, University of Bari, School of Medicine, Policlinico, Bari, Piazza G. Cesare 11 - 70124, Bari, Italy. Tel.: +39-0805478791, Fax: +39-0805478796, E-mail:
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