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1.
BMJ ; 368: l6669, 2020 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915124

RESUMO

OBJECTIVE: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: The Nurses' Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366). MAIN EXPOSURES: Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%). MAIN OUTCOME: Life expectancy free of diabetes, cardiovascular diseases, and cancer. RESULTS: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50. CONCLUSION: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Estilo de Vida Saudável/fisiologia , Expectativa de Vida , Neoplasias , Comportamento de Redução do Risco , Adulto , Consumo de Bebidas Alcoólicas , Índice de Massa Corporal , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/psicologia , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/psicologia , Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/prevenção & controle , Neoplasias/psicologia , Pesquisa em Enfermagem , Estudos Prospectivos , Fumar
2.
J Vasc Surg ; 70(2): 569-579.e4, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30922758

RESUMO

BACKGROUND: Malnutrition is frequent among vascular surgery patients, given their age, chronic comorbidities, and poor functional status, and it is believed to increase their operative risk. We aimed to assess the combined use of recent significant weight loss (>10% body mass) and serum albumin levels as a nutritional status index to predict outcomes. METHODS: We analyzed vascular surgery data from the American College of Surgeons National Surgical Quality Improvement Program database (2005-2012; N = 238,082) to compare operative death (in-hospital and 30-day operative death) across eight nutritional status groups based on weight loss (yes/no) and albumin category: very low albumin level (VL-Alb; <2.50 g/dL), low albumin level (L-Alb; 2.50-3.39 g/dL), normal albumin level (N-Alb; 3.40-4.39 g/dL), and high albumin level (H-Alb; 4.40-5.40 g/dL). Risk-adjusted odds ratios (AOR) with 95% confidence intervals were estimated by multivariable logistic regression (N-Alb [no weight loss], reference). RESULTS: The study population included 113,936 patients for whom albumin level was available (age, 67 ± 13 years; 60.2% male). Operative death was documented in 5160 (4.53%) patients. The eight-category nutritional status was more predictive of operative death than age alone (C statistic, 0.74 vs 0.63). A high discrimination multivariable model for operative death was derived (C statistic, 0.851). Low albumin level was associated with increased death that worsened in case of weight loss: VL-Alb + WL, AOR = 3.83 (3.03-4.83); VL-Alb, AOR = 3.36 (3.06-3.69); L-Alb + WL, AOR = 2.46 (1.98-3.05); and L-Alb, AOR = 1.99 (1.84-2.15). Weight loss was associated with increased death even if albumin level was normal: N-Alb + WL, AOR = 1.77 (1.34-2.35); and H-Alb + WL, AOR = 1.91 (0.69-5.31). H-Alb was protective (AOR = 0.65 [0.55-0.76]). CONCLUSIONS: Nutritional status predicts outcomes of vascular surgery. Serum albumin level and weight loss should be incorporated in patients' risk stratification.


Assuntos
Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Albumina Sérica Humana/metabolismo , Procedimentos Cirúrgicos Vasculares , Perda de Peso , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Bases de Dados Factuais , Feminino , Humanos , Masculino , Desnutrição/sangue , Desnutrição/mortalidade , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
3.
Metabolism ; 89: 1-7, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30227144

RESUMO

CONTEXT: Liquid Chromatography Mass Spectroscopy (LC-MS/MS) is the preferred method to measure 25 hydroxyvitamin D (25OHD) levels, but laboratories are increasingly adopting automated platform assays. OBJECTIVE: We assessed the performance of commonly used automated immunoassays, with that of LC-MS/MS, and the National Institute of Standards and Technology (NIST) reference values, to measure 25OHD levels. METHODS/SETTING: We compared serum 25OHD levels obtained from 219 elderly subjects, enrolled in a vitamin D trial, using the Diasorin Liaison platform assay, and the tandem LC-MS/MS method. We also assessed the performance of the Diasorin and Roche automated assays, expressed as mean % bias from the NIST standards, based on the vitamin D External Quality Assessment Scheme (DEQAS) reports, from 2013 to 2017. RESULTS: Serum 25OHD levels were significantly lower in the Diasorin compared to LC-MS/MS assay at baseline, 18.5 ±â€¯7.8 vs 20.5 ±â€¯7.6 ng/ml (p < 0.001), and all other time points. Diasorin (25OHD) = 0.76 × LC-MS/MS (25OHD) + 4.3, R2 = 0.596. The absolute bias was independent of 25OHD values, and the pattern unfit for any cross-calibration. The proportion of subjects considered for vitamin D treatment based on pre-set cut-offs differed significantly between the 2 assays. There also was wide variability in the performance of both automated assays, compared to NIST reference values. CONCLUSION: The performance of most widely used automated assays is sub-optimal. Our findings underscore the pressing need to re-consider current practices with regard to 25OHD measurements, interpretation of results from research studies, meta-analyses, the development of vitamin D guidelines, and their relevance to optimizing health.


Assuntos
Tomada de Decisão Clínica , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Idoso , Automação , Cromatografia Líquida de Alta Pressão , Feminino , Guias como Assunto , Humanos , Imunoensaio , Luminescência , Masculino , Espectrometria de Massas , Estado Nutricional , Sobrepeso/sangue , Valores de Referência , Reprodutibilidade dos Testes , Vitamina D/sangue
4.
Cardiovasc Diagn Ther ; 8(2): 146-155, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29850405

RESUMO

Background: Cardiovascular disease is the most common cause of morbidity and mortality worldwide. Numerous strategies have been effective in reducing cardiovascular disease risk, from pharmacological approaches to lifestyle modification interventions. One of these strategies includes the reduction in dietary sodium which in turn reduces cardiovascular risk by reducing high blood pressure, perhaps the most important cardiovascular risk factor. Methods: We evaluated an educational dietary salt reduction intervention in a cardiac care unit population in Lebanon, assessing salt related knowledge and behaviours before and after administering an evidence-based educational leaflet to patients. Results: Salt-related knowledge improved significantly immediately post-intervention and subsequently fell on 4-week follow-up, but remained above baseline. Three of the four salt-related behaviours measured improved on 4-week follow-up: trying to buy low-salt foods increased from 54% to 74% (P=0.007), adding salt at the table reduced from 44% to 34% (P=0.03) and trying to buy food with no added salt increased from 24% to 52% (P=0.02) of the cohort. Adding salt during cooking did not differ significantly. A trend towards improved behavioural risk category in the cohort overall was observed on follow-up (P=0.07), 32% of participants were categorised as high behavioural risk pre-intervention, reducing to 17% on follow-up. Multi-ordered regression modelling identified being in the high-risk behavioural category at baseline as a predictor of being in the high-risk or moderate-risk category on follow-up. Conclusions: This hospital-based educational intervention had a modestly positive impact on salt-related knowledge and behaviour, with participants in the highest behavioural risk category at baseline being most resistant to behavioural improvement.

5.
Eur J Cardiothorac Surg ; 54(2): 294-301, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29481591

RESUMO

OBJECTIVES: Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting. Although transient, POAF is linked to increased late mortality. We hypothesized that POAF increases late cerebrovascular (CeV) and composite cerebrovascular/cardiovascular/vascular (CV* = CeV + CV + Other-V) but not non-cardiovascular (Non-CV) mortality. METHODS: We analysed 8807 non-salvage coronary artery bypass grafting patients (1994-2011). Fifteen-year and time-segmented (early, 0-1 year; intermediate, 1-6 years and late, 6-15 years) all-cause and cause-specific mortality were compared for POAF versus No-POAF patients. Corresponding POAF versus No-POAF adjusted hazard ratios [AHRs (95% confidence interval, CI)] were derived using the competing risk Cox regression. RESULTS: POAF occurred in 1992 (23%) patients. Complications other than POAF occurred in 1875 (21%) patients but were more frequent among POAF patients (31% vs 18%; P < 0.001). Overall mean follow-up was 9 ± 4 years. POAF patients had a higher 15-year unadjusted mortality (53% vs 39%; P < 0.001) and were consequently associated with higher adjusted all-cause [AHR (95% CI) = 1.23 (1.14-1.33)] and composite cardiovascular [CV*: AHR (95% CI) = 1.15 (1.02-1.30)] mortality. The trends towards a higher 15-year CeV [AHR (95% CI) = 1.34 (0.94-1.91)] and Non-CV [AHR (95% CI) = 1.12 (0.99-1.26)] mortality were not significant. Time-segmented analyses showed that (i) POAF increased all-cause mortality early, and this persisted in the intermediate and late periods and (ii) CeV [AHR (95% CI) = 2.14 (1.14-4.04)] and CV* [AHR (95% CI) = 1.31 (1.06-1.62)] mortality rates were increased in the intermediate but not in the early or late periods. Non-CV mortality was similar in POAF and No-POAF for all time intervals. These findings were corroborated in propensity-matched sub-cohorts and in sensitivity analyses in patients free of any other complication. CONCLUSIONS: POAF is associated with worse long-term survival principally driven by increased intermediate-term cerebrovascular and cardiovascular mortality, while Non-CV mortality was similar.


Assuntos
Fibrilação Atrial/etiologia , Fibrilação Atrial/mortalidade , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Complicações Pós-Operatórias/mortalidade , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Retina ; 38(2): 416-423, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28221257

RESUMO

PURPOSE: To report the clinical outcome after intravitreal dexamethasone implant in patients with retinitis pigmentosa and cystoid macular edema. METHODS: Multicenter retrospective case series of eyes with retinitis pigmentosa and cystoid macular edema that underwent intravitreal dexamethasone implant. Primary outcome measures were best-corrected visual acuity in LogMAR and central macular thickness. Statistical analyses used two-tailed comparison with Wilcoxon signed-rank test. RESULTS: There were a total of 45 eyes from 34 patients with a mean age of 32.7 years (range 16-57) and mean follow-up of 15.5 ± 13.0 months. At Month 3 after the first injection, mean initial best-corrected visual acuity improved from 0.61 ± 0.38 (20/81) to 0.37 ± 0.16 (20/47) (P = 0.012), whereas mean central macular thickness (µm) decreased from 506 ± 288 µm to 311.7 ± 71.6 µm (P < 0.001) and mean intraocular pressure increased from 15.7 ± 2.3 mmHg to 19.8 ± 11.0 mmHg (P = 0.01). Fourteen eyes had multiple injections (1-7 reinjections) at a mean interval of 6 months. Treatment effect was durable with multiple injections, but with seven eyes developing visually significant cataracts. CONCLUSION: Best-corrected visual acuity improved up to 4 months in around half of the eyes. Eyes that benefited the most were pseudophakic, steroid nonresponsive, with large initial central macular thickness, and profuse fluorescein dye leakage.


Assuntos
Dexametasona/administração & dosagem , Macula Lutea/patologia , Edema Macular/tratamento farmacológico , Retinite Pigmentosa/complicações , Acuidade Visual , Adolescente , Adulto , Relação Dose-Resposta a Droga , Implantes de Medicamento , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Injeções Intravítreas , Macula Lutea/efeitos dos fármacos , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Retinite Pigmentosa/diagnóstico , Retinite Pigmentosa/tratamento farmacológico , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento , Adulto Jovem
7.
Front Public Health ; 5: 225, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28913331

RESUMO

As energy drink consumption continues to grow worldwide and within the United States, it is important to critically examine the nutritional content and effects on population health of these beverages. This mini-review summarizes the current scientific evidence on health consequences from energy drink consumption, presents relevant public health challenges, and proposes recommendations to mitigate these issues. Emerging evidence has linked energy drink consumption with a number of negative health consequences such as risk-seeking behaviors, poor mental health, adverse cardiovascular effects, and metabolic, renal, or dental conditions. Despite the consistency in evidence, most studies are of cross-sectional design or focus almost exclusively on the effect of caffeine and sugar, failing to address potentially harmful effects of other ingredients. The negative health effects associated with energy drinks (ED) are compounded by a lack of regulatory oversight and aggressive marketing by the industry toward adolescents. Moreover, the rising trend of mixing ED with alcohol presents a new challenge that researchers and public health practitioners must address further. To curb this growing public health issue, policy makers should consider creating a separate regulatory category for ED, setting an evidence-based upper limit on caffeine, restricting sales of ED, and regulating existing ED marketing strategies, especially among children and adolescents.

8.
Ann Thorac Surg ; 104(2): 553-559, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28215422

RESUMO

BACKGROUND: It is not clear whether radial artery (RA), right internal thoracic artery (RITA), or saphenous vein (SV) is the preferred second bypass graft during coronary artery bypass graft surgery using the left internal thoracic artery (LITA) in patients aged less or greater than 70 years. METHODS: Late survival data were collected for 13,324 consecutive, isolated, primary coronary artery bypass graft surgery patients from three hospitals. Cox regression analysis was performed on all patients grouped by age. RESULTS: Adjusted Cox regression showed overall better RA versus SV survival (hazard ratio [HR] 0.82, p < 0.001) and no difference in RITA versus SV survival (HR 0.95, p = 0.35). However, the survival benefit of RA versus SV was seen only in patients aged less than 70 years (HR 0.77, p < 0.001); and RITA patients aged less than 70 years also had a survival benefit compared with SV (HR 0.86, p = 0.03). There was no difference in survival for RA versus RITA across all ages. CONCLUSIONS: For patients aged less than 70 years, the optimal grafting strategy is using either RA or RITA as the second preferred graft. In patients aged 70 years or more, RA and RITA grafting should be used selectively. Multiple arterial grafting using either RA or RITA should be more widely utilized during coronary artery bypass graft surgery for patients less than 70 years of age.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Previsões , Artéria Torácica Interna/transplante , Artéria Radial/transplante , Veia Safena/transplante , Idoso , Doença da Artéria Coronariana/mortalidade , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
9.
J Clin Endocrinol Metab ; 101(12): 4860-4870, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27676398

RESUMO

BACKGROUND: Little is known about the changes in calciotropic hormones during puberty and their relationship to bone mass during this critical period for skeletal accretion. OBJECTIVES: Investigate changes in calciotropic hormones, IGF-1, body composition, and their associations with bone metabolism in adolescents. METHODS: Post hoc analyses were performed from data on 335 healthy school children, ages 10-17 years, with hypovitaminosis D who participated in a vitamin D randomized controlled trial. Baseline serum biochemistries; hormonal studies; densitometry at the spine, hip, and total body; and body composition were used. ANOVA and regression analyses were implemented to evaluate changes in variables of interest across pubertal stages, within and between genders. RESULTS: Bone mass and body composition parameters increased substantially across Tanner stages in both genders. Serum calcium, 1,25-dihydroxyvitamin D, and 25-hydroxyvitamin D levels did not vary by Tanner stages in both genders. Conversely, serum phosphorus, alkaline phosphatase, IGF-1, PTH, and osteocalcin peaked for the most part at Tanner stage II in girls and stage III in boys. 1,25-Dihydroxyvitamin D correlations with bone mass were not consistent, whereas IGF-1 was the most robust correlate of bone mass at several skeletal sites in early Tanner stages in both genders (R = 0.3-0.6). CONCLUSION: Serum phosphorus, alkaline phosphatase, IGF-1, PTH, and osteocalcin, but not calcium or 1,25-dihydroxyvitamin D, increased significantly in early puberty, with gender difference except for PTH, peaking earlier in girls than in boys. IGF-1 is a robust predictor of bone mass, an effect mediated in large part by increments in lean mass.


Assuntos
Fosfatase Alcalina/sangue , Densidade Óssea/fisiologia , Fator de Crescimento Insulin-Like I/metabolismo , Osteocalcina/sangue , Hormônio Paratireóideo/sangue , Fósforo/sangue , Puberdade/fisiologia , Vitamina D/análogos & derivados , Adolescente , Composição Corporal/fisiologia , Criança , Feminino , Humanos , Masculino , Puberdade/sangue , Vitamina D/sangue , Deficiência de Vitamina D/sangue
10.
Am J Cardiol ; 118(10): 1480-1485, 2016 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-27642113

RESUMO

The 2013 American College of Cardiology/American Heart Association cardiovascular prevention guidelines use a new pooled cohort equation (PCE) to predict 10-year risk of atherosclerotic cardiovascular disease (ASCVD) events which form the basis of treatment recommendations. Coronary artery calcium score (CACS) has been proposed as a means to assess atherosclerotic risk. We sought to study the level of agreement in predicted ASCVD risk by CACS and PCE-calculated models and the potential impact on therapy of additional CACS testing. We studied 687 treatment naive, consecutive patients (mean age 53.5 years, 72% men) who had a CACS study at our institution. Clinical and imaging data were recorded. ASCVD risk was calculated using the published PCE-based algorithm. CACS-based risk was categorized by previously published recommendations. Risk stratification comparisons were made and level of agreement calculated. In the cohort, mean ASCVD PCE-calculated risk was 5.3 ± 5.2% and mean CACS was 80 ± 302 Agatston units (AU). Of the intermediate PCE-calculated risk (5% to <7.5%) cohort, 85% had CACS <100 AU. Of the cohort categorized as reasonable to treat per the ASCVD prevention guidelines, 40% had a CACS of 0 AU and an additional 44% had CACS >0 but <100 AU. The level of agreement between the new PCE model of ASCVD risk and demonstrable coronary artery calcium is low. CACS testing may be most beneficial in those with an intermediate risk of ASCVD (PCE-calculated risk of 5% to <7.5%) where, in approximately half of patients, CACS testing significantly refined risk assessment primarily into a very low-risk category.


Assuntos
American Heart Association , Aterosclerose/prevenção & controle , Cálcio/metabolismo , Cardiologia , Vasos Coronários/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Guias de Prática Clínica como Assunto , Adulto , Idoso , Aterosclerose/epidemiologia , Aterosclerose/metabolismo , Vasos Coronários/metabolismo , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Estados Unidos/epidemiologia , Adulto Jovem
11.
J Bone Miner Res ; 31(7): 1473-80, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26841085

RESUMO

We showed a beneficial effect of vitamin D supplementation on musculoskeletal parameters in adolescent girls in a 1-year, randomized, double-blinded placebo-controlled trial (RCT). Our objective for this study was to investigate the residual effect of vitamin D supplementation on bone mineral content (BMC), bone mineral density (BMD), at the lumbar spine and hip, lean mass, and height, 1 year after trial completion. We performed post hoc analyses in 167 adolescents, 86 girls and 81 boys, age 13.9 ± 2 years, who received vitamin D or placebo during the trial, and continued into the follow-up trial. Musculoskeletal parameters were measured at baseline, 12 months (intervention), and 24 months (follow-up). ANOVA and t tests were used to compare results between the placebo group and the merged vitamin D arms (200 or 2000 IU/day), by gender. Baseline characteristics were comparable between treatment groups at entry into the extension. Girls who had received vitamin D during the trial, had significantly larger hip BMC increments compared to those assigned to placebo, at 24 months compared to study entry, but not 24 compared to 12 months, which persisted in adjusted analyses. There were no significant differences in bone mass changes between treatment groups in boys, at 24 months compared to 12 months or to baseline. The beneficial effect of vitamin D supplementation on hip bone mass, achieved in girls during the trial, persisted 1 year after trial completion. These net cumulative increments, 1 year after discontinuation of supplementation, may have important implications on optimizing peak bone mass accretion in adolescent girls. © 2016 American Society for Bone and Mineral Research.


Assuntos
Densidade Óssea/efeitos dos fármacos , Cabeça do Fêmur/metabolismo , Desenvolvimento Musculoesquelético/efeitos dos fármacos , Vitamina D/administração & dosagem , Adolescente , Criança , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Caracteres Sexuais
12.
J Saudi Heart Assoc ; 27(4): 234-43, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26557741

RESUMO

BACKGROUND: The use of the Coronary Artery Calcium Score (CACS) for risk categorization instead of the Framingham Risk Score (FRS) or European Heart SCORE (EHS) to improve classification of individuals is well documented. However, the impact of reclassifying individuals using CACS on initiating lipid lowering therapy is not well understood. We aimed to determine the percentage of individuals not requiring lipid lowering therapy as per the FRS and EHS models but are found to require it using CACS and vice versa; and to determine the level of agreement between CACS, FRS and EHS based models. METHODS: Data was collected for 500 consecutive patients who had already undergone CACS. However, only 242 patients met the inclusion criteria and were included in the analysis. Risk stratification comparisons were conducted according to CACS, FRS, and EHS, and the agreement (Kappa) between them was calculated. RESULTS: In accordance with the models, 79.7% to 81.5% of high-risk individuals were down-classified by CACS, while 6.8% to 7.6% of individuals at intermediate risk were up-classified to high risk by CACS, with slight to moderate agreement. Moreover, CACS recommended treatment to 5.7% and 5.8% of subjects untreated according to European and Canadian guidelines, respectively; whereas 75.2% to 81.2% of those treated in line with the guidelines would not be treated based on CACS. CONCLUSION: In this simulation, using CACS for risk categorization warrants lipid lowering treatment for 5-6% and spares 70-80% from treatment in accordance with the guidelines. Current strong evidence from double randomized clinical trials is in support of guideline recommendations. Our results call for a prospective trial to explore the benefits/risks of a CACS-based approach before any recommendations can be made.

13.
Ann Thorac Surg ; 100(3): 810-7; discussion 817-8, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26116479

RESUMO

BACKGROUND: Left internal thoracic artery (LITA) and radial artery (RA) multi-arterial CABG (MABG) is generally associated with improved long-term survival compared with traditional LITA and saphenous vein single arterial CABG (SABG). We examined the hypothesis that this multi-arterial survival advantage persists irrespective of left ventricular ejection fraction (LVEF). METHODS: We retrospectively analyzed the primary, non-salvage multi-graft CABG experience (n = 11,261; 64.4 ± 10.4 years, 70.4% men) from 2 institutions (1995 to 2011). Risk-adjusted 15-year survival was pairwise compared for the MABG versus SABG grafting approaches within 3 LVEF subcohorts (>0.50, n = 4,833 [44% MABG]; 0.36 to 0.50, n = 4,465 [39% MABG]; and ≤ 0.35, n = 1,963 [35% MABG]) using propensity-matched and covariate adjusted Cox regression (all patients) comparisons. RESULTS: Propensity matching yielded 1,317 (LVEF > 0.50), 1,179 (LVEF, 0.36 to 0.50), and 470 (LVEF ≤ 0.35) well-matched grafting method pairs. Acute perioperative mortality was equivalent between MABG and SABG within each LVEF group, but increased with decreasing LVEF. MABG was uniformly associated with better 15-year survival compared with SABG for all LVEF categories. The associated matched-adjusted hazard ratios (95% confidence intervals) were consistent across EF groups at 0.79 (0.68 to 0.93), 0.80 (0.69 to 0.93), and 0.82 (0.66 to 1.0), respectively. Covariate adjusted HR in all patients concurred with matched results. CONCLUSIONS: MABG results in significantly enhanced long-term survival compared with LITA/SVG SABG regardless of the degree of LV dysfunction. These results favor MABG as the therapy of choice in patients with LV dysfunction.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/cirurgia
14.
Am J Cardiol ; 115(7): 924-31, 2015 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-25682436

RESUMO

Sudden cardiac death (SCD) is a leading cause of mortality in patients with cardiomyopathy. Although angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) decrease cardiac mortality in these cohorts, their role in preventing SCD has not been well established. We sought to determine whether the use of ACEi or ARB in patients with cardiomyopathy is associated with a lower incidence of appropriate implantable cardiac defibrillator (ICD) shocks in the Genetic Risk Assessment of Defibrillator Events study that included subjects with an ejection fraction of ≤30% and ICDs. Treatment with ACEi/ARB versus no-ACEi/ARB was physician dependent. There were 1,509 patients (mean age [SD] 63 [12] years, 80% men, mean [SD] EF 21% [6%]) with 1,213 (80%) on ACEi/ARB and 296 (20%) not on ACEi/ARB. We identified 574 propensity-matched patients (287 in each group). After a mean (SD) of 2.5 (1.9) years, there were 334 (22%) appropriate shocks in the entire cohort. The use of ACEi/ARB was associated with lower incidence of shocks at 1, 3, and 5 years in the matched cohort (7.7%, 16.7%, and 18.5% vs 13.2%, 27.5%, and 32.0%; RR = 0.61 [0.43 to 0.86]; p = 0.005). Among patients with glomerular filtration rate (GFR) >60 and 30 to 60 ml/min/1.73 m(2), those on no-ACEi/ARB were at 45% and 77% increased risk of ICD shock compared with those on ACEi/ARB, respectively. ACEi/ARB were associated with significant lower incidence of appropriate ICD shock in patients with cardiomyopathy and GFR ≥30 ml/min/1.73 m(2) and with neutral effect in those with GFR <30 ml/min/1.73 m(2).


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Insuficiência Cardíaca Sistólica/terapia , Medição de Risco/métodos , Idoso , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Feminino , Seguimentos , Insuficiência Cardíaca Sistólica/mortalidade , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
15.
Nutrients ; 6(11): 5079-102, 2014 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-25401502

RESUMO

Sodium intake is high in Lebanon, a country of the Middle East region where rates of cardiovascular diseases are amongst the highest in the world. This study examines salt-related knowledge, attitude and self-reported behaviors amongst adult Lebanese consumers and investigates the association of socio-demographic factors, knowledge and attitudes with salt-related behaviors. Using a multicomponent questionnaire, a cross-sectional study was conducted in nine supermarkets in Beirut, based on systematic random sampling (n = 442). Factors associated with salt-related behaviors were examined by multivariate regression analysis. Specific knowledge and attitude gaps were documented with only 22.6% of participants identifying processed foods as the main source of salt, 55.6% discerning the relationship between salt and sodium, 32.4% recognizing the daily limit of salt intake and 44.7% reporting being concerned about the amount of salt in their diet. The majority of participants reported behavioral practices that increase salt intake with only 38.3% checking for salt label content, 43.7% reporting that their food purchases are influenced by salt content and 38.6% trying to buy low-salt foods. Knowledge, attitudes and older age were found to significantly predict salt-related behaviors. Findings offer valuable insight on salt-related knowledge, attitude and behaviors in a sample of Lebanese consumers and provide key information that could spur the development of evidence-based salt-reduction interventions specific to the Middle East.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Cloreto de Sódio na Dieta/administração & dosagem , Adulto , Estudos Transversais , Dieta Hipossódica , Comportamento Alimentar , Feminino , Rotulagem de Alimentos , Comportamentos Relacionados com a Saúde , Humanos , Líbano , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Cloreto de Sódio na Dieta/análise , Inquéritos e Questionários , Adulto Jovem
16.
J Thorac Cardiovasc Surg ; 148(5): 1860-1868.e2, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24928262

RESUMO

OBJECTIVES: The association of new-onset postoperative atrial fibrillation (POAF) and late death after coronary artery bypass grafting (CABG) has been confounded by the frequent concomitant serious complications that co-occur with POAF. We aimed to define the magnitude and time dependence of the effect of isolated POAF on late survival after uncomplicated CABG to comprehensively account for comorbidity and perioperative confounding factors. METHODS: Nonsalvage CABG patients with no history of AF, no concomitant aortic or valvular surgery, and no perioperative complications other than POAF were studied (n=6305). Patients were divided into AF (n=1211, 68 years old, 72% male) and no-AF (n=5094, 63 years old, 70% male) groups. Propensity matching was done using 55 patient variables, including coronary grafts, completeness of revascularization, and transfusion data. The AF effect was quantified using time-segmented hazard ratios by Cox regression analysis. RESULTS: Single (1-to-1), double (1-to-2), and triple (1-to-3) propensity matching of the AF and no-AF was achieved for 1196, 993, and 719 cases, respectively. The AF group showed significantly worse, yet time-varying, 0- to 18-year survival: 0 to 1 year, HR, 1.18 (95% confidence interval, 0.77-1.81); 1 to 6 years, HR, 1.37 (95% confidence interval, 1.12 to 1.67); and 6 to 17 years, HR, 1.25 (95% confidence interval, 1.05 to 1.49). CONCLUSIONS: Isolated POAF was associated with a time-varying increase in mortality after CABG. Given these findings and the high incidence of POAF, efforts to reduce POAF should be pursued to potentially improve resource usage, morbidity, and mortality.


Assuntos
Fibrilação Atrial/mortalidade , Ponte de Artéria Coronária/mortalidade , Idoso , Fibrilação Atrial/diagnóstico , Distribuição de Qui-Quadrado , Ponte de Artéria Coronária/efeitos adversos , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Metabolism ; 63(7): 968-78, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24874590

RESUMO

The aim of the current study is to investigate the prevalence of hypovitaminosis D in Lebanese subjects, its robust predictors, evaluate the relationship between 25 hydroxy vitamin D [25(OH)D] and parathyroid hormone levels, and derive desirable vitamin D levels, based on a large hospital laboratory database spanning all age groups. Data from a large representative digitized database of 9147 subjects, mostly outpatients, evaluated between 2000-2004 and 2007-2008, in whom information on age, gender, service, and time of the year, was analyzed. The PTH-25(OH)D relationship was studied in a subset of 657 adult subjects, in whom such data were available. At a 25(OH)D cut-off of<20 ng/ml, the prevalence of hypovitaminosis D ranged between 58% and 62% in pediatric subjects, 44% and 60% in adults, and 41% and 62% in elderly, in the 2 study periods. At a cut-off <30 ng/ml, the prevalence was above 78%, in most sub-groups. Regardless of cut-off used, the only significant predictors of high mean 25(OH)D levels were the male gender in the pediatric group, and female gender in adults and elderly, summer/fall seasons, out-patient status, as well as study period. Curve fitting of the PTH-25(OH)D relationship, in adults and elderly, revealed a plateau at 25(OH)D levels of 17-21 ng/ml, depending on sub-study group. Hypovitaminosis D is prevalent in our sunny country, even using a conservative population-derived cut-off of 20 ng/ml, and thus the need for a public health strategy for supplementation.


Assuntos
Deficiência de Vitamina D/epidemiologia , 25-Hidroxivitamina D 2/sangue , Centros Médicos Acadêmicos , Adulto , Idoso , Calcifediol/sangue , Criança , Clima , Estudos Transversais , Suplementos Nutricionais , Feminino , Promoção da Saúde , Humanos , Líbano/epidemiologia , Masculino , Política Nutricional , Hormônio Paratireóideo/sangue , Guias de Prática Clínica como Assunto , Prevalência , Estudos Retrospectivos , Fatores de Risco , Vitamina D/uso terapêutico , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/prevenção & controle
18.
J Bone Miner Res ; 29(4): 944-51, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24123134

RESUMO

Several organizations issued recommendations on desirable serum 25-hydroxy vitamin D [25(OH)D] levels and doses of vitamin D needed to achieve them. Trials allowing the formulation of evidence-based recommendations in adolescents are scarce. We investigated the ability of two doses of vitamin D3 in achieving recommended vitamin D levels in this age group. Post hoc analyses on data from a 1-year double-blind trial that randomized 336 Lebanese adolescents, aged 13 ± 2 years, to placebo, vitamin D3 at 200 IU/day (low dose), or 2000 IU/day (high dose). Serum 25(OH)D level and proportions of children achieving levels ≥ 20 ng/mL and 30 ng/mL were determined. At baseline, mean 25(OH)D was 15 ± 7 ng/mL, 16.4 ± 7 ng/mL in boys, and 14 ± 8 ng/mL in girls, p=0.003, with a level ≥ 20 ng/mL in 18% and ≥ 30 ng/mL in 5% of subjects. At 1 year, mean levels were 18.6 ± 6.6 ng/mL in the low-dose group, 17.1 ± 6 ng/mL in girls, and 20.2 ± 7 ng/mL in boys, p=0.01, and 36.3 ± 22.3 ng/mL in the high-dose group, with no sex differences. 25(OH)D increased to ≥ 20 ng/mL in 34% of children in the low-dose and 96% in the high-dose group, being higher in boys in the low-dose arm only; it remained ≥ 30 ng/mL in 4% of children in the low-dose arm but increased to 64% in the high-dose arm. Baseline 25(OH)D level, body mass index (BMI), and vitamin D dose assigned were the most significant predictors for reaching a 25(OH)D level ≥ 20 ng/mL and 30 ng/mL. A daily dose of 2000 IU raised 25(OH)D level ≥ 20 ng/mL in 96% of adolescents (98% boys versus 93% girls). Dose-response studies are needed to determine in a definitive manner the daily allowance of vitamin D for Middle Eastern adolescents with a similar profile.


Assuntos
Colecalciferol/administração & dosagem , Vitamina D/análogos & derivados , Adolescente , Criança , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Radioimunoensaio , Vitamina D/sangue
19.
Can J Ophthalmol ; 48(4): 312-6, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23931472

RESUMO

OBJECTIVE: To assess the impact of thiazolidinedione (TZDs) use on macular thickness and volume in patients with diabetes with no macular edema and no diabetic retinopathy (DR) or mild nonproliferative diabetic retinopathy (NPDR). DESIGN: Cross-sectional prospective pilot study. PARTICIPANTS: One hundred twenty patients (60 in each group) were enrolled, but 108 completed the study (59 in the TZD group and 49 in the non-TZD group). METHODS: Patients with type II diabetes mellitus were categorized into 2 groups depending on TZD intake. Those with no prior history of treatment for DR were considered for the study. Patients in both groups had assessment of visual acuity and dilated fundus examination. Only patients with no evidence of macular edema and no DR or mild-NPDR were included. Spectral-domain ocular coherence tomography (SD-OCT) was used for measurement of central retinal thickness (CRT) and macular volume. Main outcome measure was difference in mean macular volume and central thickness between the TZD and the non-TZD groups. RESULTS: Baseline demographics and characteristics were well matched between both groups. There was no significant difference in mean CRT of both groups (p = 0.13), but macular volume was significantly lower in the TZD group (p = 0.038). CONCLUSIONS: Patients with no macular edema and no DR or mild NPDR on TZDs did not show evidence of fluid retention in the macula on SD-OCT. Larger studies are needed to confirm these results.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Retinopatia Diabética/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Retina/efeitos dos fármacos , Tiazolidinedionas/uso terapêutico , Glicemia/metabolismo , Estudos Transversais , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Edema Macular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pioglitazona , Estudos Prospectivos , Retina/patologia , Rosiglitazona , Líquido Sub-Retiniano , Tomografia de Coerência Óptica , Acuidade Visual
20.
Bone ; 56(2): 296-303, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23810841

RESUMO

BACKGROUND: We have shown in a randomized controlled trial that vitamin D increases bone mass, lean mass and bone area in adolescent girls, but not boys. These increments may translate into improvements in bone geometry and therefore bone strength. This study investigated the impact of vitamin D on hip geometric dimensions from DXA-derived hip structural analyses in adolescents who participated in the trial. METHODS: 167 girls (mean age 13.1 years) and 171 boys (mean age 12.7 years) were randomly assigned to receive weekly placebo oil or vitamin D3, at doses of 1400 IU or 14,000 IU, in a double blind placebo-controlled 1-year trial. DXA images were obtained at baseline and one year, and hip images were analyzed using the hip structural analysis (HSA) software to derive parameters of bone geometry. These include outer diameter (OD), cross sectional area (CSA), section modulus (Z), and buckling ratio (BR) at the narrow neck (NN), intertrochanteric (IT), and shaft (S) regions. Analysis of Covariance (ANCOVA) was used to examine group differences for changes of bone structural parameters. RESULTS: In the overall group of girls, vitamin D supplementation increased aBMD (7.9% and 6.8% in low and high doses, versus 4.2% in placebo) and reduced the BR of NN (6.1% and 2.4% in low and high doses, versus 1.9% in placebo). It also improved aBMD (7.9% and 5.2% versus 3.6%) and CSA (7.5% and 5.1% versus 4.1%) of the IT and OD of the S (2.4% and 2.5% versus 0.8% respectively). Significant changes in the OD and BR of the NN, in the overall group of girls remained, after adjusting for lean mass, and were unaffected with further adjustments for lifestyle, pubertal status, and height measures. Conversely, boys did not exhibit any significant changes in any parameters of interest. A dose effect was not detected and subgroup analyses revealed no beneficial effect of vitamin D by pubertal stage. CONCLUSIONS: Vitamin D supplementation improved bone mass and several DXA-derived structural bone parameters, in adolescent girls, but not boys. This occurred at a critical site, the femoral neck, and if maintained through adulthood could improve bone strength and lower the risk of hip fractures.


Assuntos
Densidade Óssea/efeitos dos fármacos , Colecalciferol/uso terapêutico , Articulação do Quadril/efeitos dos fármacos , Adolescente , Feminino , Fêmur/efeitos dos fármacos , Humanos , Masculino , Ossos Pélvicos/efeitos dos fármacos
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