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Mink S, Drexel H, Leiherer A, Frick M, Reimann P, Saely CH, Fraunberger P. Interplay of inflammatory markers and anti-SARS-CoV-2 antibodies in COVID-19 mortality: A prospective cohort study. Int J Infect Dis 2024; 143:107016. [PMID: 38521446 DOI: 10.1016/j.ijid.2024.107016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVES Despite high global vaccination coverage, it remains unclear how vaccination and anti-SARS-CoV-2 antibodies affect immune responses and inflammation levels in patients with COVID-19. It is further unclear whether the inflammatory response differs depending on antibody levels and whether the combination of antibody and inflammation levels in COVID-19 patients affects mortality rates. METHODS We conducted a prospective multicenter cohort study that included 1031 hospitalized COVID-19 patients from five hospitals. Anti-SARS-CoV-2-spike antibodies, interleukin-6 (IL6), and CRP were measured on hospital admission. The prespecified endpoint was all-cause in-hospital mortality. RESULTS We observed significantly lower levels of CRP (P<0.001) and IL6 (P<0.001) in patients with antibody levels above 1200 BAU/ml. After adjusting for potential confounders, patients with high levels of inflammatory markers (CRP>6 mg/dl or IL6>100 pg/ml) combined with low levels of anti-SARS-CoV-2-spike antibodies (<1200 BAU/ml) were approximately 8 times more likely to die than patients with low inflammatory responses and high antibody levels (CRP: aHR 7.973, 95% CI 2.744-23.169, P<0.001; IL6: aHR 8.973, 95% CI 3.549-22.688, P<0.001). CONCLUSION Hospitalized COVID-19 patients presenting with high inflammatory markers and low antibody levels exhibited the highest mortality risks. Higher antibody levels are associated with lower levels of inflammation in hospitalized COVID-19 patients.
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Affiliation(s)
- Sylvia Mink
- Central Medical Laboratories, Feldkirch, Austria; Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein.
| | - Heinz Drexel
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein; VIVIT Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Andreas Leiherer
- Central Medical Laboratories, Feldkirch, Austria; VIVIT Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Matthias Frick
- Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Patrick Reimann
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein; Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christoph H Saely
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein; VIVIT Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Peter Fraunberger
- Central Medical Laboratories, Feldkirch, Austria; Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
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Leiherer A, Muendlein A, Mink S, Mader A, Saely CH, Festa A, Fraunberger P, Drexel H. Machine Learning Approach to Metabolomic Data Predicts Type 2 Diabetes Mellitus Incidence. Int J Mol Sci 2024; 25:5331. [PMID: 38791370 DOI: 10.3390/ijms25105331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Metabolomics, with its wealth of data, offers a valuable avenue for enhancing predictions and decision-making in diabetes. This observational study aimed to leverage machine learning (ML) algorithms to predict the 4-year risk of developing type 2 diabetes mellitus (T2DM) using targeted quantitative metabolomics data. A cohort of 279 cardiovascular risk patients who underwent coronary angiography and who were initially free of T2DM according to American Diabetes Association (ADA) criteria was analyzed at baseline, including anthropometric data and targeted metabolomics, using liquid chromatography (LC)-mass spectroscopy (MS) and flow injection analysis (FIA)-MS, respectively. All patients were followed for four years. During this time, 11.5% of the patients developed T2DM. After data preprocessing, 362 variables were used for ML, employing the Caret package in R. The dataset was divided into training and test sets (75:25 ratio) and we used an oversampling approach to address the classifier imbalance of T2DM incidence. After an additional recursive feature elimination step, identifying a set of 77 variables that were the most valuable for model generation, a Support Vector Machine (SVM) model with a linear kernel demonstrated the most promising predictive capabilities, exhibiting an F1 score of 50%, a specificity of 93%, and balanced and unbalanced accuracies of 72% and 88%, respectively. The top-ranked features were bile acids, ceramides, amino acids, and hexoses, whereas anthropometric features such as age, sex, waist circumference, or body mass index had no contribution. In conclusion, ML analysis of metabolomics data is a promising tool for identifying individuals at risk of developing T2DM and opens avenues for personalized and early intervention strategies.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), A-6800 Feldkirch, Austria
- Central Medical Laboratories, A-6800 Feldkirch, Austria
- Faculty of Medical Sciences, Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), A-6800 Feldkirch, Austria
| | - Sylvia Mink
- Central Medical Laboratories, A-6800 Feldkirch, Austria
- Faculty of Medical Sciences, Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein
| | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), A-6800 Feldkirch, Austria
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
| | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), A-6800 Feldkirch, Austria
- Faculty of Medical Sciences, Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
| | - Andreas Festa
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), A-6800 Feldkirch, Austria
| | - Peter Fraunberger
- Central Medical Laboratories, A-6800 Feldkirch, Austria
- Faculty of Medical Sciences, Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), A-6800 Feldkirch, Austria
- Faculty of Medical Sciences, Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein
- Vorarlberger Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
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3
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Ratz M, Vogel JB, Kührer H, Säly CH, Mündlein A, Vonbank A, Mader A, Fraunberger P, Leiherer A, Drexel H. 25 years of lipid-lowering therapy: secular trends in therapy of coronary patients. Wien Klin Wochenschr 2024:10.1007/s00508-024-02365-x. [PMID: 38743139 DOI: 10.1007/s00508-024-02365-x] [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: 02/20/2024] [Accepted: 04/05/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND AIM Guidelines on dyslipidemia and lipid-lowering therapy (LLT) over the years recommend lower low-density lipoprotein cholesterol (LDL-C) goals by more intense therapy. Nevertheless, LDL‑C has increased in the general population. Real-world trends of LLT medication as well as of LDL‑C levels in cardiovascular high-risk patients are unclear. METHODS From 2158 patients who were referred for elective coronary angiography, lipid medication was analyzed at admission in three cardiovascular observational studies (OS) over the last 25 years: OS1: 1999-2000, OS2: 2005-2008 and OS3: 2022-2023. The three studies were performed at the same cardiology unit of a tertiary care hospital in Austria. RESULTS The proportion of patients without LLT significantly decreased from OS1 through OS2 to OS3 (49.4%, 45.6%, and 18.5%, respectively, ptrend < 0.001). Moreover, the percentage of patients under high-intensity statin treatment significantly increased from 0% to 5.1%, and 56.5% (ptrend < 0.001). Significantly more patients became treated by more than one compound (OS1: 1.8%, OS2: 1.6%, OS3: 31.2%; ptrend < 0.001). In the latest OS3, a trend to fixed-dose combination of statins with ezetimibe was observed. Mean LDL‑C levels decreased from 129 mg/dL over 127 mg/dL to 83 mg/dL, respectively (ptrend < 0.001). Of the patients on high-intensity therapy 34% met the recent ESC/EAS goals (LDL-C < 55 mg/dL), but only 3% on non-intense therapy. CONCLUSION We conclude that during the observational period of a quarter of a century, treatment intensity increased and LDL‑C levels improved considerably. Guidelines apparently matter in this high-risk population and are considered by primary care physicians.
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Affiliation(s)
- Magdalena Ratz
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Johannes B Vogel
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Heike Kührer
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Christoph H Säly
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Axel Mündlein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
| | - Alexander Vonbank
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Peter Fraunberger
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
- Central Medical Laboratories, Feldkirch, Austria
| | - Andreas Leiherer
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein.
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria.
- Central Medical Laboratories, Feldkirch, Austria.
| | - Heinz Drexel
- Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein.
- Vorarlberg Institute for Vascular Investigation & Treatment, (VIVIT), Carinagasse 47, 6800, Feldkirch, Austria.
- Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
- Drexel University College of Medicine, Philadelphia, PA, USA.
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Leiherer A, Brozek W, Muendlein A, Ulmer H, Saely CH, Fraunberger P, Nagel G, Zitt E, Drexel H, Concin H. The value of earlier-in-life systolic and diastolic blood pressure for cardiovascular risk prediction. iScience 2024; 27:109097. [PMID: 38384855 PMCID: PMC10879708 DOI: 10.1016/j.isci.2024.109097] [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: 11/22/2023] [Revised: 12/20/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
Blood pressure (BP) varies over a lifetime. This cardiovascular observation study (OS) compared the predictive value of earlier- and later-in-life blood pressure (BP) in 1,497 cardiovascular disease patients utilizing readings taken during a health survey (HS) and 15 years later from the same subjects at the baseline of this OS. Prediction of the cardiovascular risk during the OS follow-up (21 years) was significantly more effective if the earlier BP readings at HS were used instead of recent OS readings (NRI = 0.30, p < 0.001). For HS readings, each 10 mm Hg increase of systolic and diastolic BP was associated with a 17% and 20% higher risk, respectively. At OS, systolic BP lost significance and diastolic BP reversed its association. Noteworthy, different BP categorizations (European vs. US guidelines) yielded similar results. This study highlights the poor predictive power of BP readings in elderly cardiovascular disease patients but emphasizes the significant prognostic value of earlier-in-life BP.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | | | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Hanno Ulmer
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph H. Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Peter Fraunberger
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
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Leiherer A, Muendlein A, Saely CH, Laaksonen R, Fraunberger P, Drexel H. Ceramides improve cardiovascular risk prediction beyond low-density lipoprotein cholesterol. Eur Heart J Open 2024; 4:oeae001. [PMID: 38292914 PMCID: PMC10826640 DOI: 10.1093/ehjopen/oeae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024]
Abstract
Aims Low-density lipoprotein cholesterol (LDL-C) is the best documented cardiovascular risk predictor and at the same time serves as a target for lipid-lowering therapy. However, the power of LDL-C to predict risk is biased by advanced age, comorbidities, and medical treatment, all known to impact cholesterol levels. Consequently, such biased patient cohorts often feature a U-shaped or inverse association between LDL-C and cardiovascular or overall mortality. It is not clear whether these constraints for risk prediction may likewise apply to other lipid risk markers in particular to ceramides and phosphatidylcholines. Methods and results In this observational cohort study, we recorded cardiovascular mortality in 1195 patients over a period of up to 16 years, comprising a total of 12 262 patient-years. The median age of patients at baseline was 67 years. All participants were either consecutively referred to elective coronary angiography or diagnosed with peripheral artery disease, indicating a high cardiovascular risk. At baseline, 51% of the patients were under statin therapy. We found a U-shaped association between LDL-C and cardiovascular mortality with a trough level of around 150 mg/dL of LDL-C. Cox regression analyses revealed that LDL-C and other cholesterol species failed to predict cardiovascular risk. In contrast, no U-shaped but linear association was found for ceramide- and phosphatidylcholine-containing markers and these markers were able to significantly predict the cardiovascular risk even after multivariate adjustment. Conclusion We thus suggest that ceramides- and phosphatidylcholine-based predictors rather than LDL-C may be used for a more accurate cardiovascular risk prediction in high-risk patients.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein
- Medical Central Laboratories, Carinagasse 41, A-6800 Feldkirch, Austria
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein
| | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria
| | - Reijo Laaksonen
- Finnish Cardiovascular Research Center, University of Tampere, FI-33014 Tampere, Finland
- Zora Biosciences, FI-02150 Espoo, Finland
| | - Peter Fraunberger
- Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein
- Medical Central Laboratories, Carinagasse 41, A-6800 Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein
- Vorarlberger Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
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Geiger K, Muendlein A, Leiherer A, Gaenger S, Brandtner EM, Wabitsch M, Fraunberger P, Drexel H, Heinzle C. Myricetin attenuates hypoxia-induced inflammation in human adipocytes. Mol Biol Rep 2023; 50:9833-9843. [PMID: 37843712 DOI: 10.1007/s11033-023-08865-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Adipose tissue hypoxia plays a crucial role in the development of chronic low-grade systemic inflammation which has been associated with the pathogenesis of obesity-related diseases. Myricetin is a natural compound present in numerous plant-based foods with presumed anti-inflammatory and beneficial health effects. The impact of this flavonoid on hypoxia-induced expression of inflammatory adipokines and hypoxia-regulated pathways is unknown so far and has been addressed in the present study. METHODS Differentiated human Simpson-Golabi-Behmel syndrome (SGBS) adipocytes were cultured with or without myricetin under normoxic and hypoxic conditions for varying time periods. The effect of hypoxia and myricetin on the expression of the investigated adipokines was measured by real-time RT-PCR. Western blot analysis was used for the detection of transcription factors involved in hypoxia-regulated pathways. RESULTS Myricetin interfered in the hypoxia-induced regulation of adipokines and the underlying pathways, which are involved in transmitting the inflammatory response. It strongly repressed hypoxia-induced expression of apelin, leptin, chemerin, asprosin, and DPP-4 and HIF-1α accumulation in the nucleus was diminished. Furthermore, the activation of the key regulators in the inflammatory response NF-κB, Akt, and CREB was suppressed by myricetin under hypoxic conditions. Myricetin also decreased hypoxia-induced accumulation of the pro-tumorigenic transcription factors Snail and Slug in the nucleus. CONCLUSION Taken together, our results indicated that myricetin regulated hypoxia-induced expression of adipokines and hypoxia-regulated pathways in human adipocytes. Our study therefore provided evidence of the anti-inflammatory effects of myricetin in hypoxia-treated human adipocytes.
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Affiliation(s)
- Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.
- Medical Central Laboratories, Feldkirch, Austria.
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Medical Central Laboratories, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Stella Gaenger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Eva Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | | | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Vorarlberger Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Christine Heinzle
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Medical Central Laboratories, Feldkirch, Austria
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Muendlein A, Heinzle C, Leiherer A, Brandtner EM, Geiger K, Gaenger S, Fraunberger P, Mader A, Saely CH, Drexel H. Circulating glypican-4 is a new predictor of all-cause mortality in patients with heart failure. Clin Biochem 2023; 121-122:110675. [PMID: 37844682 DOI: 10.1016/j.clinbiochem.2023.110675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Heart failure confers a high burden of morbidity and mortality. However, risk prediction in heart failure patients still is limited. Blood-based biomarkers hold promise to improve clinical risk assessment. Recently we have identified circulating glypican-4 (GPC4) as a significant predictor of mortality in coronary angiography patients and patients with peripheral artery disease. The impact of serum GPC4 on mortality in patients with heart failure is unknown and is addressed in this prospective cohort study. METHODS We prospectively recorded all-cause mortality in 288 patients with heart failure. GPC4 levels were measured using an enzyme-linked immunosorbent assay at baseline. RESULTS During the 24-month follow-up period, 28.1% (n = 81) of the patients died. Serum GPC4 significantly predicted all-cause mortality (hazard ratio (HR) per doublingof GPC4 = 3.57 [2.31-5.53]; P < 0.001). Subgroup analysis showed that GPC4 was significantly associated with all-cause mortality in patients with reduced ejection fraction (HR per doubling = 3.25 [1.75-6.04]; P < 0.001) as well as in those with preserved ejection fraction (HR per doubling = 3.07 [1.22-7.70]; P = 0.017). The association between serum GPC4 and all-cause mortality remained significant in multivariable Cox regression analysis correcting for traditional risk factors (P = 0.035). Results from C-statistics indicated an additional prognostic value of GPC4 relative to NT-proBNP for the prediction of two-year all-cause mortality (P = 0.030). CONCLUSION Circulating GPC4 independently predicts all-cause mortality in patients with heart failure.
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Affiliation(s)
- Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.
| | - Christine Heinzle
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Medical Central Laboratories, Feldkirch, Austria
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Medical Central Laboratories, Feldkirch, Austria; Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Eva Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Medical Central Laboratories, Feldkirch, Austria
| | - Stella Gaenger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | | | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University in the Principality of Liechtenstein, Triesen, Liechtenstein; Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University in the Principality of Liechtenstein, Triesen, Liechtenstein; Vorarlberger Landeskrankenhausbetriebsgesellschaft, Feldkirch, Austria; Drexel University College of Medicine, Philadelphia, PA, USA
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8
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Mink S, Saely CH, Leiherer A, Frick M, Plattner T, Drexel H, Fraunberger P. Anti-SARS-CoV-2 antibody levels predict outcome in COVID-19 patients with type 2 diabetes: a prospective cohort study. Sci Rep 2023; 13:18326. [PMID: 37884649 PMCID: PMC10603091 DOI: 10.1038/s41598-023-45700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023] Open
Abstract
Patients with type 2 diabetes (T2D) constitute one of the most vulnerable subgroups in COVID-19. Despite high vaccination rates, a correlate of protection to advise vaccination strategies for novel SARS-CoV-2 variants of concern and lower mortality in this high-risk group is still missing. It is further unclear what antibody levels provide protection and whether pre-existing organ damage affects this threshold. To address these gaps, we conducted a prospective multicenter cohort study on 1152 patients with COVID-19 from five hospitals. Patients were classified by diabetes and vaccination status. Anti-SARS-CoV-2-spike-antibodies, creatinine and NTproBNP were measured on hospital admission. Pre-specified endpoints were all-cause in-hospital-mortality, ICU admission, endotracheal intubation, and oxygen administration. Propensity score matching was applied to increase comparability. We observed significantly lower anti-SARS-CoV-2-spike-antibodies in diabetic non-survivors compared to survivors (mean, 95% CI 351BAU/ml, 106-595 vs. 1123, 968-1279, p < 0.001). Mortality risk increased two-fold with each standard deviation-decrease of antibody levels (aHR 1.988, 95% CI 1.229-3.215, p = 0.005). T2D patients requiring oxygen administration, endotracheal intubation and ICU admission had significantly lower antibody levels than those who did not (p < 0.001, p = 0.046, p = 0.011). While T2D patients had significantly worse outcomes than non-diabetic patients, the differences were less pronounced compared to propensity-score-matched non-diabetic patients. Anti-SARS-CoV-2 spike antibodies on hospital admission are inversely associated with oxygen administration, endotracheal intubation, intensive care and in-hospital mortality in diabetic COVID-19 patients. Pre-existing comorbidities may have a greater impact on outcome than diabetes status alone.
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Affiliation(s)
- Sylvia Mink
- Central Medical Laboratories, Carinagasse 41, 6800, Feldkirch, Vorarlberg, Austria.
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein.
| | - Christoph H Saely
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
- VIVIT Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Andreas Leiherer
- Central Medical Laboratories, Carinagasse 41, 6800, Feldkirch, Vorarlberg, Austria
- VIVIT Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Matthias Frick
- Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Thomas Plattner
- Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
- VIVIT Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Peter Fraunberger
- Central Medical Laboratories, Carinagasse 41, 6800, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
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Muendlein A, Heinzle C, Brandtner EM, Leiherer A, Geiger K, Gaenger S, Drexel H, Dechow T, Decker T. Plasma apolipoprotein M predicts overall survival in metastatic breast cancer patients. Breast Cancer Res Treat 2023; 201:571-576. [PMID: 37490173 DOI: 10.1007/s10549-023-07045-4] [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: 05/10/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Apolipoprotein M (APOM) is a plasma apolipoprotein closely involved with lipid metabolism and inflammation. In vitro studies suggest that APOM may also have a tumor-suppressive role in breast cancer. In the present study, we aimed to evaluate the impact of plasma APOM levels on the prognosis of breast cancer patients. METHODS We measured APOM levels using an enzyme-linked immunosorbent assay in 75 patients with ER-positive/HER2-negative metastatic breast cancer. The endpoint was overall survival (OS) at 24 months. RESULTS During the 24-month follow-up period, 34.7% of the patients died. Baseline APOM levels were significantly reduced in patients who deceased during follow-up compared to survivors (42.7 ± 14.5 µg/mL versus 52.2 ± 13.8 µg/mL; P = 0.003). Cox regression analysis showed a hazard ratio of 0.30 [95% confidence interval 0.15-0.61]; P < 0.001 per doubling of APOM levels. Correction for age, C-reactive protein, menopausal state, histology of the primary tumor, metastatic site, number of metastases, endocrine resistance, scheduled therapy line, and kind of scheduled therapy indicated that circulating APOM predicted OS independently of these parameters (HRper doubling = 0.23 [0.09-0.56; P = 0.001). CONCLUSIONS Our study suggests that circulating APOM is significantly linked with reduced mortality in metastatic breast cancer patients.
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Affiliation(s)
- Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment Laboratory, Stadtstrasse 33, 6850, Dornbirn, Austria.
| | - Christine Heinzle
- Vorarlberg Institute for Vascular Investigation and Treatment Laboratory, Stadtstrasse 33, 6850, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Eva Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment Laboratory, Stadtstrasse 33, 6850, Dornbirn, Austria
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment Laboratory, Stadtstrasse 33, 6850, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment Laboratory, Stadtstrasse 33, 6850, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Stella Gaenger
- Vorarlberg Institute for Vascular Investigation and Treatment Laboratory, Stadtstrasse 33, 6850, Dornbirn, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment Laboratory, Stadtstrasse 33, 6850, Dornbirn, Austria
- Drexel University College of Medicine, Philadelphia, PA, USA
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Leiherer A, Muendlein A, Saely CH, Geiger K, Brandtner EM, Heinzle C, Gaenger S, Mink S, Laaksonen R, Fraunberger P, Drexel H. Coronary Event Risk Test (CERT) as a Risk Predictor for the 10-Year Clinical Outcome of Patients with Peripheral Artery Disease. J Clin Med 2023; 12:6151. [PMID: 37834795 PMCID: PMC10573503 DOI: 10.3390/jcm12196151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Ceramides are a new kind of lipid biomarker and have already been demonstrated to be valuable risk predictors in coronary patients. Patients with peripheral artery disease (PAD) are a population with a worse prognosis and higher mortality risk compared to coronary artery disease (CAD) patients. However, the value of ceramides for risk prediction in PAD patients is still vague, as addressed in the present study. (2)Methods: This observational study included 379 PAD patients. The primary endpoint was all-cause mortality at 10 years of follow-up. A set of ceramides was measured by LC-MS/MS and combined according to the Coronary Event Risk Test (CERT) score, which categorizes patients into one of four risk groups (low risk, moderate risk, high risk, very high risk). (3) Results: Kaplan-Meier survival curves revealed that the overall survival of patients decreased with the increasing risk predicted by the four CERT categories, advancing from low risk to very high risk. Cox regression analysis demonstrated that each one-category increase resulted in a 35% rise in overall mortality risk (HR = 1.35 [1.16-1.58]). Multivariable adjustment, including, among others, age, LDL-cholesterol, type 2 diabetes, and statin treatment before the baseline, did not abrogate this significant association (HR = 1.22 [1.04-1.43]). Moreover, we found that the beneficial effect of statin treatment is significantly stronger in patients with a higher risk, according to CERT. (4) Conclusions: We conclude that the ceramide-based risk score CERT is a strong predictor of the 10-year mortality risk in patients with PAD.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
| | - Christoph H. Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
| | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Eva-Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
| | - Christine Heinzle
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Stella Gaenger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
| | - Sylvia Mink
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Reijo Laaksonen
- Finnish Cardiovascular Research Center, University of Tampere, FI-33014 Tampere, Finland;
- Zora Biosciences, FI-02150 Espoo, Finland
| | - Peter Fraunberger
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Vorarlberger Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
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Muendlein A, Geiger K, Heinzle C, Gaenger S, Winder T, Severgnini L, Reimann P, Brandtner EM, Leiherer A, Drexel H, Decker T, Nonnenbroich C, Dechow T. Cell-free circulating RAS mutation concentrations significantly impact the survival of metastatic colorectal cancer patients. J Cancer Res Clin Oncol 2023; 149:6435-6444. [PMID: 36763171 DOI: 10.1007/s00432-023-04623-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/10/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE RAS mutations are predictors of an adverse outcome in EGFR-targeted therapies and have been proposed as prognostic biomarkers of survival in metastatic colorectal cancer (mCRC). The analysis of circulating tumor DNA from plasma samples, known as liquid biopsies, has indicated that the RAS mutation status may change over time, potentially affecting patients' prognosis. To further evaluate the clinical validity of RAS mutation retesting using liquid biopsies, we prospectively investigated the impact of the circulating quantitative RAS mutation status on the course of mCRC. METHODS The present study included 81 consecutively recruited patients with mCRC. We used targeted next-generation sequencing of circulating cell-free DNA to determine and quantify plasma RAS mutation status. RESULTS Patients with a RAS mutation detected by liquid biopsy (37%; n = 30) were at increased risk of death during the follow-up period compared to RAS wild-type patients. Patients with evidence of a RAS mutation in the primary tumor but a putative RAS mutation loss in plasma (28%; n = 11) showed a prolonged survival compared to patients with a preserved RAS mutation status. Also, circulating RAS mutation concentrations significantly affected the outcome: The mortality risk of patients with a high RAS mutation concentration increased fivefold compared to subjects with a putative RAS mutation loss or low RAS mutation concentration. CONCLUSION Our results emphasize the clinical value of circulating RAS mutations in managing mCRC.
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Affiliation(s)
- Axel Muendlein
- Molecular Biology Laboratory, Vorarlberg Institute for Vascular Investigation and Treatment, Dornbirn, Austria.
| | - Kathrin Geiger
- Molecular Biology Laboratory, Vorarlberg Institute for Vascular Investigation and Treatment, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Christine Heinzle
- Molecular Biology Laboratory, Vorarlberg Institute for Vascular Investigation and Treatment, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Stella Gaenger
- Molecular Biology Laboratory, Vorarlberg Institute for Vascular Investigation and Treatment, Dornbirn, Austria
| | - Thomas Winder
- Department of Haematology and Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Luciano Severgnini
- Department of Haematology and Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Patrick Reimann
- Department of Haematology and Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Eva Maria Brandtner
- Molecular Biology Laboratory, Vorarlberg Institute for Vascular Investigation and Treatment, Dornbirn, Austria
| | - Andreas Leiherer
- Molecular Biology Laboratory, Vorarlberg Institute for Vascular Investigation and Treatment, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Heinz Drexel
- Molecular Biology Laboratory, Vorarlberg Institute for Vascular Investigation and Treatment, Dornbirn, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
- Drexel University College of Medicine, Philadelphia, PA, USA
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Mink S, Saely CH, Frick M, Leiherer A, Drexel H, Fraunberger P. Association between Lipid Levels, Anti-SARS-CoV-2 Spike Antibodies and COVID-19 Mortality: A Prospective Cohort Study. J Clin Med 2023; 12:5068. [PMID: 37568470 PMCID: PMC10420155 DOI: 10.3390/jcm12155068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Recent studies suggest that both lipid levels and anti-severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) antibody levels are associated with outcome in coronavirus disease 2019 (COVID-19). While both parameters have separately been implicated in the neutralization and clearance of pathogens during severe infections, it is currently unclear whether the interplay of these parameters affects outcome in COVID-19. We therefore aimed to determine whether there was a relationship between lipoproteins, anti-SARS-CoV-2 antibodies, and COVID-19 mortality. METHODS In this prospective, multicenter cohort study, we recruited 1152 hospitalized patients with COVID-19 from five hospitals. Total cholesterol (TC), LDL-C, HDL-C, triglycerides, and anti-SARS-CoV-2 spike antibodies were measured on hospital admission. The investigated endpoint was in-hospital mortality. RESULTS LDL-C, HDL-C, and TC were significantly lower in non-survivors than in survivors (mg/dL, 95%CI; 56.1, 50.4-61.8 vs. 72.6, 70.2-75.0, p < 0.001; 34.2, 31.7-36.8 vs. 38.1, 37.2-39.1, p = 0.025; 139.3, 130.9-147.7 vs. 157.4, 54.1-160.6, p = 0.002). Mortality risk increased progressively with lower levels of LDL-C, HDL-C, and TC (aOR 1.73, 1.30-2.31, p < 0.001; 1.44, 1.10-1.88, p = 0.008; 1.49, 1.14-1.94, p < 0.001). Mortality rates varied between 2.1% for high levels of both LDL-C and anti-SARS-CoV-2 antibodies and 16.3% for low levels of LDL-C and anti-SARS-CoV-2 antibodies (aOR 9.14, 95%CI 3.17-26.34, p < 0.001). Accordingly, for total cholesterol and anti-SARS-CoV-2 antibodies, mortality rates varied between 2.1% and 15.0% (aOR 8.01, 95%CI 2.77-23.18, p < 0.001). CONCLUSION The combination of serum lipid levels and anti-SARS-CoV-2 antibodies is strongly associated with in-hospital mortality of patients with COVID-19. Patients with low levels of LDL-C and total cholesterol combined with low levels of anti-SARS-CoV-2 antibodies exhibited the highest mortality rates.
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Affiliation(s)
- Sylvia Mink
- Central Medical Laboratories, 6800 Feldkirch, Austria
- Medical-Scientific Faculty, Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Christoph H. Saely
- Medical-Scientific Faculty, Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
- VIVIT Institute, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Matthias Frick
- Department of Internal Medicine, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Andreas Leiherer
- Central Medical Laboratories, 6800 Feldkirch, Austria
- Medical-Scientific Faculty, Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
- VIVIT Institute, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
| | - Heinz Drexel
- Medical-Scientific Faculty, Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
- VIVIT Institute, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Peter Fraunberger
- Central Medical Laboratories, 6800 Feldkirch, Austria
- Medical-Scientific Faculty, Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
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Sprenger L, Maechler M, Vonbank A, Larcher B, Mader A, Plattner T, Leiherer A, Muendlein A, Drexel H, Saely CH. NON-ALCOHOLIC FATTY LIVER DISEASE AND TYPE 2 DIABETES ARE MUTUALLY INDEPENDENT PREDICTORS OF MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH ESTABLISHED CARDIOVASCULAR DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Mader A, Sprenger L, Vonbank A, Larcher B, Maechler M, Plattner T, Leiherer A, Muendlein A, Drexel H, Saely CH. REMNANT CHOLESTEROL PREDICTS MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH CORONARY ARTERY DISEASE BOTH AMONG PATIENTS WITH TYPE 2 DIABETES AND IN NONDIABETIC INDIVIDUALS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Sprenger L, Maechler M, Vonbank A, Larcher B, Mader A, Plattner T, Leiherer A, Muendlein A, Drexel H, Saely CH. THE A BODY SHAPE INDEX AND TYPE 2 DIABETES ARE MUTUALLY INDEPENDENT PREDICTORS OF MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH ESTABLISHED CARDIOVASCULAR DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02138-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Sprenger L, Maechler M, Vonbank A, Larcher B, Mader A, Plattner T, Leiherer A, Muendlein A, Drexel H, Saely CH. CHRONIC KIDNEY DISEASE, TYPE 2 DIABETES AND THE RISK OF MAJOR CARDIOVASCULAR EVENTS IN CORONARY ARTERY DISEASE VERSUS PERIPHERAL ARTERY DISEASE PATIENTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Sprenger L, Maechler M, Vonbank A, Larcher B, Mader A, Plattner T, Leiherer A, Muendlein A, Drexel H, Saely CH. TYPE 2 DIABETES, CHRONIC KIDNEY DISEASE AND MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH ESTABLISHED CARDIOVASCULAR DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Muendlein A, Heinzle C, Brandtner EM, Leiherer A, Drexel H, Dechow T, Decker T. Circulating glypican-4 is a predictor of 24-month overall survival in metastatic breast cancer. Oncol Res Treat 2023; 46:151-156. [PMID: 36750040 DOI: 10.1159/000529547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/28/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND & OBJECTIVE Endocrine treatment combined with CDK4/6 inhibitors is the preferred treatment strategy in patients presenting with ER-positive/HER2-negative breast cancer, but the clinical course remains highly variable among individual patients. There is an unmet need for prognostic or predictive biomarkers in this important group of patients. Recently, we have identified circulating glypican-4 (GPC4) as a new biomarker of inferior outcomes in patients with metastatic colorectal cancer. The impact of plasma GPC4 levels on the survival of breast cancer patients is unknown and has been addressed in the present study. METHODS Our study included 47 patients with ER-positive/HER2-negative metastatic breast cancer prior to treatment with CDK4/6 inhibitors combined with endocrine therapy. The endpoint was overall survival (OS) at 24 months. GPC4 levels were measured in plasma using an enzyme-linked immunosorbent assay. RESULTS Increased circulating GPC4 levels were significantly linked to advanced age, postmenopausal state, visceral metastases, and invasive lobular carcinoma. During the two-year observational follow-up period, 25.5 % of patients died. The area under the receiver operating characteristic curve (ROC-AUC) analysis revealed an AUC of 0.713 [0.555-0.871]; P=0.029 for OS and an optimal cut-off value of GPC4 for predicting OS of 4.77 ng/mL. No patient showing GPC4 values below this cut-off died during the observational period. Cox regression analysis showed a hazard ratio of 2.14 [95% confidence interval: 1.24-3.67]; P=0.006 for one standard deviation change of plasma GPC4. CONCLUSIONS In conclusion, our study suggests circulating GPC4 as a significant predictor of poor survival in metastatic breast cancer patients.
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Affiliation(s)
- Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment, Molecular Biology Laboratory, Dornbirn, Austria,
| | - Christine Heinzle
- Vorarlberg Institute for Vascular Investigation and Treatment, Molecular Biology Laboratory, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Eva Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment, Molecular Biology Laboratory, Dornbirn, Austria
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment, Molecular Biology Laboratory, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment, Molecular Biology Laboratory, Dornbirn, Austria
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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Muendlein A, Severgnini L, Decker T, Heinzle C, Leiherer A, Geiger K, Drexel H, Winder T, Reimann P, Mayer F, Nonnenbroich C, Dechow T. Circulating syndecan-1 and glypican-4 predict 12-month survival in metastatic colorectal cancer patients. Front Oncol 2022; 12:1045995. [PMID: 36353562 PMCID: PMC9638102 DOI: 10.3389/fonc.2022.1045995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022] Open
Abstract
Cell surface syndecans and glypicans play important roles in the development and prognosis of colorectal cancer (CRC). Their soluble forms from proteoglycan shedding can be detected in blood and have been proposed as new prognostic biomarkers in several cancer entities. However, studies on circulating syndecan-1 (SDC1) and glypican-4 (GPC4) in CRC are limited. We, therefore, evaluated the impact of plasma SDC1 and GPC4 on the prognosis of metastatic (m)CRC patients. The present study included 93 patients with mCRC. The endpoints were progression-free survival (PFS) and overall survival (OS) at 12 months. SDC1 and GPC4 levels were measured in plasma using enzyme-linked immunosorbent assays. Plasma levels of SDC1 and GPC4 were significantly correlated. Significant correlations of these two markers were also found with carcinoembryonic antigen (CEA). Kaplan-Meier curve analyses indicated that PFS and OS probabilities significantly decreased with increasing levels of SDC1 and GPC4, respectively. Multivariable Cox regression analyses showed that both markers were significantly associated with PFS and OS independently from clinicopathological characteristics including CEA. Respective adjusted hazard ratios (HR) together with corresponding 95% confidence intervals for one standard deviation change of SDC1 were 1.32 [1.02-1.84] for PFS and 1.48 [1.01-2.15] for OS. Adjusted HRs [95% confidence intervals] of GPC4 were 1.42 [1.07-1.89] for PFS and 2.40 [1.51-3.81] for OS. Results from area under the receiver operating characteristic curve analyses suggest that GPC4 and SDC1 add additional prognostic values to CEA for OS. In conclusion, we showed significant associations of circulating SDC1 and GPC4 with poor survival of mCRC patients.
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Affiliation(s)
- Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment, Molecular Biology Laboratory, Dornbirn, Austria
- *Correspondence: Axel Muendlein,
| | - Luciano Severgnini
- Department of Haematology and Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - Christine Heinzle
- Vorarlberg Institute for Vascular Investigation and Treatment, Molecular Biology Laboratory, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment, Molecular Biology Laboratory, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment, Molecular Biology Laboratory, Dornbirn, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment, Molecular Biology Laboratory, Dornbirn, Austria
- Department of Internal Medicine, Academic Teaching Hospital Bregenz, Bregenz, Austria
| | - Thomas Winder
- Department of Haematology and Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Patrick Reimann
- Department of Haematology and Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Frank Mayer
- Praxis und Tagesklinik Prof. Dr. Oettle Helmut Prof. Mayer Frank, Friedrichshafen, Germany
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20
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Leiherer A, Ulmer H, Muendlein A, Saely CH, Fraunberger P, Mader A, Sprenger L, Maechler M, Vonbank A, Larcher B, Brozek W, Nagel G, Zitt E, Concin H, Drexel H. Value of blood pressure measurement earlier versus later in life to predict cardiovascular mortality. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Hypertension is a potent risk factor for cardiovascular morbidity and mortality. High blood pressure (BP) correlates closely with all-cause and cardiovascular mortality.
The purpose of this study was to compare the value of systolic blood pressure earlier versus later in life to predict cardiovascular mortality.
In a cardiovascular observation study (OS) we prospectively recorded fatal cardiovascular events over up to 19 years in 1282 patients of whom 570 had the Metabolic Syndrome (MetS) at baseline. These patients had participated in a health survey (HS) 15 years prior to the OS baseline. BP was measured both at the HS and at the baseline of the OS.
We found that the increase in cardiovascular mortality matched the increase of BP in the HS in a linear way but this is not the case for BP assessed at the OS (figure). A cox regression analysis revealed that each millimeter of mercury (mm Hg) increased the risk for cardiovascular death by 2% (HR = 1.02 [1.01–1.03], p<0.001). Applying a stratification for the presence of MetS, we found that in both groups BP was a significant predictor of cardiovascular mortality (HRMetS = 1.02 [1.01–1.02], p<0.001 and HRnoMetS = 1.02 [1.01–1.03], p<0.001). In contrast, BP as measured at the baseline of the OS was not significantly associated with cardiovascular death during follow-up neither in the total population nor in any subgroup (HR = 1.00 [0.99–1.01], p=0.652; HRMetS = 1.00 [0.99–1.01], p=0.468 and HRnoMetS = 1.00 [0.99–1.01], p=4.66).
We thus conclude that BP assessed earlier in life is a better predictor of cardiovascular mortality than BP assessed later in life.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Leiherer
- Vorarlberg Institute for Vascular Investigation & Treatment , Feldkirch , Austria
| | - H Ulmer
- Agency of Preventive and Social Medicine , Bregenz , Austria
| | - A Muendlein
- Vorarlberg Institute for Vascular Investigation & Treatment , Feldkirch , Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein , Triesen , Liechtenstein
| | | | - A Mader
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - L Sprenger
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - M Maechler
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - A Vonbank
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - B Larcher
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - W Brozek
- Agency of Preventive and Social Medicine , Bregenz , Austria
| | - G Nagel
- Agency of Preventive and Social Medicine , Bregenz , Austria
| | - E Zitt
- Agency of Preventive and Social Medicine , Bregenz , Austria
| | - H Concin
- Agency of Preventive and Social Medicine , Bregenz , Austria
| | - H Drexel
- County Hospital Bregenz , Bregenz , Austria
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21
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Leiherer A, Muendlein A, Brandtner E, Saely CH, Vonbank A, Mader A, Sprenger L, Maechler M, Jylha A, Laaperi M, Laaksonen R, Maerz W, Fraunberger P, Kleber M, Drexel H. Ceramide-based lipid profiles and the prevalence of type 2 diabetes differ between patients with coronary artery disease and those with peripheral artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Serum lipids and metabolic diseases, in particular type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD), predict the atherosclerotic diseases coronary artery disease (CAD) and peripheral arterial disease (PAD).
Purpose
The purpose of this study was to investigate in how far a more detailed characterization including serum lipids improves discrimination of PAD from CAD.
Method
A cohort of 274 statin-naïve patients with either PAD (n=89) or stable CAD (n=185) were referred to metabolic screening and were characterized using nuclear magnetic resonance- and liquid chromatography-tandem mass spectrometry based advanced lipid and lipoprotein analysis. Results were validated in an independent cohort of 1239 patients with PAD or CAD.
Results
We found a significant difference in T2D prevalence and in the ceramide-based lipid profile between PAD and CAD patients. However, neither cholesterol-based markers (including LDL-C, HDL-C) and detailed lipoprotein profiles nor the LD status differed significantly between PAD and CAD patients (figure). The difference between ceramide-based lipid profiles of CAD and PAD remained significant also after adjusting for body composition, smoking, inflammatory parameters, and T2D.
Conclusion
We conclude that PAD and CAD differ in ceramide-based lipid profiles and T2D status, but not in other lipid characteristics or metabolic diseases.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Leiherer
- Vorarlberg Institute for Vascular Investigation & Treatment , Feldkirch , Austria
| | - A Muendlein
- Vorarlberg Institute for Vascular Investigation & Treatment , Feldkirch , Austria
| | - E Brandtner
- Vorarlberg Institute for Vascular Investigation & Treatment , Feldkirch , Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein , Triesen , Liechtenstein
| | - A Vonbank
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - A Mader
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - L Sprenger
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - M Maechler
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - A Jylha
- Zora Biosciences , Espoo , Finland
| | | | | | - W Maerz
- Medical University of Graz , Graz , Austria
| | | | - M Kleber
- Medical Faculty Mannheim, Heidelberg University , Mannheim , Germany
| | - H Drexel
- County Hospital Bregenz , Bregenz , Austria
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22
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Mader A, Sprenger L, Vonbank A, Larcher B, Maechler M, Grabher V, Leiherer A, Muendlein A, Drexel H, Saely C. Cystatin C predicts incident diabetes in angiographied coronary patients. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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23
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Leiherer A, Muendlein A, Geiger K, Saely C, Grabher V, Fraunberger P, Drexel H. The new myokine myonectin is significantly associated with type 2 diabetes in elderly cardiovascular disease patients. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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24
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Muendlein A, Heinzle C, Leiherer A, Geiger K, Brandtner EM, Gaenger S, Fraunberger P, Saely CH, Drexel H. Serum glypican-4 is associated with the 10-year clinical outcome of patients with peripheral artery disease. Int J Cardiol 2022; 369:54-59. [DOI: 10.1016/j.ijcard.2022.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 12/30/2022]
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25
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Leiherer A, Muendlein A, Saely C, Larcher B, Mader A, Maechler M, Sprenger L, Grabher V, Laaksonen R, Laaperi M, Jylha A, Fraunberger P, Drexel H. The ceramide- and phosphatidylcholine- based coronary event risk test2 (CERT2) and cardiovascular mortality in men and women with type 2 diabetes. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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26
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Saely C, Vonbank A, Larcher B, Mader A, Maechler M, Sprenger L, Grabher V, Leiherer A, Muendlein A, Drexel H. Type 2 diabetes and risk of major cardiovascular events in peripheral artery disease versus coronary artery disease patients. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Mader A, Maechler M, Larcher B, Sprenger L, Grabher V, Leiherer A, Muendlein A, Vonbank A, Drexel H, Saely C. Type 2 diabetes significantly modulates the power of lipoprotein(a) to predict cardiovascular events and mortality in young coronary artery disease patients. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Mader A, Sprenger L, Vonbank A, Larcher B, Maechler M, Grabher V, Leiherer A, Muendlein A, Drexel H, Saely C. Remnant cholesterol in patients with established cardiovascular disease predicts cardiovascular events both among patients with type 2 diabetes and among non-diabetic subjects. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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29
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Brozek W, Ulmer H, Pompella A, Nagel G, Leiherer A, Preyer O, Concin H, Zitt E. Response to comments on "Gamma-glutamyl-transferase is associated with incident hip fractures in women and men ≥ 50 years: a large population-based cohort study". Osteoporos Int 2022; 33:1827-1829. [PMID: 35763075 DOI: 10.1007/s00198-022-06442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Wolfgang Brozek
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria.
| | - Hanno Ulmer
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Alfonso Pompella
- Department of Translational Research and New Technologies in Medicine and Surgery, Università di Pisa, Pisa, Italy
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | - Oliver Preyer
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria
| | - Hans Concin
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
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30
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Schillemans T, Tragante V, Maitusong B, Gigante B, Cresci S, Laguzzi F, Vikström M, Richards M, Pilbrow A, Cameron V, Foco L, Doughty RN, Kuukasjärvi P, Allayee H, Hartiala JA, Tang WHW, Lyytikäinen LP, Nikus K, Laurikka JO, Srinivasan S, Mordi IR, Trompet S, Kraaijeveld A, van Setten J, Gijsberts CM, Maitland-van der Zee AH, Saely CH, Gong Y, Johnson JA, Cooper-DeHoff RM, Pepine CJ, Casu G, Leiherer A, Drexel H, Horne BD, van der Laan SW, Marziliano N, Hazen SL, Sinisalo J, Kähönen M, Lehtimäki T, Lang CC, Burkhardt R, Scholz M, Jukema JW, Eriksson N, Åkerblom A, James S, Held C, Hagström E, Spertus JA, Algra A, de Faire U, Åkesson A, Asselbergs FW, Patel RS, Leander K. Associations of Polymorphisms in the Peroxisome Proliferator-Activated Receptor Gamma Coactivator-1 Alpha Gene With Subsequent Coronary Heart Disease: An Individual-Level Meta-Analysis. Front Physiol 2022; 13:909870. [PMID: 35812313 PMCID: PMC9260705 DOI: 10.3389/fphys.2022.909870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The knowledge of factors influencing disease progression in patients with established coronary heart disease (CHD) is still relatively limited. One potential pathway is related to peroxisome proliferator–activated receptor gamma coactivator-1 alpha (PPARGC1A), a transcription factor linked to energy metabolism which may play a role in the heart function. Thus, its associations with subsequent CHD events remain unclear. We aimed to investigate the effect of three different SNPs in the PPARGC1A gene on the risk of subsequent CHD in a population with established CHD. Methods: We employed an individual-level meta-analysis using 23 studies from the GENetIcs of sUbSequent Coronary Heart Disease (GENIUS-CHD) consortium, which included participants (n = 80,900) with either acute coronary syndrome, stable CHD, or a mixture of both at baseline. Three variants in the PPARGC1A gene (rs8192678, G482S; rs7672915, intron 2; and rs3755863, T528T) were tested for their associations with subsequent events during the follow-up using a Cox proportional hazards model adjusted for age and sex. The primary outcome was subsequent CHD death or myocardial infarction (CHD death/myocardial infarction). Stratified analyses of the participant or study characteristics as well as additional analyses for secondary outcomes of specific cardiovascular disease diagnoses and all-cause death were also performed. Results: Meta-analysis revealed no significant association between any of the three variants in the PPARGC1A gene and the primary outcome of CHD death/myocardial infarction among those with established CHD at baseline: rs8192678, hazard ratio (HR): 1.01, 95% confidence interval (CI) 0.98–1.05 and rs7672915, HR: 0.97, 95% CI 0.94–1.00; rs3755863, HR: 1.02, 95% CI 0.99–1.06. Similarly, no significant associations were observed for any of the secondary outcomes. The results from stratified analyses showed null results, except for significant inverse associations between rs7672915 (intron 2) and the primary outcome among 1) individuals aged ≥65, 2) individuals with renal impairment, and 3) antiplatelet users. Conclusion: We found no clear associations between polymorphisms in the PPARGC1A gene and subsequent CHD events in patients with established CHD at baseline.
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Affiliation(s)
- Tessa Schillemans
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Vinicius Tragante
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Buamina Maitusong
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bruna Gigante
- Division of Cardiovascular Medicine, Department of Medicine, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sharon Cresci
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Federica Laguzzi
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Max Vikström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mark Richards
- Department of Medicine, Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Anna Pilbrow
- Department of Medicine, Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Vicky Cameron
- Department of Medicine, Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Luisa Foco
- Institute for Biomedicine, Eurac Research, Bolzano, Italy
| | - Robert N. Doughty
- Heart Health Research Group, The University of Auckland, Auckland, New Zealand
| | - Pekka Kuukasjärvi
- Finnish Cardiovascular Research Center - Tampere, Department of Cardio-Thoracic Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hooman Allayee
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jaana A. Hartiala
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - W. H. Wilson Tang
- Department of Cardiovascular and Metabolic Sciences and Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic Ohio, Cleveland, OH, United States
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Ohio, Cleveland, OH, United States
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories Ltd., Tampere, Finland
- Finnish Cardiovascular Research Center - Tampere, Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kjell Nikus
- Finnish Cardiovascular Research Center - Tampere, Department of Cardiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jari O. Laurikka
- Finnish Cardiovascular Research Center - Tampere, Department of Cardio-Thoracic Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Heart Center, Department of Thoracic Surgery, Tampere University Hospital, Tampere, Finland
| | - Sundararajan Srinivasan
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ify R. Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Stella Trompet
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
- Section of Gerontology and Geriatrics, and Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Adriaan Kraaijeveld
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jessica van Setten
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Crystel M. Gijsberts
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Anke H. Maitland-van der Zee
- Amsterdam University Medical Centers, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Christoph H. Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Yan Gong
- Center for Pharmacogenomics and Precision Medicine, Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, United States
| | - Julie A. Johnson
- Center for Pharmacogenomics and Precision Medicine, Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, United States
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Rhonda M. Cooper-DeHoff
- Center for Pharmacogenomics and Precision Medicine, Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, United States
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Gavino Casu
- Azienda Ospedaliero Universitaria, Sassari, Italy
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Department of Medicine and Intensive Care, County Hospital Bregenz, Bregenz, Austria
| | - Benjamin D. Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, United States
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
| | - Sander W. van der Laan
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nicola Marziliano
- Medicine Laboratory Unit, ASST Rhodense (Rho-Milano), Lombardy, Italy
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Stanley L. Hazen
- Department of Cardiovascular and Metabolic Sciences and Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic Ohio, Cleveland, OH, United States
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Ohio, Cleveland, OH, United States
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mika Kähönen
- Finnish Cardiovascular Research Center - Tampere, Department of Clinical Physiology, Faculty of Medicine and Health Technology, Department of Clinical Physiology, Tampere University, Tampere, Finland
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories Ltd., Tampere, Finland
- Finnish Cardiovascular Research Center - Tampere, Department of Clinical Physiology, Faculty of Medicine and Health Technology, Department of Clinical Physiology, Tampere University, Tampere, Finland
| | - Chim C. Lang
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ralph Burkhardt
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
- LIFE Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Markus Scholz
- LIFE Research Center for Civilization Diseases, Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - Niclas Eriksson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Axel Åkerblom
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Stefan James
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - John A. Spertus
- Saint Luke´s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Ale Algra
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ulf de Faire
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Agneta Åkesson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Folkert W. Asselbergs
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Faculty of Population Health Sciences, Institute of Cardiovascular Science and Institute of Health Informatics, University College London, London, United Kingdom
| | - Riyaz S. Patel
- Faculty of Population Health Sciences, Institute of Cardiovascular Science and Institute of Health Informatics, University College London, London, United Kingdom
- Bart’s Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Karin Leander,
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Brozek W, Ulmer H, Pompella A, Nagel G, Leiherer A, Preyer O, Concin H, Zitt E. Gamma-glutamyl-transferase is associated with incident hip fractures in women and men ≥ 50 years: a large population-based cohort study. Osteoporos Int 2022; 33:1295-1307. [PMID: 35059776 DOI: 10.1007/s00198-022-06307-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/30/2021] [Accepted: 01/08/2022] [Indexed: 12/30/2022]
Abstract
UNLABELLED The association of serum gamma-glutamyl-transferase (GGT) with hip fracture risk has not been examined in women and men ≥ 50 years. We show that elevated GGT was associated with increased hip fracture risk, particularly in men. GGT could be a candidate serum marker of long-term hip fracture risk in the elderly. INTRODUCTION We herein examined a possible relation between serum levels of GGT and hip fracture risk in women and men aged ≥ 50 years, which has not been investigated before. METHODS In this population-based prospective cohort study, approximately 41,000 women and nearly 33,000 men ≥ 50 years participating in a medical prevention program 1985-2005 in western Austria were followed up for the occurrence of osteoporotic hip fractures during 2003-2013. ICD-10 based discharge diagnoses for hip fracture included S72.0, S72.1, and S72.2 available from all regional hospitals. GGT-related hip fracture risk was ascertained at each participant´s first and last examination during the prevention program. In a subset of 5445 participants, alcohol consumption could be included as a covariate. RESULTS In men, hip fracture risk rose significantly by 75% and 86% for every tenfold increase of GGT measured at the first and last examination, respectively, and in women, hip fracture risk rose by 22% from the last examination. Elevated GGT (≥ 36 U/l in women, ≥ 56 U/l in men) at the first examination was associated with increased hip fracture risk only in men (HR 1.51, 95% CI 1.25-1.82), and at the last examination in both women (HR 1.14, 95% CI 1.02-1.28) and men (HR 1.61, 95% CI 1.33-1.95). Alcohol consumption had no significant influence on GGT-mediated hip fracture risk in women and men. CONCLUSIONS Our findings identified an association of elevated GGT and hip fracture in women and men ≥ 50 years and suggest GGT as a candidate serum marker of long-term hip fracture risk in an elderly population.
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Affiliation(s)
- W Brozek
- Agency for Preventive and Social Medicine, Bregenz, Austria.
| | - H Ulmer
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - A Pompella
- Department of Translational Research and New Technologies in Medicine and Surgery, Università Di Pisa, Pisa, Italy
| | - G Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - A Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | - O Preyer
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - H Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - E Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
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Atzl M, Muendlein A, Winder T, Fraunberger P, Brandtner EM, Geiger K, Klausberger M, Duerkop M, Sprenger L, Mutschlechner B, Volgger A, Benda M, Severgnini L, Jaeger JB, Drexel H, Lang A, Leiherer A. SARS-CoV-2 RBD-specific and NP-specific antibody response of healthcare workers in the westernmost Austrian state Vorarlberg: a prospective cohort study. BMJ Open 2022; 12:e052130. [PMID: 35613821 PMCID: PMC9174531 DOI: 10.1136/bmjopen-2021-052130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Austria, and particularly its westernmost federal state Vorarlberg, developed an extremely high incidence rate during the COVID-19 pandemic. Healthcare workers (HCWs) worldwide are known to have an increased risk of contracting the disease within the working environment and, therefore, the seroprevalence in this population is of particular interest. We thus aimed to analyse SARS-CoV-2-specific antibody dynamics in Vorarlberg HCWs. DESIGN Prospective cohort study of HCWs including testing at three different time points for the prevalence of anti-SARS-CoV-2 IgG antibodies specific for nucleocapsid protein (NP) and receptor-binding domain (RBD). SETTING All five state hospitals of Vorarlberg. PARTICIPANTS A total of 395 HCWs, enrolled in June 2020 (time point 1 (t1)), 2 months after the end of the first wave, retested between October and November at the beginning of the second wave (time point 2 (t2)) and again at the downturn of the second wave in January 2021 (time point 3 (t3)). MAIN OUTCOMES We assessed weak and strong seropositivity and associated factors, including demographic and clinical characteristics, symptoms consistent with COVID-19 infection, infections verified by reverse transcription PCR (RT-PCR) and vaccinations. RESULTS At t1, 3% of HCWs showed strong IgG-specific responses to either NP or RBD. At t2, the rate had increased to 4%, and at t3 to 14%. A strong response was found to be stable for up to 10 months. Overall, only 55% of seropositive specimen had antibodies against both antigens RBD and NP; 29% had only RBD-specific and 16% only NP-specific antibodies. Compared with the number of infections found by RT-PCR, the number of HCWs being seropositive was 38% higher. CONCLUSION AND RELEVANCE Serological testing based on only one antigen implicates the risk of missing infections; thus, the set of antigens should be broadened in the future. The seroprevalence among participating HCWs was comparable to the general population in Austria. Nevertheless, in view of undetected infections, monitoring and surveillance should be reconsidered.
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Affiliation(s)
- Michele Atzl
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Thomas Winder
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Peter Fraunberger
- Medical Central Laboratories, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Eva-Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | - Miriam Klausberger
- Department of Biotechnology, University of Natural Resources and Life Sciences (BOKU) Vienna, Wien, Austria
| | - Mark Duerkop
- Department of Biotechnology, University of Natural Resources and Life Sciences (BOKU) Vienna, Wien, Austria
| | - Lukas Sprenger
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Beatrix Mutschlechner
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Andreas Volgger
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Magdalena Benda
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Luciano Severgnini
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Johannes B Jaeger
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Department of Internal Medicine and Intensive Care, Academic Teaching Hospital Bregenz, Bregenz, Austria
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Alois Lang
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Medical Central Laboratories, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
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Mader A, Maechler M, Larcher B, Sprenger L, Grabher V, Leiherer A, Muendlein A, Vonbank A, Drexel H, Saely CH. TYPE 2 DIABETES SIGNIFICANTLY MODULATES THE POWER OF LIPOPROTEIN(A) TO PREDICT CARDIOVASCULAR EVENTS AND MORTALITY IN YOUNG CORONARY ARTERY DISEASE PATIENTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02529-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maechler M, Vonbank A, Larcher B, Mader A, Sprenger L, Grabher V, Leiherer A, Muendlein A, Drexel H, Saely CH. TYPE 2 DIABETES AND CONGESTIVE HEART FAILURE ARE MUTUALLY INDEPENDENT PREDICTORS OF THE PRESENCE OF ALBUMINURIA. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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35
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Mader A, Sprenger L, Vonbank A, Larcher B, Maechler M, Grabher V, Leiherer A, Muendlein A, Drexel H, Saely CH. REMNANT CHOLESTEROL IN PATIENTS WITH ESTABLISHED CARDIOVASCULAR DISEASE PREDICTS CARDIOVASCULAR EVENTS BOTH AMONG PATIENTS WITH TYPE 2 DIABETES AND AMONG NON-DIABETIC SUBJECTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02549-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Muendlein A, Brandtner EM, Leiherer A, Geiger K, Heinzle C, Gaenger S, Fraunberger P, Mader A, Saely CH, Drexel H. Serum glypican-4 is a marker of future vascular risk and mortality in coronary angiography patients. Atherosclerosis 2022; 345:33-38. [DOI: 10.1016/j.atherosclerosis.2022.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/24/2022] [Accepted: 02/11/2022] [Indexed: 12/17/2022]
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Saely CH, Maechler M, Vonbank A, Sprenger L, Mader A, Larcher B, Zanolin-Purin D, Leiherer A, Muendlein A, Drexel H. Single and joint impact of type 2 diabetes and of congestive heart failure on albuminuria: Data from subgroup analysis and data on moderate albuminuria. Data Brief 2022; 40:107817. [PMID: 35071710 PMCID: PMC8762350 DOI: 10.1016/j.dib.2022.107817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/07/2022] Open
Abstract
We investigated 180 consecutive patients with congestive heart failure (CHF), of whom 83 had type 2 diabetes (T2DM) and 97 did not have diabetes as well as 223 controls without CHF, of whom 39 had T2DM and 184 did not have diabetes. Data was recorded by standardized interviews and by standardized examination protocols at our institution and were extracted from medical records. Here, we analyzed data on gender differences. Further, we examined the effect of CHF and T2DM on moderate albuminuria, i.e. on an albumin-creatinine ratio (ACR) of 30–300 mg/g. Table 1 shows baseline characteristics of our patients stratified by gender. Table 2 gives ACRs and prevalence rates of albuminuria separately for men and women. In logistic regression analyses adjusting for age, sex, body mass index, LDL cholesterol, history of smoking, history of hypertension, use of statins, ACE inhibitors/angiotensin II receptor blockers, aldosterone antagonists and other antihypertensive medication CHF and T2DM predicted the prevalence of albuminuria in a mutually independent manner in men (OR 4.93 [95% CI 1.76–13.85]; p = 0.002 and OR 2.38 [1.11–5.11]; p = 0.027, respectively), as well as in women (OR 5.66 [95% CI 1.76–18.20]; p = 0.004 and OR 3.53 [1.38–9.08]; p = 0.009, respectively). There was no significant interaction between gender and CHF or T2DM regarding the presence of albuminuria (p = 0.933 and 0.533, respectively), indicating that the association of CHF and T2DM with albuminuria did not differ significantly between men and women. In multivariate analysis of covariance, CHF and T2DM proved to be independent predictors of ACR in women after adjustment for age, sex, body mass index, LDL cholesterol, history of smoking, history of hypertension, use of statins, ACE inhibitors/angiotensin II receptor blockers, aldosterone antagonists and other antihypertensive medication (F = 5.38; p = 0.022 and F = 4.95; p = 0.028, respectively); for men the corresponding F-values were 2.70; p = 0.102 and 3.12; p = 0.079, respectively. There was no significant interaction between gender and CHF or T2DM regarding ACR (p = 0.464 and 0.202, respectively), indicating that the association of CHF and T2DM with the ACR did not differ significantly between men and women. Regarding moderate albuminuria, both CHF and T2DM predicted moderate albuminuria adjusted in a mutually independent manner after the adjustments described above, with ORs of 4.75 [95% CI 2.16–10.45]; p< 0.001 and OR 2.08 [1.13–3.83]; p=0.018, respectively. The data set presented here could be reused with similar patient cohorts for pooled analysis.
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38
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Leiherer A, Mündlein A, Brandtner EM, Säly CH, Ramadani H, Vonbank A, Mader A, Dopheide JF, Jylhä A, Lääperi M, Laaksonen R, März W, Fraunberger P, Kleber M, Drexel H. Lipid profiles of patients with manifest coronary versus peripheral atherosclerosis - Is there a difference? J Intern Med 2021; 290:1249-1263. [PMID: 34337800 DOI: 10.1111/joim.13368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM Peripheral arterial disease (PAD) and coronary artery disease (CAD) are both caused by atherosclerosis. Serum lipids and lipoproteins are predictive of the development of atherosclerosis but it is not clear if they differ in the two manifestations, PAD and CAD. We tested whether a more detailed characterization of the lipid and lipoprotein patterns of PAD and CAD allows a clear differentiation between the two atherosclerotic phenotypes. METHODS A cohort of 274 statin-naïve patients with either newly diagnosed imaging proven PAD (n = 89) or stable CAD (n = 185) was characterized using nuclear magnetic resonance- and liquid chromatography-tandem mass spectrometry-based advanced lipid and lipoprotein analysis. An independent cohort of 1239 patients with PAD and CAD was used for validation. RESULTS We found a significant difference in markers of inflammation as well as ceramide and phosphatidylcholine levels between patients with PAD and CAD. In contrast, basic lipid markers including total cholesterol, LDL cholesterol, HDL cholesterol, lipoprotein(a) or detailed lipoprotein profiles did not differ significantly between patients with PAD and CAD. Applying ratios and scores derived from ceramides and phosphatidylcholines further improved the discrimination between PAD and CAD. These significant differences were independent of body composition, from the status of smoking or type 2 diabetes mellitus, and also from apolipoprotein C-III and other inflammatory parameters which were different between CAD and PAD. CONCLUSION The present study clearly suggests that PAD and CAD differ in terms of their ceramide- and phosphatidylcholine-based lipid patterns but not in lipoprotein characteristics.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,Medical Central Laboratories, Feldkirch, Austria
| | - Axel Mündlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Eva Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Christoph H Säly
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Hana Ramadani
- Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland
| | - Alexander Vonbank
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Jörn F Dopheide
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland
| | | | | | - Reijo Laaksonen
- Zora Biosciences, Espoo, Finland.,Finnish Cardiovascular Research Center, University of Tampere, Tampere, Finland
| | - Winfried März
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Synlab Academy, Synlab Holding, Mannheim, Germany
| | - Peter Fraunberger
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,Medical Central Laboratories, Feldkirch, Austria
| | - Marcus Kleber
- Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein.,Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.,Department of Internal Medicine, Academic Teaching Hospital Bregenz, Bregenz, Austria
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Saely CH, Maechler M, Vonbank A, Sprenger L, Mader A, Larcher B, Zanolin-Purin D, Leiherer A, Muendlein A, Drexel H. Single and joint impact of type 2 diabetes and of congestive heart failure on albuminuria. J Diabetes Complications 2021; 35:108046. [PMID: 34598838 DOI: 10.1016/j.jdiacomp.2021.108046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/27/2021] [Accepted: 09/07/2021] [Indexed: 12/31/2022]
Abstract
AIMS Albuminuria is a characteristic feature of diabetic nephropathy, and urine albumin excretion is also increased in patients with congestive heart failure (CHF). However, no data are available on the single and joint associations of type 2 diabetes mellitus (T2DM) and CHF with albuminuria. This issue was addressed in the present study. METHODS We investigated 4 groups of patients: 180 patients with CHF, of whom 83 had T2DM (CHF+/T2DM+) and 97 did not have diabetes (CHF+/T2DM-) and 223 controls without CHF, of whom 39 had T2DM (CHF-/T2DM+) and 184 did not have diabetes (CHF-/T2DM-). RESULTS The albumin-creatinine ratio (ACR) was 9.2 [5.7-16.9] mg/g in CHF-/T2DM- patients. Compared to this group it was higher in CHF-/T2DM+ patients (16.1 [7.7-27.8] mg/g; p = 0.004), in CHF+/T2DM- patients (22.0 [9.0-76.8] mg/g; p < 0.001) and in CHF+/T2DM+ patients (66.2 [16.0-177.0] mg/g; p < 0.001), in whom in turn it was higher than in CHF-/T2DM+ (p < 0.001) or in CHF+/T2DM- (p = 0.001) patients. The ACR did not differ significantly between CHF-/T2DM+ and CHF+/T2DM- patients (p = 0.188). In multivariate analysis of covariance, CHF and T2DM proved to be independent predictors of ACR after multivariate adjustment (F = 5.68; p = 0.018 and F = 4.79; p = 0.029, respectively). CONCLUSIONS We conclude that T2DM and CHF are mutually independent determinants of albuminuria.
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Affiliation(s)
- Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria; Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein; Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Maximilian Maechler
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria; Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein; Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Alexander Vonbank
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria; Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein; Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Lukas Sprenger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria; Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein; Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria; Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein; Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Barbara Larcher
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria; Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein; Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Daniela Zanolin-Purin
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria; Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria; Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein; Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria; Drexel University College of Medicine, 2900 W Queen Ln, PA 19129, Philadelphia, USA.
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Sprenger L, Mader A, Larcher B, Mächler M, Vonbank A, Zanolin-Purin D, Leiherer A, Muendlein A, Drexel H, Saely CH. Type 2 diabetes and the risk of cardiovascular events in peripheral artery disease versus coronary artery disease. BMJ Open Diabetes Res Care 2021; 9:9/2/e002407. [PMID: 34782334 PMCID: PMC8593703 DOI: 10.1136/bmjdrc-2021-002407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/18/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes mellitus (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. How cardiovascular risk compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes is unclear and is addressed in the present study. RESEARCH DESIGN AND METHODS We prospectively recorded major cardiovascular events (MACE; ie, cardiovascular death, myocardial infarction or stroke) over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123). RESULTS The event rate for MACE increased over our four investigated groups: it was lowest in CAD/T2DM- patients (2.52 events per 100 person-years). It was significantly higher in CAD/T2DM+ patients (3.96 events per 100 person-years; p<0.001), in PAD/T2DM- patients (3.68 events per 100 person-years; p=0.022), and in PAD/T2DM+ patients (7.10 events per 100 person-years; p<0.001), who in turn were at a higher risk than CAD/T2DM+ or PAD/T2DM- patients (p=0.001 and p<0.001, respectively). Cox regression analysis after multivariate adjustment showed that the presence of T2DM (HR=1.44 (95% CI 1.09 to 1.92); p=0.012) and the presence of PAD versus CAD (HR=1.48 (95% CI 1.15 to 1.91); p=0.002) were mutually independent predictors of cardiovascular events. CONCLUSIONS In conclusion, our data show that T2DM as well as the presence of PAD versus CAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of cardiovascular events.
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Affiliation(s)
- Lukas Sprenger
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Arthur Mader
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Barbara Larcher
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Maximilian Mächler
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Alexander Vonbank
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Daniela Zanolin-Purin
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Andreas Leiherer
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Axel Muendlein
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Heinz Drexel
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, County Hospital Bregenz, Bregenz, Vorarlberg, Austria
| | - Christoph H Saely
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
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Leiherer A, Muendlein A, Saely CH, Larcher B, Mader A, Maechler M, Sprenger L, Mutschlechner B, Benda M, Laaksonen R, Laaperi M, Jylha A, Fraunberger P, Drexel H. The ceramide- and phosphatidylcholine- based Coronary Event Risk Test2 (CERT2) and cardiovascular mortality in men and women with type 2 diabetes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The recently introduced Coronary Event Risk Test version 2 (CERT2) is a validated cardiovascular risk predictor score that uses circulating ceramide and phosphatidylcholine concentrations.
The purpose of this study was to investigate the power of CERT2 to predict cardiovascular mortality in 280 male and 121 female patients with type 2 diabetes (T2DM).
Prospectively, we recorded 55 cardiovascular deaths in men and 19 in women during a mean follow-up time of 7.6±3.6 and 8.1±3.4 years respectively.
Overall, cardiovascular survival decreased with increasing CERT2 risk categories (figure 1). In Cox regression models, CERT2 significantly predicted the incidence of cardiovascular mortality in male patients with T2DM (unadj. HR 1.82 [1.39–2.37] per standard deviation; p<0.001), the unadj. HR in women was 1.36 [0.83–2.22]; p=0.228). After adjustment for age, BMI, current smoking, LDL cholesterol, HDL cholesterol, hypertension, and statin use the HR in men was 1.73 [1.31–2.29]; p<0.001) and 1.40 [083–2.36]; p=0.210 in women. Interaction terms CERT2 x gender were non-significant both in univariate analysis (p=0.354) and after multivariate adjustment (p=0.359).
We conclude that sex does not significantly impact the association of CERT2 with cardiovascular mortality in patients with T2DM.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | | | | | - A Jylha
- Zora Biosciences, Espoo, Finland
| | | | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
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Mader A, Sprenger L, Vonbank A, Larcher B, Maechler M, Mutschlechner B, Benda M, Leiherer A, Muendlein A, Drexel H, Saely CH. Remnant cholesterol in patients with established cardiovascular disease predicts cardiovascular events both among patients with type 2 diabetes and among non-diabetic subjects. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Remnant cholesterol, which is calculated as total cholesterol minus LDL cholesterol minus HDL cholesterol has attracted interest as a marker of cardiovascular event risk.
The purpose of this study was to investiage whether remnant cholesterol has the power to predict cardiovascular events in patients with established cardiovascular disease.
We enrolled 1822 consecutive patients with established cardiovascular disease, including 1472 with angiographically proven stable CAD, 350 with sonographically proven peripheral artery disease. Prospectively, cardiovascular events were recorded over a mean follow-up period of 6.2±3.2 years.
At baseline, remnant cholesterol was significantly higher in patients with T2DM (n=608) than in non-diabetic subjects (27±25 vs. 21±21 mg/dl; p<0.001). During follow-up, 584 of our patients suffered cardiovascular events; the event rate was significantly higher in patients with T2DM than in non-diabetic subjects (45.4 vs. 32.2%; p<0.001). Remnant cholesterol in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index and LDL cholesterol independently predicted cardiovascular events in the total study population (standardized adjusted HR 1.15 [1.07–1.23]; p<0.001), and in patients with T2DM as well as in non-diabetic subjects (standardized adjusted HRs 1.17 [1.03–1.34]; p=0.013 and 1.12 [1.01–1.23]; p=0.028, respectively).
From our data we conclude that remnant cholesterol in patients with established cardiovascular disease predicts cardiovascular events both among patients with T2DM and among non-diabetic subjects.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | - A Vonbank
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | - A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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Leiherer A, Muendlein A, Geiger K, Saely CH, Larcher B, Mader A, Maechler M, Sprenger L, Mutschlechner B, Benda M, Fraunberger P, Drexel H. The new myokine myonectin is significantly associated with type 2 diabetes in elderly patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The novel myokine myonectin is predominantly expressed in skeletal muscle and is involved in the regulation of metabolic homeostasis. A putative association between myonectin and type 2 diabetes mellitus (T2DM) has been discussed controversially in current literature.
The purpose of this study was to investigate the association between myonectin and T2DM at different ages.
We measured myonectin in 410 vascular risk patients with a mean age of 66 years.
Myonectin did not correlate with age (r=−0.19; p=0.697). From our patients 219 (53%) were >65 years, with a mean age of 74 years and 191 ≤65 years, with a mean age of 57 years. The prevalence of T2DM was 40.6% vs. 42.4% in the older as compared to the younger age group. Myonectin concentrations were significantly decreased in elderly patients with T2DM compared to non-diabetic subjects (1.8 vs. 4.2 ng/ml; p=0.002), whereas no significant difference was observed in younger patients (2.6 vs. 2.3 ng/ml; p=0.183). Concordantly, regression analysis revealed an unadjusted odds ratio (OR) of 0.24 [0.07–0.81] (p=0.021) for the association between myonectin and T2DM in elderly patients but not in younger patients (OR=1.08 [0.80–1.45]; p=0.609). The association between myonectin and T2D; remained significant after adjusting for sex, body mass index, LDL cholesterol, HDL cholesterol, current smoking, as well as statin intake in elderly but remained non-significant in younger patients (OR=0.23 [0.07–0.81]; p=0.021 vs. OR=1.05 [0.76–1.46]; p=0.769).
We conclude that plasma myonectin levels are significantly associated with T2DM, particularly in elderly vascular risk patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - K Geiger
- VIVIT Institute, Feldkirch, Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | | | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
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Sprenger L, Vonbank A, Larcher B, Mader A, Maechler M, Mutschlechner B, Benda M, Leiherer A, Muendlein A, Drexel H, Saely CH. Type 2 diabetes, chronic kidney disease and major cardiovascular events in patients with established coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Both type 2 diabetes (T2DM) and chronic kidney disease (CKD) confer a high risk of cardiovascular disease (CVD), and these conditions frequently coincide.
The purpose of this study was to investigate the single and joint effects of T2DM and CKD on major cardiovascular events (MACE) in a high-risk population of patients with established coronary artery disease (CAD).
We prospectively investigated 1460 patients with angiographically proven CAD over 10.4±4.8 years, of whom 454 (30.8%) had T2DM and 251 (17.1%) had CKD.
MACE occurred more frequently in T2DM patients than in non-diabetic subjects (40.4% vs 28.7%, p<0.001) and in patients with CKD (eGFR <60ml/min/1.73m2) than in those with an eGRF ≥60ml/min/1.73m2 (51.6% vs 28.3%, p<0.001). When both, T2DM and CKD were considered, 863 subjects had neither T2DM nor CKD, 346 had T2DM but not CKD, 148 did not have diabetes but had CKD, and 103 had both T2DM and CKD. When compared with the incidence of MACE among patients with neither T2DM nor CKD (25.3%), MACE occurred more frequently in patients with T2DM who did not have CKD (35.8%; p<0.001) as well as in non-diabetic patients with CKD (47.6%; p<0.001) and occurred most freuently in patients with both, T2DM and CKD (57.4%; p<0.001), in whom the incidence of MACE was higher than in those with T2DM but not CKD (p<0.001) or those without T2DM but with CKD (p=0.025); the incidence of MACE was higher in non-diabetic CKD patients than in T2DM patients who did not have CKD (p=0.041). In Cox regression analysis, T2DM (HR=1.46 [1.20–1.78]; p<0.001) and CKD (HR=1.81 [1.45–2.27]; p<0.001) were mutually independent predictors of MACE after multivariate adjustment.
We conclude that T2DM and CKD are mutually independent risk factors for MACE in patients with established CAD. CAD patients with both CKD and T2DM are an extremely high risk for MACE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - A Vonbank
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | - A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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Mader A, Maechler M, Larcher B, Sprenger L, Mutschlechner B, Benda M, Leiherer A, Muendlein A, Vonbank A, Drexel H, Saely CH. Type 2 diabetes significantly modulates the power of lipoprotein(a) to predict cardiovascular events and mortality in young coronary artery disease patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Lipoprotein(a) [Lp(a)] is an important cardiovascular risk factor especially in young individuals.
The purpose of this study was to investigate whether Lp(a) has the power to predict cardiovascular events in young coronary artery disease (CAD) patients with type 2 diabetes (T2DM).
Lp(a) was measured in a cohort of 731 patients with angiographically proven CAD who were aged <65 years. Vascular events were recorded over a mean follow-up of 6.6±3.2 years.
At baseline, 216 patients had T2DM, and 515 did not have diabetes. During follow-up, 30.2% of our patients suffered cardiovascular events. Lp(a) proved to be a strong and independent predictor of vascular events in the total study cohort (standardized adjusted HR=1.30 [1.07–1.56]; p=0.007). In subgroup analyses by diabetes status, Lp(a) significantly predicted vascular events in non-diabetic patients (standardized adjusted HR= 1.39 [1.12–1.74]; p=0.003) but not in diabetic patients (standardized adjusted HR=0.93 [0.63–1.38]; p=0.731). An interaction term Lp(a) x T2DM was significant (p=0.002), indicating that T2DM significantly modulated the power of Lp(a) to predict cardiovascular events.
We conclude that Lp(a) significantly modulates the power of Lp(a) to predict cardiovascular events in CAD patients <65 years.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | - A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - A Vonbank
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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Saely CH, Vonbank A, Larcher B, Mader A, Maechler M, Sprenger L, Mutschlechner B, Benda M, Leiherer A, Muendlein A, Drexel H. Type 2 diabetes and risk of major cardiovascular events in peripheral artery disease versus coronary artery disease patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The prevalence of type 2 diabetes (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD.
The purpose of this study was to investigate how the incidence of major cardiovascular events compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes (T2DM).
We prospectively recorded major cardiovascular events and death over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123).
When compared to the incidence of MACE in CAD+/T2DM- patients (25.1%), it was significantly higher in CAD+/T2DM+ patients (35.4%; p<0.001), in PAD+/T2DM- patients (30.2%; p=0.022) and in PAD+/T2DM+ patients (47.2%; p<0.001). Patients with both PAD and T2DM in turn were at a higher risk than CAD+/T2DM+ or PAD+/T2DM- patients (p=0.001 and p<0.001, respectively). The incidence of MACE did not differ significantly between PAD+/T2DM- and CAD+/T2DM+ patients (p=0.413). Compared to patients with CAD, Cox regression analyses after multivariate adjustment showed an adjusted hazard ratio of 1.46 [1.14–1.87], p=0.002 for the presence of PAD. Conversely, T2DM increased the risk of MACE after multivariate adjustment in CAD and PAD patients (adjusted HR 1.58 [1.27–1.98], p<0.001).
In conclusion, our data show that T2DM and the presence of PAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of MACE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C H Saely
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - A Vonbank
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - B Larcher
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - A Mader
- Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | | | | | - M Benda
- VIVIT Institute, Feldkirch, Austria
| | - A Leiherer
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - H Drexel
- County Hospital Bregenz, Bregenz, Austria
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Yazdani B, Delgado GE, Scharnagl H, Krämer BK, Drexel H, März W, Scherberich JE, Leiherer A, Kleber ME. Combined Use of Serum Uromodulin and eGFR to Estimate Mortality Risk. Front Med (Lausanne) 2021; 8:723546. [PMID: 34568379 PMCID: PMC8455921 DOI: 10.3389/fmed.2021.723546] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Serum uromodulin (sUmod) shows a strong direct correlation with eGFR in patients with impaired kidney function and an inverse association with mortality. However, there are patients in whom only one of both markers is decreased. Therefore, we aimed to investigate the effect of marker discordance on mortality risk. sUmod and eGFR were available in 3,057 participants of the Ludwigshafen Risk and Cardiovascular Health study and 529 participants of the VIVIT study. Both studies are monocentric prospective studies of patients that had been referred for coronary angiography. Participants were categorized into four groups according to the median values of sUmod (LURIC: 146 ng/ml, VIVIT: 156) and eGFR (LURIC: 84 ml/min/1.73 m2, VIVIT: 87). In 945 LURIC participants both markers were high (UHGH), in 935 both were low (ULGL), in 589 only eGFR (UHGL), and in 582 only sUmod (ULGH) was low. After balancing the groups for cardiovascular risk factors, hazard ratios (95%CI) for all-cause mortality as compared to UHGH were 2.03 (1.63-2.52), 1.43 (1.13-1.81), and 1.32 (1.03-1.69) for ULGL, UHGL, and ULGH, respectively. In VIVIT, HRs were 3.12 (1.38-7.08), 2.38 (1.01-5.61), and 2.06 (0.81-5.22). Adding uromodulin to risk prediction models that already included eGFR as a covariate slightly increased the Harrell's C and significantly improved the AUC in LURIC. In UHGL patients, hypertension, heart failure and upregulation of the renin-angiotensin-aldosterone-system seem to be the driving forces of disease development, whereas in ULGH patients metabolic disturbances might be key drivers of increased mortality. In conclusion, SUmod/eGFR subgroups mirror distinct metabolic and clinical patterns. Assessing sUmod additionally to creatinine or cystatin C has the potential to allow a more precise risk modeling and might improve risk stratification.
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Affiliation(s)
- Babak Yazdani
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Graciela E Delgado
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Bernhard K Krämer
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for Angioscience, Mannheim, Germany
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment at the Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Drexel University College of Medicine, Philadelphia, PA, United States.,Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland
| | - Winfried März
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
| | - Jürgen E Scherberich
- Klinikum München-Harlaching, Teaching Hospital of the Ludwig-Maximilians University, Munich, Germany.,KfH-München Süd, Munich, Germany
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment at the Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Medical Central Laboratories, Feldkirch, Austria
| | - Marcus E Kleber
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,SYNLAB MVZ Humangenetik Mannheim, Mannheim, Germany
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Leiherer A, Mündlein A, Laaksonen R, Lääperi M, Jylhä A, Fraunberger P, Drexel H. Comparison of recent ceramide-based coronary risk prediction scores in cardiovascular disease patients. Eur J Prev Cardiol 2021; 29:947-956. [PMID: 34417607 DOI: 10.1093/eurjpc/zwab112] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 12/27/2022]
Abstract
AIM Cholesterol-based risk prediction is often insufficient in cardiovascular disease (CVD) patients. Ceramides are a new kind of biomarkers for CVD. The Coronary Event Risk Test (CERT) is a validated cardiovascular risk predictor that uses only circulating ceramide levels, determined by coupled liquid chromatography-mass spectrometry, to allocate patients into one of four risk categories. This test has recently been modified (CERT2) by additionally including phosphatidylcholine levels. METHODS AND RESULTS In this observational cohort study, we have recruited 999 Austrian patients with CVD and followed them for up to 13 years. We found that CERT and CERT2 both predicted cardiovascular events, cardiovascular mortality, and overall mortality. CERT2 had the higher performance compared to CERT and also to the recent cardiovascular risk score of the ESC/EAS guidelines (Systematic COronary Risk Evaluation (SCORE)) for low-risk European countries. Combining CERT2 with the ESC/EAS-SCORE, predictive capacity was further increased leading to a hazard ratio of 3.58 (2.02-6.36; P < 0.001) for cardiovascular events, 11.60 (2.72-49.56; P = 0.001) for cardiovascular mortality, and 9.86 (4.23-22.99; P < 0.001) for overall mortality when patients with very high risk (category 4) were compared to those with low risk (category 1). The use of the combined score instead of the ESC/EAS-SCORE significantly improved the predictive power according to the integrated discrimination improvement index (P = 0.004). CONCLUSION We conclude that CERT and CERT2 are powerful predictors of cardiovascular events, cardiovascular mortality, and overall mortality in CVD patients. Including phosphatidylcholine to a ceramide-based score increases the predictive performance and is best in combination with classical risk factors as used in the ESC/EAS-SCORE.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria.,Medical Central Laboratories, Carinagasse 41, A-6807, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24 FL-9495 Triesen, Liechtenstein
| | - Axel Mündlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24 FL-9495 Triesen, Liechtenstein
| | - Reijo Laaksonen
- Finnish Cardiovascular Research Center, University of Tampere, Arvo Ylpön katu 34, 33520 Tampere, Finland.,Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | - Mitja Lääperi
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | - Antti Jylhä
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | - Peter Fraunberger
- Medical Central Laboratories, Carinagasse 41, A-6807, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24 FL-9495 Triesen, Liechtenstein
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24 FL-9495 Triesen, Liechtenstein.,Department of Internal Medicine, Academic Teaching Hospital Bregenz, Carl-Pedenz-Str. 2, A-6900 Bregenz, Austria.,Drexel University College of Medicine, 2900 W Qeen Ln, PA 19129 Philadelphia, PA, USA
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Maechler M, Vonbank A, Larcher B, Mader A, Sprenger L, Mutschlechner B, Leiherer A, Zanolin-Purin D, Muendlein A, Drexel H, Saely C. Single and joint impact of type 2 diabetes and of congestive heart failure on Albuminuria. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Saely CH, Maechler M, Mader A, Larcher B, Sprenger L, Mutschlechner B, Klement M, Zanolin-Purin D, Leiherer A, Muendlein A, Vonbank A, Drexel H. REMNANT CHOLESTEROL IN PATIENTS WITH ESTABLISHED CORONARY ARTERY DISEASE PREDICTS CARDIOVASCULAR EVENTS BOTH AMONG PATIENTS WITH TYPE 2 DIABETES AND AMONG NON-DIABETIC SUBJECTS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02922-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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