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1.
Hypertension ; 79(1): 251-260, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34775789

RESUMO

Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18-94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was -10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (-8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.

2.
EClinicalMedicine ; 40: 101099, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34490415

RESUMO

Background: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there has been increasing urgency to identify pathophysiological characteristics leading to severe clinical course in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Human leukocyte antigen alleles (HLA) have been suggested as potential genetic host factors that affect individual immune response to SARS-CoV-2. We sought to evaluate this hypothesis by conducting a multicenter study using HLA sequencing. Methods: We analyzed the association between COVID-19 severity and HLAs in 435 individuals from Germany (n = 135), Spain (n = 133), Switzerland (n = 20) and the United States (n = 147), who had been enrolled from March 2020 to August 2020. This study included patients older than 18 years, diagnosed with COVID-19 and representing the full spectrum of the disease. Finally, we tested our results by meta-analysing data from prior genome-wide association studies (GWAS). Findings: We describe a potential association of HLA-C*04:01 with severe clinical course of COVID-19. Carriers of HLA-C*04:01 had twice the risk of intubation when infected with SARS-CoV-2 (risk ratio 1.5 [95% CI 1.1-2.1], odds ratio 3.5 [95% CI 1.9-6.6], adjusted p-value = 0.0074). These findings are based on data from four countries and corroborated by independent results from GWAS. Our findings are biologically plausible, as HLA-C*04:01 has fewer predicted bindings sites for relevant SARS-CoV-2 peptides compared to other HLA alleles. Interpretation: HLA-C*04:01 carrier state is associated with severe clinical course in SARS-CoV-2. Our findings suggest that HLA class I alleles have a relevant role in immune defense against SARS-CoV-2. Funding: Funded by Roche Sequencing Solutions, Inc.

3.
Hypertension ; 77(2): 571-581, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33390046

RESUMO

Aortic pulse wave velocity (PWV) is directly related to arterial stiffness. Different methods for the determination of PWV coexist. The aim of this prospective study was to evaluate the prognostic value of PWV in high-risk patients with suspected coronary artery disease undergoing invasive angiography and to compare 3 different methods for assessing PWV. In 1040 patients, invasive PWV (iPWV) was measured during catheter pullback. Additionally, PWV was estimated with a model incorporating age, central systolic blood pressure, and pulse waveform characteristics obtained from noninvasive measurements (estimated PWV). As a third method, PWV was calculated with a formula solely based on age and blood pressure (formula-based PWV). Survival analysis was based on continuous PWV as well as using cutoff values. After a median follow-up duration of 1565 days, 24% of the patients reached the combined end point (cardiovascular events or mortality). Cox proportional hazard ratios per 1 SD were 1.35 for iPWV, 1.37 for estimated PWV, and 1.28 for formula-based PWV (P<0.0001 for all 3 methods) in univariate analysis, remaining statistically significant after comprehensive multivariable adjustments. In a model including a modified risk score for coronary artery disease, iPWV and estimated PWV remained borderline significant. The net reclassification improvement was significant for iPWV (0.173), formula-based PWV (0.181), and estimated PWV (0.230). All 3 methods for the determination of PWV predicted cardiovascular events and mortality in patients with suspected coronary artery disease. This indicates that iPWV as well as both noninvasive estimation methods are suitable for the assessment of arterial stiffness, bearing in mind their individual characteristics.


Assuntos
Aorta/fisiopatologia , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Angiografia Coronária , Idoso , Aorta/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Análise de Onda de Pulso , Taxa de Sobrevida , Rigidez Vascular/fisiologia
4.
J Hum Hypertens ; 34(4): 326-334, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31358883

RESUMO

Cardiovascular mortality is the leading cause of death in Austria, with uncontrolled blood pressure (BP) as a major risk factor. Increased arterial stiffness can indicate high cardiovascular risk. In a screening project, we acquired brachial waveforms with automated oscillometric devices in 45 public pharmacies and at 2 public health events in Upper Austria. Brachial BP was measured, and aortic pulse wave velocity (aoPWV) was estimated, using age, systolic BP, and waveform characteristics, with the validated ARCSolver algorithm. Using age-specific percentiles from a previous population study, we defined healthy (HVA) and early (EVA) vascular aging. In a subgroup, 24-h ambulatory BP monitoring was performed to verify hypertension status. Overall, 10,973 individuals (age 20-94 years) participated. Mean BP was 133/83 mm Hg. In all, 38.1% of participants had elevated BPs (≥140/90 mm Hg), 57.3% out of 3980 participants with known hypertension, and 29.5% out of 6066 participants without known hypertension. In all, 1.0% of participants had aoPWV below 10th reference percentile (HVA), with a negligible proportion above 60 years. In total, 37.3% were above the 90th reference percentile (EVA), with proportions rising from one-quarter in youngest partcipants to one-half in oldest participants. In participants with EVA, BP in the pharmacy was elevated in 79.5%. We were able to motivate a high number of customers at pharmacies to participate in a screening program by combining the measurements of BP and vascular aging. However, awareness and control of arterial hypertension in Austria remains suboptimal, and the high prevalence of EVA is alarming.


Assuntos
Hipertensão , Farmácias , Rigidez Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Áustria/epidemiologia , Pressão Sanguínea , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Pessoa de Meia-Idade , Prevalência , Análise de Onda de Pulso , Adulto Jovem
5.
Rheumatol Int ; 38(1): 37-50, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29094181

RESUMO

Autoinflammatory syndromes (AIS) are characterized by recurring events of inflammation, leading to a variety of organ manifestations and fever attacks. A subgroup of AIS is commonly referred to as hereditary periodic fever syndromes (HPFS). There is substantial evidence that autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus are strongly associated with cardiovascular morbidity and mortality. The link between AIS and cardiovascular disease is not that clear, even if the concept of continuous inflammation as a risk factor for cardiovascular disease is widely accepted. Research on the association of AIS and cardiovascular disease is increasing within the last years. In this review, we will discuss the association of several AIS with cardiovascular disease. Based on the rarity of some entities, lack of data, however, led to exclusion of some rare AIS. Especially, for Behcet's disease (BD), adult-onset Still's disease (AOSD), and Familial Mediterranean fever (FMF), there is an association with a number of cardiovascular abnormalities. BD is the AIS, which is most strongly associated with manifestation in the arterial and venous system. AOSD is strongly associated with cardiac inflammation (peri-/myocarditis). FMF patients are likely to suffer from serositis. Of note, there seems to be a link between variants of AOSD as well as FMF and idiopathic recurrent acute pericarditis.


Assuntos
Doenças Cardiovasculares/etiologia , Doenças Hereditárias Autoinflamatórias/complicações , Humanos , Fatores de Risco
6.
Clin Rheumatol ; 35(10): 2421-5, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27338733

RESUMO

While there is a lot of evidence published on the association of cardiovascular (CV) disease and rheumatoid arthritis (RA), little is known about urinary albumin excretion (UAE)-a marker of CV risk-in this particular high-risk population. Therefore, we investigated UAE in a large cross-sectional study. We used data from the US National Health and Nutrition Examination Survey (NHANES), including the years 2007-2012. Primary outcome was the proportion of patients with a urinary albumin-creatinine ratio (ACR) >30 mg/g. A total of 14,648 study participants (representing a population size of 174,663,008) with available ACR were included in the study (14,179 without RA and 469 with RA). In the RA group, the proportion of patients with an ACR >30 mg/g was 10.46 % (95 % CI 7.47-14.45 %) and in the non-RA group this proportion was 13.39 % (95 % CI 12.65-14.16 %; p = 0.09). There was a strong association between RA and DM (OR 5.84; 95 % CI 4.48-7.62). In the RA group, significantly more patients had a former CV event (OR 3.01; 95 % CI 2.28-3.97). Adjustments for DM, smoking status, former CV event, age, systolic blood pressure, and gender did not substantially alter the association between RA and ACR >30 mg/g (OR 0.82; 95 % CI 0.51-1.33). We did not find evidence for a difference in UAE in patients with or without RA, despite the fact that RA was associated with DM and, in addition, RA patients more often had a previous CV event. These findings may support the assumption that despite an increased CV risk, UAE does not play a major role in RA patients.


Assuntos
Albuminúria/complicações , Artrite Reumatoide/urina , Doenças Cardiovasculares/etiologia , Adulto , Artrite Reumatoide/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Fatores de Risco
7.
Clin Rheumatol ; 35(2): 461-5, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25805536

RESUMO

In rheumatology, sufficient disease control is a central part of the treatment concept. However, modern treatment strategies are associated with a substantial economic burden for health care systems. Ecological studies offer the unique opportunity to analyse differences between groups as well as group level effects. In the present analytical multi-site ecological study, we investigated whether more powerful national economies as measured by the gross domestic product per capita (GDPpc) are associated with better disease control in RA patients as measured by the disease activity score 28 (DAS28). We used aggregated data on RA patients from the recently published COMORA study as well as the World Health Organization database. There was a strong negative correlation between DAS28 and GDPpc (r = -0.815; p = 0.0002). Adjustment for sex, smoking status, disease duration or current employment status did not significantly change this association. There was a strong, negative correlation between DAS28 and age (r = -0.870; p < 0.001) and a strong, positive correlation between GDPpc and age (r = 0.737; p = 0.002). Adjustment for age reduced the regression coefficient (DAS28/GDPpc) to -0.000018 (p = 0.054). There was a negative correlation between DAS28 and current employment status (r = -0.642; p = 0.008) and a positive correlation between GDPpc and employment status (r = 0.722; p = 0.002). In conclusion, there is evidence of an association between disease control and GDPpc. This association is alleviated after adjustment for age. Of note, in countries with higher GDPpc, a higher proportion of RA patients are currently employed. This is true despite the fact that RA patients in countries with higher GDPpc are also older.


Assuntos
Artrite Reumatoide/economia , Artrite Reumatoide/terapia , Emprego , Feminino , Produto Interno Bruto , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
8.
Int J Rheum Dis ; 17(6): 606-11, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24931356

RESUMO

OBJECTIVE: Patients with rheumatoid arthritis (RA) are at significantly higher risk of cardiovascular (CV) morbidity and mortality compared with the general population. Traditional CV risk factors cannot explain the total excess of CV morbidity and mortality in RA patients. At present, it is not clear whether treatment with statins might be of benefit in RA patients. The aim of the present systematic literature review is to summarize the published evidence concerning treatment with statins and its impact on CV events in RA patients. METHODS: A systematic literature review of studies on RA and statins was carried out in the database PubMed. Search terms were 'simvastatin OR atorvastatin OR fluvastatin OR lovastatin OR pravastatin OR rosuvastatin OR statin AND arthritis'. Papers were included in this review when the reported outcome was on CV events in RA patients. After exclusion of the studies not fulfilling our inclusion criteria four studies were finally analyzed. The total number of RA patients included in these studies was 4896. RESULTS: Statins were associated with reduced CV events and mortality in RA in primary prevention but not in secondary prevention. In secondary prevention after myocardial infarction (MI) there was no statistically significant difference between RA or non-RA patients either receiving atorvastatin 80 mg or simvastatin 20-40 mg daily. Treatment with atorvastatin 80 mg led to a reduction in overall risk of CV disease in both patients with and without inflammatory joint disease compared to patients receiving the conventional/low-dose statin treatment. Statin discontinuation in RA patients was associated with an increased risk of acute myocardial infarction or CV mortality. Myalgia, diarrhoea, abdominal pain and nausea may be more frequent in RA patients than in controls. CONCLUSION: The published evidence shows that in RA patients statin treatment appears to reduce CV risk in primary prevention and that statin discontinuation is associated with an increased risk for CV events. However, the significance of statin treatment in RA patients still remains unclear as only very little evidence has been published. Whether all RA patients would benefit from treatment with statins still needs to be investigated.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Doenças Cardiovasculares/prevenção & controle , Dislipidemias/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Humanos , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Resultado do Tratamento
9.
Yonsei Med J ; 54(1): 253-7, 2013 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-23225828

RESUMO

We systematically reviewed the literature on the infectious risk in patients treated with tumour necrosis factor blocking agents (TNF-BA) undergoing surgery: we searched the Medline (PubMed) and the online archive from the Annual European Congress of Rheumatology and the Annual Scientific Meeting of the American College of Rheumatology. Of total 1259 reports, 14 were finally analysed. With one exception all were retrospective. Four of 6 studies compared patients on TNF-BA with those not receiving TNF-BA, and found an increased risk of infection with the use of TNF-BA. None of the other studies which compared continued with discontinued treatment at surgery found an increased risk of infection, when the medication was continued perioperatively. In conclusion, while in theory there is an increased risk of infections when TNF-BA are administered perioperatively, the available literature does not necessarily support this. It rather appears that patients receiving TNF-BA are a priori at a higher risk of postoperative infections. Scheduling surgery at the end of the drug interval and adding one "safety" week prior to surgery should be an acceptable plan in daily clinical practice.


Assuntos
Artrite/cirurgia , Infecções , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Certolizumab Pegol , Etanercepte , Humanos , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Imunoglobulina G/uso terapêutico , Infliximab , Período Perioperatório , Polietilenoglicóis/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Receptores do Fator de Necrose Tumoral/uso terapêutico , Estudos Retrospectivos , Risco
10.
Clin Exp Rheumatol ; 30(5): 765-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22935608

RESUMO

OBJECTIVES: Published data were analysed to determine if the use of tumour necrosis factor (TNF) blocking agents in male patients during time of conception is associated with an increased risk of fetal abnormalities or complications during pregnancy. Moreover, we were interested in the impact of TNFblocking agents on sperm quality characteristics. METHODS: We performed a systematic literature review (Medline, online archives of Annual European Congress of Rheumatology and the American College of Rheumatology). One-hundred and thirty-nine Articles of potentially relevant reports were identified and screened for retrieval and nine articles were included in the final analysis. RESULTS: Overall, there were sixty cases, where expectant fathers used TNFblocking agents shortly before conception. The outcomes of the pregnancies are documented in twenty-eight events. We did not find any documentation of miscarriages or physical abnormities associated with TNF blocking treatment and paternity; however, we did find documentation evidence that sperm motility and vitality even may improve under TNF-blocking therapy. This improvement may be caused by a decrease in disease activity. CONCLUSIONS: Published data suggest that TNF-blocking therapy in male patients during time of conception does not increase the risk of adverse pregnancy outcome. In addition TNF-blocking therapy does not appear to reduce male fertility.


Assuntos
Fertilização/efeitos dos fármacos , Fatores Imunológicos/efeitos adversos , Espermatozoides/efeitos dos fármacos , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Anormalidades Induzidas por Medicamentos/etiologia , Animais , Feminino , Humanos , Infertilidade Masculina/induzido quimicamente , Masculino , Gravidez , Complicações na Gravidez/induzido quimicamente , Resultado da Gravidez , Medição de Risco , Fatores de Risco , Motilidade Espermática/efeitos dos fármacos , Espermatozoides/patologia
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