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1.
Rev. bras. med. esporte ; 29: e2022_0168, 2023. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1394832

RESUMEN

ABSTRACT Introduction: Several programs to encourage physical activity has been encouraged to reduce the sedentary lifestyle in China. Running is among them because it has potentially positive effects on cardiovascular diseases, hypertension, diabetes mellitus, and hypercholesterolemia, in addition to the intrinsic psychological and social benefits of outdoor sports. Objective: Explore the protective effect of running on the cardiac system by analyzing strategies for cultivating exercise health awareness. Methods: A group of ten healthy volunteers, five women aged 25-35 years, underwent a 45-minute running program, performed four times a week for three weeks. Data collected by spirometry and cardiac monitoring were collected, treated, compared, and discussed. This paper introduced the concept of subjective exercise intensity to find the best analysis and judgment of Cardiac Function. Finally, a quantitative investigation involving the analysis of 315 questionnaires explored the current status of sports health awareness in running fans. Results: Heart rate amplitude during running remained in the range of 120-160, belonging to the normal heart rate range for the surveyed audience. In most cases, women's heart rate was higher than men's (P<0.05). The exercise intensity was fixed at a frequency below the value of 16, which is a slightly strenuous stage, and the relative exercise intensity was controlled between 50% and 71.5%. Conclusion: Running has a good cardiac protective effect, and its followers are highly aware of sports health. Due to the beneficial effect of sports practice, its dissemination is recommended as a form of physical and social therapeutic activity. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.


RESUMO Introdução: Com o intuito de reduzir o índice de sedentarismo na China, diversos programas de incentivo à atividade física foram estimulados. A corrida está dentre eles pois tem potenciais efeitos positivos nas doenças cardiovasculares, hipertensão arterial, diabetes mellitus e hipercolesterolemia, além dos benefícios psicológicos e sociais intrínsecos na prática esportiva ao ar livre. Objetivo: Explorar o efeito protetor da corrida no sistema cardíaco analisando as estratégias para a cultura da consciência sanitária do exercício. Métodos: Um grupo de dez voluntários saudáveis, com cinco mulheres e idade entre 25 a 35 anos foram submetidos a um programa de corrida por 45 minutos, realizado quatro vezes por semana, durante três semanas. Dados coletados por espirometria e monitoramento cardíaco foram coletados, tratados, comparados e discutidos. Este artigo introduziu o conceito de intensidade de exercício subjetivo para encontrar a melhor análise e julgamento da Função Cardíaca. Por fim, uma investigação quantitativa envolvendo a análise de 315 questionários explorou a situação atual da conscientização em saúde esportiva em adeptos da corrida. Resultados: A amplitude de frequência cardíaca durante a corrida manteve-se na faixa de 120-160, pertencente à faixa normal de frequência cardíaca ao público pesquisado. A frequência cardíaca das mulheres foi maior do que a dos homens na maioria dos casos (P<0,05). A intensidade do exercício fixou-se numa frequência inferior ao valor de 16, que é um estágio ligeiramente extenuante, e a intensidade relativa do exercício ficou controlada entre 50% e 71,5%. Conclusão: A corrida apresenta um bom efeito protetor cardíaco, seus adeptos possuem elevada conscientização da saúde esportiva. Devido ao efeito salutar da prática esportiva, recomenda-se a sua divulgação como forma de atividade terapêutica física e social. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.


RESUMEN Introducción: Con el fin de reducir el estilo de vida sedentario en China, se han estimulado varios programas para fomentar la actividad física. La carrera se encuentra entre ellos porque tiene potenciales efectos positivos sobre las enfermedades cardiovasculares, la hipertensión, la diabetes mellitus y la hipercolesterolemia, además de los beneficios psicológicos y sociales intrínsecos del deporte al aire libre. Objetivo: Explorar el efecto protector de correr sobre el sistema cardíaco analizando las estrategias para cultivar la conciencia de la salud del ejercicio. Métodos: Un grupo de diez voluntarios sanos, cinco mujeres, con edades comprendidas entre los 25 y los 35 años, fueron sometidos a un programa de carrera durante 45 minutos, realizado cuatro veces por semana durante tres semanas. Los datos recogidos por la espirometría y la monitorización cardíaca fueron recogidos, tratados, comparados y discutidos. Este trabajo introdujo el concepto de intensidad subjetiva del ejercicio para encontrar el mejor análisis y juicio de la Función Cardíaca. Por último, una investigación cuantitativa que incluyó el análisis de 315 cuestionarios exploró el estado actual de la conciencia de la salud deportiva en los aficionados a las carreras. Resultados: La amplitud de la frecuencia cardíaca durante la carrera se mantuvo en el rango de 120-160, perteneciendo al rango de frecuencia cardíaca normal para el público encuestado. La frecuencia cardíaca de las mujeres fue mayor que la de los hombres en la mayoría de los casos (P<0,05). La intensidad del ejercicio se fijó en una frecuencia inferior al valor de 16, que es una etapa ligeramente agotadora, y la intensidad relativa del ejercicio se controló entre el 50% y el 71,5%. Conclusión: La acción de correr presenta un buen efecto cardioprotector, sus adeptos poseen alta conciencia de la salud deportiva. Debido al efecto saludable de la práctica deportiva, se recomienda su difusión como forma de actividad terapéutica física y social. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Enfermedades Cardiovasculares/prevención & control , Ejercicio Físico/fisiología , Diabetes Mellitus/prevención & control , Frecuencia Cardíaca/fisiología , Hipercolesterolemia/prevención & control
2.
Ann Lab Med ; 43(1): 29-37, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36045054

RESUMEN

Background: High LDL-cholesterol (LDL-C) is an established risk factor for cardiovascular disease and is considered an important therapeutic target. It can be measured directly or calculated from the results of other lipid tests. The Friedewald formula is the most widely used formula for calculating LDL-C. We modified the Friedewald formula for a more accurate and practical estimation of LDL-C. Methods: Datasets, including measured triglyceride, total cholesterol, HDL-cholesterol, and LDL-C concentrations were collected and assigned to derivation and validation sets. The datasets were further divided into five groups based on triglyceride concentrations. In the modified formula, LDL-C was defined as total cholesterol - HDL-cholesterol - (triglyceride/adjustment factor). For each group, the adjustment factor that minimized the difference between measured LDL-C and calculated LDL-C using modified formula was obtained. For validation, measured LDL-C and LDL-C calculated using the modified formula (LDL-CM), Friedewald formula (LDL-CF), Martin-Hopkins formula (LDL-CMa), and Sampson formula (LDL-CS) were compared. Results: In the derivation set, the adjustment factors were 4.7, 5.9, 6.3, and 6.4 for the groups with triglyceride concentrations <100, 101-200, 201-300, and >300 mg/dL, respectively. In the validation set, the coefficient of determination (R2) between measured and calculated LDL-C was higher for LDL-CM than for LDL-CF (R2=0.9330 vs. 0.9206). The agreement according to the National Cholesterol Education Program Adult Treatment Panel III classification of LDL-C was 86.36%, 86.08%, 86.82%, and 86.15% for LDL-CM, LDL-CF, LDL-CMa, and LDL-CS, respectively. Conclusions: We proposed a practical, improved LDL-C calculation formula by applying different factors depending on the triglyceride concentration.


Asunto(s)
Enfermedades Cardiovasculares , Hipercolesterolemia , Hiperlipidemias , Adulto , HDL-Colesterol , LDL-Colesterol , Humanos , Triglicéridos
3.
Curr Opin Nephrol Hypertens ; 32(1): 27-34, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36250471

RESUMEN

PURPOSE OF REVIEW: Lipid disorder is a prevalent complication in kidney transplant recipients (KTRs) resulting in cardiovascular disease (CVD), which influences on patient outcomes. Immunosuppressive therapy demonstrated the major detrimental effects on metabolic disturbances. This review will focus on the effect of immunosuppressive drugs, lipid-lowering agents with current management, and future perspectives for lipid management in KTRs. RECENT FINDINGS: The main pathogenesis of hyperlipidemia indicates an increase in lipoprotein synthesis whilst the clearance of lipid pathways declines. Optimization of immunosuppression is a reasonable therapeutic strategy for lipid management regarding immunologic risk. Additionally, statin is the first-line lipid-lowering drug, followed by a combination with ezetimibe to achieve the low-density lipoprotein cholesterol (LDL-C) goal. However, drug interaction between statins and immunosuppressive medications should be considered because both are mainly metabolized through cytochrome P450 3A4. The prevalence of statin toxicity was significantly higher when concomitantly prescribed with cyclosporin, than with tacrolimus. SUMMARY: To improve cardiovascular outcomes, LDL-C should be controlled at the target level. Initiation statin at a low dose and meticulous titration is crucial in KTRs. Novel therapy with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, which is highly effective in reducing LDL-C and cardiovascular complications, and might prove to be promising therapy for KTRs with statin resistance or intolerance.


Asunto(s)
Anticolesterolemiantes , Enfermedades Cardiovasculares , Trasplante de Riñón , Humanos , Anticolesterolemiantes/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/etiología , LDL-Colesterol , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipolipemiantes/uso terapéutico , Proproteína Convertasa 9/metabolismo , Receptores de Trasplantes , Trasplante de Riñón/efectos adversos
4.
Maturitas ; 167: 82-89, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36308975

RESUMEN

OBJECTIVE: Adverse pregnancy outcomes (APOs) and early menopause are each associated with increased risk of cardiovascular disease (CVD); whether APOs are associated with age at menopause is unclear. We examined the association of gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), preterm birth, and multiple gestation with age at natural menopause. STUDY DESIGN: Observational, prospective study within the Nurses' Health Study II cohort (1989-2019). MAIN OUTCOMES MEASURES: Risk of early natural menopause, defined as occurring before the age of 45 years, and age at onset of natural menopause (hazard ratio (HR) >1 indicates younger age at menopause). RESULTS: The mean [SD] baseline age of 69,880 parous participants was 34.5 [4.7] years. Compared with participants who had a term singleton first birth, those with a term multiple-gestation first birth had higher risk of early menopause (HR: 1.65, 95% CI: 1.05, 2.60) and younger age at natural menopause (HR: 1.46, 95% CI: 1.31, 1.63). Estimates for preterm multiple gestation were of similar magnitude. Menopause occurred at a younger age for those with a preterm birth with spontaneous labor (HR: 1.08, 95% CI: 1.03, 1.14) compared to those with a term birth with spontaneous labor. Conversely, estimates for GDM (HR: 0.95, 95% CI: 0.89, 1.02) and HDP (preeclampsia, HR: 0.93, 95% CI: 0.89, 0.97) suggested an association with older age at menopause. CONCLUSIONS: In this large cohort study, several statistically significant associations between APOs and age at natural menopause were observed. A deeper understanding of the relationships among APOs, menopause, and CVD is needed to help identify people at higher risk for early menopause and later CVD.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Gestacional , Preeclampsia , Nacimiento Prematuro , Embarazo , Femenino , Humanos , Resultado del Embarazo , Estudios de Cohortes , Estudios Prospectivos , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Factores de Riesgo , Preeclampsia/epidemiología , Preeclampsia/etiología , Diabetes Gestacional/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Menopausia
5.
Int J Cancer ; 152(2): 123-136, 2023 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-35904874

RESUMEN

Data on diet and survival among people with metastatic colorectal cancer are limited. We examined dietary fat in relation to all-cause mortality and cancer progression or death among 1149 people in the Cancer and Leukemia Group B (Alliance)/Southwest Oncology Group (SWOG) 80405 trial who completed a food frequency questionnaire at initiation of treatment for advanced or metastatic colorectal cancer. We examined saturated, monounsaturated, total and specific types (n-3, long-chain n-3 and n-6) of polyunsaturated fat, animal and vegetable fats. We hypothesized higher vegetable fat intake would be associated with lower risk of all-cause mortality and cancer progression. We used Cox proportional hazards regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI). Over median follow-up of 6.1 years (interquartile range [IQR]: 5.3, 7.2 y), we observed 974 deaths and 1077 events of progression or death. Participants had a median age of 59 y; 41% were female and 86% identified as White. Moderate or higher vegetable fat was associated with lower risk of mortality and cancer progression or death (HRs comparing second, third and fourth to first quartile for all-cause mortality: 0.74 [0.62, 0.90]; 0.75 [0.61, 0.91]; 0.79 [0.63, 1.00]; P trend: .12; for cancer progression or death: 0.74 [0.62, 0.89]; 0.78 [0.64, 0.95]; 0.71 [0.57, 0.88]; P trend: .01). No other fat type was associated with all-cause mortality and cancer progression or death. Moderate or higher vegetable fat intake may be associated with lower risk of cancer progression or death among people with metastatic colorectal cancer.


Asunto(s)
Enfermedades Cardiovasculares , Neoplasias del Colon , Neoplasias del Recto , Femenino , Animales , Masculino , Grasas de la Dieta , Dieta , Causas de Muerte
6.
Rheum Dis Clin North Am ; 49(1): 1-17, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36424020

RESUMEN

Cardiovascular diseases (CVDs) are the leading causes of death in the world, but declining trends for cardiovascular (CV) mortality and morbidity have been observed during the last decades. Reports on secular trends regarding the excess CV mortality and morbidity in rheumatoid arthritis show diverging results. Data support that also patients with inflammatory arthritis have benefited from improved treatment and prevention for CVD, which can be observed, for example, in decreased case fatality after CV event. However, several recent studies indicate a remaining excess CV risk in patients with inflammatory arthritis.


Asunto(s)
Artritis Reumatoide , Enfermedades Cardiovasculares , Humanos , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Artritis Reumatoide/epidemiología
7.
Rheum Dis Clin North Am ; 49(1): 165-178, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36424023

RESUMEN

Systemic auto-immune inflammatory arthritides are associated with increased cardiovascular (CV) risk compared to those without these conditions, and is a leading cause of morbidity and mortality. Newer biologic drug modifying antirheumatoid drugs (bDMARD) and small molecules have transformed treatment paradigms enabling tighter control of disease activity and in some cases, remission. There is evidence to suggest that the majority of bDMARDs may also reduce cardiovascular risk, although prospective interventional data remain sparse. Additionally, recent results raise concern for treatments targeting specific pathways that may negatively affect cardiovascular risk. This review will cover key biologic pathways targeted in rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathies.


Asunto(s)
Antirreumáticos , Artritis Reumatoide , Productos Biológicos , Enfermedades Cardiovasculares , Humanos , Antirreumáticos/efectos adversos , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Estudios Prospectivos , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/complicaciones , Productos Biológicos/efectos adversos
8.
Rheum Dis Clin North Am ; 49(1): 19-43, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36424025

RESUMEN

Cardiovascular disease (CVD) risk is increased in most inflammatory rheumatic diseases (IRDs), reiterating the role of inflammation in the initiation and progression of atherosclerosis. An inverse association of CVD risk with body weight and lipid levels has been described in IRDs. Coronary artery calcium scores, plaque burden and characteristics, and carotid plaques on ultrasound optimize CVD risk estimate in IRDs. Biomarkers of cardiac injury, autoantibodies, lipid biomarkers, and cytokines also improve risk assessment in IRDs. Machine learning and deep learning algorithms for phenotype and image analysis hold promise to improve CVD risk stratification in IRDs.


Asunto(s)
Aterosclerosis , Enfermedades Cardiovasculares , Placa Aterosclerótica , Enfermedades Reumáticas , Humanos , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Factores de Riesgo , Aterosclerosis/etiología , Placa Aterosclerótica/diagnóstico por imagen , Enfermedades Reumáticas/complicaciones , Biomarcadores , Lípidos
9.
Rheum Dis Clin North Am ; 49(1): 179-191, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36424024

RESUMEN

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most prescribed pharmacologic therapies worldwide due to their therapeutic analgesic efficacy and relative tolerability. In the past several decades, various cardiovascular (CV) adverse events have emerged regarding both traditional NSAIDs (tNSAIDs) and cyclo-oxygenase 2 (COX-2) selective (coxibs). This review will provide an updated report on the CV risk profile of NSAIDs, focusing on several of the larger clinical trials, meta-analyses, and registry studies. We aim to provide rheumatologists with a framework for NSAID use in the context of rheumatologic chronic pain management. Recent findings: In patients with and without CV diseases, the use of NSAIDs, both tNSAIDs and coxibs, is associated with an increased risk of adverse CV events, myocardial infarction, heart failure, and cerebrovascular events. These CV risks have increased within weeks of coxib use and higher doses of tNSAIDs. The risk of adverse CV events is heterogenous across NSAIDs; naproxen and low-dose ibuprofen appear to have lower increased CV risk among NSAIDs. A variation in CV risk is associated with multiple factors, including NSAID class, COX-2 selectivity, treatment dose and duration, and baseline patient risk. Summary: Many important questions remain regarding the safety of NSAIDs and whether the culmination of research performed could inform us whether specific patient subtypes or NSAID class may have a more favorable profile. tNSAIDs such as naproxen and low-dose ibuprofen may have a lower CV risk profile, while coxibs have a more favorable GI risk profile. In general, any NSAID can be optimized if used at the lowest effective dose for the shortest amount of time, especially among individuals with increased CV risk.


Asunto(s)
Enfermedades Cardiovasculares , Inhibidores de la Ciclooxigenasa 2 , Humanos , Inhibidores de la Ciclooxigenasa 2/efectos adversos , Naproxeno/efectos adversos , Ibuprofeno , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/epidemiología , Ciclooxigenasa 2 , Antiinflamatorios no Esteroideos/efectos adversos
10.
Rheum Dis Clin North Am ; 49(1): 81-96, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36424028

RESUMEN

Takayasu's arteritis (TAK) and giant cell arteritis (GCA) are the 2 most common primary large vessel vasculitides (LVV). They share common vascular targets, clinical presentations, and histopathology, but target a strikingly different patient demographic. While GCA predominantly affects elderly people of northern European ancestry, TAK preferentially targets young women of Asian heritage. Cardiovascular diseases (CVD), including ischemic heart disease, cerebrovascular disease, aortic disease, and thromboses, are significantly increased in LVV. In this review, we will compare and contrast the issue of CVD in patients with TAK and GCA, with respect to prevalence, risk factors, and mechanisms of events to gain an understanding of the relative contributions of active vasculitis, vascular damage, and accelerated atherosclerosis. Controversies and possible mitigation strategies will be discussed.


Asunto(s)
Aterosclerosis , Enfermedades Cardiovasculares , Arteritis de Células Gigantes , Arteritis de Takayasu , Humanos , Femenino , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/terapia , Arteritis de Células Gigantes/epidemiología , Arteritis de Células Gigantes/terapia , Arteritis de Takayasu/epidemiología , Arteritis de Takayasu/terapia , Factores de Riesgo
11.
Scand Cardiovasc J ; 57(1): 8-16, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36404730

RESUMEN

Objectives. Severe obesity is associated with a high risk of comorbidities and alterations of cardiac structure and function. The primary aim of the study was to investigate the proportion of diastolic dysfunction (DD) at baseline, and changes in cardiac function from baseline (T1) to 6 months follow-up (T2) among participants with severe obesity attending a lifestyle-intervention. The secondary aim was to explore changes in body mass index (BMI), physical fitness (VO2peak) and cardiovascular risk from T1 to T2 and 12 months follow-up (T3).Design. This was an open single-site prospective observational study. Patients were recruited from an obesity clinic to a lifestyle-intervention consisting of three 3-weeks intermittent stays over 12-months period. Echocardiography was performed at T1 and T2 and BMI, VO2peak and cardiovascular risk measured at T1, T2 and T3.Results. Fifty-six patients were included (mean age 45.1 years; BMI 41.9). Six of 52 patients (12%) had grade 1 DD at T1, while five subjects had DD at T2. E/A ratio (11%, p = .005) and mitral deceleration time (9%, p = .014) were improved at T2. A reduction in BMI (-1.8, p < .001) and improvement in VO2peak (1.6 mL/kg min, p = .026) were assessed at T2 and this improvement persisted at T3. The total cardiovascular risk score was not significantly changed.Conclusion. The patients with severe obesity had low prevalence of DD. For all participants, an improvement in diastolic parameters, and an important initial weight loss was observed.Clinical Trial number: NCT02826122.


Asunto(s)
Enfermedades Cardiovasculares , Obesidad Mórbida , Humanos , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/terapia , Proyectos Piloto , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Factores de Riesgo , Estilo de Vida , Factores de Riesgo de Enfermedad Cardiaca
12.
J Intensive Care Med ; 38(1): 78-85, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35722731

RESUMEN

PURPOSE: To examine the impact of chronic comorbidities on mortality in Acute Respiratory Distress Syndrome (ARDS). MATERIALS AND METHODS: Retrospective cohort study of adults with ARDS (ICD-10-CM code J80) from the National Inpatient Sample between January, 2016 and December, 2018. For the primary outcome of mortality, we conducted weighted logistic regression adjusting for factors identified on univariate analysis as potentially significant or differing between the two groups at baseline. We used negative binomial regression adjusting for the same comorbidities to identify risk factors for longer length of stay (LOS) among ARDS survivors. RESULTS: After exclusions, 1046 records were analyzed (3355 ARDS survivors and 1875 non-survivors.) The comorbidities examined included hypertension, diabetes mellitus, obesity, hypothyroidism, alcohol and drug use, chronic kidney disease (CKD), cardiovascular disease, chronic liver disease, chronic pulmonary disease and malignancy. In multivariate analysis, we found that malignancy (OR 2.26, 95% CI 1.84-2.78, p < 0.001), cardiovascular disease (OR 1.54, 95% CI 1.23-1.92, p < 0.001), and CKD (OR 1.75, 95% CI 1.22-2.50, p = 0.002) increased the risk of death. In interaction analyses, cardiovascular disease combined with either malignancy or CKD conferred higher odds of death compared to either risk factor alone. CONCLUSIONS: The comorbidity of malignancy confers the most reliable risk of poor outcomes in ARDS with higher odds of hospital death and a simultaneous association with longer hospital LOS among survivors.


Asunto(s)
Enfermedades Cardiovasculares , Insuficiencia Renal Crónica , Síndrome de Dificultad Respiratoria , Adulto , Humanos , Estudios Retrospectivos , Enfermedad Crónica
13.
Curr Probl Cardiol ; 48(1): 101380, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36031015

RESUMEN

Immune checkpoint inhibitors (ICI) have known associations with cardiotoxicity. However, a representative quantification of the adverse cardiovascular events and cardiovascular attendances amongst Asian users of ICI has been lacking. This retrospective cohort study identified all ICI users in Hong Kong, China, between 2013 and 2021. All patients were followed up until the end of 2021 for the primary outcome of major adverse cardiovascular event (MACE; a composite of cardiovascular mortality, myocardial infarction, heart failure, and stroke). Patients with prior diagnosis of any component of MACE were excluded from all MACE analyses. In total, 4324 patients were analyzed (2905 (67.2%) males; median age 63.5 years old (interquartile range 55.4-70.7 years old); median follow-up 1.0 year (interquartile range 0.4-2.3 years)), of whom 153 were excluded from MACE analyses due to prior events. MACE occurred in 116 (2.8%) with an incidence rate (IR) of 1.7 [95% confidence interval: 1.4, 2.0] events per 100 patient-years; IR was higher within the first year of follow-up (2.9 [2.3, 3.5] events per 100 patient-years). Cardiovascular hospitalization(s) occurred in 188 (4.4%) with 254 episodes (0.5% of all episodes) and 1555 days of hospitalization (1.3% of all hospitalized days), for whom the IR of cardiovascular hospitalization was 5.6 [4.6, 6.9] episodes per 100 person-years with 52.9 [39.8, 70.3] days' stay per 100 person-years. Amongst Asian users of ICI, MACE was uncommon, and a small proportion of hospitalizations were cardiovascular in nature. Most MACE and cardiovascular hospitalizations occurred during the first year after initiating ICI.


Asunto(s)
Enfermedades Cardiovasculares , Insuficiencia Cardíaca , Infarto del Miocardio , Masculino , Humanos , Persona de Mediana Edad , Anciano , Femenino , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Estudios Retrospectivos , Hospitalización , Insuficiencia Cardíaca/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología
14.
Sci Total Environ ; 856(Pt 1): 159014, 2023 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-36162568

RESUMEN

The cardiometabolic effects of air pollution in the context of mixtures and the underlying mechanisms remain not fully understood. This study aims to investigate the joint effect of air pollutant mixtures on a broad range of cardiometabolic parameters, examine the susceptibility of obese individuals, and determine the role of circulating fatty acids. In this panel study, metabolically healthy normal-weight (MH-NW, n = 49) and obese (MHO, n = 39) adults completed three longitudinal visits (257 person-visits in total). Personal exposure levels of PM2.5, PM10, O3, NO2, SO2, CO and BC were estimated based on fixed-site monitoring data, time-activity logs and infiltration factor method. Blood pressure, glycemic homeostasis, lipid profiles, systematic inflammation and coagulation biomarkers were measured. Targeted metabolomics was used to quantify twenty-eight plasma free fatty acids (FFAs). Bayesian kernel machine regression models were applied to establish the exposure-response relationships and identify key pollutants. Significant joint effects of measured air pollutants on systematic inflammation and coagulation biomarkers were observed in the MHO group, instead of the MH-NW group. Lipid profiles showed the most significant changes in both groups and O3 contributed the most to the total effect. Specific FFA patterns were identified, and de novo lipogenesis (DNL)-related pattern was most closely related to blood lipid profiles. In particular, interaction analysis suggested that DNL-related FFA pattern augmented the effects of O3 on triglyceride (TG, Pinteraction = 0.040), high-density lipoprotein cholesterol (HDL-C, Pinteraction = 0.106) and TG/HDL-C (Pinteraction = 0.020) in the MHO group but not MH-NW group. This modification was further confirmed by interaction analysis with estimated activity of SCD1, a key enzyme in the DNL pathway. Therefore, despite being metabolically healthy, obese subjects have a higher cardiometabolic susceptibility to air pollution, especially O3, and the DNL pathway may represent an intrinsic driver of lipid susceptibility. This study provides new insights into the cardiometabolic susceptibility of obese individuals to air pollution.


Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Enfermedades Cardiovasculares , Adulto , Humanos , Contaminantes Atmosféricos/efectos adversos , Contaminantes Atmosféricos/análisis , Ácidos Grasos no Esterificados , Material Particulado/efectos adversos , Material Particulado/análisis , Teorema de Bayes , Contaminación del Aire/efectos adversos , Contaminación del Aire/análisis , Obesidad/epidemiología , Lípidos/análisis , Biomarcadores/análisis , Inflamación
15.
Curr Probl Cardiol ; 48(1): 101435, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36183977

RESUMEN

Cardiovascular disease and cancer are the leading causes of death worldwide. With advent of novel and improved cancer therapies, a growing population of cancer patients with cardiac complications is seen. Taking this into consideration, the clinical studies have also shifted their focus from the study of a single disease to the interdisciplinary study of oncology and cardiology. This current review article provides a comprehensive review of all major articles and guidelines from the year 2021-2022 in the field of cardio-oncology.


Asunto(s)
Cardiología , Enfermedades Cardiovasculares , Cardiopatías , Neoplasias , Humanos , Cardiotoxicidad/etiología , Oncología Médica , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Enfermedades Cardiovasculares/complicaciones
16.
Sci Total Environ ; 856(Pt 2): 159035, 2023 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-36191716

RESUMEN

BACKGROUND: Few studies have been conducted on the association between domestic solid fuel combustion and incident nonfatal cardiovascular disease (CVD). We assessed the prospective association between domestic fuel type and incident nonfatal CVD among Chinese adults aged ≥45 years. METHODS: This was a prospective cohort study using data from the China Longitudinal Study of Health and Retirement (CHARLS) that recruited 8803 participants ≥45 years in 2013. Household fuel types were assessed based on self-reports, including solid fuel (coal, crop residue, or wood fuel) and clean fuel (central heating, solar power, natural gas, liquefied petroleum gas, electricity, or marsh gas). Nonfatal CVD was defined as self-reported physician-diagnosed nonfatal CVD. We established Cox proportional hazard regression models with age as the time scale and strata by sex to evaluate the hazard ratios (HRs) and 95 % confidence intervals (95 % CIs). RESULTS: After a median follow-up of five years, 970 (11.02 %) nonfatal CVD cases were documented, including 423 (9.96 %) in males and 547 (12.01 %) in females. Participants with exposure to solid fuel for cooking and clean fuel for heating [HR (95 % CI):2.01 (1.36-2.96)], solid fuel for heating and clean fuel for cooking [HR (95 % CI):1.45 (1.06-1.99)], and solid fuel for both heating and cooking [HR (95 % CI):1.43 (1.07-1.92)] had an elevated nonfatal CVD risk compared to users of cleaner fuel for both cooking and heating. Those whom self-reported switching from solid fuels to cleaner fuels for cooking had significantly decreased nonfatal CVD risk [HR (95 % CI):0.76 (0.58-0.99)] than participants who did not switch to cleaner fuels. CONCLUSIONS: Exposure to domestic solid fuel burning for cooking or heating is associated with an elevated nonfatal CVD risk. Notably, switching cooking fuels from solid to cleaner fuels is related to a reduced risk of nonfatal CVD.


Asunto(s)
Contaminación del Aire Interior , Enfermedades Cardiovasculares , Persona de Mediana Edad , Masculino , Femenino , Humanos , Anciano , Enfermedades Cardiovasculares/epidemiología , Estudios Prospectivos , Estudios Longitudinales , Jubilación , China/epidemiología , Culinaria
17.
Arch Gerontol Geriatr ; 104: 104820, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36108360

RESUMEN

INTRODUCTION: The aim of this paper is to demonstrate how graphical chain models can be used to model how cardiovascular disease affected quality of life in later life over the course of 17 years of data. METHODS: Waves 1-9 of the English Longitudinal Study of Ageing was used to investigate how quality of life changed over each wave using the CASP-19 questionnaire, and whether having experienced a cardiovascular event had an effect on quality of life. RESULTS: A total of 12,099 participants were included in the study. Participants had a mean age of 64.2 years, the majority of which were over 50 years old. Older people are more likely to have cardiac events. A one-unit rise in CES-D 8-item score was related with a 14% increased risk of CVD at Wave 1. Those with an O-level, A-level, or degree (or equivalent) had lower CVD risks than those with no education. Women had half the CVD risk of men. Living alone reduced the risk of a CVD-event by 15%. Moderate and vigorous exercise lowered cardiac event risk compared to no exercise. Current or ex-smokers have a 30% higher risk of CVD than non-smokers. Cardiovascular event was significantly associated with quality of life at waves 1 and 2 only. DISCUSSION: Events related to cardiovascular disease only affected quality of life in later life up to 4 years. Factors such as age, depression, perceived position on social ladder, and high levels of physical activity affected quality of life throughout the majority of waves.


Asunto(s)
Enfermedades Cardiovasculares , Calidad de Vida , Anciano , Femenino , Humanos , Masculino , Envejecimiento , Enfermedades Cardiovasculares/epidemiología , Ejercicio Físico , Estudios Longitudinales , Factores de Riesgo , Persona de Mediana Edad , Escolaridad , Fumar/efectos adversos
18.
Sci Total Environ ; 855: 158896, 2023 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-36150596

RESUMEN

BACKGROUND: The adverse health effects of household air pollution have been widely explored, but few studies have evaluated the effects of household air pollution on the risk of cardiometabolic multimorbidity (CMM), a pressing public health concern worldwide. Thus, we aimed to investigate whether exposure to household use of polluting fuels is associated with morbid CMM and, if so, whether a healthy lifestyle could mitigate this association. METHODS: In this prospective, nationwide representative cohort of the China Health and Retirement Longitudinal Study (CHARLS), participants free of CMM (defined as the coexistence of 2 or more of the following: heart disease, stroke, and diabetes or high blood sugar) were included in 2011-2012 and followed for CMM incidence until 2018. Household air pollution was measured as the use of solid fuels for cooking and heating. The healthy lifestyle score was determined by six factors, physical activity, smoking, body mass index, total cholesterol, blood glucose, and blood pressure, and categorized into three groups (unhealthy, 0-1 factors; intermediate, 2-4; and healthy, 5-6). Cox proportional hazards models investigated associations between household air pollution and incident CMM. The potential modifier effect of a healthy lifestyle score was tested through stratified analyses. RESULTS: Among 7125 eligible participants, 239 incident cases of CMM were identified over a median follow-up of 7.0 years. After adjustment for potential confounders, the use of solid household fuels for heating was associated with more significant hazards of CMM (adjusted hazard ratio [HR] 1.71, 95 % confidence interval [CI] 1.28 to 2.28), while use for cooking (HR, 1.14; 95 % CI, 0.85 to 1.52) was not. Compared with participants in the unhealthy group, those in the healthy and intermediate groups had considerably lower CMM risk, with adjusted HRs (95 % CI) of 0.17 (0.09 to 0.31) and 0.39 (0.29 to 0.53), respectively, regardless of the household air pollution category. Importantly, when participants adhered to a healthy lifestyle, exposure to household air pollution was no longer significantly associated with a higher risk of CMM (adjusted HR 1.77, 95 % CI 0.51 to 6.12; P = 0.369). CONCLUSIONS: Household usage of polluting fuels was significantly associated with a higher risk of CMM, and adherence to a healthy lifestyle may mitigate this adverse effect. From a broader perspective, our findings underscore the importance of public health policies and interventions targeting multiple exposures (air pollution, physical activity, smoking, etc.) in enhancing the prevention of detrimental cardiometabolic health effect.


Asunto(s)
Contaminación del Aire Interior , Contaminación del Aire , Enfermedades Cardiovasculares , Humanos , Multimorbilidad , Estudios Longitudinales , Estudios Prospectivos , Jubilación , Culinaria , Estilo de Vida Saludable , China/epidemiología
19.
J Affect Disord ; 320: 91-97, 2023 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-36183825

RESUMEN

BACKGROUND: The course of depression is variable; however, few studies examined the relationship between long-term cumulative depressive symptoms and adverse health outcomes in the elderly. METHODS: In this cohort study, we used data from the Health and Retirement Study (HRS) over 24 years and the English Longitudinal Study of Ageing (ELSA) over 16 years. Cumulative depressive symptoms were estimated by calculating the areas under the curve based on the Center for Epidemiological Research Depression scale assessed at four examinations. Outcomes include cognitive decline, incident dementia, cardiovascular disease (CVD), cancer, and all-cause mortality. RESULTS: A total of 8284 American (mean age: 60.1 years; male: 35.4 %) and 4314 British (60.1 years; 42.4 %) were included in the analysis. The median follow-up was 16.1 years in the HRS and 9.9 years in the ELSA. Similar results were observed in two cohorts. Comparing with the first tertile of cumulative depressive symptoms, the third tertile experienced faster cognitive decline (p = 0.013 in the ELSA and p < 0.001 in the HRS), increased risk of dementia (both p < 0.001), CVD (both p < 0.001) and all-cause mortality (p = 0.002 in the HRS). Strong dose-response relationships were observed. We did not found clearly association between cumulative depressive symptoms and incident cancer. CONCLUSIONS: This study suggests that long-term cumulative depressive symptoms were associated with subsequent faster cognitive decline and greater risks for dementia, CVD and all-cause mortality, but not cancer. These findings provide insights on potential effective strategy that may improve health in the elderly, future clinical trials are needed to determine causality.


Asunto(s)
Enfermedades Cardiovasculares , Disfunción Cognitiva , Demencia , Humanos , Masculino , Anciano , Persona de Mediana Edad , Depresión/psicología , Estudios Longitudinales , Estudios de Cohortes , Estudios Prospectivos , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/complicaciones , Demencia/psicología , Factores de Riesgo
20.
Phytomedicine ; 108: 154531, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36375237

RESUMEN

BACKGROUND: Ophiocordyceps sinensis (OS), a medicinal fungus, has been made into OS preparations, which are frequently used as adjunctive therapy for patients with Diabetic Kidney Disease (DKD) in China. It is necessary to assess the efficacy and safety of OS preparations in the adjunctive treatment of DKD by conducting a systematic review and meta-analysis. OBJECTIVE: Ophiocordyceps sinensis preparations were evaluated for their efficacy and safety as adjunctive therapy to conventional drugs (angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)) for DKD. METHODS: We searched seven electronic literature databases for randomized controlled trials (RCTs) comparing ACEI/ARB and OS combined with ACEI/ARB from inception up to March 2022. Two reviewers extracted data and assessed the risk of bias independently. Evidence certainty was rated using the GRADE system. Standardized mean difference (SMD) or mean difference (MD) was pooled with random effects models and was reported with corresponding 95% confidence intervals (CIs). Meta-analysis, sensitivity analysis and Egger's test were performed using R software (version 14.2) (PROSPERO registration no. CRD42021248634). RESULTS: Thirty eight RCTs involving 3167 patients met the inclusion criteria. No trials were reported with outcomes about kidney disease progression and cardiovascular events. In meta-analysis, compared with the control group of ACEI/ARB alone, OS combined with ACEI/ARB can achieve better effects in the treatment of DKD on reducing serum creatinine (Scr) [MDScr =-11.48 95% CI [-15.78, -7.18], p < 0.01], blood urea nitrogen (BUN) [MDBUN= -1.00, 95% CI [-1.44, -0.55], p < 0.01], ß2-microglobulin (ß2-MG) [SMDß2-MG= -1.32, 95% CI [-2.27, -0.37], p < 0.01], cystatin C (CysC) [MDCysC=-0.64, 95% CI [-0.83, -0.45], p < 0.01], 24-h urine proteinuria (24hUP) [SMD24hUP= -1.99, 95% CI [-2.68; -1.31], p < 0.01], urine microalbumin (UALB) [MDUALB= -37.41, 95% CI [-44.76, -30.06], p < 0.01] and decreasing urinary albumin excretion rate (UAER) [MDUAER= -24.11, 95% CI [-30.54, -17.68], p < 0.01] and albumin creatinine ratio (ACR) [SMDACR = 1.01, 95% CI [-1.73, -0.29], p < 0.01]. The OS adjuvant treatment also improved outcomes of blood pressure, blood glucose, blood lipid, inflammation and oxidative stress. No significant change in fasting blood glucose (FPG), glycated hemoglobin (HbA1c), malondialdehyde (MDA), and transforming growth factor beta 1 (TGF-ß1) was detected. Yet, no significant difference was found about the adverse events between the two groups. CONCLUSIONS: Ophiocordyceps sinensis preparation combined with ACEI/ARB has beneficial influence on renal function, decrease proteinuria, dyslipidemia, and even oxidative stress and inflammation in DKD patients. However, there is no trial that evaluated outcomes of kidney disease progression and cardiovascular events. Future study should move beyond surrogate endpoints to actual cardiovascular or renal outcome benefits with an aim to explore effects of OS preparation in the long-term.


Asunto(s)
Enfermedades Cardiovasculares , Cordyceps , Diabetes Mellitus , Nefropatías Diabéticas , Humanos , Nefropatías Diabéticas/tratamiento farmacológico , Proteinuria/tratamiento farmacológico , Progresión de la Enfermedad , Inflamación , Albúminas
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