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Xv Y, Al-Magedi AAS, Cao N, Tao Q, Wu R, Ji Z. Risk factors for incisional hernia after gastrointestinal surgeries in non-tumor patients. Hernia 2024; 28:147-154. [PMID: 38010469 DOI: 10.1007/s10029-023-02914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/14/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Incisional hernia (IH) is a common secondary ventral hernia after abdominal incisions and there is still little reliable evidence to predict and prevent IH. This study aimed to estimate risk factors of its incidence, especially concentrating on blood results. METHODS 96 patients received midline laparotomy for gastrointestinal benign diseases and suffered from IH were enrolled in the IH group. A control group of 192 patients were randomly selected from patients underwent midline laparotomy for gastrointestinal benign diseases without IH. RESULTS Patients in the IH group exhibited higher age (P < 0.001), BMI (P < 0.001), hernia history (P = 0.001) and laparotomy history (P < 0.001). Rate of coronary heart disease (P = 0.046), hypertension (P < 0.001), diabetes (P = 0.008), incisional infection (P = 0.004) and emergency surgery (P = 0.041) were also higher in the IH group. Patients with IH had lower levels of Hb (P = 0.002), TP (P = 0.013), ALB (P < 0.001), A/G (P = 0.019), PA (P < 0.001), HDL-C (P = 0.008) and ApoA1 (P = 0.005). Meanwhile, patients in the control group bore lower levels of LDH (P = 0.008), GLU (P = 0.007), BUN (P = 0.048), UA (P = 0.021), TG (P = 0.011), TG/HDL-C (P = 0.002), TC/HDL-C (P = 0.013), ApoB/ApoA1 (P = 0.001) and Lp(a) (P = 0.001). A multivariate logistic regression revealed that high BMI, laparotomy history, incisional infection, decreased PA, elevated levels of UA, Lp(a) and ApoB/ApoA1 were independent risk factors of IH. CONCLUSION This is the first study to reveal the relationship between IH and serum biochemical levels, and give a prediction through the nomograph model. These results will help surgeons identify high-risk patients, and take measures to prevent IH during the perioperative period.
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Affiliation(s)
- Y Xv
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - A A S Al-Magedi
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - N Cao
- Department of General Surgery, Lishui People's Hospital, 86 Chongwen Road, Yongyang Street, Nanjing, 211200, China
| | - Q Tao
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - R Wu
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
| | - Z Ji
- School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
- Department of General Surgery, Lishui People's Hospital, 86 Chongwen Road, Yongyang Street, Nanjing, 211200, China.
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Sukkari MH, Al-Bast B, Al Tamimi R, Giesing W, Siddique M. Is there a benefit of aspirin therapy for primary prevention to reduce the risk of atherosclerotic cardiovascular disease in patients with elevated Lipoprotein (a)-A review of the evidence. Am J Prev Cardiol 2023; 15:100579. [PMID: 37736358 PMCID: PMC10509658 DOI: 10.1016/j.ajpc.2023.100579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Aspirin has long been recognized as a beneficial treatment for atherosclerotic cardiovascular disease (ASCVD) due to its antiplatelet effects. However, there is a need to more precisely identify individuals who would benefit from aspirin therapy for primary prevention in order to reduce the risk of ASCVD. Those with elevated lipoprotein (a) [Lp(a)] levels are at increased risk of ASCVD. In this article, we provide an overview of studies that have explored the use of aspirin therapy in individuals with elevated Lp(a). We discuss the potential mechanisms by which aspirin therapy may reduce ASCVD risk, and present a review of the data on the effectiveness of aspirin therapy in reducing ASCVD risk in individuals with elevated Lp(a). The presented evidence suggests that individuals with elevated Lp(a) benefit more from aspirin therapy for reduction of ASCVD events than the general population.
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Affiliation(s)
- Mohamad Hekmat Sukkari
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Basma Al-Bast
- Cardiovascular Division, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Raad Al Tamimi
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - William Giesing
- Methodist Dallas Medical Center, Internal medicine, Dalles, TX, USA
| | - Momin Siddique
- Cardiovascular Division, Southern Illinois University School of Medicine, Springfield, IL, USA
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Motawea KR, Elhalag RH, Aboelenein M, Ibrahim N, Swed S, Fathy H, Awad DM, Mohamed Belal M, Talaat NE, Rozan SS, Aiash H, Mostafa MR. Association of aortic valve calcification and high levels of lipoprotein (a): Systematic review and Meta-analysis. Curr Probl Cardiol 2023; 48:101746. [PMID: 37100357 DOI: 10.1016/j.cpcardiol.2023.101746] [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: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
AIM This study aimed to assess the association between aortic valve calcification and lipoprotein (a). METHODS We searched PUBMED, WOS, and SCOPUS databases. Inclusion criteria were any controlled clinical trials or observational studies that reported the level of Lipoprotein A in patients with aortic valve calcifications, excluding case reports, editorials and animal studies. RevMan software (5.4) was used to perform the meta-analysis. RESULTS After complete screening, 7 studies were included with a total number of 446179 patients included in the analysis. The pooled analysis showed a statistically significant association between the incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls (SMD = 1.71, 95% CI = 1.04 to 2.38, p-value < 0.00001). CONCLUSION This meta-analysis showed a statistically significant association between the incidence of aortic valve calcium and increased levels of lipoprotein (a) compared with controls. Patients with high levels of lipoprotein (a) are at increased risk of developing aortic valve calcification. Medications targeting lipoprotein (a) in future clinical trials may be useful in primary prevention of aortic valve calcification in high risk patients.
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Affiliation(s)
| | | | | | | | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Hager Fathy
- Faculty of Medicine, Minia University, Egypt
| | - Dina M Awad
- Faculty of Medicine, Alexandria University, Egypt
| | | | | | | | - Hani Aiash
- Upstate Medical University, NY, USA, Cardiovascular perfusion Department
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Jun JE, Kang H, Hwang YC, Ahn KJ, Chung HY, Jeong IK. The association between lipoprotein (a) and carotid atherosclerosis in patients with type 2 diabetes without pre-existing cardiovascular disease: A cross-sectional study. Diabetes Res Clin Pract 2021; 171:108622. [PMID: 33316308 DOI: 10.1016/j.diabres.2020.108622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/29/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022]
Abstract
AIMS Lipoprotein (a) [Lp(a)] has been considered a determinant of residual cardiovascular risk. We aimed to investigate associations between serum Lp(a) levels and carotid atherosclerosis. METHODS This cross-sectional study included 662 type 2 diabetic patients without cardiovascular disease. The mean value of three right and left measurements was used to indentify increased carotid intima-media thickness (CIMT). A carotid plaque was defined as a focal wall thickening >50% of the surrounding IMT or its CIMT ≥1.5 mm. The presence of carotid atherosclerosis was defined as having CIMT ≥1.0 mm or carotid plaque. RESULTS A total of 34.3% of patients had carotid atherosclerosis. The median Lp(a) level was significantly higher in subjects with carotid atherosclerosis (14.6 vs. 10.2 mg/dL, P < 0.001). The log-transformed Lp(a) level per 1-standard deviation increase was significantly associated with higher risk of the presence of carotid atherosclerosis (odds ratio [OR] 1.46; 95% confidence interval [CI] 1.16 - 1.84, P = 0.001) after adjusting other parameters. The log Lp(a) level was still significantly associated with the risk of carotid atherosclerosis in subjects with optimal low-density lipoprotein cholesterol (LDL-C) <100 mg/dL (OR 1.48; 95% CI 1.16 - 1.88, P = 0.001). Higher Lp(a) and LDL-C had an additive effect on the presence of carotid atherosclerosis. CONCLUSION Elevated Lp(a) was significantly associated with the presence of carotid atherosclerosis in patients with type 2 diabetes, independent of conventional cardiometabolic risk factors.
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Affiliation(s)
- Ji Eun Jun
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
| | - Hongsun Kang
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
| | - You-Cheol Hwang
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
| | - Kyu Jeung Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
| | - Ho-Yeon Chung
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
| | - In-Kyung Jeong
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea.
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Abstract
PURPOSE The LipidCardio Study was established for in-depth analyses of cardiovascular risk factors, providing well-defined cardiovascular and metabolic phenotypes. In particular, the role of lipoproteins in the pathobiological process and treatment of cardiovascular disease (CVD) will be a main focus. PARTICIPANTS 1005 individuals aged 21 years and older undergoing cardiac catheterisation during 17 months at a tertiary academic cardiology centre were enrolled (troponin-positive acute coronary syndrome was exclusion criterion). The baseline data not only contain detailed phenotyping, broad biochemical parameters, genetic data, but also standardised personal and family history, a screening test for cognitive impairment, pulse wave analysis and measurements of hand grip strength, among others. Blood samples were stored in a biobank for future analyses. FINDINGS TO DATE The mean age of the participants at enrolment was 70.9±11.1 years (70% male). Coronary angiography provided evidence of obstructive coronary artery disease (CAD) in 69.9% of participants. Those with evidence of CAD were significantly more likely to be male, inactive, diabetic and with a family history of CVD than participants without CAD.About 20% of patients had lipoprotein(a) (Lp(a)) concentrations above 106.9 nmol/L (fifth quintile). These patients had significantly increased odds of obstructive CAD compared with participants in quintiles 1-4 (crude OR 1.70, 95% CI 1.17 to 2.48, p=0.005). There was reasonable evidence that with increasing severity of CAD the odds of having elevated Lp(a) increased. We were able to replicate the established strong association between specified single nucleotide polymorphisms (SNPs) in the LPA gene (rs10455872, rs3798220 and rs186696265) and the APOE gene (rs7412), and the concentration of Lp(a), validating our phenotype database and biobank. FUTURE PLANS Mortality information will be obtained in 2 year intervals. Follow-up phone interviews will be conducted at 3 and 6 years after enrolment. We seek to cooperate with other researchers, for example, by sharing data and biobank samples.
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Affiliation(s)
- Maximilian König
- Medical Department, Division of Nephrology and Internal Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Samita Joshi
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - David M Leistner
- Department of Cardiology, Campus Benjamin Franklin (CBF), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin (CBF), Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Berlin, Berlin, Germany
| | - David Sinning
- Department of Cardiology, Campus Benjamin Franklin (CBF), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ilja Demuth
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Charité - Universitätsmedizin Berlin, BCRT - Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
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Abstract
The structural similarity with plasminogen as well as thrombogenic and atherogenic in vitro functions raise the question if lipoprotein(a) (Lp(a)) is a risk factor for venous thromboembolism (VTE) and ischemic stroke. Numerous case-control and prospective studies using different cut-off values to define high Lp(a) generated conflicting evidence for both VTE and ischemic stroke. Several meta-analyses demonstrated independent associations of elevated Lp(a) with a history of VTE or ischemic stroke. However, the evidence of prospective studies for associations of Lp(a) with incident stroke or recurrent VTE remains inconclusive. For ischemic stroke, data suggest that Lp(a) increases the risk of large-artery atherosclerosis stroke, but not cardioembolic or lacunar stroke. Lp(a) may increase the risk of VTE in the presence of additional thrombophilic risk factors. Larger cohort studies are needed to elaborate the importance of higher Lp(a) cut-offs and interactions with other risk factors and subgroups of stroke or VTE. The value of Lp(a) to estimate residual vascular risk after the first thromboembolic event remains to be adequately explored.
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Affiliation(s)
- Alexander Heinrich Nave
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, 10117, Charitéplatz 1, Berlin, Germany.
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.
| | - Arnold von Eckardstein
- Institute of Clinical Chemistry, University and University Hospital of Zurich, Raemistraße 100, 8091, Zurich, Switzerland
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