RESUMO
BACKGROUND: Cross-sectional and longitudinal studies have been conducted to investigate the association between migraine and any headache and white matter hyperintensities (WMH). However, studies are inconsistent regarding the strength of the association and its clinical significance. The aim of our study was to investigate the association between headache and its subtypes (migraine with aura (MigA+), migraine without aura (MigA-), non-migraine headache (nonMigHA)) and WMH and its course in the population-based 1000BRAINS study using state-of-the-art imaging techniques and migraine classification according to modified international classification of headache disorders. METHODS: Data from 1062 participants (45% women, 60.9 ± 13.0 years) with ever or never headache (neverHA) and complete quantitative (WMH volume) and qualitative (Fazekas classification) WMH data at first imaging and after 3.7 ± 0.7 years (393 participants) were analyzed. The sex-specific association between headache and its subtypes and WMH volume and its change was evaluated by linear regression, between headache and its subtypes and Fazekas score high vs. low (2-3 vs. 0-1) by log-binomial regression, adjusted for confounders. RESULTS: The lifetime prevalence of headache was 77.5% (10.5% MigA+, 26.9% MigA-, 40.1% nonMigHA). The median WMH volume was 4005 (IQR: 2454-6880) mm3 in women and 4812 (2842-8445) mm3 in men. Women with any headaches (all headache types combined) had a 1.23 [1.04; 1.45]-fold higher WMH volume than women who reported never having had a headache. There was no indication of higher Fazekas grading or more WMH progression in women with migraine or any headaches. Men with migraine or any headaches did not have more WMH or WMH progression compared to men without migraine or men who never had headache. CONCLUSIONS: Our study demonstrated no increased occurrence or progression of WMH in participants with mgiraine. But, our results provide some evidence of greater WMH volume in women with headache of any type including migraine. The underlying pathomechanisms and the reasons why this was not shown in men are unclear and require further research.
Assuntos
Progressão da Doença , Imageamento por Ressonância Magnética , Transtornos de Enxaqueca , Substância Branca , Humanos , Feminino , Masculino , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico por imagem , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/patologia , Cefaleia/epidemiologia , Cefaleia/diagnóstico por imagem , Estudos Transversais , Idoso , Estudos Longitudinais , Adulto , Fatores SexuaisRESUMO
OBJECTIVES: Cardiovascular diseases (CVDs) occur more often in people living with HIV (PLWH) than in the general population. It has been reported that CVD risk scores developed for the general population underestimate the CVD risk in PLWH. Performances of the Framingham Risk Score (FRS), the Systematic Coronary Risk Evaluation (SCORE) and the atherosclerotic cardiovascular disease (asCVD) risk score in PLWH were compared with the general population to quantify score-specific differences in risk prediction. METHODS: HIV-positive outpatients from the HIV-HEART (HIVH) study (n = 567) were compared with participants from the population-based Heinz Nixdorf Recall (HNR) study (n ~ 4440) both recruited from the German Ruhr area. During a follow-up time of around 5 years, the associations between the FRS and incident CVD and peripheral artery disease (CVD_pAD), SCORE and coronary heart disease (CHD), and asCVD and incident CVD were examined using logistic regression. Score performances were assessed by comparing the areas under the curve (AUCs). RESULTS: The mean ages were 52.9 ± 6.7 and 59.1 ± 7.7 years in the HIVH and HNR studies, respectively. There were fewer incident CVD events in the HNR study than in the HIVH study (CVD_pAD: 3.9% vs. 12.1%; CHD: 2.1% vs. 7.8%; CVD: 3.5% vs. 9.9%). Age- and sex-adjusted CVD risk was greater with increasing FRS, SCORE and asCVD in both cohorts, but the scores performed more accurately in the HNR than in HIVH study (AUCs FRS: 0.71 vs. 0.65; SCORE: 0.70 vs. 0.62; asCVD: 0.74 vs. 0.62). CONCLUSIONS: Associations between risk scores and future CVD were observed in both cohorts, but the score performances were less reliable in PLWH than in the general population.
Assuntos
Aterosclerose , Doenças Cardiovasculares , Infecções por HIV , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Pessoa de Meia-Idade , Medição de Risco , Fatores de RiscoRESUMO
BACKGROUND: Scientific evidence suggests an association between psoriasis and cardiovascular and metabolic diseases. However, there are hardly any sex-specific results from population-based studies reporting the prevalence of cardiovascular risk factors in patients with psoriasis and point estimates of the association between psoriasis and cardiovascular and metabolic disorders. OBJECTIVE: Aims are to evaluate the sex-specific prevalence of psoriasis and cardiovascular risk factors, and to estimate sex-specific associations between psoriasis and diabetes type 2 (DM) and metabolic syndrome (MetS). METHODS: We used data of 3723 participants (45-75 years, 54.1% women) without coronary heart disease and missing data (psoriasis, DM, MetS) from the Heinz Nixdorf Recall study. Standardized information on health outcomes and risk factors was assessed. We performed descriptive statistics and multiple regression analyses to calculate prevalence rate ratios (PR) and 95% confidence intervals (95% CI). RESULTS: The prevalence of psoriasis was 3.8% (n = 143), with no differences between sex. We observed more often metabolic and cardiovascular risk factors in women with psoriasis compared to women without psoriasis. Interestingly, in men, this pattern was partly reversed. Multiple regression analyses revealed distinctly elevated PRs for DM for both women and men with psoriasis (fully adjusted PR: 2.43; 95% CI: 1.17-5.07, resp. 2.09; 1.16-3.76). Regarding the MetS, the results were inconsistent, showing a positive association between psoriasis and MetS in women (1.84; 1.14-2.98), but a negative association in men, even though with a wide 95% CI (0.69; 0.42-1.12). CONCLUSION: The results of our cross-sectional, population-based analysis show a distinct association between psoriasis and DM, whereas for the MetS the results contrasted between men and women, translating in women with MetS showing a higher and in men a lower chance to be psoriatic. Our results emphasize the urgent need for sex-specific research, studying the effects of psoriasis on metabolic disorders as well as effective sex tailored prevention measures.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Fatores de Risco de Doenças Cardíacas , Síndrome Metabólica/epidemiologia , Psoríase/complicações , Idoso , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Psoríase/epidemiologia , Fatores SexuaisRESUMO
BACKGROUND AND AIMS: There is controversy on the potentially benign nature of metabolically healthy obesity (MHO), i.e., obese persons with few or no metabolic abnormalities. So far, associations between MHO and coronary artery calcification (CAC), a measure of subclinical atherosclerosis, have mainly been studied cross-sectionally in Asian populations. We assessed cross-sectional and longitudinal MHO CAC associations in a Caucasian population. METHODS AND RESULTS: In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany, CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. For cross-sectional and longitudinal analyses, we included 1585 participants free of coronary heart disease at baseline, with CAC measurements at baseline and at follow-up, and with either normal weight (BMI 18.5-24.9 kg/m2) or obesity (BMI ≥30.0 kg/m2) at baseline. We used four definitions of MHO. In our main analysis, we defined obese persons as metabolically healthy if they met ≤1 of the NCEP ATP III criteria for the definition of the metabolic syndrome - waist circumference was not taken into account because of collinearity with BMI. Persons with MHO had a higher prevalence of CAC than metabolically healthy normal weight (MHNW) persons (prevalence ratio = 1.59 (95% confidence interval 1.38-1.84) for the main analysis). Persons with MHO had slightly larger odds of CAC progression than persons with MHNW (odds ratios ranged from 1.17 (0.69-1.99) to 1.48 (1.02-2.13) depending on MHO definition and statistical approach). CONCLUSION: Our analyses on MHO CAC associations add to the evidence that MHO is not a purely benign health condition.
Assuntos
Doença da Artéria Coronariana/epidemiologia , Obesidade Metabolicamente Benigna/epidemiologia , Calcificação Vascular/epidemiologia , Idoso , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estudos Transversais , Progressão da Doença , Feminino , Alemanha/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade Metabolicamente Benigna/diagnóstico , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Calcificação Vascular/diagnóstico por imagemRESUMO
In contrast to the situation in the 1960s and 1970s, the mortality risk for patients with myocardial infarction has been clearly reduced, particularly for those with myocardial infarction with cardiogenic shock (MICS). Approximately 510â¯% of patients with a myocardial infarction are affected by a MICS and the mortality risk is between 30â¯% and 50â¯%. The primary percutaneous coronary intervention with stent implantation should be carried out as quickly as possible in order to reduce the mortality to around 20â¯%. This article gives an overview of the currently available options for conservative and fibrinolytic treatment of MICS, of the interventional treatment of cardiogenic shock in the era of intravenous and intracoronary infarct treatment as well as without thrombolysis. In addition, the currently available mechanical support systems and the possibilities for surveillance and monitoring of patients are presented.
Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Choque Cardiogênico , Terapia Trombolítica , Humanos , Infarto do Miocárdio/complicações , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapiaRESUMO
Aortic diseases include not only the thoracic but also the abdominal part of the aorta. In the etiology cardiovascular risk factors, such as hypertension, smoking and hyperlipoproteinemia play a major role, but more and more genetic diseases with familiar predisposition are being identified. Even large aneurysms remain asymptomatic as long as other organs in the neighborhood are not damaged and no acute aortic event occurs including aortic dissection, intramural hematoma, penetrating aortic ulcer, and traumatic aortic injury. Standardized algorithms allow precise and rapid diagnosis for initiating medicinal therapy or operative and/or endovascular interventions (thoracic/endovascular aortic repair, TEVAR/EVAR) in this emergency situation. Specialized aortic centers are recommended to form localized regional networks.
Assuntos
Doenças da Aorta , Implante de Prótese Vascular , Procedimentos Endovasculares , Aorta Torácica , Doenças da Aorta/diagnóstico , Doenças da Aorta/terapia , Humanos , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND AND AIMS: As a modifiable lifestyle factor, diet is hypothesized to play an important role in the progression of atherosclerosis. The aim of this study was to explore associations of comprehensive dietary patterns derived by cluster analysis with degree and progression of coronary artery calcification (CAC) over five years of follow-up. METHODS AND RESULTS: In the population-based Heinz Nixdorf Recall study, 3718 participants (45-75 years; 47.6% men) without coronary heart disease completed a food frequency questionnaire at baseline. Five distinct dietary patterns were identified using cluster analysis: "Health-conscious", "Traditional German/Less alcohol", "Mediterranean-like", "Western" and "Animal fat/Alcohol" (used as reference). CAC was measured using electron-beam computed tomography at baseline and five years later. CAC after five years was predicted based on sex- and age-specific baseline percentiles. After comparing observed and predicted CAC Scores, CAC progression was classified as slow, expected, or rapid. Compared to "Animal fat/Alcohol" diet, a "Mediterranean-like" diet was associated with a relative risk (RR) for a rapid CAC progression in both sexes (men: 0.61; 95%-confidence interval [95%-CI]: 0.41; 0.90; women: 0.59; 95%-CI: 0.45; 0.78). Furthermore, reduced RRs were observed in women with a "Health-conscious" and a "Traditional German/Less alcohol" diet (0.63; 95%-CI: 0.47; 0.84, respectively 0.69; 95%-CI: 0.52; 0.90). No association was observed for a "Western" diet for both sexes. Similar results were revealed for degree of CAC. CONCLUSION: The study results support the hypothesis that a "Mediterranean-like" diet is associated with a lower CAC-progression and lower degree of CAC in men and women.
Assuntos
Doença da Artéria Coronariana/epidemiologia , Dieta , Comportamento Alimentar , Calcificação Vascular/epidemiologia , Idoso , Consumo de Bebidas Alcoólicas , Análise por Conglomerados , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/prevenção & controle , Dieta/efeitos adversos , Inquéritos sobre Dietas , Dieta Saudável , Dieta Mediterrânea , Dieta Ocidental , Gorduras na Dieta , Progressão da Doença , Feminino , Alemanha/epidemiologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Proteção , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/prevenção & controleRESUMO
The tricuspid valve and the right ventricle are hemodynamically closely related. Pathological changes of the valve or of the ventricle itself and also various diseases beyond that can result in a downward spiral of mutual interference, which is of prognostic importance for the patient. The development of a functional tricuspid regurgitation is of great importance. Especially with the help of 3D-echocardiography, more and more changes and mechanisms have been identified that are crucial in this process. This article provides a review of the relationship between the tricuspid valve and the right ventricle emphasizing the current knowledge of the causes, the pathophysiological concepts, the underlying structural changes and the therapeutic approaches based on this.
Assuntos
Ventrículos do Coração/fisiopatologia , Hemodinâmica/fisiologia , Insuficiência da Valva Tricúspide/fisiopatologia , Valva Tricúspide/fisiopatologia , Cardiomegalia/diagnóstico por imagem , Cardiomegalia/fisiopatologia , Ecocardiografia Tridimensional , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Músculos Papilares/fisiopatologia , Prognóstico , Estatística como Assunto , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologiaRESUMO
BACKGROUND/OBJECTIVES: Sleep duration influences weight change in children and young adults, but there is less evidence in middle-aged, and, in particular, older adults. We assessed associations between sleep duration, daytime napping and sleep disturbances, respectively, with change of weight and waist circumference in older subjects. Contrary to previous studies, we also used two points in time to assess sleep characteristics. METHODS: We used data from the population-based Heinz Nixdorf Recall study, a cohort study in Germany with a baseline and two follow-up visits (age 45-74 years, median follow-up 5.1 years for first, 5.2 years for second follow-up visit). In adjusted linear regression models (N=3751), we estimated weight change between baseline and first follow-up visit in relation to various self-reported sleep characteristics measured at baseline. Furthermore, we estimated change of weight and waist circumference, respectively, between first and second follow-up visit in relation to patterns of sleep characteristics measured at baseline and at the first follow-up visit (N=2837). RESULTS: In all analyses, short and long sleep duration, sleep disturbances, and regular daytime napping were associated with <1 kg of weight gain and <1 cm of gain in waist circumference over 5 years compared with the respective reference categories. For example, compared with 7-<8 h night sleep, short night sleep (⩽5 h at baseline) was associated with 0.5 kg of weight gain (95% confidence interval: -0.1; 1.1 kg). CONCLUSIONS: Our study gave no evidence that sleep characteristics were associated with clinically relevant weight gain in the older population.
Assuntos
Peso Corporal/fisiologia , Transtornos do Sono-Vigília/fisiopatologia , Sono/fisiologia , Aumento de Peso/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Circunferência da Cintura/fisiologiaAssuntos
Anticorpos Monoclonais/uso terapêutico , Anticolesterolemiantes/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/imunologia , Inibidores de PCSK9 , Pró-Proteína Convertase 9/imunologia , Medicina Baseada em Evidências , Humanos , Terapia de Alvo Molecular/métodos , Resultado do TratamentoRESUMO
Infective endocarditis is an endovascular infection usually caused by bacteria. Mortality rate is still approximately 20 %. To improve patients' prognosis by implementation of current diagnostic and therapeutic evidence, the European Society of Cardiology published an updated version of the guidelines for management of infective endocarditis in 2015. It strengthens the role of imaging modalities like PET/CT for detection of infectious foci when echocardiography remains negative and highlights the use of modern tests for identification of possible pathogens. New diagnostic criteria were introduced to integrate these methods for improved diagnostic sensitivity. Complicated cases should be treated in reference centers with on-site cardiac surgery. The antibiotic and early surgical management should be discussed in a multidisciplinary endocarditis team. A few years ago, the indication for endocarditis prophylaxis was limited to high-risk patients. These recommendations were confirmed in current guidelines.
Assuntos
Antibacterianos/administração & dosagem , Técnicas de Imagem Cardíaca/normas , Procedimentos Cirúrgicos Cardíacos/normas , Cardiologia/normas , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/terapia , Antibacterianos/normas , Terapia Combinada/métodos , Terapia Combinada/normas , Diagnóstico Diferencial , Ecocardiografia/normas , Endocardite Bacteriana/microbiologia , Europa (Continente) , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/normas , Guias de Prática Clínica como AssuntoRESUMO
Andreas Grüntzig can be regarded as the pioneer of modern cardiology. Based on the previous experiences of Charles Dotter in Portland, Oregon, and after many years of preparation as a young 38-year-old physician and consultant he carried out the first percutaneous transluminal coronary angioplasty (PTCA) in a 38-year-old patient in Zurich in 1977, supported by the cardiac surgeons A. Senning and M. Turina. Despite high ranking publications and early preparedness to share his experiences the development of PTCA stagnated and was met with great scepticism. The technique was new, technically difficult and aimed at aortocoronary bypass surgery, which was itself still in its infancy 10 years after the introduction in Cleveland in 1968. Even after several years only two patients per week were admitted for treatment in Zurich. In a similar way the young cardiac surgeon H.R. Andersen was a pioneer in Denmark whose ideas and own experiments with a balloon catheter-assisted aortic valve implantation were not initially taken up by the leading companies of the time and publication of the data suffered lengthy delays. It took 10 years before Prof. A. Cribier in Rouen followed up his ideas and carried out the first valve implantation again in pioneer work after many years of preparation in 2002. Again, the new method for treatment of very old and high risk patients needed many years before it was accepted. The breakthrough only became possible when this new technique began to be used in cardiac surgery after the introduction of hybrid cardiac catheter operating rooms. Despite evidence-based studies innovative methods are not subject to the same criteria throughout Europe with respect to the timely introduction of innovative and validated procedures also in consideration of reimbursement and this has become an important initiative of the European Society of Cardiology (ESC).
Assuntos
Angioplastia Coronária com Balão/estatística & dados numéricos , Cardiologia/tendências , Técnicas de Diagnóstico Cardiovascular/estatística & dados numéricos , Uso Excessivo dos Serviços de Saúde , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Difusão de Inovações , Alemanha/epidemiologia , HumanosRESUMO
The presence and extent of coronary artery calcification (CAC) is established in primary prevention since the CAC score is the single best predictor of future cardiovascular events. While CAC progresses with increasing age, individual CAC progression can be estimated based on the subject's age, gender, and CAC percentile at first examination. To date, several algorithms and methods for the definition of CAC progression are available in the literature. Increased CAC progression is associated with traditional cardiovascular risk factors including hypertension, diabetes, and smoking status. Also, lipid-lowering therapy may influence the progression of CAC. Epicardial adipose tissue is a further cardiovascular risk marker that may lead to intensified CAC progression if its volume increases. In terms of clinical implications, initial data suggest that extensive CAC progression is linked to worse outcome; however, further studies are needed to establish this relationship and to define appropriate time intervals between repetitive examinations. This review article gives an overview of the existing literature with an emphasis on various definitions of CAC progression, predictors of increased CAC progression, as well as clinical implications.
Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Calcificação Vascular/diagnóstico por imagem , Animais , Progressão da Doença , HumanosRESUMO
Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases [Eur Heart Journal (2014) 35, 28732926,doi:10.1093/eurheartj/ehu281]. In Table 3, the radiation for MRI is "0" and not "-". The corrected table is shown below.
RESUMO
Noncompaction cardiomyopathy (NCCM) is a genetic myocardial disorder, which is characterized by a two-layered ventricle wall with a thin compact outer layer and a noncompacted inner layer, with prominent trabeculations and deep intratrabecular recesses communicating with the ventricle cavity without any contact to the coronary system. Before the initial description as isolated left ventricle cardiomyopathy (ILVCN) in 1984 by Engberding and Bender, the morphological characteristics had been described only in association with other congenital cardiac disorders, such as atresia of the semilunar valves. The disease usually involves the myocardium of the left ventricle but involvement of the right ventricular has recently been shown. Due to delayed diagnosis and therapy, in advanced stages NCCM can result in heart failure. Life-threatening complications, such as malignant arrhythmia with sudden cardiac death and embolic events have been observed in patients with NCCM. A multimodal investigation including echocardiography and cardiac magnet resonance tomography (CMR) as well as a focused analysis of symptoms can allow a valid diagnosis.