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1.
J Appl Physiol (1985) ; 128(4): 907-913, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32163327

RESUMO

Postural orthostatic tachycardia syndrome (POTS) is accompanied by reduced brain blood flow, autonomic dysfunction, and orthostatic intolerance. We hypothesized that wearing a neck compression collar would attenuate orthostatic symptoms, increase brain blood flow, and influence autonomic reflexes. Ten participants with POTS (9 women, age: 36 ± 10) underwent two trials of supine rest, paced deep breathing (6 breaths/min), Valsalva maneuver (40 mmHg for 15 s), and 70° upright tilt. For one trial, participants wore a neck compression device (Q30 Innovations). Blood pressure, heart rate (HR), brain blood flow velocity, stroke volume, respiratory rate, and end-tidal gases were continuously measured. The Vanderbilt Orthostatic Symptom Score was compiled at the end of tilt. The use of the collar reduced the orthostatic symptom score of participants with POTS during upright tilt (26.9 ± 12.5 to 18.7 ± 13.1, P = 0.04). Collar compression in the supine condition reduced the low-frequency domain of HR variability (60 ± 18 to 51 ± 23 normalized units, P = 0.04) and increased the change in HR (15 ± 5 to 17 ± 6 bpm, P = 0.02) and E:I ratio (1.2 ± 0.1 to 1.3 ± 0.1, P = 0.01) during paced deep breathing. Throughout tilt, wearing the collar reduced respiratory rate (baseline: 13 ± 3 to 12 ± 4 breath/min; tilt: 18 ± 5 to 15 ± 5 breath/min; main effect of collar P = 0.048), end-tidal oxygen (baseline: 115 ± 5 to 112 ± 5 mmHg; tilt: 122 ± 10 to 118 ± 11 mmHg; main effect of collar P = 0.026). In participants with POTS, wearing the Q-collar reduced orthostatic symptoms, increased the HR response to deep breathing, and decreased resting ventilation.NEW & NOTEWORTHY We found that using a neck compression collar alleviated orthostatic symptoms in upright posture in participants with postural orthostatic tachycardia syndrome (POTS). This could be due to compression of the baroreceptors and subsequent changes in autonomic function. Indeed, we observed increased heart rate responsiveness to paced deep breathing and reductions of respiratory rate and end-tidal O2 (suggesting reduced ventilation). Further, wearing the collar reduced mean blood velocity in the brain during Valsalva perhaps due to higher brain blood volume.

2.
Scand J Med Sci Sports ; 30(6): 1054-1063, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32119140

RESUMO

BACKGROUND: Hypoestrogenemia due to menopause is associated with increased cardiovascular disease risk, in part due to elevated indexes of aortic wave reflection (AWRI) and central (aortic) blood pressure. We sought to investigate whether AWRI and central blood pressure are also augmented in hypoestrogenic exercise-trained premenopausal women with functional hypothalamic amenorrhea (ExFHA). METHODS: In age- (pooled mean ± SEM, 24 ± 1 years), BMI- (21 ± 1 kg/m2 ), and cardiorespiratory fitness-matched (45 ± 2 ml/kg/min) eumenorrheic ovulatory (ExOv; n = 11) and ExFHA women (n = 10), we assessed aortic blood pressure and waveform characteristics (augmentation index and wave reflection amplitude) obtained from radial pressure waves (applanation tonometry). Doppler ultrasound determined cardiac output (CO) and total peripheral resistance (TPR). Measures were recorded before and 1 hour after 45 minutes of moderate intensity exercise to determine the influence of exercise-induced increases in nitric oxide. RESULTS: Pre-exercise, AIx75, central systolic BP (SBPc), and CO were lower (P < .05) and TPR higher (P < .05) in ExFHA. Post-exercise, AIx75 was unchanged (P > .05) in ExFHA but was lowered (P < .05) in ExOv. Both groups demonstrated increased CO, and lowered SBPc and TPR, yet TPR remained higher (P < .05), and CO and SBPc lower (P < .05) in ExFHA. CONCLUSIONS: Despite hypoestrogenemia, functional compliance of the central arteries and central BP is not augmented, yet TPR is higher, in ExFHA versus ExOv. An acute bout of dynamic exercise did not alter AIx75 in ExFHA, suggesting blunted vascular responsiveness to exercise-induced increases in nitric oxide, possibly due to augmented vascular tone. These findings have relevance in understanding the vascular consequences of hypoestrogenemia during the premenopausal years.


Assuntos
Aorta/fisiologia , Estrogênios/deficiência , Exercício Físico , Hemodinâmica , Pré-Menopausa , Adolescente , Adulto , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Análise de Onda de Pulso , Adulto Jovem
6.
Arthritis Res Ther ; 19(1): 31, 2017 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-28183339

RESUMO

BACKGROUND: Electrocardiogram (ECG) cardiovascular disease (CVD) abnormalities (ECG-CVD) are predictive of subsequent CVD events in the general population. Systemic lupus erythematosus (SLE) patients are vulnerable to CVD. We aimed to determine the prevalence of ECG-CVD in SLE patients and to examine the risk factors associated with ECG-CVD. METHODS: A 12-lead resting supine ECG was performed on consecutive adult patients attending the clinic. One cardiologist interpreted the ECGs. ECG-CVD were defined as the presence of one or more of the following 4 elements (ECG-4): ST-segment and/or T-wave abnormalities, left ventricular hypertrophy (LVH), left axis deviation (LAD), left bundle branch block (LBBB) and right bundle branch block (RBBB). ECG-5 included the same elements as ECG-4 and the Q-wave. Repeated measurement data were created and the associations between ECG-4/ECG-5 and demographics were evaluated with univariate and multivariate Cox regression models. RESULTS: Of 487 SLE patients, 104 (21.4%) and 118 (24.2%) patients had one or more of the ECG-4 and ECG-5 elements, respectively. A higher prevalence of ECG-CVD was found in patients with a longer SLE disease duration, and the burden of ECG-CVD elements increased with age. Increased age, active SLE disease, and damage were associated with ECG4 and ECG-5, while treatment of hyperlipidemia was protective. CONCLUSION: A high prevalence of ECG-4 (21.4%) and ECG-5 (24.2%) was found in this SLE cohort. Controlling SLE disease activity is important since it was associated with ECG-4 and ECG-5. Early identification of ECG-4 and ECG-5 in SLE patients might allow for better stratification and risk management.


Assuntos
Doenças Cardiovasculares/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Adulto , Doenças Cardiovasculares/etiologia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais
7.
Eur J Cancer ; 68: 11-21, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27693889

RESUMO

BACKGROUND: Aromatase inhibitors (AIs) may increase cardiovascular risk relative to tamoxifen in post-menopausal women with breast cancer. This risk has not been well-quantified outside of clinical trials. METHODS: Observational population-based cohort study of women aged >55 years diagnosed with stage I-III breast cancer between 2005 and 2010. Women treated with AIs or tamoxifen were followed to March 2012. The primary outcome was hospitalisation for myocardial infarction (MI). Cause-specific hazards were compared using tamoxifen as the reference group. Inverse probability of treatment weighting using the propensity score was used to reduce confounding due to measured baseline covariates. Results were confirmed using two cause-specific hazards models. Subgroup analyses included women aged ≥66 years, those with prior ischaemic heart disease, and a 'lower-risk group' aged <74 years with stage I-II cancer and no prior ischaemic heart disease. RESULTS: In 7409 aromatase inhibitor-treated and 1941 tamoxifen-treated women, the median age was 71 versus 74 years, respectively (p < 0.001). Baseline prevalence of ischaemic heart disease was similar (17.0% versus 16.9%, p = 0.96). Over a mean of 1184 d of follow-up, there were 123 hospitalisations for MI; the cause-specific hazard was higher with AIs (hazard ratio 2.02; 95% confidence interval 1.16-3.53 in the weighted sample). We observed comparable patterns within pre-defined subgroups and when adjusted using cause-specific hazards models. CONCLUSION: Aromatase inhibitors are associated with a higher risk of MI compared with tamoxifen. This risk should be accounted for when managing aromatase inhibitor-treated women.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Infarto do Miocárdio/epidemiologia , Sistema de Registros , Tamoxifeno/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Quimioterapia Adjuvante , Estudos de Coortes , Feminino , Humanos , Armazenamento e Recuperação da Informação , Modelos Logísticos , Estadiamento de Neoplasias , Ontário/epidemiologia , Pós-Menopausa , Pontuação de Propensão , Modelos de Riscos Proporcionais , Fatores de Risco
8.
Menopause ; 23(4): 390-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26694735

RESUMO

OBJECTIVE: Delayed heart rate (HR) recovery in the immediate postexercise period has been linked to adverse cardiovascular prognosis. The after effects of an acute bout of exercise on HR modulation in postmenopausal women (PMW) and the influence of estrogen therapy are unknown. METHODS: In 13 sedentary PMW (54 ± 2 y, mean ± SEM), we assessed HR variability (HRV)--an index of HR modulation--and the influence of estrogen therapy on HRV. HRV in the frequency domain was quantified during supine rest and again 60 minutes after treadmill exercise for 45 minutes, at 60% VO2peak. PMW were studied before and after 4 weeks of oral estradiol. To obtain reference values for the after effects of exercise on HRV in healthy young women, 14 premenopausal women (PreM) completed the identical exercise protocol. RESULTS: Compared with PreM, PMW demonstrated lower high frequency (vagal modulation) and total HRV (P < 0.05) at rest. In PreM, all HRV values were similar before and after exercise. In contrast, in PMW after exercise, despite having identical HR to PreM, high frequency and total HRV were all lower (all P ≤ 0.01) compared with pre-exercise HRV values. Estrogen therapy had no effect on pre or postexercise values for HRV. CONCLUSIONS: When compared with PreM, PMW have identical HR, but lower vagal HR modulation at rest and delayed HRV recovery after exercise. Estrogen does not restore baseline HRV or accelerate HRV recovery postexercise, suggesting aging rather than estrogen deficiency per se may lower HRV in PMW.


Assuntos
Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Pós-Menopausa/fisiologia , Pressão Sanguínea , Eletrocardiografia , Terapia de Reposição de Estrogênios , Teste de Esforço , Feminino , Humanos , Pessoa de Meia-Idade , Consumo de Oxigênio , Pré-Menopausa/fisiologia , Descanso , Nervo Vago/fisiologia
9.
Clin Sci (Lond) ; 129(10): 885-93, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26221028

RESUMO

Compared with eumenorrhoeic women, exercise-trained women with functional hypothalamic amenorrhoea (ExFHA) exhibit low heart rates (HRs) and absent reflex renin-angiotensin-system activation and augmentation of their muscle sympathetic nerve response to orthostatic stress. To test the hypothesis that their autonomic HR modulation is altered concurrently, three age-matched (pooled mean, 24 ± 1 years; mean ± S.E.M.) groups of women were studied: active with either FHA (ExFHA; n=11) or eumenorrhoeic cycles (ExOv; n=17) and sedentary with eumenorrhoeic cycles (SedOv; n=17). Blood pressure (BP), HR and HR variability (HRV) in the frequency domain were determined during both supine rest and graded lower body negative pressure (LBNP; -10, -20 and -40 mmHg). Very low (VLF), low (LF) and high (HF) frequency power spectra (ms(2)) were determined and, owing to skewness, log10-transformed. LF/HF ratio and total power (VLF + LF + HF) were calculated. At baseline, HR and systolic BP (SBP) were lower (P<0.05) and HF and total power were higher (P<0.05) in ExFHA than in eumenorrhoeic women. In all groups, LBNP decreased (P<0.05) SBP, HF and total power and increased (P<0.05) HR and LF/HF ratio. However, HF and total power remained higher (P<0.05) and HR, SBP and LF/HF ratio remained lower (P<0.05) in ExFHA than in eumenorrhoeic women, in whom measures did not differ (P>0.05). At each stage, HR correlated inversely (P<0.05) with HF. In conclusion, ExFHA women demonstrate augmented vagal yet unchanged sympathetic HR modulation, both at rest and during orthostatic stress. Although the role of oestrogen deficiency is unclear, these findings are in contrast with studies reporting decreased HRV in hypoestrogenic post-menopausal women.


Assuntos
Amenorreia/fisiopatologia , Frequência Cardíaca/fisiologia , Hipotálamo/fisiopatologia , Pré-Menopausa/fisiologia , Adulto , Análise de Variância , Pressão Sanguínea/fisiologia , Estudos Transversais , Estrogênios/sangue , Estrogênios/deficiência , Exercício Físico/fisiologia , Feminino , Humanos , Postura/fisiologia , Sistema Renina-Angiotensina/fisiologia , Nervo Vago/fisiologia , Adulto Jovem
10.
Hypertension ; 65(5): 1089-95, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25776076

RESUMO

Our prior observations in normotensive postmenopausal women stimulated the hypotheses that compared with eumenorrheic women, active hypoestrogenic premenopausal women with functional hypothalamic amenorrhea would demonstrate attenuated reflex renin-angiotensin-aldosterone system responses to an orthostatic challenge, whereas to defend blood pressure reflex increases in muscle, sympathetic nerve activity would be augmented. To test these hypotheses, we assessed, in recreationally active women, 12 with amenorrhea (ExFHA; aged 25 ± 1 years; body mass index 20.7 ± 0.7 kg/m(2); mean ± SEM) and 17 with eumenorrhea (ExOv; 24 ± 1 years; 20.9 ± 0.5 kg/m(2)), blood pressure, heart rate, plasma renin, angiotensin II, aldosterone, and muscle sympathetic nerve activity at supine rest and during graded lower body negative pressure (-10, -20, and -40 mm Hg). At baseline, heart rate and systolic blood pressure were lower (P<0.05) in ExFHA (47 ± 2 beats/min and 94 ± 2 mm Hg) compared with ExOv (56 ± 2 beats/min and 105 ± 2 mm Hg), but muscle sympathetic nerve activity and renin-angiotensin-aldosterone system constituents were similar (P>0.05). In response to graded lower body negative pressure, heart rate increased (P<0.05) and systolic blood pressure decreased (P<0.05) in both groups, but these remained consistently lower in ExFHA (P<0.05). Lower body negative pressure elicited increases (P<0.05) in renin, angiotensin II, and aldosterone in ExOv, but not in ExFHA (P>0.05). Muscle sympathetic nerve activity burst incidence increased reflexively in both groups, but more so in ExFHA (P<0.05). Otherwise, healthy hypoestrogenic ExFHA women demonstrate low blood pressure and disruption of the normal circulatory response to an orthostatic challenge: plasma renin, angiotensin II, and aldosterone fail to increase and blood pressure is defended by an augmented sympathetic vasoconstrictor response.


Assuntos
Estrogênios/deficiência , Exercício Físico/fisiologia , Postura/fisiologia , Pré-Menopausa/fisiologia , Reflexo/fisiologia , Sistema Renina-Angiotensina/fisiologia , Sistema Nervoso Simpático/fisiologia , Adolescente , Adulto , Aldosterona/sangue , Angiotensina II/sangue , Pressão Sanguínea/fisiologia , Estrogênios/sangue , Feminino , Seguimentos , Humanos , Valores de Referência , Renina/sangue , Adulto Jovem
11.
Br J Sports Med ; 48(21): 1580, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25313134

RESUMO

STUDY QUESTION: What are the rates of serious cardiovascular events in those who undergo primary total joint arthroplasty (TJA) compared with those who do not within three years of initial assessment? SUMMARY ANSWER: Undergoing elective primary TJA within three years of initial assessment was associated with a significant 12.4% absolute reduction in subsequent risk of serious cardiovascular events. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Osteoarthritis is associated with increased mortality, particularly secondary to cardiovascular disease, with the risk for mortality proportional to the degree of disability secondary to the arthritis. This study suggests that management of hip or knee osteoarthritis with arthroplasty decreases the risk for subsequent serious cardiovascular events.

12.
Am J Physiol Regul Integr Comp Physiol ; 307(5): R498-500, 2014 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-24944241

RESUMO

The renin-angiotensin-aldosterone system (RAAS) is integrally involved in multiple cardiovascular physiological processes including arterial blood pressure (BP) regulation. Over activity of the RAAS has been implicated in the pathogenesis of a number of cardiovascular disease entities, including hypertension. Several lines of evidence suggest estrogen favorably modulates the RAAS. Conversely, estrogen deficiency due to menopause may contribute to over activity of the RAAS. Of importance, estrogen deficiency in women is not exclusive to the postmenopausal period. Functional hypothalamic amenorrhea is a reversible cause of premenopausal hypoestrogenemia. In contrast to postmenopausal women (PMW), premenopausal women with exercise-associated functional hypothalamic amenorrhea demonstrate decreased, not increased, resting BP compared with their estrogen-replete eumenorrheic counterpart. In this review we briefly examine the effects of estrogen status on the RAAS and present the hypothesis that the RAAS is altered in physically active women with functional hypothalamic amenorrhea.


Assuntos
Estrogênios/fisiologia , Atividade Motora/fisiologia , Sistema Renina-Angiotensina/fisiologia , Amenorreia/fisiopatologia , Animais , Pressão Sanguínea/fisiologia , Feminino , Humanos , Pré-Menopausa/fisiologia
13.
J Clin Endocrinol Metab ; 99(5): 1798-806, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24606076

RESUMO

INTRODUCTION: Exercise-trained hypoestrogenic premenopausal women with functional hypothalamic amenorrhea (ExFHA) exhibit impaired endothelial function. The vascular effects of an acute bout of exercise, a potent nitric oxide stimulus, in these women are unknown. METHODS: Three groups were studied: recreationally active ExFHA women (n = 12; 24.2 ± 1.2 years of age; mean ± SEM), and recreationally active (ExOv; n = 14; 23.5 ± 1.2 years of age) and sedentary (SedOv; n = 15; 23.1 ± 0.5 years of age) ovulatory eumenorrheic women. Calf blood flow (CBF) and brachial artery flow-mediated dilation (FMD) were evaluated using plethysmographic and ultrasound techniques, respectively, both before and 1 hour after 45 minutes of moderate-intensity exercise. Endothelium-independent dilation was assessed at baseline using glyceryl trinitrate. Calf vascular resistance (CVR) and brachial peak shear rate, as determined by the area under the curve (SRAUCpk), were also calculated. RESULTS: FMD and glyceryl trinitrate responses were lower (P < .05) in ExFHA (2.8% ± 0.4% and 11.6% ± 0.7%, respectively) than ExOv (8.8% ± 0.7% and 16.7% ± 1.3%) and SedOv (8.0% ± 0.5% and 17.1% ± 1.8%). SRAUCpk was also lower (P < .05) in ExFHA. Normalization of FMD for SRAUCpk (FMD/SRAUCpk) did not alter (P > .05) the findings. CBF was lower (P < .05) and CVR higher (P < .05) in ExFHA. After exercise, FMD and SRAUCpk were augmented (P < .05), but remained lower (P < .05), in ExFHA. FMD/SRAUCpk no longer differed (P > .05) between the groups. CBF in ExFHA was increased (P < .05) and CVR decreased (P < .05) to levels observed in ovulatory women. CONCLUSIONS: Acute dynamic exercise improves vascular function in ExFHA women. Although the role of estrogen deficiency per se is unclear, our findings suggest that low shear rate and increased vasoconstrictor tone may play a role in impaired basal vascular function in these women.


Assuntos
Amenorreia/fisiopatologia , Artéria Braquial/fisiopatologia , Endotélio Vascular/fisiopatologia , Exercício Físico/fisiologia , Doenças Hipotalâmicas/fisiopatologia , Estresse Mecânico , Adulto , Artéria Braquial/diagnóstico por imagem , Feminino , Humanos , Fluxo Sanguíneo Regional/fisiologia , Ultrassonografia
14.
PLoS One ; 9(3): e91286, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24608134

RESUMO

BACKGROUND: Because individuals with osteoarthritis (OA) avoid physical activities that exacerbate symptoms, potentially increasing risk for cardiovascular disease (CVD) and death, we assessed the relationship between OA disability and these outcomes. METHODS: In a population cohort aged 55+ years with at least moderately severe symptomatic hip and/or knee OA, OA disability (Western Ontario McMaster Universities (WOMAC) OA scores; Health Assessment Questionnaire (HAQ) walking score; use of walking aids) and other covariates were assessed by questionnaire. Survey data were linked to health administrative data to determine the relationship between baseline OA symptom severity to all-cause mortality and occurrence of a composite CVD outcome (acute myocardial infarction, coronary revascularization, heart failure, stroke or transient ischemic attack) over a median follow-up of 13.2 and 9.2 years, respectively. RESULTS: Of 2156 participants, 1,236 (57.3%) died and 822 (38.1%) experienced a CVD outcome during follow-up. Higher (worse) baseline WOMAC function scores and walking disability were independently associated with a higher all-cause mortality (adjusted hazard ratio, aHR, per 10-point increase in WOMAC function score 1.04, 95% confidence interval, CI 1.01-1.07, p = 0.004; aHR per unit increase in HAQ walking score 1.30, 95% CI 1.22-1.39, p<0.001; and aHR for those using versus not using a walking aid 1.51, 95% CI 1.34-1.70, p<0.001). In survival analysis, censoring on death, risk of our composite CVD outcome was also significantly and independently associated with greater baseline walking disability ((aHR for use of a walking aid = 1.27, 95% CI 1.10-1.47, p = 0.001; aHR per unit increase in HAQ walking score = 1.17, 95% CI 1.08-1.27, p<0.001). CONCLUSIONS: Among individuals with hip and/or knee OA, severity of OA disability was associated with a significant increase in all-cause mortality and serious CVD events after controlling for multiple confounders. Research is needed to elucidate modifiable mechanisms.


Assuntos
Doenças Cardiovasculares/complicações , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/mortalidade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/mortalidade , Idoso , Doenças Cardiovasculares/diagnóstico , Causas de Morte , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Dor/complicações , Prognóstico
15.
BMJ ; 347: f6187, 2013 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-24174640

RESUMO

OBJECTIVE: To examine whether total joint arthroplasty of the hip and knee reduces the risk for serious cardiovascular events in patients with moderate-severe osteoarthritis. DESIGN: Propensity score matched landmark analysis. SETTING: Ontario, Canada. PARTICIPANTS: 2200 adults with hip or knee osteoarthritis aged 55 or more at recruitment (1996-98) and followed prospectively until death or 2011. MAIN OUTCOME MEASURE: Rates of serious cardiovascular events for those who received a primary total joint arthroplasty compared with those did not within an exposure period of three years after baseline assessment. RESULTS: The propensity score matched cohort consisted of 153 matched pairs of participants with moderate-severe arthritis. Over a median follow-up period of seven years after the landmark date (start of the study), matched participants who underwent a total joint arthroplasty during the exposure period were significantly less likely than those who did not to experience a cardiovascular event (hazards ratio 0.56, 95% confidence interval 0.43 to 0.74, P<0.001). Within seven years of the exposure period the absolute risk reduction was 12.4% (95% confidence interval 1.7% to 23.1%) and number needed to treat was 8 (95% confidence interval 4 to 57 patients). CONCLUSIONS: Using a propensity matched landmark analysis in a population cohort with advanced hip or knee osteoarthritis, this study found a cardioprotective benefit of primary elective total joint arthroplasty.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Pontuação de Propensão , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
16.
J Rheumatol ; 40(12): 2006-14, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24128779

RESUMO

OBJECTIVE: To quantify the independent role of each of low-density lipoprotein cholesterol (LDL-C), total cholesterol:high-density lipoprotein cholesterol ratio (TC:HDL-C), triglyceride (TG) level, and HDL-C as a marker of coronary risk in systemic lupus erythematosus (SLE). METHODS: Patients with lipid measurements taken before a coronary event (or last clinic visit) were included. Mean and time-adjusted mean (TAM) levels were calculated for each lipid variable in each patient. Time-dependent proportional hazards regression models were used to quantify the risk of coronary event [myocardial infarction (MI) or angina], after adjustment for age. RESULTS: Among 384 patients, over a mean (SD) followup of 3.81 (2.58) years, there were 21 "first" coronary events (6 MI, 15 angina). Mean and TAM LDL-C (HR 1.83, 95% CI 1.19-2.81, p = 0.006), TC:HDL ratio (HR 1.43, 95% CI 1.02-2.00, p = 0.04), and TG (HR 2.11, 95% CI 1.32-3.39, p = 0.0019) were predictive of coronary event at subsequent visits. In contingency table analysis, TAM LDL-C cutpoint of 2.0 mmol/l had a sensitivity and negative predictive value for coronary event of 85.7% (95% CI 63.7-97.0) and 93.9% (95% CI 83.1-98.7), respectively. However, at this cutpoint the specificity was only 12.7% (95% CI 9.4-16.5). CONCLUSION: This study links LDL-C, TC:HDL-C ratio, and TG to coronary risk in patients with SLE and quantifies the magnitude of this risk. SLE-specific risk assessment levels for lipids may be selected to optimize positive or negative predictive values.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/metabolismo , Lipídeos/sangue , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/metabolismo , Adulto , Angina Pectoris/epidemiologia , Angina Pectoris/metabolismo , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Morte Súbita Cardíaca/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/metabolismo , Modelos de Riscos Proporcionais , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Triglicerídeos/sangue
18.
Can J Cardiol ; 28(2 Suppl): S42-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22424283

RESUMO

New data suggest that persistent chest pain, despite normal coronary angiography, is less benign than previously thought. It has long been recognized that cardiac syndrome X (CSX) is associated with significant suffering, disability, and health care costs, but the biggest shift in thinking comes in terms of long-term risk. It is now recognized that the prognosis is not benign and that a significant proportion of patients are at increased cardiovascular disease risk. Of major debate is the question of whether the mechanisms that explain this chest pain are cardiac vs noncardiac. The most current definition of CSX is the triad of angina, ischemia, and normal coronary arteries, which is associated with an increased cardiovascular risk. This paper provides a review of CSX, epidemiology of the problem, proposed explanatory mechanisms, and important next steps in research. Central to this review is the proposition that new insights into CSX will be fostered by both clinical and scientific collaboration between cardiovascular and pain scientists.


Assuntos
Gerenciamento Clínico , Comunicação Interdisciplinar , Angina Microvascular , Microvasos , Isquemia Miocárdica , Pós-Menopausa/metabolismo , Canadá/epidemiologia , Dor no Peito/metabolismo , Dor no Peito/fisiopatologia , Angiografia Coronária/métodos , Vasos Coronários/metabolismo , Vasos Coronários/fisiopatologia , Efeitos Psicossociais da Doença , Feminino , Humanos , Angina Microvascular/diagnóstico , Angina Microvascular/epidemiologia , Angina Microvascular/etiologia , Angina Microvascular/fisiopatologia , Angina Microvascular/terapia , Microvasos/metabolismo , Microvasos/fisiopatologia , Isquemia Miocárdica/complicações , Isquemia Miocárdica/metabolismo , Isquemia Miocárdica/fisiopatologia , Prognóstico , Pesquisa , Fatores de Risco , Estresse Psicológico/etiologia , Tempo
19.
Arthritis Res Ther ; 13(5): R156, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21955652

RESUMO

INTRODUCTION: Previous studies have shown that traditional risk factors such as hypercholesterolemia and hypertension account for only a small proportion of the dramatically increased risk of atherosclerotic coronary artery disease (CAD) in systemic lupus erythematosus (SLE). However, in these studies, exposure to risk factors was measured only at baseline. In this study, our objective was to compare measures of cumulative exposure with remote and recent values for each of total cholesterol (TC), systolic (SBP), and diastolic (DBP) blood pressure in terms of ability to quantify risk of atherosclerotic CAD in patients with SLE. METHODS: Patients in the Toronto lupus cohort had TC and BP measured at each clinic visit and were followed up prospectively for the occurrence of CAD. For each patient, arithmetic mean, time-adjusted mean (AM) and area-under-the-curve (AUC) were calculated for serial TC, SBP, and DBP measurements. Proportional hazards regression models were used to compare these summary measures with recent and first-available ("remote") measurements in terms of ability to quantify risk of CAD events, defined as myocardial infarction, angina, or sudden cardiac death. RESULTS: The 991 patients had a mean ± SD of 19 ± 19 TC measurements per patient. Over a follow-up of 6.7 ± 6.4 years, 86 CAD events occurred; although remote TC was not significantly predictive of CAD, mean and AM TC were more strongly predictive (hazard ratio (HR) 2.07; P = 0.003) than recent TC (HR 1.86, P = 0.001). AUC TC was not predictive of CAD. A similar pattern was seen for DBP and SBP. Older age, male sex, higher baseline and recent disease activity score, and corticosteroid use also increased CAD risk, whereas antimalarials were protective. CONCLUSIONS: In contrast to the population-based Framingham model, first-available TC and BP are not predictive of CAD among patients with SLE, in whom measures reflecting cumulative exposure over time are better able to quantify CAD risk. This is an important consideration in future studies of dynamic risk factors for CAD in a chronic relapsing-remitting disease such as SLE. Our findings also underpin the importance of adequate control of SLE disease activity while minimizing corticosteroid use, and highlight the cardioprotective effect of antimalarials.


Assuntos
Colesterol/sangue , Doença da Artéria Coronariana/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Adulto , Pressão Sanguínea/fisiologia , Estudos de Coortes , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/etiologia , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/complicações , Hipertensão/sangue , Hipertensão/complicações , Lúpus Eritematoso Sistêmico/sangue , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Regulação para Cima/fisiologia , Adulto Jovem
20.
J Clin Endocrinol Metab ; 96(12): 3638-48, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21956422

RESUMO

CONTEXT: Evidence indicates that hypoestrogenemia is linked with accelerated progression of atherosclerosis. Premenopausal women presenting with ovulatory disruption due to functional hypothalamic amenorrhea (FHA) are characterized by hypoestrogenemia. One common and reversible form of FHA in association with energy deficiency is exercise-associated amenorrhea (EAA). EVIDENCE ACQUISITION: Articles were found via PubMed search for both original and review articles based on peer review publications between 1974 and 2011 reporting on cardiovascular changes in women with FHA, with emphasis placed on women with EAA. EVIDENCE SYNTHESIS: Despite participation in regular exercise training, hypoestrogenic women with EAA demonstrate paradoxical changes in cardiovascular function, including endothelial dysfunction, a known permissive factor for the progression and development of atherosclerosis. Such alterations suggest that the beneficial effects of regular exercise training on vascular function are obviated in the face of hypoestrogenemia. The long-term cardiovascular consequences of altered vascular function in response to ovulatory disruption in women with EAA remain to be determined. Retrospective data, however, suggest premature development and progression of coronary artery disease in older premenopausal women reporting a history of hypothalamic ovulatory disruption. Importantly, in women with EAA, estrogen therapy, folic acid supplementation without change in menstrual status, and resumption of menses restores endothelial function. In this review, we focus on the influence of hypoestrogenemia in association with energy deficiency in mediating changes in cardiovascular function in women with EAA, including endothelial function, regional blood flow, lipid profile, and autonomic control of blood pressure, heart rate, and baroreflex sensitivity. The influence of exercise training is also considered. CONCLUSION: With the premenopausal years typically considered to be cardioprotective in association with normal ovarian function, ovarian disruption in women with EAA is of importance. Further investigation of the short-term, and potentially long-term, cardiovascular consequences of hypoestrogenemia in women with EAA is recommended.


Assuntos
Amenorreia/complicações , Aterosclerose/etiologia , Estrogênios/deficiência , Exercício Físico/fisiologia , Doenças Hipotalâmicas/complicações , Feminino , Humanos
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