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2.
Eur Heart J ; 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34405232

RESUMO

AIMS: The aim of this article was to compare rates of all-cause death at 10 years following coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with or without diabetes. METHODS AND RESULTS: The SYNTAXES study evaluated up to 10-year survival of 1800 patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to receive either PCI or CABG in the SYNTAX trial. Ten-year all-cause death according to diabetic status and revascularization strategy was examined. In diabetics (n = 452), the risk of mortality was numerically higher with PCI compared with CABG at 5 years [19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval (CI): 0.96, 2.43, P = 0.075], with the opposite seen between 5 and 10 years (PCI vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P = 0.366). Irrespective of diabetic status, there was no significant difference in all-cause death at 10 years between patients receiving PCI or CABG, the absolute treatment difference was 1.9% in diabetics (PCI vs. CABG: 36.4% vs. 34.5%, difference: 1.9%, 95% CI: -7.6%, 11.1%, P = 0.551). Among insulin-treated patients (n = 182), all-cause death at 10 years was numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI: -6.5%, 22.5%, P = 0.227). CONCLUSIONS: The treatment effects of PCI vs. CABG on all-cause death at 10 years in patients with 3VD and/or LMCAD were similar irrespective of the presence of diabetes. There may, however, be a survival benefit with CABG in patients with insulin-treated diabetes. The association between revascularization strategy and very long-term ischaemic and safety outcomes for patients with diabetes needs further investigation in dedicated trials. TRIAL REGISTRATION: SYNTAX: ClinicalTrials.gov reference: NCT00114972 and SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050.

3.
Eur Heart J ; 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34405875

RESUMO

AIM: The aim of this study was to compare long-term all-cause mortality between patients receiving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using multiple (MAG) or single arterial grafting (SAG). METHODS AND RESULTS: The current study is a post hoc analysis of the SYNTAX Extended Survival Study, which compared PCI with CABG in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) and evaluated survival with ≥10 years of follow-up. The primary endpoint was all-cause mortality at maximum follow-up (median 11.9 years) assessed in the as-treated population. Of the 1743 patients, 901 (51.7%) underwent PCI, 532 (30.5%) received SAG, and 310 (17.8%) had MAG. At maximum follow-up, all-cause death occurred in 305 (33.9%), 175 (32.9%), and 70 (22.6%) patients in the PCI, SAG, and MAG groups, respectively (P < 0.001). Multiple arterial grafting [adjusted hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.49-0.89], but not SAG (adjusted HR 0.83, 95% CI 0.67-1.03), was associated with significantly lower all-cause mortality compared with PCI. In patients with 3VD, both MAG (adjusted HR 0.55, 95% CI 0.37-0.81) and SAG (adjusted HR 0.68, 95% CI 0.50-0.91) were associated with significantly lower mortality than PCI, whereas in LMCAD patients, no significant differences between PCI and MAG (adjusted HR 0.90, 95% CI 0.56-1.46) or SAG (adjusted HR 1.11, 95% CI 0.81-1.53) were observed. In patients with revascularization of all three major myocardial territories, a positive correlation was observed between the number of myocardial territories receiving arterial grafts and survival (Ptrend = 0.003). CONCLUSION: Our findings suggest that MAG might be the more desirable configuration for CABG to achieve lower long-term all-cause mortality than PCI in patients with 3VD and/or LMCAD. TRIAL REGISTRATION: Registered on clinicaltrial.gov. SYNTAXES: NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050); SYNTAX: NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972).

4.
J Am Coll Cardiol ; 78(1): 27-38, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34210411

RESUMO

BACKGROUND: The benefit of optimal medical therapy (OMT) on 5-year outcomes in patients with 3-vessel disease and/or left main disease after percutaneous coronary intervention or coronary artery bypass grafting (CABG) was demonstrated in the randomized SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial. OBJECTIVES: The objective of this analysis is to assess the impact of the status of OMT at 5 years on 10-year mortality after percutaneous coronary intervention or CABG. METHODS: This is a subanalysis of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which evaluated for up to 10 years the vital status of patients who were originally enrolled in the SYNTAX trial. OMT was defined as the combination of 4 types of medications: at least 1 antiplatelet drug, statin, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and beta-blocker. After stratifying participants by the number of individual OMT agents at 5 years and randomized treatment, a landmark analysis was conducted to assess the association between treatment response and 10-year mortality. RESULTS: In 1,472 patients, patients on OMT at 5 years had a significantly lower mortality at 10 years compared with those on ≤2 types of medications (13.1% vs 19.9%; adjusted HR: 0.470; 95% CI: 0.292-0.757; P = 0.002) but had a mortality similar to those on 3 types of medications. Furthermore, patients undergoing CABG with the individual OMT agents, antiplatelet drug and statin, at 5 years had lower 10-year mortality than those without. CONCLUSIONS: In patients with 3-vessel and/or left main disease undergoing percutaneous coronary intervention or CABG, medication status at 5 years had a significant impact on 10-year mortality. Patients on OMT with guideline-recommended pharmacologic therapy at 5 years had a survival benefit. (Synergy Between PCI With Taxus and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; Taxus Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas de Receptores de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Ponte de Artéria Coronária , Doença da Artéria Coronariana , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Intervenção Coronária Percutânea , Inibidores da Agregação Plaquetária/administração & dosagem , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Quimioterapia Combinada/métodos , Quimioterapia Combinada/estatística & dados numéricos , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Período Pós-Operatório , Resultado do Tratamento
5.
J Am Coll Cardiol ; 77(22): 2761-2773, 2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34082905

RESUMO

BACKGROUND: The optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear. OBJECTIVES: The goal of this study was to investigate 10-year all-cause mortality, life expectancy, 5-year major adverse cardiac or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in elderly individuals (>70 years old) with 3-vessel disease (3VD) and/or left main disease (LMD). METHODS: In the present pre-specified analysis on age of the SYNTAX Extended Survival study, 10-year all-cause death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox proportional hazards models among elderly or nonelderly patients. Life expectancy was estimated by restricted mean survival time within 10 years, and QOL status according to the Seattle Angina Questionnaire up to 5 years was assessed by linear mixed-effects models. RESULTS: Among 1,800 randomized patients, 575 patients (31.9%) were elderly. Ten-year mortality did not differ significantly between PCI and CABG in elderly (44.1% vs. 41.1%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.84 to 1.40) and nonelderly patients (21.1% vs. 16.6%; HR: 1.30; 95% CI: 1.00 to 1.69; pinteraction = 0.332). Among elderly patients, 5-year MACCE was comparable between PCI and CABG (39.4% vs. 35.1%; HR: 1.18; 95% CI: 0.90 to 1.56), whereas it was significantly higher in PCI over CABG among nonelderly patients (36.3% vs. 23.0%; HR: 1.69; 95% CI: 1.36 to 2.10; pinteraction = 0.043). There were no significant difference in life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: -0.4 to 0.7) and 5-year QOL status between PCI and CABG among elderly patients. CONCLUSIONS: Elderly patients with 3VD and/or LMD had comparable 10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL status irrespective of revascularization mode. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050) (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).

6.
Am Heart J ; 239: 19-26, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33992606

RESUMO

Angiography-derived physiological assessment of coronary lesions has emerged as an alternative to wire-based assessment aiming at less-invasiveness and shorter procedural time as well as cost effectiveness in physiology-guided decision making. However, current available image-derived physiology software have limitations including the requirement of multiple projections and are time consuming. METHODS/DESIGN: The ReVEAL iFR (Radiographic imaging Validation and EvALuation for Angio-iFR) trial is a multicenter, multicontinental, validation study which aims to validate the diagnostic accuracy of the Angio-iFR medical software device (Philips, San Diego, US) in patients undergoing angiography for Chronic Coronary Syndrome (CCS). The Angio-iFR will enable operators to predict both the iFR and FFR value within a few seconds from a single projection of cine angiography by using a lumped parameter fluid dynamics model. Approximately 440 patients with at least one de-novo 40% to 90% stenosis by visual angiographic assessment will be enrolled in the study. The primary endpoint is the sensitivity and specificity of the iFR and FFR for a given lesion compared to the corresponding invasive measures. The enrollment started in August 2019, and was completed in March 2021. SUMMARY: The Angio-iFR system has the potential of simplifying physiological evaluation of coronary stenosis compared with available systems, providing estimates of both FFR and iFR. The ReVEAL iFR study will investigate the predictive performance of the novel Angio-iFR software in CCS patients. Ultimately, based on its unique characteristics, the Angio-iFR system may contribute to improve adoption of functional coronary assessment and the workflow in the catheter laboratory.


Assuntos
Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Vasos Coronários , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Software/normas , Angiografia Coronária/métodos , Angiografia Coronária/tendências , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Precisão da Medição Dimensional , Humanos , Avaliação de Resultados em Cuidados de Saúde , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença
7.
Catheter Cardiovasc Interv ; 98(4): E513-E522, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34000088

RESUMO

OBJECTIVES: This study aimed to assess the predictive ability of the Global Registry of Acute Coronary Events (GRACE) risk score 2.0 in contemporary acute coronary syndrome (ACS) patients, and its relation to antiplatelet strategies. BACKGROUND: The predictive value of the GRACE risk score in the contemporary ACS cohort and the appropriate antiplatelet regimen according to the risk remain unclear. METHODS: This is a subgroup analysis of the all-comers, randomized GLOBAL LEADERS trial, comparing ticagrelor monotherapy versus conventional dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). The GRACE risk score 2.0 with 1-year mortality prediction was implemented. The randomized antiplatelet effect was assessed in predefined three GRACE risk-groups; low-risk (GRACE <109), moderate-risk (GRACE 109-140), and high-risk (GRACE >140). RESULTS: The GRACE risk score was available in 6,594 out of 7,487 ACS patients among whom 1,743, 2,823, and 2,028 patients were classified as low-risk, moderate-risk, and high-risk, respectively. At 1 year, all-cause mortality occurred in 120 patients (1.8%). The discrimination ability of the GRACE model was moderate (C-statistic = 0.742), whereas 1-year mortality risk was overestimated (mean predicted mortality rate: 3.9%; the Hosmer-Lemeshow chi-square: 21.47; p = 0.006). There were no significant interactions between the GRACE risk strata and effects of the ticagrelor monotherapy on ischemic or bleeding outcomes at 1 year compared to the reference strategy. CONCLUSION: The GRACE risk score 2.0 is valuable in discriminating high risk ACS patients, however, the recalibration of the score is recommended for better risk stratification. There is no significant differences in efficacy and safety of ticagrelor monotherapy across the three GRACE risk strata.

8.
Am J Cardiol ; 151: 30-38, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34049676

RESUMO

Numerous studies have demonstrated a paradoxical association between higher baseline body mass index (BMI) and lower long-term mortality risk after coronary revascularization, known as the "obesity paradox", possibly relying on the single use of BMI. The current study is a post-hoc analysis of the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended follow-up of the SYNTAX trial comparing percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in patients with left-main coronary artery disease (LMCAD) or three-vessel disease (3VD). Patients were stratified according to baseline BMI and/or waist circumference (WC). Out of 1,800 patients, 1,799 (99.9%) and 1,587 (88.2%) had available baseline BMI and WC data, respectively. Of those, 1,327 (73.8%) patients had High BMI (≥25 kg/m2), whereas 705 (44.4%) patients had High WC (>102 cm for men or >88 cm for women). When stratified by both BMI and WC, 10-year mortality risk was significantly higher in patients with Low BMI/Low WC (adjusted hazard ratio [HR]: 1.65; 95% confidence interval [CI]: 1.09 to 2.51), Low BMI/ High WC (adjusted HR: 2.74; 95% CI: 1.12 to 6.69), or High BMI/High WC (adjusted HR: 1.59; 95% CI: 1.11 to 2.27) compared to those with High BMI/Low WC. In conclusion, the "obesity paradox" following coronary revascularization would be driven by low long-term mortality risk of the High BMI/Low WC group. Body composition should be assessed by the combination of BMI and WC in the appropriate evaluation of the long-term risk of obesity in patients with LMCAD or 3VD.


Assuntos
Índice de Massa Corporal , Doença da Artéria Coronariana/cirurgia , Mortalidade , Revascularização Miocárdica , Obesidade/epidemiologia , Circunferência da Cintura , Idoso , Composição Corporal , Ponte de Artéria Coronária , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Prognóstico , Modelos de Riscos Proporcionais
9.
EuroIntervention ; 16(12): e997-e1004, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-32928717

RESUMO

AIMS: The purpose of the Multivessel TALENT trial is to compare clinical outcomes of the novel Supraflex Cruz stent with those of the SYNERGY stent in patients with three-vessel disease (3VD) undergoing state-of-the-art percutaneous coronary intervention (PCI). METHODS AND RESULTS: In this prospective, randomised, 1:1 balanced, multicentre, open-label trial, 1,550 patients with de novo 3VD without left main disease will be assigned to the Supraflex Cruz or SYNERGY arm. The following treatment principles of "best practice" PCI will be applied: Heart Team consensus based on SYNTAX score II treatment recommendation, functional lesion evaluation by quantitative flow ratio (QFR), stent optimisation by intravascular imaging, optimal pharmacological treatment and prasugrel monotherapy. The primary endpoint is a non-inferiority comparison of the patient-oriented composite endpoint (POCE) of all-cause death, any stroke, any myocardial infarction, or any revascularisation, at 12 months post procedure. The powered secondary endpoint is a superiority comparison of the vessel-oriented composite endpoint (VOCE), defined as vessel-related cardiovascular death, vessel-related myocardial infarction, or clinically and physiologically indicated target vessel revascularisation, at 24 months. CONCLUSIONS: The Multivessel TALENT trial will be evaluating a novel treatment strategy for complex coronary artery disease with state-of-the-art PCI based on angiography-derived QFR with novel ultra-thin Supraflex Cruz stents, compared with SYNERGY stents. Clinical Trial Registration URL: https://www.clinicaltrials.gov/ct2/show/NCT04390672. Unique Identifier: NCT04390672


Assuntos
Doença da Artéria Coronariana , Stents Farmacológicos , Intervenção Coronária Percutânea , Implantes Absorvíveis , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/cirurgia , Everolimo/uso terapêutico , Humanos , Polímeros , Estudos Prospectivos , Sirolimo/uso terapêutico , Stents , Resultado do Tratamento
10.
BMC Med Res Methodol ; 19(1): 186, 2019 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-31506063

RESUMO

BACKGROUND: Population attributable fractions (PAF) measure the proportion of disease prevalence that would be avoided in a hypothetical population, similar to the population of interest, but where a particular risk factor is eliminated. They are extensively used in epidemiology to quantify and compare disease burden due to various risk factors, and directly influence public policy regarding possible health interventions. In contrast to individual specific metrics such as relative risks and odds ratios, attributable fractions depend jointly on both risk factor prevalence and relative risk. The relative contributions of these two components is important, and usually needs to be presented in summary tables that are presented together with the attributable fraction calculation. However, representing PAF in an accessible graphical format, that captures both prevalence and relative risk, may assist interpretation. METHODS: Taylor-series approximations to PAF in terms of risk factor prevalence and log-odds ratio are derived that facilitate simultaneous representation of PAF, risk factor prevalence and risk-factor/disease log-odds ratios on a single co-ordinate axis. Methods are developed for binary, multi-category and continuous exposure variables. RESULTS: The methods are demonstrated using INTERSTROKE, a large international case control dataset focused on risk factors for stroke. CONCLUSIONS: The described methods could be used as a complement to tables summarizing prevalence, odds ratios and PAF, and may convey the same information in a more intuitive and visually appealing manner. The suggested nomogram can also be used to visually estimate the effects of health interventions which only partially reduce risk factor prevalence. Finally, in the binary risk factor case, the approximations can also be used to quickly convert logistic regression coefficients for a risk factor into approximate PAFs.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Algoritmos , Hipertensão/complicações , Modelos Teóricos , Fumar/efeitos adversos , Acidente Vascular Cerebral/diagnóstico , Apolipoproteína A-I/metabolismo , Apolipoproteínas B/metabolismo , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
11.
BMJ ; 364: l772, 2019 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-30867146

RESUMO

OBJECTIVE: To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults. DESIGN: International prospective cohort study. SETTING: 18 high, middle, and low income countries, sampled from urban and rural communities. PARTICIPANTS: 103 570 people who provided morning fasting urine samples. MAIN OUTCOME MEASURES: Association of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category variable for joint sodium and potassium was generated: sodium excretion (low (<3 g/day), moderate (3-5 g/day), and high (>5 g/day) sodium intakes) by potassium excretion (greater/equal or less than median 2.1 g/day). RESULTS: Mean estimated sodium and potassium urinary excretion were 4.93 g/day and 2.12 g/day, respectively. After a median follow-up of 8.2 years, 7884 (6.1%) participants had died or experienced a major cardiovascular event. Increasing urinary sodium excretion was positively associated with increasing potassium excretion (unadjusted r=0.34), and only 0.002% had a concomitant urinary excretion of <2.0 g/day of sodium and >3.5 g/day of potassium. A J-shaped association was observed of sodium excretion and inverse association of potassium excretion with death and cardiovascular events. For joint sodium and potassium excretion categories, the lowest risk of death and cardiovascular events occurred in the group with moderate sodium excretion (3-5 g/day) and higher potassium excretion (21.9% of cohort). Compared with this reference group, the combinations of low potassium with low sodium excretion (hazard ratio 1.23, 1.11 to 1.37; 7.4% of cohort) and low potassium with high sodium excretion (1.21, 1.11 to 1.32; 13.8% of cohort) were associated with the highest risk, followed by low sodium excretion (1.19, 1.02 to 1.38; 3.3% of cohort) and high sodium excretion (1.10, 1.02 to 1.18; 29.6% of cohort) among those with potassium excretion greater than the median. Higher potassium excretion attenuated the increased cardiovascular risk associated with high sodium excretion (P for interaction=0.007). CONCLUSIONS: These findings suggest that the simultaneous target of low sodium intake (<2 g/day) with high potassium intake (>3.5 g/day) is extremely uncommon. Combined moderate sodium intake (3-5 g/day) with high potassium intake is associated with the lowest risk of mortality and cardiovascular events.


Assuntos
Doenças Cardiovasculares/urina , Potássio/urina , Sódio/urina , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Potássio na Dieta/administração & dosagem , Potássio na Dieta/efeitos adversos , Estudos Prospectivos , Sódio na Dieta/administração & dosagem , Sódio na Dieta/efeitos adversos
12.
Br. med. j. Clin. res. ed ; 364(1772): 01-14, Mar. 2019. tabela, gráfico, ilustração
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1025000

RESUMO

PARTICIPANTS: 103 570 people who provided morning fasting urine samples. MAIN OUTCOME MEASURES: Association of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category variable for joint sodium and potassium was generated: sodium excretion (low (<3 g/day), moderate (3-5 g/day), and high (>5 g/day) sodium intakes) by potassium excretion (greater/equal or less than median 2.1 g/day). RESULTS: OBJECTIVE: To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults. DESIGN: International prospective cohort study. SETTING: 18 high, middle, and low income countries, sampled from urban and rural communities. ARTICIPANTS: 103 570 people who provided morning fasting urine samples. MAIN OUTCOME MEASURES: Association of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category variable for joint sodium and potassium was generated: sodium excretion (low (<3 g/day), moderate (3-5 g/day), and high (>5 g/day) sodium intakes) by potassium excretion (greater/equal or less than median 2.1 g/day). RESULTS: Mean estimated sodium and potassium urinary excretion were 4.93 g/day and 2.12 g/day, respectively. After a median follow-up of 8.2 years, 7884 (6.1%) participants had died or experienced a major cardiovascular event. Increasing urinary sodium excretion was positively associated with increasing potassium excretion (unadjusted r=0.34), and only 0.002% had a concomitant urinary excretion of <2.0 g/day of sodium and >3.5 g/day of potassium. A J-shaped association was observed of sodium excretion and inverse association of potassium excretion with death and cardiovascular events. For joint sodium and potassium excretion categories, the lowest risk of death and cardiovascular events occurred in the group with moderate sodium excretion (3-5 g/day) and higher potassium excretion (21.9% of cohort). Compared with this reference group, the combinations of low potassium with low sodium excretion (hazard ratio 1.23, 1.11 to 1.37; 7.4% of cohort) and low potassium with high sodium excretion (1.21, 1.11 to 1.32; 13.8% of cohort) were associated with the highest risk, followed by low sodium excretion (1.19, 1.02 to 1.38; 3.3% of cohort) and high sodium excretion (1.10, 1.02 to 1.18; 29.6% of cohort) among those with potassium excretion greater than the median. Higher potassium excretion attenuated the increased cardiovascular risk associated with high sodium excretion (P for interaction=0.007). CONCLUSIONS: These findings suggest that the simultaneous target of low sodium intake (<2 g/day) with high potassium intake (>3.5 g/day) is extremely uncommon. Combined moderate sodium intake (3-5 g/day) with high potassium intake is associated with the lowest risk of mortality and cardiovascular events. (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Potássio/urina , Sódio/urina , Mortalidade , Dieta/efeitos adversos
13.
Exp Gerontol ; 119: 14-24, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30677467

RESUMO

BACKGROUND: Hypertension is established to cause vascular end-organ damage. Other forms of dysregulated blood pressure (BP) behaviour, such as orthostatic hypotension have also been associated with cardiovascular (CV) events. The eye is potentially vulnerable to dysregulated systemic BP if ocular circulation autoregulation is impaired. We investigated whether phenotypes of abnormal BP stabilisation after orthostasis, an autonomic stressor, had a relationship with contrast sensitivity (CS), an outcome measure of subtle psychophysical visual function. METHODS: This was a cross-sectional study from wave 1 of The Irish Longitudinal Study on Ageing (TILDA). From beat-to-beat orthostatic BP (BP), measured by digital photoplethysmography during active stand, 4 phenotypes have been defined 1) normal stabilisation 2) orthostatic hypotension, 3) orthostatic hypertension 4) BP variability. Contrast sensitivity was measured using a Functional Visual Analyzer. Multivariable linear regression models investigated the relationship between orthostatic BP phenotypes and contrast sensitivity in 4289 adults aged ≥50 years adjusting for, demographics, cardiovascular risk factors, self-reported eye pathologies, objective hypertension and antihypertensives. A sensitivity analysis adjusted for age-related macular degeneration, glaucoma, diabetic retinopathy and maculopathy identified on retinal photographs. Finally models were compared, adjusting for alternative measures of cataract versus not, to examine the potential effect of cataract on any associations. RESULTS: Systolic orthostatic BP variability was associated with worse contrast sensitivity, in the primary and the sensitivity analysis. Adjusting for alternative measures of clinical cataract attenuated the association by 18%. CONCLUSIONS: Orthostatic BP variability is associated with worse contrast sensitivity, independent of hypertension and retinal pathology and may be a cardiovascular biomarker of early ocular pathology.


Assuntos
Envelhecimento/patologia , Pressão Sanguínea , Sensibilidades de Contraste , Hipotensão Ortostática/complicações , Idoso , Anti-Hipertensivos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Hipotensão Ortostática/tratamento farmacológico , Irlanda/epidemiologia , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco
14.
J Gerontol B Psychol Sci Soc Sci ; 74(2): 287-297, 2019 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-28444243

RESUMO

Objectives: This study assessed the association between sexual activity, mismatches in the importance attributed to sex within couples, and relationship quality in older Irish adults. Method: We used data from the Irish Longitudinal Study on Ageing (TILDA) to derive a scale of subjective relationship strain in married or cohabiting individuals. Negative binomial regression was used to assess the association between relationship strain and sexual activity. Separate models assessed the associations with importance of sex and within-couple mismatch in the importance attributed to sex and whether these associations were independent from sexual activity. Age interactions were tested. Results: Sexual activity and within-couple mismatch in the importance attributed to sex were associated with relationship strain. The frequency of sexual activity was consistently associated with less relationship strain for men, but less so for women when the importance attributed to sex was accounted for. Results were largely consistent across age groups for men, but sexual activity and importance of sex varied with age in women. Discussion: Frequent sexual activity was associated with less strain within-intimate relationships. For women, this association was weakened when accounting for the importance attributed to sex. Within-couple mismatch in the importance attributed to sex was associated with relationship strain, independent from frequency of sexual activity, for both men and women at all ages.


Assuntos
Casamento/psicologia , Comportamento Sexual/psicologia , Fatores Etários , Idoso , Envelhecimento/psicologia , Conflito Familiar/psicologia , Feminino , Humanos , Irlanda , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
15.
Exp Gerontol ; 106: 80-87, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29501627

RESUMO

PURPOSE: Age related macular degeneration (AMD) is a leading cause of irreversible visual loss in developed countries. It is associated with vascular risk factors including hypertension. Dysregulated blood pressure (BP) behaviour including orthostatic hypertension (OHTN), hypotension (OH) and BP variability (BPV) are associated with end-organ damage, particularly in the brain. We investigated if abnormal orthostatic BP (OBP) was a risk factor for AMD, for which a vascular aetiology is implicated. METHODS: A nationally representative, cross-sectional study was carried out 2009/2010 in The Irish Longitudinal Study on Ageing (TILDA). Beat-to-beat BP data, measured by digital photoplethysmography during active stand, was used to characterise OBP behaviour in the 30-110 s after standing. OH, OHTN, BPV and normal stabilisation recovery phenotypes were defined. AMD was identified following masked grading of 45° monoscopic colour retinal photographs, which were centred on the macula and taken with a NIDEK AFC-210 non-mydriatic auto-fundus camera. The relationship between OBP recovery phenotypes and AMD in 3750 adults aged ≥50 years was investigated using multivariate logistic regression models, adjusted for traditional AMD risk factors. RESULTS: From 30 to 110 s post active stand, systolic and diastolic OHTN was associated with increased odds of AMD after adjustment for demographics, health behaviours including smoking, family history of AMD, self-report (SR) diabetes, SR cataracts, objective hypertension and prescribed antihypertensives. No evidence of heterogeneity of OHTN effect was found between those who were hypertensive to those who were normotensive. CONCLUSIONS: This study provides evidence that OHTN may be an independent cardiovascular risk factor for AMD.


Assuntos
Envelhecimento/patologia , Hipertensão/complicações , Degeneração Macular/epidemiologia , Degeneração Macular/etiologia , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Estudos Transversais , Feminino , Humanos , Hipertensão/tratamento farmacológico , Vida Independente , Irlanda/epidemiologia , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco
16.
Age Ageing ; 47(3): 408-415, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29546387

RESUMO

Background: the dramatic shift in the global population demographic has led to increasing numbers of older people undergoing hospitalisation and surgical procedures. Objectives: to determine whether hospitalisation or hospitalisation with surgery under general anaesthesia is associated with poorer cognitive performance in adults over the age of 50. Methods: cognitive function in the domains of global cognition, memory and executive function was assessed in 8,023 individuals at waves 1 and 2 of The Irish Longitudinal Study on Ageing (TILDA), 2 years apart. Mixed-effects models were used to investigate the hypothesis after adjustment for risk factors for cognitive decline and potential confounders. Results: during the 12 months preceding wave 1, 472 participants were hospitalised (mean age 67.0, 54.9% female) and a further 560 participants (mean age 64.6, 52.1% female) were hospitalised and underwent surgery with general anaesthesia; 6,938 (mean age 63.5, 54.5% female) were not hospitalised. There was a 14% higher error rate (IRR[95% CI] = 1.14[1.06, 1.22]) in the MMSE in the hospitalisation group and a 6% higher error rate (IRR[95% CI] = 1.06[0.99, 1.13]) in the surgery group compared to those with no hospitalisation. Poorer cognitive performance in the memory tasks was evident in both hospitalisation and hospitalisation with surgery groups (immediate recall: [95% CI] = -0.13 words[-0.22,-0.04] versus -0.13 words[-0.21,-0.04] and delayed recall: -0.20 words[-0.33,-0.06] versus -0.20[-0.32, -0.07]) compared to those with no hospitalisation. Increased error in the time-based prospective memory task was observed in the hospitalisation group and the surgery group (OR[95% CI] = 1.32[1.08, 1.60] versus 1.29[1.07, 1.55]). Conclusion: hospitalisation and hospitalisation with surgery and general anaesthesia are associated with poorer global and domain specific cognitive performance.


Assuntos
Anestesia Geral/efeitos adversos , Transtornos Cognitivos/epidemiologia , Cognição , Envelhecimento Cognitivo/psicologia , Hospitalização , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Fatores Etários , Idoso , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Função Executiva , Feminino , Humanos , Irlanda/epidemiologia , Estudos Longitudinais , Masculino , Memória , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
17.
J Epidemiol Community Health ; 72(4): 287-293, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29332011

RESUMO

BACKGROUND: Cystatin C has been proposed as a confirmatory test of chronic kidney disease (CKD). This is most applicable to older individuals with CKD, the majority of whom have a creatinine-based estimated glomerular filtration rate (eGFR) of 45-59 mL/min/1.73 m2 (CKD stage 3a). We sought to examine the utility of cystatin C as a confirmatory test of CKD across the age range in the general population of older adults. METHODS: Cross-sectional analysis of 5386 participants from The Irish Longitudinal Study on Ageing, a cluster-sampled national cohort of community-dwelling adults aged ≥50 years. Cystatin C and creatinine were measured simultaneously using standardised assays. Using generalised additive models, we modelled the distributions of creatinine and cystatin C per year of age from four distributional parameters: location, dispersion, skewness, kurtosis. Among participants with CKD stage 3a, we estimated the predicted probability of cystatin C eGFR <60 mL/min/1.73 m2 ('confirmed CKD') as a function of age. RESULTS: Median age was 62 years, 53% were female and median cystatin C eGFR was 80 mL/min/1.73 m2. We observed progressive variability in cystatin C with increasing age. Compared with creatinine, cystatin C levels rose sharply beyond the age of 65. Among participants with CKD stage 3a (n=463), the predicted probability of 'confirmed CKD' increased steadily with age, from 15% at age 50 to 80% at age 80. CONCLUSIONS: The clinical utility of cystatin C may be maximised in middle-aged individuals, in whom the distribution of cystatin C is less variable than older adults, and the pretest probability of confirming CKD is lower.


Assuntos
Envelhecimento , Creatinina/sangue , Cistatina C/sangue , Taxa de Filtração Glomerular/fisiologia , Rim/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Vida Independente , Testes de Função Renal , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Fatores de Risco
18.
Am J Geriatr Psychiatry ; 26(4): 438-448, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29275903

RESUMO

OBJECTIVES: Few studies examine the relationship between Timed Up-and-Go (TUG), a commonly used clinical test, and cognitive decline. This study examines whether TUG, usual gait speed (UGS), and dual-task gait speed (DTGS) predict decline in global cognition, executive function, processing speed, memory, and attention with follow-up of up to 5.9 years. DESIGN: Longitudinal study. SETTING: The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort study. PARTICIPANTS: Community-dwelling adults aged ≥65 years, with Mini-Mental State Examination (MMSE) score ≥18 and no known history of memory impairment, dementia, Alzheimer's disease or Parkinson's disease were included (N = 2,250). MEASUREMENTS: Participants completed mobility tasks during the baseline health assessment and cognitive tasks during interviews conducted at 2 year intervals (waves 1, 2, and 3) and health assessments (waves 1 and 3). Linear and Poisson mixed effects regression models were used to examine longitudinal associations between mobility and each cognitive test, adjusting for sociodemographics and physical and mental health. RESULTS: There was little evidence of an association between TUG, UGS, or DTGS with decline in cognitive function after adjusting for confounders. CONCLUSIONS: These mobility tasks are not sensitive predictors of cognitive decline in this high-functioning, community-dwelling sample; nonetheless, limited decline in cognitive function was observed during follow-up. Further work with longer follow-up and/or analysis of more specific and comprehensive measures associated with gait is required.


Assuntos
Envelhecimento/fisiologia , Cognição , Avaliação da Deficiência , Marcha/fisiologia , Limitação da Mobilidade , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/diagnóstico , Função Executiva , Feminino , Humanos , Irlanda , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
19.
Front Immunol ; 8: 987, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28871258

RESUMO

Regulatory T-cells (Treg) are essential for maintaining immune homeostasis and tolerance. Surface glycosylation is ubiquitous on mammalian cells and regulates diverse biological processes. While it is currently well accepted that surface glycan expression influences multiple aspects of T-cell function, little is known about the relevance of glycosylation to Treg biology. This study aimed to profile the surface glycosylation characteristics of Treg in various lymphoid compartments of mouse and in human peripheral blood with comparison to non-regulatory, conventional CD4+ T-cells (Tconv). It also sought to determine the relationship between the surface glycosylation characteristics and suppressive potency of Treg. Lectin-based flow cytometric profiling demonstrated that Treg surface glycosylation differs significantly from that of Tconv in the resting state and is further modified by activation stimuli. In mouse, the surface glycosylation profiles of FoxP3+ Treg from spleen and lymph nodes were closely comparable but greater variability was observed for Treg in thymus, bone marrow, and blood. Surface levels of tri/tetra-antennary N-glycans correlated with expression of proteins known to be involved in Treg suppressive functions, including GITR, PD-1, PD-L1, CD73, CTLA-4, and ICOS. In coculture experiments involving purified Treg subpopulations and CD4+ or CD8+ Tconv, higher surface tri/tetra-antennary N-glycans was associated with greater Treg suppressive potency. Enzymatic manipulation of mouse Treg surface glycosylation resulting in a temporary reduction of surface N-glycans significantly reduced Treg capacity to suppress Tconv activation through contact-dependent mechanisms. Overall, these findings demonstrate that Treg have distinctive surface glycan characteristics that show variability across anatomical locations and are modulated by activation events. They also provide evidence of an important role for surface glycosylation in determining Treg phenotype and suppressive potency. These insights may prove relevant to the analysis of Treg in disease settings and to the further development of Treg-based immunotherapies.

20.
J Epidemiol Community Health ; 71(10): 981-989, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28798151

RESUMO

BACKGROUND: Height is regarded as a marker of early-life illness, adversity, nutrition and psychosocial stress, but the extent to which differences in height are determined by early-life socioeconomic circumstances, particularly in contemporary populations, is unclear. This study examined socioeconomic differences in children's height trajectories from birth through to 21 years of age in four European countries. METHODS: Data were from six prospective cohort studies-Generation XXI, Growing Up in Ireland (infant and child cohorts), Millennium Cohort Study, EPITeen and Cardiovascular Risk in Young Finns Study-comprising a total of 49 492 children with growth measured repeatedly from 1980 to 2014. We modelled differences in children's growth trajectories over time by maternal educational level using hierarchical models with fixed and random components for each cohort study. RESULTS: Across most cohorts at practically all ages, children from lower educated mothers were shorter on average. The gradient in height was consistently observed at 3 years of age with the difference in expected height between maternal education groups ranging between -0.55 and -1.53 cm for boys and -0.42 to -1.50 cm for girls across the different studies and widening across childhood. The height deficit persists into adolescence and early adulthood. By age 21, boys from primary educated maternal backgrounds lag the tertiary educated by -0.67 cm (Portugal) and -2.15 cm (Finland). The comparable figures for girls were -2.49 cm (Portugal) and -2.93 cm (Finland). CONCLUSIONS: Significant differences in children's height by maternal education persist in modern child populations in Europe.


Assuntos
Estatura , Desenvolvimento Infantil , Escolaridade , Fatores Socioeconômicos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Europa (Continente) , Feminino , Finlândia , Disparidades nos Níveis de Saúde , Humanos , Lactente , Recém-Nascido , Irlanda , Masculino , Portugal , Fatores Sexuais , Reino Unido , Adulto Jovem
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