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Pan L, Xie C, Liu M. Development of nutrition label use scale for patients of coronary heart disease and examination of its reliability and validity. Front Psychol 2023; 14:1168951. [PMID: 37885741 PMCID: PMC10598845 DOI: 10.3389/fpsyg.2023.1168951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Background A proper evaluation on the intention of using nutrition label in patients with coronary heart disease (CHD) is crucial to design and formulate of behavior-based interventions. A valid and reliable instrument based on theoretical basis is needed to measure individual intention toward nutrition label use and identify underlying socio-cognitive factors. Object To develop and test validity and reliability of the theoretically based nutrition label use (NLU) scale and to promote the use of nutrition labels in CHD patients. Methods A questionnaire was developed based on the theory of planned behavior (TPB), empirical literatures, expert review and pilot tested. A total of 460 CHD patients in a hospital in Changsha were investigated using this questionnaire from April 2021 to August 2021. The items and dimensions in the scale were explored and confirmed using item-analysis, content validity, exploratory factor analytical (EFA), confirmatory factor analytical (CFA), internal consistency and split-half reliability tests. Results A total of 33 items with 4 structural factors were identified, including 10 items of attitude, 6 items of subjective norm, 12 items of perceived behavior control, and 5 items of intention. The total variance explained by the EFA model was 68.563%. The model was further tested with CFA. The measurement model fitted the data well (Ratio of chi-square minimum and degree of freedom (CMIN/DF) =1.743, goodness of fit index (GFI) =0.814, incremental fit index (IFI) =0.946, Tuker-Lewis index (TLI) =0.940, the comparative fit index (CFI) =0.945, the root mean square error of approximation (RMSEA) =0.057). The content validation index (CVI) of the scale was 0.82, and the CVI of the items ranged from 0.8 to 1.00. The reliability of the scale was 0.976 (p < 0 0.001) using Cronbach's alpha and 0.937 (p < 0.001) using the split-half coefficient. Conclusion The newly developed Nutrition Label Use Scale can serve as a valid and reliable tool to evaluate the nutrition label use of CHD patients.
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Affiliation(s)
- Lu Pan
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Caixia Xie
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mengjiao Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
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2
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Liang X, Chou OHI, Cheung BMY. The association between denture use and cardiovascular diseases. The United States National Health and Nutrition Examination Survey 2009-2018. Front Cardiovasc Med 2023; 9:1000478. [PMID: 36704477 PMCID: PMC9871755 DOI: 10.3389/fcvm.2022.1000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction Poor dental health is associated with cardiovascular diseases (CVD). However, the relationship between CVD and denture use is currently unknown. This study aimed to investigate whether denture use is associated with CVD among American adults. Methods 10,246 non-pregnant subjects aged 30-59 years from five cycles (2009-2018) of the United States National Health and Nutrition Examination Survey (NHANES) were included in this study. Participants who were observed by a dental examiner wearing denture/partial denture/plates were defined as denture users. CVD was defined as self-reported coronary heart disease, myocardial infarction, angina pectoris, stroke, and congestive heart failure. The association between denture use and CVD was analyzed using logistic regression with adjustment for potential cofounders. Results 4.4% (95% CI, 3.9-5.0) participants had CVD, and 3.5% (95% CI, 2.8-4.5) participants were denture users. Denture use was associated with CVD [OR = 4.26, 95% CI (2.90-6.28), P < 0.01], which remained significant [adjusted OR = 1.82, 95% CI (1.15-2.88), P < 0.01] after adjustments for sociodemographic characteristics, smoking, alcohol use, drug addiction, body mass index (BMI), and abnormal medical conditions including gum problem, hypertension, diabetes, and hyperlipidemia. Women with dentures had significantly higher odds of CVD [adjusted OR = 2.13, 95% CI (1.10-4.11), P = 0.025]. Conclusion In this nationally representative survey, denture use was associated with CVD. Denture use may be an unconventional risk factor for assessing CVD risks, especially in women. Future studies are required to investigate whether CVD and denture use is causally related.
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Affiliation(s)
- Xiaopeng Liang
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Oscar Hou In Chou
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Bernard M. Y. Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China,*Correspondence: Bernard M. Y. Cheung,
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3
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Khan A, Khan A, Khan MM, Farid K, Alam MM, Su’ud MBM. Cardiovascular and Diabetes Diseases Classification Using Ensemble Stacking Classifiers with SVM as a Meta Classifier. Diagnostics (Basel) 2022; 12:2595. [PMID: 36359438 PMCID: PMC9689866 DOI: 10.3390/diagnostics12112595] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 08/11/2023] Open
Abstract
Cardiovascular disease includes coronary artery diseases (CAD), which include angina and myocardial infarction (commonly known as a heart attack), and coronary heart diseases (CHD), which are marked by the buildup of a waxy material called plaque inside the coronary arteries. Heart attacks are still the main cause of death worldwide, and if not treated right they have the potential to cause major health problems, such as diabetes. If ignored, diabetes can result in a variety of health problems, including heart disease, stroke, blindness, and kidney failure. Machine learning methods can be used to identify and diagnose diabetes and other illnesses. Diabetes and cardiovascular disease both can be diagnosed using several classifier types. Naive Bayes, K-Nearest neighbor (KNN), linear regression, decision trees (DT), and support vector machines (SVM) were among the classifiers employed, although all of these models had poor accuracy. Therefore, due to a lack of significant effort and poor accuracy, new research is required to diagnose diabetes and cardiovascular disease. This study developed an ensemble approach called "Stacking Classifier" in order to improve the performance of integrated flexible individual classifiers and decrease the likelihood of misclassifying a single instance. Naive Bayes, KNN, Linear Discriminant Analysis (LDA), and Decision Tree (DT) are just a few of the classifiers used in this study. As a meta-classifier, Random Forest and SVM are used. The suggested stacking classifier obtains a superior accuracy of 0.9735 percent when compared to current models for diagnosing diabetes, such as Naive Bayes, KNN, DT, and LDA, which are 0.7646 percent, 0.7460 percent, 0.7857 percent, and 0.7735 percent, respectively. Furthermore, for cardiovascular disease, when compared to current models such as KNN, NB, DT, LDA, and SVM, which are 0.8377 percent, 0.8256 percent, 0.8426 percent, 0.8523 percent, and 0.8472 percent, respectively, the suggested stacking classifier performed better and obtained a higher accuracy of 0.8871 percent.
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Affiliation(s)
- Asfandyar Khan
- Institute of Computer Science and Information Technology, ICS/IT FMCS the University of Agriculture, Peshawar 25130, Pakistan
| | - Abdullah Khan
- Institute of Computer Science and Information Technology, ICS/IT FMCS the University of Agriculture, Peshawar 25130, Pakistan
| | - Muhammad Muntazir Khan
- Institute of Computer Science and Information Technology, ICS/IT FMCS the University of Agriculture, Peshawar 25130, Pakistan
| | - Kamran Farid
- Institute of Computer Science and Information Technology, ICS/IT FMCS the University of Agriculture, Peshawar 25130, Pakistan
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Jahangiry L, Abbasalizad Farhangi M, Najafi M, Sarbakhsh P. Clusters of the Risk Markers and the Pattern of Premature Coronary Heart Disease: An Application of the Latent Class Analysis. Front Cardiovasc Med 2021; 8:707070. [PMID: 34957228 PMCID: PMC8692946 DOI: 10.3389/fcvm.2021.707070] [Citation(s) in RCA: 3] [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: 05/08/2021] [Accepted: 11/03/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Coronary heart disease (CHD) is the major cause of mortality in the world with a significant impact on the younger population. The aim of this study was to identify prematurity among patients with coronary artery bypass graft surgery (CABG) based on the clustering of CHD risk factors. Methods: Patients were recruited from an existing cohort of candidates for CABG surgery named Tehran Heart Center Coronary Outcome Measurement (THC-COM). A latent class analysis (LCA) model was formed using 11 potential risk factors as binary variables: cigarette smoking, obesity, diabetes, family history of CHD, alcohol use, opium addiction, hypertension, history of stroke, history of myocardial infarction (MI), peripheral vascular disease (PVD), and hyperlipidemia (HLP). We analyzed our data to figure out how the patients are going to be clustered based on their risk factors. Results: For 566 patients who were studied, the mean age (SD) and BMI of patients were 59.1 (8.9) and 27.3 (4.1), respectively. The LCA model fit with two latent classes was statistically significant (G2 = 824.87, df = 21, p < 0.0001). The mean (SD) age of patients for Class I and Class II was 55.66 (8.55) and 60.87 (8.66), respectively. Class I (premature) was characterized by a high probability of smoking, alcohol consumption, opium addiction, and a history of MI (P < 0.05), and class II by a high probability of obesity, diabetes, and hypertension. Conclusion: Latent class analysis calculated two groups of severe CHD with distinct risk markers. The younger group, which is characterized by smoking, addiction, and the history of MI, can be regarded as representative of premature CHD.
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Affiliation(s)
- Leila Jahangiry
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Health Education and Health Promotion Department, School of Health, Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahdi Najafi
- Department of Anesthesiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Parvin Sarbakhsh
- Department of Epidemiology and Biostatistics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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5
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Wan H, Han W, Wu Z, Lie Z, Li D, Su S. Whole blood dynamic platelet aggregation counting and 1-year clinical outcomes in patients with coronary heart diseases treated with clopidogrel. Platelets 2021; 32:968-974. [PMID: 32892681 DOI: 10.1080/09537104.2020.1817886] [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] [Indexed: 10/23/2022]
Abstract
In the setting of coronary heart diseases (CHDs) on treatment with clopidogrel, ADP-induced platelet aggregation has been demonstrated with ischemic events. However, there were very limited data for predicting ischemic events by platelet function test via dynamic platelet aggregation counting (DPAC). The present study aimed to evaluate the relationship between adenosine diphosphate (ADP)-induced whole blood platelet aggregation rates (PARs) and clinical outcomes in patients with CHDs on treatment with clopidogrel. We have retrospectively analyzed the clinical data of consecutive patients with CHDs based on the electronic medical records between May 2016 and December 2018. The primary endpoint was a composite endpoint events (CEEs) of ischemic cardiovascular events (including acute coronary syndrome, heart failure, transient ischemic attack, and cerebral infarction) and all-cause death. A total of 490 patients (mean age 66.6 years, 71% man) were received ADP-induced PARs via DPAC. On follow-up (mean 374 days), 107 subjects (21.8%) developed CEEs. Cox regression analysis indicated that the risk of CEEs was independently associated with ADP-induced whole blood PARs [HR: 1.023, 95% CI: 1.005-1.041, P = .011]. The distribution of CYP2C19 loss of function gene was higher in patients with on-treatment platelet hyperresponsiveness (10/12 vs 38/75, P = .042). In conclusion, ADP-induced whole blood PARs via DPAC is feasible, which can predict the incidence of 1-year CEEs in patients with CHDs on treatment with clopidogrel. CYP2C19 gene polymorphism was associated with clopidogrel on-treatment platelet hyperresponsiveness.
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Affiliation(s)
- Huaibin Wan
- Department of Cardiology, Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong, China
| | - Weichao Han
- Department of Pharmacy, Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong, China
| | - Zhihao Wu
- Department of Cardiology, Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong, China
| | - Zhenbang Lie
- Department of Cardiology, Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong, China
| | - Daqiang Li
- Department of Cardiology, Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong, China
| | - Shaohui Su
- Department of Cardiology, Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong, China
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Zhang M, Huang L, Yang J, Xu W, Su H, Cao J, Wang Q, Pu J, Qian K. Ultra-Fast Label-Free Serum Metabolic Diagnosis of Coronary Heart Disease via a Deep Stabilizer. Adv Sci (Weinh) 2021; 8:e2101333. [PMID: 34323397 PMCID: PMC8456274 DOI: 10.1002/advs.202101333] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/19/2021] [Indexed: 05/07/2023]
Abstract
Although mass spectrometry (MS) of metabolites has the potential to provide real-time monitoring of patient status for diagnostic purposes, the diagnostic application of MS is limited due to sample treatment and data quality/reproducibility. Here, the generation of a deep stabilizer for ultra-fast, label-free MS detection and the application of this method for serum metabolic diagnosis of coronary heart disease (CHD) are reported. Nanoparticle-assisted laser desorption/ionization-MS is used to achieve direct metabolic analysis of trace unprocessed serum in seconds. Furthermore, a deep stabilizer is constructed to map native MS results to high-quality results obtained by established methods. Finally, using the newly developed protocol and diagnosis variation characteristic surface to characterize sensitivity/specificity and variation, CHD is diagnosed with advanced accuracy in a high-throughput/speed manner. This work advances design of metabolic analysis tools for disease detection as it provides a direct label-free, ultra-fast, and stabilized platform for future protocol development in clinics.
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Affiliation(s)
- Mengji Zhang
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringInstitute of Medical Robotics and Med‐X Research InstituteShanghai Jiao Tong UniversityShanghai200030P. R. China
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai Cancer Institute160 Pujian RoadShanghai200127P. R. China
| | - Lin Huang
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringInstitute of Medical Robotics and Med‐X Research InstituteShanghai Jiao Tong UniversityShanghai200030P. R. China
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai Cancer Institute160 Pujian RoadShanghai200127P. R. China
| | - Jing Yang
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringInstitute of Medical Robotics and Med‐X Research InstituteShanghai Jiao Tong UniversityShanghai200030P. R. China
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai Cancer Institute160 Pujian RoadShanghai200127P. R. China
| | - Wei Xu
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringInstitute of Medical Robotics and Med‐X Research InstituteShanghai Jiao Tong UniversityShanghai200030P. R. China
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai Cancer Institute160 Pujian RoadShanghai200127P. R. China
| | - Haiyang Su
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringInstitute of Medical Robotics and Med‐X Research InstituteShanghai Jiao Tong UniversityShanghai200030P. R. China
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai Cancer Institute160 Pujian RoadShanghai200127P. R. China
| | - Jing Cao
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringInstitute of Medical Robotics and Med‐X Research InstituteShanghai Jiao Tong UniversityShanghai200030P. R. China
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai Cancer Institute160 Pujian RoadShanghai200127P. R. China
| | - Qian Wang
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringInstitute of Medical Robotics and Med‐X Research InstituteShanghai Jiao Tong UniversityShanghai200030P. R. China
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai Cancer Institute160 Pujian RoadShanghai200127P. R. China
| | - Jun Pu
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai Cancer Institute160 Pujian RoadShanghai200127P. R. China
| | - Kun Qian
- State Key Laboratory for Oncogenes and Related GenesSchool of Biomedical EngineeringInstitute of Medical Robotics and Med‐X Research InstituteShanghai Jiao Tong UniversityShanghai200030P. R. China
- State Key Laboratory for Oncogenes and Related GenesDivision of CardiologyRenji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai Cancer Institute160 Pujian RoadShanghai200127P. R. China
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7
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Martini D, Godos J, Marventano S, Tieri M, Ghelfi F, Titta L, Lafranconi A, Trigueiro H, Gambera A, Alonzo E, Sciacca S, Buscemi S, Ray S, Galvano F, Del Rio D, Grosso G. Nut and legume consumption and human health: an umbrella review of observational studies. Int J Food Sci Nutr 2021; 72:871-878. [PMID: 33541169 DOI: 10.1080/09637486.2021.1880554] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 12/14/2022]
Abstract
Consumption of nuts and legumes has been associated with several health benefits. The aim of this study was to systematically review existing meta-analyses of observational studies on nut and legume intake and non-communicable diseases, and assess the level of evidence. Out of the six meta-analyses focussed on legume and 15 on nut intake, a possible association with decreased risk of colorectal adenoma and coronary heart disease was found for higher legume consumption, and a decreased risk of cardiovascular and cancer mortality, colon cancer, hypertension and ischaemic stroke for higher nut consumption. The association between legume consumption and cardiovascular diseases (CVDs), as well as nut consumption and risk of cancer, CVD incidence and all-cause mortality, was deemed as "limited" due to heterogeneity between results and/or potential confounding factors. General benefit towards better health can be observed for nut and legume consumption. Further studies are needed to better elucidate potential confounding factors.
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Affiliation(s)
- Daniela Martini
- Department of Food, Environmental, and Nutritional Sciences, Università degli Studi di Milano, Milan, Italy
| | - Justyna Godos
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Stefano Marventano
- Childhood and Adolescent Department, Rimini Women's Health, AUSL Romagna, Rimini, Italy
| | - Maria Tieri
- SmartFood Program, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Ghelfi
- Fondazione De Marchi-Department of Pediatrics, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
| | - Lucilla Titta
- SmartFood Program, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessandra Lafranconi
- University of Milano - Bicocca, Milan, Italy.,Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Helena Trigueiro
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
| | - Angelo Gambera
- Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, Catania, Italy
| | - Elena Alonzo
- Food and Nutrition Security and Public Health Service, ASP Catania, Catania, Italy
| | - Salvatore Sciacca
- Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, Catania, Italy
| | - Silvio Buscemi
- Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,Wolfson College, University of Cambridge, Cambridge, UK.,Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, UK.,Human Nutrition Research Unit, Medical Research Council (MRC), Cambridge, UK
| | - Fabio Galvano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Daniele Del Rio
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,Human Nutrition Unit, Department of Veterinary Science, University of Parma, Parma, Italy.,School of Advanced Studies on Food and Nutrition, University of Parma, Parma, Italy
| | - Giuseppe Grosso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.,NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
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Shariful Islam SM, Chow CK, Redfern J, Kok C, Rådholm K, Stepien S, Rodgers A, Hackett ML. Effect of text messaging on depression in patients with coronary heart disease: a substudy analysis from the TEXT ME randomised controlled trial. BMJ Open 2019; 9:e022637. [PMID: 30787075 PMCID: PMC6398727 DOI: 10.1136/bmjopen-2018-022637] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the effects on depression scores of a lifestyle-focused cardiac support programme delivered via mobile phone text messaging among patients with coronary heart disease (CHD). DESIGN Substudy and secondary analysis of a parallel-group, single-blind randomised controlled trial of patients with CHD. SETTING A tertiary hospital in Sydney, Australia. INTERVENTION The Tobacco, Exercise and dieT MEssages programme comprised four text messages per week for 6 months that provided education, motivation and support on diet, physical activity, general cardiac education and smoking, if relevant. The programme did not have any specific mental health component. OUTCOMES Depression scores at 6 months measured using the Patient Health Questionnaire-9 (PHQ-9). Treatment effect across subgroups was measured using log-binomial regression model for the binary outcome (depressed/not depressed, where depressed is any score of PHQ-9 ≥5) with treatment, subgroup and treatment by subgroup interaction as fixed effects. RESULTS Depression scores at 6 months were lower in the intervention group compared with the control group, mean difference 1.9 (95% CI 1.5 to 2.4, p<0.0001). The frequency of mild or greater depressive symptoms (PHQ-9 scores≥5) at 6 months was 21/333 (6.3%) in the intervention group and 86/350 (24.6%) in the control group (relative risk (RR) 0.26, 95% CI 0.16 to 0.40, p<0.001). This proportional reduction in depressive symptoms was similar across groups defined by age, sex, education, body mass index, physical activity, current smoking, current drinking and history of depression, diabetes and hypertension. In particular, the rates of PHQ-9 ≥5 among people with a history of depression were 4/44 (9.1%) vs 29/62 (46.8%) in intervention vs control (RR 0.19, 95% CI 0.07 to 0.51, p<0.001), and were 17/289 (5.9%) vs 57/288 (19.8%) among others (RR 0.30, 95% CI 0.18 to 0.50, p<0.001). CONCLUSIONS Among people with CHD, a cardiac support programme delivered via mobile phone text messaging was associated with fewer symptoms of mild-to-moderate depression at 6 months in the treatment group compared with controls. TRIAL REGISTRATION NUMBER ACTRN12611000161921.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Victoria, Australia
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Julie Redfern
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cindy Kok
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karin Rådholm
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden
| | - Sandrine Stepien
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maree L Hackett
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Health, The University of Central Lancashire, Preston, UK
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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9
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Reissigová J, Zvolský M. Short-term prediction of coronary heart disease mortality in the Czech Republic based on data from 1968-2014. Cent Eur J Public Health 2018; 26:10-15. [PMID: 29684291 DOI: 10.21101/cejph.a4936] [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: 09/29/2017] [Accepted: 03/06/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim was to explore the patterns of the coronary heart disease (CHD) mortality rates over the past almost 50 years (1968-2014) in the Czech Republic, and to predict the mortality rates in 2015-2019. METHODS The number of deaths from CHD and the population size were stratified by sex and age. The mortality rates were age-standardized to European population. Their values in 2015-2019 were estimated using the joinpoint log-linear regression, local log-linear regression and negative binomial log-linear regression, separately for males and females. RESULTS A positive change in the trend of the age-standardized mortality rates from CHD was detected after the collapse of communism in 1989. In 1991-2000, the mortality trend was sharply downward, with an annual percent change of -5.8 % for males and -5.2 % for females. In 2000-2014, the decreasing trend was not so sharp (-1.3 % for males and -0.7% for females), yet it should continue in 2015-2019. The crude mortality rates for females are slightly higher than those for males since 2007, however, they are increasing for both sexes. The mortality rates are rising mainly in the age group of 85+ years (in 2014, 25.4% of CHD deaths of males and 54.4% of females occurred at the age of 85+ years). CONCLUSIONS The age-standardized mortality rates are predicted to decrease in 2015-2019, but the crude mortality rates should increase due to increase in average life expectancy. The burden of deaths is moving to the age group of 85 years and older, mainly in females. A total of 26,039 CHD deaths were registered in the Czech Republic in 2014, and 29,653 are predicted for 2019, if the current trends continue.
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Affiliation(s)
- Jindra Reissigová
- Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
| | - Miroslav Zvolský
- Institute of Health Information and Statistics, Prague, Czech Republic
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10
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Ziebolz D, Reiss L, Schmalz G, Krause F, Haak R, Mausberg RF. Different views of dentists and general medical practitioners on dental care for patients with diabetes mellitus and coronary heart diseases: results of a questionnaire-based survey in a district of Germany. Int Dent J 2017; 68:197-203. [PMID: 29274083 DOI: 10.1111/idj.12353] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this questionnaire-based study was to evaluate the views of dentists (Ds) and general medical practitioners (GPs) on different aspects of dental care for patients with diabetes mellitus (DM) or coronary heart disease (CHD). METHODS Reliable and comparable questionnaires for Ds and GPs, with 23 questions, were sent to 1,000 randomly selected Ds and 1,000 randomly selected GPs. Questions were asked about patients with DM or CHD regarding their dental care and potentially related issues (e.g. antibiotic prophylaxis). The responses received within 12 weeks were evaluated and statistically analysed using chi-square and Mann-Whitney U tests (P < 0.05). RESULTS The response rate was 39% (n = 391) for Ds and 18% (n = 181) for GPs. Both groups stated that they used the medical history as well as patient interviews to assess patients. However, only 55% of Ds assumed correct identification of every at-risk patient compared with 100% of GPs (P < 0.01). Furthermore, Ds speculated that they inform their patients more often about their at-risk status than do GPs (P < 0.01). Neither Ds nor GPs appeared to be confident in their knowledge about adequate antibiotic prophylaxis. Interdisciplinary collaboration was considered insufficient, although Ds had a higher rate of regular collaboration (68% for Ds vs. 40% for GPs; P < 0.01). CONCLUSION Ds and GPs have differing views on dental care of patients with DM or CHD, and Ds showed more interest in this issue. These results might partially explain the insufficient collaboration between Ds and GPs.
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Affiliation(s)
- Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Lucie Reiss
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Felix Krause
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Rainer F Mausberg
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Goettingen, Goettingen, Germany
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11
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Li Z, Zhang S, Cao L, Li W, Ye YC, Shi ZX, Wang ZR, Sun LX, Wang JW, Jia LT, Wang W. Tanshinone IIA and Astragaloside IV promote the angiogenesis of mesenchymal stem cell-derived endothelial cell-like cells via upregulation of Cx37, Cx40 and Cx43. Exp Ther Med 2017; 15:1847-1854. [PMID: 29434774 PMCID: PMC5776521 DOI: 10.3892/etm.2017.5636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/29/2017] [Indexed: 12/17/2022] Open
Abstract
Tanshinone IIA (Tan IIA) and Astragaloside IV (AGS-IV) were used as therapeutic treatments for coronary heart diseases (CHDs) in ancient China. However, the underlying mechanisms mediating the effects of Tan IIA and AGS-IV in angiogenesis remain unknown. In the present study, mesenchymal stem cells (MSCs) were induced to differentiate into endothelial cell (EC)-like cells in vitro and the effects of Tan IIA and/or AGS-IV on the functions of these cells, including cell proliferation and tube formation, were assessed. Compared with the single-agent groups (Tan IIA or AGS-IV only), combined-agent (Tan IIA and AGS-IV) treatment significantly enhanced the proliferation and tube formation capacity of EC-like cells. In addition, the expression of connexin 37 (Cx37), Cx40 and Cx43 in the combined-agent group was significantly increased compared with the single-agent groups. Furthermore, enhanced gap junctional intercellular communication (GJIC) was identified in the combined-agent group, as evidenced by increased dye transfer in scrape-loading dye transfer assays. In conclusion, Tan IIA and AGS-IV may promote the angiogenesis of EC-like cells by upregulating the expression of Cx37, Cx40 and Cx43 and enhancing GJIC function. The results of the present study may provide experimental evidence for the clinical application of Tan IIA and AGS-IV as a treatment for CHDs.
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Affiliation(s)
- Zhe Li
- Department of Traditional Chinese Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China.,Second Clinical Medical College, Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi 710026, P.R. China
| | - Sha Zhang
- Department of Traditional Chinese Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Liang Cao
- Department of Traditional Chinese Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Wei Li
- Department of Histology and Embryology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yu-Chen Ye
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Zi-Xuan Shi
- Department of Acupuncture, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi'an, Shaanxi 710003, P.R. China
| | - Zong-Ren Wang
- Department of Traditional Chinese Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Lian-Xu Sun
- Department of Traditional Chinese Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Jia-Wei Wang
- Department of Traditional Chinese Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Lin-Tao Jia
- Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Wen Wang
- Department of Traditional Chinese Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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12
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Lv C, Liu C, Yao Z, Gao X, Sun L, Liu J, Song H, Li Z, Du X, Sun J, Li Y, Ye K, Wang R, Huang Y. The Clinical Pharmacokinetics and Pharmacodynamics of Warfarin When Combined with Compound Danshen: A Case Study for Combined Treatment of Coronary Heart Diseases with Atrial Fibrillation. Front Pharmacol 2017; 8:826. [PMID: 29209208 PMCID: PMC5702344 DOI: 10.3389/fphar.2017.00826] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/31/2017] [Indexed: 12/11/2022] Open
Abstract
Warfarin is used as anticoagulant and Compound Danshen prescription (CDP) is able to promote blood circulation. The combination might produce a synergic effect for patients of coronary heart diseases (CHDs) with atrial fibrillation (AF). Whether the combination increases the bleeding risk of warfarin is unclear, so the effects of Compound Danshen dripping pill (CDDP) on the pharmacokinetics (PK) and pharmacodynamics (PD) profiles of warfarin was investigated in patients. The dose and blood concentrations of warfarin, the four indicators of blood coagulation, prothrombin time, activated partial thromboplatin time, thrombin time, fibrinogen, and international normalized ratio value were compared when with and without CDDP treatment. The population PK (PPK) and PPK-PD models were established to assess patient demographics, genetic polymorphisms and CDDP as covariates. And the Seattle Angina Questionnaire was used to evaluate clinical efficacy, and the bleeding risk of combination was analyzed. The results indicated that CDDP had little influence on PK and PD profiles of warfarin in most patients and the combination of CCDP and warfarin would be a promising alternative regime for CHD with AF patients. The study was registered on China Clinical Trial Registry with number ChiCTR-ONRC-13003523.
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Affiliation(s)
- Chunxiao Lv
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Changxiao Liu
- State Key Laboratory of Drug Delivery Technology and Pharmacokinetics, Tianjin Institute of Pharmaceutical Research, Tianjin, China
| | - Zhuhua Yao
- Department of Cardiology, People's Hospital of Tianjin, Tianjin, China
| | - Xiumei Gao
- Engineering Research Center of Modern Chinese Medicine Discovery and Preparation Technique, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lanjun Sun
- Department of Cardiology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jia Liu
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Haibo Song
- National Center for ADR Monitoring of China, Center for Drug Reevaluation of CFDA, Beijing, China
| | - Ziqiang Li
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xi Du
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jinxia Sun
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanfen Li
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Kui Ye
- Department of Vascular Surgery, Tianjin 4th Center Hospital, Tianjin, China
| | - Ruihua Wang
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuhong Huang
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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13
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Wilentz JB, Kleinman DV, Alfano MC. Meeting commentary: Santa Fe Group Salon Expanding Oral Healthcare for America's Seniors, September 28-30, 2016. J Am Dent Assoc 2017; 148:272-4. [PMID: 28359455 DOI: 10.1016/j.adaj.2017.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 01/30/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OVERVIEW A meeting to explore ways to expand access to oral health care for seniors-possibly by expanding a dental benefit in Medicare-was convened in Arlington, VA, by the Santa Fe Group. Four factors motivated the meeting: PRACTICAL IMPLICATIONS: The model Medicare dental benefit presented generated much discussion. There was agreement that any dental benefit must attract participating dentists. Agreement was also reached on the importance of public demonstration projects to further establish cost savings from dental care for patients with comorbid diseases, the need to collaborate with nondental advocacy and policy groups to establish that overall health benefits for seniors are gained by adding oral health care, and the necessity of oral health literacy campaigns working directly at the community level with the general public and others, including educators and the media, as well as with policy makers and providers from all health fields and at all levels of professional training.
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14
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Wang X, Hu YC, Zhang RY, Jin DX, Jiang Y, Zhang HN, Cong HL. Effect of cyclosporin A intervention on the immunological mechanisms of coronary heart disease and restenosis. Exp Ther Med 2016; 12:3242-3248. [PMID: 27882144 PMCID: PMC5103772 DOI: 10.3892/etm.2016.3775] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 07/15/2016] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to investigate the effect of cyclosporin A (CSA) intervention on the immunological mechanisms underlying coronary heart disease (CHD) and restenosis (RS) in rabbits. A total of 48 rabbits were randomly divided into normal control (N), N + CSA, CHD model, CHD + CSA, RS model and RS + CSA groups. Rabbits in the respective groups received different treatments prior to sacrifice at the end of week 12. Iliac arteries were harvested from the rabbits for morphological analysis and to determine the mRNA and protein expression levels of cluster of differentiation (CD) 40/CD40 ligand (CD40L), CD134/CD134 ligand (CD134L) and inflammatory factors, including matrix metalloproteinase (MMP)-1, MMP-9, vascular cell adhesion protein (VCAM)-1, interleukin (IL)-6 and tumor necrosis factor (TNF)-α, by reverse transcription-quantitative polymerase chain reaction and immunohistochemical staining. As compared with the N group, the mRNA expression levels of MMP-9, VCAM-1 and TNF-α were significantly increased in the CHD and RS groups (P<0.05), but were significantly decreased in the groups with CSA intervention, as compared with those without CSA intervention (P<0.05). Conversely, there were no significant differences in the expression levels of MMP-1 and IL-6 among the six groups, although a decreasing trend of IL-6 expression was observed following intervention with CSA. Furthermore, there were significant differences in the mRNA and protein expression levels of CD40/CD40L and CD134/CD134L among the N, CHD and RS groups (P<0.05), and between the groups with and without CSA intervention. The present study demonstrated that CSA intervention exerted beneficial effects on CHD and RS, and further studies are required to investigate the mechanisms underlying the effects of CSA on CHD.
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Affiliation(s)
- Xuan Wang
- Cardiology Department, Tianjin Medical University, Tianjin 300070, P.R. China; Cardiology Department, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Yue-Cheng Hu
- Cardiology Department, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Ru-Yan Zhang
- Cardiology Department, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Dong-Xia Jin
- Cardiology Department, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Yuan Jiang
- Cardiology Department, Tianjin Medical University, Tianjin 300070, P.R. China
| | - He-Nan Zhang
- Cardiology Department, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Hong-Liang Cong
- Cardiology Department, Tianjin Chest Hospital, Tianjin 300222, P.R. China
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15
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Sanjuán P, García-Zamora C, Ruiz MÁ, Rueda B, Arranz H, Castro A. Benefit Finding in Cardiac Patients: Relationships with Emotional Well-Being and Resources after Controlling for Physical Functional Impairment. Span J Psychol 2016; 19:E50. [PMID: 27641065 DOI: 10.1017/sjp.2016.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Benefit finding (BF) is defined as the individual's perception of positive change as a result of coping with an adverse life event. The beneficial effects of BF on well-being could be because BF favors the improvement of resources like self-efficacy, social support and effective coping. The main objective of this longitudinal 8 week study was to explore, in a sample of cardiac patients (n = 51), the combined contribution of BF and these resources to the positive affect. Moreover, we wanted to check whether these resources were derived from BF or, on the contrary, these resources were antecedents of BF. Results showed that after controlling for functional capacity, only effective coping could predict the positive affect at Time 1 (β = .32, p < .05), while the BF predicted it at Time 2 (β = .23, p < .001). Only social support predicted BF (β = .26, p < .05), but not the opposite. We discussed the desirability of promoting these processes to improve the emotional state of cardiac patients.
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16
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Sanjuán P, Montalbetti T, Pérez-García AM, Bermúdez J, Arranz H, Castro A. A Randomised Trial of a Positive Intervention to Promote Well-Being in Cardiac Patients. Appl Psychol Health Well Being 2016; 8:64-84. [PMID: 26876425 DOI: 10.1111/aphw.12062] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Negative emotions are linked to the onset and development of coronary heart diseases (CHD), whereas positive emotions are associated with better health and lower mortality rates among patients with these diseases. The objective of this randomised trial was to improve cardiac patients' emotional states using a Programme to Improve Well-being (PIW) based exclusively on positive interventions (those that promote intentional behaviours and thoughts to improve well-being). METHODS Cardiac patients (n = 108) were randomly assigned to two parallel groups. In the control group, they participated in only a Cardiac Rehabilitation Programme (CRP group), whereas the intervention group also participated in the PIW (CRP+PIW group). Physical functional capacity, depressive symptoms, hostility, and negative and positive affect were assessed at T1 (baseline) and T2 (8 weeks later). RESULTS At T2, after controlling for functional capacity, the CRP+PIW group reported a significantly less negative affect than the CRP group. Moreover, the CRP group did not change from T1 to T2, whereas the CRP+PIW group reported more positive emotions and fewer negative emotions and hostility at T2 than at T1. CONCLUSIONS Positive interventions effectively improve the emotional state of cardiac patients. We suggest that specific modules should be included in the CRP to improve well-being.
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Affiliation(s)
- Pilar Sanjuán
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | | | | | - José Bermúdez
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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17
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Wang LH, Liu CK, Chen CH, Kao LT, Lin HC, Huang CY. No increased risk of coronary heart disease for patients receiving androgen deprivation therapy for prostate cancer in Chinese/Taiwanese men. Andrology 2015; 4:128-32. [PMID: 26711703 DOI: 10.1111/andr.12141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/19/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
Abstract
The relationship between androgen deprivation therapy (ADT) and coronary heart disease (CHD) remains controversial. Furthermore, the majority of such studies focused on Caucasian populations, and there is still a paucity of studies among Asian populations. This population-based study aimed to investigate the relationship between ADT and CHD in an ethnic Chinese (i.e., Taiwanese) population. We used data sourced from the Taiwan 'Longitudinal Health Insurance Database'. This study included 1278 patients with prostate cancer in the study group and 1278 subjects without prostate cancer in the comparison group. Each patient was individually tracked for a 3-year period to identify those who had subsequently received a diagnosis of CHD. The results showed that the incidence rate of CHD during the 3-year follow-up period was 4.69 (95% CI: 2.99-5.48) per 100 person-years and 2.67 (95% CI: 2.15-3.27) per 100 person-years for the study and comparison cohort, respectively. The Cox proportional hazard regression showed that the hazard ratio for CHD during the 3-year follow-up period for prostate cancer patients was 1.65 (95% confidence interval (CI) = 1.25-2.16) compared with comparison subjects after adjusting for patients' geographic location, monthly income, urbanization level, hypertension, diabetes, hyperlipidemia, and stroke. However, we failed to find a significant difference in the adjusted hazard of CHD during the 3-year follow-up period between prostate cancer patients who did and those who did not receive ADT (hazard ratio = 1.12, 95% CI = 0.79-1.59). We concluded that prostate cancer but not ADT was significantly associated with CHD. In addition, a common cause of prostate cancer and coronary heart disease could exist.
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Affiliation(s)
- L H Wang
- School of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan
| | - C K Liu
- Department of Urology, Taipei City Hospital, Taipei, Taiwan.,College of Medicine, Fu-Jen University, New Taipei, Taiwan
| | - C H Chen
- Department & Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
| | - L T Kao
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - H C Lin
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - C Y Huang
- School of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Urology, National Taiwan University Hospital, College of Medicine National Taiwan University, Taipei, Taiwan
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18
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Orsavova J, Misurcova L, Ambrozova JV, Vicha R, Mlcek J. Fatty Acids Composition of Vegetable Oils and Its Contribution to Dietary Energy Intake and Dependence of Cardiovascular Mortality on Dietary Intake of Fatty Acids. Int J Mol Sci 2015; 16:12871-90. [PMID: 26057750 PMCID: PMC4490476 DOI: 10.3390/ijms160612871] [Citation(s) in RCA: 423] [Impact Index Per Article: 47.0] [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] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/01/2015] [Indexed: 12/14/2022] Open
Abstract
Characterizations of fatty acids composition in % of total methylester of fatty acids (FAMEs) of fourteen vegetable oils--safflower, grape, silybum marianum, hemp, sunflower, wheat germ, pumpkin seed, sesame, rice bran, almond, rapeseed, peanut, olive, and coconut oil--were obtained by using gas chromatography (GC). Saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA), palmitic acid (C16:0; 4.6%-20.0%), oleic acid (C18:1; 6.2%-71.1%) and linoleic acid (C18:2; 1.6%-79%), respectively, were found predominant. The nutritional aspect of analyzed oils was evaluated by determination of the energy contribution of SFAs (19.4%-695.7% E(RDI)), PUFAs (10.6%-786.8% E(RDI)), n-3 FAs (4.4%-117.1% E(RDI)) and n-6 FAs (1.8%-959.2% E(RDI)), expressed in % E(RDI) of 1 g oil to energy recommended dietary intakes (E(RDI)) for total fat (E(RDI)--37.7 kJ/g). The significant relationship between the reported data of total fat, SFAs, MUFAs and PUFAs intakes (% E(RDI)) for adults and mortality caused by coronary heart diseases (CHD) and cardiovascular diseases (CVD) in twelve countries has not been confirmed by Spearman's correlations.
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Affiliation(s)
- Jana Orsavova
- Language Centre, Faculty of Humanities, Tomas Bata University in Zlín, nám. T. G. Masaryka 5555, 760 01 Zlín, Czech Republic.
| | - Ladislava Misurcova
- Department of Food Analysis and Chemistry, Faculty of Technology, Tomas Bata University in Zlín, nám. T. G. Masaryka 5555, 760 01 Zlín, Czech Republic.
| | - Jarmila Vavra Ambrozova
- Department of Food Analysis and Chemistry, Faculty of Technology, Tomas Bata University in Zlín, nám. T. G. Masaryka 5555, 760 01 Zlín, Czech Republic.
| | - Robert Vicha
- Department of Chemistry, Faculty of Technology, Tomas Bata University in Zlín, nám. T. G. Masaryka 5555, 760 01 Zlín, Czech Republic.
| | - Jiri Mlcek
- Department of Food Analysis and Chemistry, Faculty of Technology, Tomas Bata University in Zlín, nám. T. G. Masaryka 5555, 760 01 Zlín, Czech Republic.
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19
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Ruquet M, Maille G, Tavitian P, Tardivo D, Hüe O, Bonfil JJ. Alveolar bone loss and ageing: possible association with coronary heart diseases and/or severe vascular diseases. Gerodontology 2014; 33:356-62. [PMID: 25395062 DOI: 10.1111/ger.12168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to utilise a new methodological approach based on radiographic examinations to demonstrate a potential association between coronary heart diseases (CHD) as well as severe hypertension and alveolar bone loss (ABL) in older adults. BACKGROUND Many studies, primarily assessing clinical parameters, underline the association between periodontal diseases and cardiovascular diseases. The relationship between ABL and CHD/vascular diseases (VD) is potentially of high importance because of their prevalence in populations, and they represent an important issue in the fields of epidemiology and public health. Therefore, this topic was approached with new tools. MATERIALS AND METHODS The study was comprised of 236 participants over 50 years. A clinical examination and a radiographic assessment of ABL were performed. Direct measures of alveolar bone level were recorded using CT scans, and different variables were studied (age, sex, Plaque index, cigarettes per day, coronary heart disease and vascular disease status). A medical examination report was attached to the investigation file. RESULTS The results confirmed a positive association between CHD/VD and periodontal destruction; alveolar bone destruction represented a risk factor for CHD/VD [odds ratio (OR): 1.27; 95% CI: 1.01-1.60; p < 0.037]. CONCLUSION This study supports an association between periodontal diseases and CHD/VD independent of known confounders, although an aetiological link of causality has not been established.
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Affiliation(s)
- Michel Ruquet
- Faculté de Médecine Nord, UMR 7268 ADÉS/Aix Marseille Université -EFS- CNRS, Marseille Cedex, France.,Faculté d'Odontologie, Aix-Marseille Université, Marseille Cedex, France
| | - Gérald Maille
- Faculté de Médecine Nord, UMR 7268 ADÉS/Aix Marseille Université -EFS- CNRS, Marseille Cedex, France.,Faculté d'Odontologie, Aix-Marseille Université, Marseille Cedex, France
| | - Patrick Tavitian
- Faculté d'Odontologie, Aix-Marseille Université, Marseille Cedex, France
| | - Delphine Tardivo
- Faculté de Médecine Nord, UMR 7268 ADÉS/Aix Marseille Université -EFS- CNRS, Marseille Cedex, France.,Faculté d'Odontologie, Aix-Marseille Université, Marseille Cedex, France
| | - Olivier Hüe
- Faculté d'Odontologie, Aix-Marseille Université, Marseille Cedex, France
| | - Jean-Jacques Bonfil
- Faculté de Médecine Nord, UMR 7268 ADÉS/Aix Marseille Université -EFS- CNRS, Marseille Cedex, France.,Faculté d'Odontologie, Aix-Marseille Université, Marseille Cedex, France
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Liu S, Li D, Huang B, Chen Y, Lu X, Wang Y. Inhibition of pancreatic lipase, α-glucosidase, α-amylase, and hypolipidemic effects of the total flavonoids from Nelumbo nucifera leaves. J Ethnopharmacol 2013; 149:263-269. [PMID: 23811214 DOI: 10.1016/j.jep.2013.06.034] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 05/21/2013] [Accepted: 06/20/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Nelumbo nucifera Gaertn. leaves have been used as medicinal herbs in the past 1300 years, specifically utilized to cure hyperlipidemia, hyperglycemia, and obesity. It has been recorded in the most famous medicinal book in China for more than 400 years. The present study aims to identify the potential therapeutic activities of the flavonoids isolated from Nelumbo nucifera leaves. MATERIALS AND METHODS Nelumbo nucifera leaf flavonoids (NLF) were tested for the inhibition of lipase, α-glucosidase, and α-amylase activities in vitro. A single dose of NLF was administered by oral gavage in mice for acute toxicity. Wistar rats with high-fat diet-induced hyperlipidemia and two other animal models were used to evaluate the hypolipidemic effects of NLF. RESULTS Our in vitro biochemistry tests revealed that the NLF showed high inhibitory activity against porcine pancreatic lipase, α-amylase, and α-glucosidase with IC50 values of 0.38 ± 0.022, 2.20 ± 0.18, and 1.86 ± 0.018 mg/mL, respectively. Furthermore, the NLF significantly lowered the lipid components, such as the total cholesterol, triglycerides, low-density lipoprotein cholesterol, and malondialdehyde, in various established in vivo systems and raised the high-density lipoprotein cholesterol. Moreover, the NLF alleviated high-fat diet-induced lipid accumulation in the liver. CONCLUSIONS The results demonstrate that NLFs can effectively ameliorate hyperlipidemia and inhibit the key enzymes related to type 2 diabetes mellitus. Our findings may provide new pharmacological basis for the treatment of hyperlipidemia, hyperglycemia, and obesity using NLFs.
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Affiliation(s)
- Song Liu
- MOE Key Laboratory of Combinatorial Biosynthesis and Drug Discovery, Institute of TCM and Natural Products, School of Pharmaceutical Sciences, Wuhan University, Wuhan 430071, PR China
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Chen Q, Hua X, Fu W, Liu D, Chen M, Cai G. Quantitative determination of fibrinogen of patients with coronary heart diseases through piezoelectric agglutination sensor. Sensors (Basel) 2010; 10:2107-2118. [PMID: 22294917 PMCID: PMC3264470 DOI: 10.3390/s100302017] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 02/08/2010] [Accepted: 03/01/2010] [Indexed: 05/31/2023]
Abstract
Fibrinogen can transform fibrin through an agglutination reaction, finally forming fibrin polymer with grid structure. The density and viscosity of the reaction system changes drastically during the course of agglutination. In this research, we apply an independently-developed piezoelectric agglutination sensor to detect the fibrinogen agglutination reaction in patients with coronary heart diseases. The terminal judgment method of determining plasma agglutination reaction through piezoelectric agglutination sensor was established. In addition, the standard curve between plasma agglutination time and fibrinogen concentration was established to determinate fibrinogen content quantitatively. The results indicate the close correlation between the STAGO paramagnetic particle method and the method of piezoelectric agglutination sensor for the detection of Fibrinogen. The correlation coefficient was 0.91 (γ = 0.91). The determination can be completed within 10 minutes. The fibrinogen concentration in the coronary heart disease group was significantly higher than that of the healthy control group (P < 0.05). The results reveal that high fibrinogen concentration is closely correlated to the incurrence, development and prognosis of coronary heart diseases. Compared with other traditional methods, the method of piezoelectric agglutination sensor has some merits such as operation convenience, small size, low cost, quick detecting, good precision and the common reacting agents with paramagnetic particle method.
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Affiliation(s)
- Qinghai Chen
- Laboratory, The Clinical Experimental Base of Biosensor and Microarray, The Center of Molecule and Gene Diagnosis, Southwest Hospital, Third Military Medical University, Chongqing 400038, China; E-Mails: (X.H); (D.L.); (M.C.)
| | - Xing Hua
- Laboratory, The Clinical Experimental Base of Biosensor and Microarray, The Center of Molecule and Gene Diagnosis, Southwest Hospital, Third Military Medical University, Chongqing 400038, China; E-Mails: (X.H); (D.L.); (M.C.)
| | - Weiling Fu
- Laboratory, The Clinical Experimental Base of Biosensor and Microarray, The Center of Molecule and Gene Diagnosis, Southwest Hospital, Third Military Medical University, Chongqing 400038, China; E-Mails: (X.H); (D.L.); (M.C.)
| | - Dongbo Liu
- Laboratory, The Clinical Experimental Base of Biosensor and Microarray, The Center of Molecule and Gene Diagnosis, Southwest Hospital, Third Military Medical University, Chongqing 400038, China; E-Mails: (X.H); (D.L.); (M.C.)
| | - Ming Chen
- Laboratory, The Clinical Experimental Base of Biosensor and Microarray, The Center of Molecule and Gene Diagnosis, Southwest Hospital, Third Military Medical University, Chongqing 400038, China; E-Mails: (X.H); (D.L.); (M.C.)
| | - Guoru Cai
- The 26th Electronics Research Institute, National Information Industry Department, Chongqing 400060, China; E-Mail: (G.C.)
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Lin Y, Mousa SS, Elshourbagy N, Mousa SA. Current status and future directions in lipid management: emphasizing low-density lipoproteins, high-density lipoproteins, and triglycerides as targets for therapy. Vasc Health Risk Manag 2010; 6:73-85. [PMID: 20234782 PMCID: PMC2835557 DOI: 10.2147/vhrm.s8725] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Indexed: 02/02/2023] Open
Abstract
Current lipid management guidelines are focused on decreasing low-density lipoprotein (LDL-C) levels as the primary target for reducing coronary heart disease (CHD) risk. Yet, many recent studies suggest that low levels of high-density lipoprotein (HDL-C) are a major independent risk factor for cardiovascular diseases. According to several clinical trials, a 1% increase in HDL-C is associated with a 0.7%–3% decrease in CHD events. The direct link between high levels of triglycerides (TG) and CHD, on the other hand, is less well defined. A large reduction in TG is needed to show a difference in CHD events, especially in men. Evidence for a shift in lipid management toward targeting both LDL-C and HDL-C as primary targets for therapy is presented. Currently, the 3-hydroxy-3-methylgutaryl coenzyme A reductase inhibitors (HMG-CoA reductase inhibitors) have proven to significantly decrease LDL-C levels, reduce CHD morbidity/mortality and improve overall survival. However, improvement of survival with statins may be due to other pleiotropic effects beyond LDL-C lowering. Fibric acid derivatives and niacin are primarily used to increase HDL-C levels, although with side effects. Future therapies targeting HDL-C may have profound results on reducing CHD morbidity and mortality. This article highlights existing and future targets in lipid management and is based on available clinical data. There is an urgent need for new treatments using a combination of drugs targeting both LDL-C and HDL-C. Such treatments are expected to have a superior outcome for dyslipidemia therapy, along with TG management.
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Affiliation(s)
- Yun Lin
- The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Albany, NY 12144, USA
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Amoruso A, Gunella G, Rondano E, Bardelli C, Fresu LG, Ferrero V, Ribichini F, Vassanelli C, Brunelleschi S. Tobacco smoke affects expression of peroxisome proliferator-activated receptor-gamma in monocyte/macrophages of patients with coronary heart disease. Br J Pharmacol 2009; 158:1276-84. [PMID: 19814730 PMCID: PMC2782336 DOI: 10.1111/j.1476-5381.2009.00442.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 04/20/2009] [Accepted: 05/25/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Tobacco smoke represents a relevant risk factor for coronary heart disease (CHD). Although peroxisome proliferator-activated receptor (PPAR)gamma activation reduces inflammation and atherosclerosis, expression of PPARgamma in cells and its modulation by smoking are poorly investigated. We previously reported that monocyte/macrophages from healthy smokers exhibited an enhanced constitutive expression of PPARgamma. Here, we evaluated PPARgamma expression and basal cytokine release in monocytes and monocyte-derived macrophages (MDMs) from 85 CHD patients, classified by their smoking habit (smokers, non-smokers and ex-smokers), and assessed the role of PPARgamma ligands in this context. EXPERIMENTAL APPROACH PPARgamma protein was detected by Western blot and semi-quantified by PPARgamma/beta-actin ratio; cytokine release was measured by elisa and nuclear factor-kappaB (NF-kappaB) translocation by electrophoretic mobility shift assays. KEY RESULTS As compared to the other groups, MDMs from smoker CHD patients exhibited a reduced PPARgamma/beta-actin ratio and an increased spontaneous release of tumour necrosis factor-alpha (TNF-alpha) and interleukin-6, but with no major variations in monocytes. In cells from selected CHD patients, rosiglitazone inhibited TNF-alpha release and NF-kappaB translocation induced by phorbol-12-myristate 13-acetate. The selective PPARgamma antagonist GW9662 reversed these effects, with some variations related to smoking habit. CONCLUSIONS AND IMPLICATIONS In CHD patients, exposure to tobacco smoke profoundly affected PPARgamma expression, and this was related to levels of secretion of pro-inflammatory cytokines. MDMs from CHD smokers showed the lowest PPARgamma expression and released more inflammatory cytokines. Moreover, rosiglitazone's ability to inhibit cytokine release and its reversal by GW9662 clearly indicated PPARgamma involvement in these changes in CHD patients.
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Affiliation(s)
- A Amoruso
- Department of Medical Sciences, School of Medicine, University of Piemonte Orientale A Avogadro, Novara, Italy
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Abstract
Timely revascularization can improve survival in patients with acute myocardial infarction. Identification of factors associated with increased use of revascularization in appropriate patients could improve outcomes. Using New York City hospital discharge records for 1988-1992 and 1998-2002, we determined revascularization rates for patients hospitalized with MI by neighborhood. Odds ratios for revascularization were estimated using a spatial model adjusting for neighborhood sociodemographic characteristics, while accounting for similarities in the rate of revascularization among geographically adjacent neighborhoods. Only 16 out of 112 New York City hospitals performed coronary revascularization. They were located in 14 of 41 neighborhoods. In general, patients living in neighborhoods with higher percentages of patients admitted to hospitals capable of revascularization service were more likely to be revascularized than those in neighborhoods with low percentages of patients admitted to hospitals with revascularization resources. This was true regardless of neighborhood availability of revascularization, after accounting for neighborhood socioeconomic characteristics and patients' clinical status. Revascularization rates in New York City increased from 1988-1992 to 1998-2002 in every neighborhood and as a whole from 103 to 326 per 1,000 hospitalized AMI patients. This increase was not explained by the addition of new revascularization services. Thus, in New York City, where only certain hospitals can perform revascularization, efficient delivery of patients to hospitals with these resources appears to increase the likelihood of revascularization performance among AMI patients without increasing the number of new hospitals capable of revascularization.
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Affiliation(s)
- Jing Fang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Abstract
OBJECTIVE To analyse trends in mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) over the period 1965 to 1998 in the European Union, other European countries, the USA, and Japan. METHODS AND RESULTS Data were derived from the World Health Organization database. In the European Union, CHD mortality in men rose from 146/100 000 in 1965-9 to 163/100 000 in 1975-9 and declined thereafter to 99/100 000 in 1995-8 (-39%). In women, the fall was from 70 to 45/100 000 (-36%). A > 55% decline in CVD was registered in both sexes. In eastern Europe, mortality from both CHD and CVD rose up to the early 1990s but has declined over the past few years in Poland and the Czech Republic. In the Russian Federation during 1995-8, mortality rates from CHD reached 330/100 000 men and 154/100 000 women and mortality rates from CVD were 203/100 000 men and 150/100 000 women-that is, they were among the highest rates worldwide. In the USA and Japan, long term trends were favourable for both CHD and CVD. CONCLUSIONS Trends in mortality from CHD and CVD were favourable in several developed areas of the world, but there were major geographical differences. In a few eastern European countries, mortality from CHD and CVD remains exceedingly high.
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Affiliation(s)
- F Levi
- Unité d'épidémiologie du cancer and Registres vaudois et neuchâtelois des tumeurs, Institut universitaire de médecine sociale et préventive, Centre Hospitalier Universitaire Vaudois, Falaises 1, 1011 Lausanne, Switzerland.
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