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1.
PLoS Med ; 17(8): e1003280, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32845900

RESUMO

BACKGROUND: Experimental and observational research has suggested the potential for increased type 2 diabetes (T2D) risk among populations taking statins for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, few studies have directly compared statin-associated benefits and harms or examined heterogeneity by population subgroups or assumed treatment effect. Thus, we compared ASCVD risk reduction and T2D incidence increases across 3 statin treatment guidelines or recommendations among adults without a history of ASCVD or T2D who were eligible for statin treatment initiation. METHODS AND FINDINGS: Simulations were conducted using Markov models that integrated data from contemporary population-based studies of non-Hispanic African American and white adults aged 40-75 years with published meta-analyses. Statin treatment eligibility was determined by predicted 10-year ASCVD risk (5%, 7.5%, or 10%). We calculated the number needed to treat (NNT) to prevent one ASCVD event and the number needed to harm (NNH) to incur one incident case of T2D. The likelihood to be helped or harmed (LHH) was calculated as ratio of NNH to NNT. Heterogeneity in statin-associated benefit was examined by sex, age, and statin-associated T2D relative risk (RR) (range: 1.11-1.55). A total of 61,125,042 U.S. adults (58.5% female; 89.4% white; mean age = 54.7 years) composed our primary prevention population, among whom 13-28 million adults were eligible for statin initiation. Overall, the number of ASCVD events prevented was at least twice as large as the number of incident cases of T2D incurred (LHH range: 2.26-2.90). However, the number of T2D cases incurred surpassed the number of ASCVD events prevented when higher statin-associated T2D RRs were assumed (LHH range: 0.72-0.94). In addition, females (LHH range: 1.74-2.40) and adults aged 40-50 years (LHH range: 1.00-1.14) received lower absolute benefits of statin treatment compared with males (LHH range: 2.55-3.00) and adults aged 70-75 years (LHH range: 3.95-3.96). Projected differences in LHH by age and sex became more pronounced as statin-associated T2D RR increased, with a majority of scenarios projecting LHHs < 1 for females and adults aged 40-50 years. This study's primary limitation was uncertainty in estimates of statin-associated T2D risk, highlighting areas in which additional clinical and public health research is needed. CONCLUSIONS: Our projections suggest that females and younger adult populations shoulder the highest relative burden of statin-associated T2D risk.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Cadeias de Markov , Guias de Prática Clínica como Assunto/normas , Adulto , Idoso , Aterosclerose/diagnóstico , Aterosclerose/tratamento farmacológico , Aterosclerose/epidemiologia , Doenças Cardiovasculares/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto/métodos , Estudos Observacionais como Assunto/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Resultado do Tratamento
2.
Vascul Pharmacol ; 133-134: 106779, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32814163

RESUMO

Atherosclerosis is a very common macrovascular complication in type 2 diabetes mellitus, and cardiovascular disease is the primary cause of death in diabetes patients. Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) are a newly identified class of drugs targeting the renal proximal tubules to increase glucose excretion. Large-scale clinical trials have confirmed the cardiovascular protective effects of SGLT inhibitors in patients with diabetes diagnosed with or at a higher risk of atherosclerotic cardiovascular disease. In addition to its direct effect on glycemic control, the function of SGLT-2i in the alleviation of volume load, renal protection, and reduction of inflammation plays an essential role in its therapeutic effect on atherosclerosis. SGLT-2i are known to decrease the levels of inflammatory factors in circulation and in arteries in situ, inhibit foam cell formation and macrophage infiltration, and sustain plaque stability, ultimately blocking the development and progression of atherosclerosis.


Assuntos
Anti-Infecciosos/uso terapêutico , Artérias/efeitos dos fármacos , Aterosclerose/tratamento farmacológico , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Inflamação/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Animais , Anti-Infecciosos/efeitos adversos , Artérias/metabolismo , Artérias/patologia , Aterosclerose/diagnóstico , Aterosclerose/metabolismo , Biomarcadores/sangue , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Humanos , Inflamação/diagnóstico , Inflamação/metabolismo , Mediadores da Inflamação/metabolismo , Placa Aterosclerótica , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos
3.
High Blood Press Cardiovasc Prev ; 27(4): 331-338, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32651891

RESUMO

INTRODUCTION: Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are proven to have profound lowering of low-density lipoprotein cholesterol (LDL-C) in patients with clinical atherosclerotic cardiovascular disease or familial hypercholesterolemia. AIM: The primary purpose of this study was to evaluate PCSK9i utilization in older adults, with a focus on efficacy outcomes within 6 months of initiation. Secondary outcomes included tolerability, out-of-pocket expenses (OPE), and barriers to initiation of therapy. METHODS: We conducted a retrospective chart review of patients ≥ 65 years prescribed PCSK9i therapy by a pharmacist-run lipid clinic within a cardiology practice. RESULTS: A total of 136 older adults were prescribed PCSK9i therapy for a Food and Drug Administration-approved indication between September 2015 and March 2019 with 98 patients included in the analyses. In terms of efficacy, 51 patients who took ≥ 3 doses of PCSK9i with baseline and follow-up lipid panels were assessed. On average, LDL-C reduced by 60% (169-67 mg/dL, p < 0.001). For tolerability, 15 patients reported treatment-emergent side effects, resulting in 10 therapy discontinuations. For the cost analysis, 72 patients reported anticipated OPE for 1 month of therapy. Ultimately 17 patients were approved for manufacturer patient assistance with $0 OPE and 31 patients utilized insurance coverage to obtain therapy reporting a median OPE of $9 United States Dollars ($0-$450). The main barrier to initiation was high OPE. CONCLUSIONS: PCSK9i are effective at lowering LDL-C in older adults. Tolerability was high among patients without a history of statin intolerance. PCSK9i remain high-cost medications to both insurance companies and patients in terms of cost-sharing responsibilities.


Assuntos
Anticolesterolemiantes/economia , Anticolesterolemiantes/uso terapêutico , Aterosclerose/tratamento farmacológico , Aterosclerose/economia , LDL-Colesterol/sangue , Custos de Medicamentos , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Hiperlipoproteinemia Tipo II/economia , Pró-Proteína Convertase 9/antagonistas & inibidores , Inibidores de Serino Proteinase/economia , Inibidores de Serino Proteinase/uso terapêutico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticolesterolemiantes/efeitos adversos , Aterosclerose/sangue , Aterosclerose/diagnóstico , Biomarcadores/sangue , Regulação para Baixo , Feminino , Gastos em Saúde , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/diagnóstico , Seguro de Serviços Farmacêuticos/economia , Masculino , Pró-Proteína Convertase 9/metabolismo , Estudos Retrospectivos , Inibidores de Serino Proteinase/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
4.
Clín. investig. arterioscler. (Ed. impr.) ; 32(3): 87-93, mayo-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-193352

RESUMO

OBJECTIVE: Post-prandial lipaemia (PL), oxidative stress (OS), and complement component C3 (C3) values are related to the atherosclerosis process. The post-prandial response of C3 after an oral fat load test (OFLT) using unsaturated fat is poorly addressed. The aim of this study was to analyze and compare the post-prandial response of OS markers and C3 values in men and women after an OFLT using unsaturated fat. METHODS: The study included a total of 22 healthy subjects with normal lipids and normal blood glucose (11 men and 11 pre-menopausal women). An oral unsaturated fat load test (OFLT: 50g fat per m2 body surface) was performed using a commercial liquid preparation of long chain triglycerides (Supracal®). OS markers and C3 were measured using standardized methods at fasting state and every 2h up to 8h after the OFLT. RESULTS: Men showed statistically significant higher C3, oxidized glutathione (GSSG), and oxidized-reduced glutathione (GSSG/GSH) ratio values at fasting state compared to that obtained in women. In addition, post-prandial C3 values and GSSG/GSH ratios were significantly higher in men compared to women. The GSSG value and GSSG/GSH ratio significantly decreased in men after the OFLT compared to fasting values. In contrast, the post-prandial OS markers decrease observed in women was not statistically significant. CONCLUSIONS: In fasting state, men showed higher statistically significant C3 values and OS markers than women. The post-prandial OS markers (GSSG and GSSG/GSH ratio) significantly decrease after the OFLT with unsaturated fat in men compared to women


OBJETIVO: Los valores de lipemia postprandial (PL), estrés oxidativo (OS) y componente C3 del complemento (C3) están relacionados con el proceso de aterosclerosis. La respuesta postprandial de C3 tras una sobrecarga oral de grasa (OFLT) utilizando grasa insaturada no es completamente conocida. Nuestro objetivo fue analizar y comparar la respuesta postprandial de los marcadores de OS y los valores de C3 en hombres y mujeres después de una OFLT utilizando grasa insaturada. MÉTODOS: Estudiamos 22 sujetos normolipidémicos y normoglicémicos (11 hombres y 11 mujeres premenopáusicas). Se realizó una sobrecarga oral con grasa insaturada (OFLT: 50g de grasa por m2 de superficie corporal) utilizando una preparación líquida comercial de triglicéridos de cadena larga (Supracal®). Los marcadores OS y C3 se midieron utilizando métodos estandarizados en estado de ayuno y cada 2 horas hasta 8 horas después de OFLT. RESULTADOS: Los hombres mostraron valores significativamente mayores de C3, glutatión oxidado (GSSG) y glutatión reducido (GSSG/GSH) en estado de ayuno en comparación con los obtenidos en mujeres. Además, los valores de C3 postprandiales y la relación GSSG/GSH fueron significativamente más altos en los hombres que en las mujeres. El valor GSSG y la relación GSSG/GSH disminuyeron significativamente en los hombres después de OFLT en comparación con los valores de ayuno. En contraste, la disminución de marcadores postprandiales de OS observada en mujeres no fue estadísticamente significativa. CONCLUSIONES: En ayunas, los hombres muestran valores estadísticamente mayores de C3 y marcadores OS que las mujeres. Los marcadores OS postprandial (GSSG y GSSG/GSH ratio) disminuyen significativamente tras OFLT con grasa insaturada en los hombres en comparación con las mujeres


Assuntos
Humanos , Masculino , Feminino , Adulto , Estresse Oxidativo/efeitos dos fármacos , Complemento C3/efeitos dos fármacos , Aterosclerose/diagnóstico , Gorduras Insaturadas/administração & dosagem , Biomarcadores , Glutationa/sangue , Gorduras Insaturadas/farmacologia , Glutationa/análise , Glutationa Peroxidase/análise , Pré-Menopausa/sangue , Índice de Massa Corporal , Antropometria , Lipoproteínas/análise , Lipídeos/análise , Gorduras na Dieta/administração & dosagem
5.
G Ital Cardiol (Rome) ; 21(7): 489-501, 2020 Jul.
Artigo em Italiano | MEDLINE | ID: mdl-32555564

RESUMO

Given the high prevalence of preexisting cardiovascular diseases and the increased incidence of adverse cardiovascular events in patients hospitalized for SARS-CoV-2 infection, the identification of optimal antithrombotic approaches in terms of risk/benefit ratio and outcome improvement appears crucial in this setting. In the present position paper we collected current evidence from the literature to provide practical recommendations on the management of antithrombotic therapies (antiplatelet and anticoagulant) in various clinical contexts prevalent during the SARS-CoV-2 outbreak: in-home management of oral anticoagulant therapy; interactions between drugs used in the SARS-CoV-2 infection and antithrombotic agents; in-hospital management of antithrombotic therapies; diagnosis, risk stratification and treatment of in-hospital thrombotic complications.


Assuntos
Aterosclerose/tratamento farmacológico , Aterosclerose/epidemiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Fibrinolíticos/uso terapêutico , Pneumonia Viral/epidemiologia , Trombose/tratamento farmacológico , Aterosclerose/diagnóstico , Betacoronavirus , Comorbidade , Infecções por Coronavirus/diagnóstico , Medicina Baseada em Evidências , Feminino , Humanos , Incidência , Itália , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Guias de Prática Clínica como Assunto , Medição de Risco , Trombose/diagnóstico , Trombose/epidemiologia , Resultado do Tratamento
7.
Mutat Res ; 784: 108309, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32430098

RESUMO

Age is the dominant risk factor for the most prevalent atherosclerotic vascular diseases, including coronary artery disease, myocardial infarction, cerebrovascular disease and stroke. In human, telomere erosion and mitochondrial DNA (mtDNA) damage play a central role in the mechanisms leading to cellular aging decline. This review summarizes the most relevant findings on the role of telomere shortening and the common mtDNA4977 deletion in the progression and evolution of atherosclerosis by combining insight from experimental models and human clinical studies. The current evidence shows a link between telomere erosion and compromised mitochondrial function and provides a new perspective regarding their potential role as clinical biomarkers and therapeutic targets.


Assuntos
Envelhecimento/patologia , Aterosclerose/diagnóstico , Biomarcadores/análise , DNA Mitocondrial/genética , Deleção de Genes , Mitocôndrias/patologia , Encurtamento do Telômero/genética , Envelhecimento/genética , Envelhecimento/metabolismo , Animais , Aterosclerose/genética , Aterosclerose/metabolismo , Humanos , Mitocôndrias/genética , Fatores de Risco
8.
Diabetes Res Clin Pract ; 163: 108156, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32333967

RESUMO

BACKGROUND: By virtue of its role in oxidized low-density lipoprotein uptake and foam cell transformation, monocyte CD36 (mCD36) is a potential non-invasive tool to detect atherosclerosis (ATH) in patients of type 2 diabetes mellitus (DM). METHODS: Flowcytometric expression of mCD36 was evaluated with reference to ankle brachial index (ABI) in 70 patients of type 2 DM [40 with and 30 without coronary artery disease (CAD) respectively] and 30 age and gender matched normoglycemic controls (NGCs). RESULTS: DM patients had significantly higher mCD36 indices than NGCs (p < 0.001). The mCD36 expression was significantly higher in DM persons with CAD and those with poor glycemia control (glycosylated haemoglobin, HbA1c ≥ 7%) than their respective counterparts (p < 0.001 for both). Thirty subjects had compromised ABI (≤0.9); all were DM persons with CAD. ABI compromised subjects had consistently higher mCD36 indices than all other sub-groups (p < 0.001 for all comparisons). Notably, within the ABI-uncompromised group, mCD36 indices differed significantly and showed progressive increase from NGCs to diabetics without and with CAD respectively. CONCLUSIONS: mCD36 plays an important role in atherogenesis. With reference to ABI, mCD36 performed robustly as a marker of ATH. Furthermore, it could stratify subjects within the 'ABI-uncompromised group' commensurate with their conventional clinico-pathological ATH risk predisposition.


Assuntos
Índice Tornozelo-Braço/métodos , Aterosclerose/diagnóstico , Antígenos CD36/metabolismo , Monócitos/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Postgrad Med ; 132(6): 544-550, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32297560

RESUMO

Objective: To examine the mean carotid intima-media thickness (CIMT) and potentially relevant determinants of increased CIMT in elders. Method: Stroke-free and cardiovascular disease-free residents aged ≥65 years were recruited in a low-income population in China. B-mode ultrasonography was performed to measure CIMT. Results: A total of 1039 individuals (47.9% men) were recruited. The mean CIMT value was 0.60 (SD: 0.09) mm. The mean CIMT was 24.07 (SEM: 6.52) µm greater in men than in women (P < 0.001) and 28.29 (SEM: 7.47) µm greater in patients with hypertension than in those without hypertension (P < 0.001). Moreover, the mean CIMT increased by 1.53 (SEM: 0.49) µm for each 1-year increase in age (P = 0.002). However, the mean CIMT decreased by 5.55 (SEM: 2.40) µm and 6.45 (SEM: 2.62) µm for every 1-mmol/L increase in triglyceride concentration and the high-density lipoprotein cholesterol: low-density lipoprotein cholesterol ratio, respectively (P < 0.05). However, high triglyceride level was negatively associated with mean CIMT only among individuals without metabolic syndrome (P = 0.036). Discussion: These findings suggest that there is an urgent need to delay atherosclerosis progression and reduce the stroke burden by managing hypertension, especially for men. Moreover, to decrease the stroke burden in rural China, caution is advised regarding lipid-lowering treatment in elderly patients without metabolic syndrome.


Assuntos
Doenças Assintomáticas , Aterosclerose , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Intervenção Médica Precoce , Triglicerídeos/sangue , Idoso , Doenças Assintomáticas/epidemiologia , Doenças Assintomáticas/terapia , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Aterosclerose/prevenção & controle , Espessura Intima-Media Carotídea , China/epidemiologia , Progressão da Doença , Diagnóstico Precoce , Intervenção Médica Precoce/métodos , Intervenção Médica Precoce/normas , Feminino , Humanos , Masculino , Pobreza/estatística & dados numéricos , Medição de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle
10.
Am J Clin Nutr ; 111(6): 1252-1258, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32320012

RESUMO

BACKGROUND: Very-long-chain SFAs (VLSFAs) have recently gained considerable attention as having beneficial effects on health and aging. OBJECTIVES: The objective of this study was to assess the associations of plasma phospholipid VLSFAs [arachidic acid (20:0), behenic acid (22:0), tricosanoic acid (23:0), and lignoceric acid (24:0)] with 20-y cognitive decline in the Atherosclerosis Risk in Communities (ARIC) participants. Furthermore, this study compared the associations of plasma phospholipid VLSFAs with 5 common groups of fatty acids [i.e., total SFAs, total MUFAs, total ω-3 (n-3) PUFAs, total marine-derived ω-3 PUFAs, total ω-6 PUFAs]. METHODS: This study used a cohort study design of 3229 ARIC participants enrolled at the Minnesota field center. Fatty acids were measured at visit 1 (1987-1989); and cognition was assessed at visits 2 (1990-1992), 4 (1996-1998), and 5 (2011-2013) using 3 tests: the Delayed Word Recall Test (DWRT), the Digit-Symbol Substitution Test (DSST), and the Word Fluency Test (WFT). RESULTS: Higher proportions of plasma phospholipid total VLSFAs and each individual VLSFA were associated with less decline in WFT, a test of verbal fluency. For example, 1 SD higher in total VLSFAs at baseline was associated with 0.057 SD (95% CI: 0.018, 0.096, P = 0.004) less cognitive decline over 20 y as measured by WFT score. None of the 5 common fatty acid groups were associated with change in WFT, but a higher proportion of plasma phospholipid total MUFAs was associated with greater decline in DWRT; higher total ω-6 PUFAs with less decline in DWRT; and higher total ω-3 and total marine-derived ω-3 PUFAs with less decline in DSST. CONCLUSIONS: This study suggests that higher proportions of plasma phospholipid VLSFAs in midlife may be associated with less 20-y cognitive decline.


Assuntos
Aterosclerose/sangue , Transtornos Cognitivos/sangue , Cognição , Ácidos Graxos/sangue , Fosfolipídeos/sangue , Idoso , Aterosclerose/diagnóstico , Aterosclerose/psicologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Estudos de Coortes , Ácidos Eicosanoicos/sangue , Ácidos Graxos/química , Ácidos Graxos Insaturados/sangue , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Prospectivos
11.
Arterioscler Thromb Vasc Biol ; 40(5): 1110-1122, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32131612

RESUMO

The immune system plays an important role in obesity-induced adipose tissue inflammation and the resultant metabolic dysfunction, which can lead to hypertension, dyslipidemia, and insulin resistance and their downstream sequelae of type 2 diabetes mellitus and cardiovascular disease. While macrophages are the most abundant immune cell type in adipose tissue, other immune cells are also present, such as B cells, which play important roles in regulating adipose tissue inflammation. This brief review will overview B-cell subsets, describe their localization in various adipose depots and summarize our knowledge about the function of these B-cell subsets in regulating adipose tissue inflammation, obesity-induced metabolic dysfunction and atherosclerosis.


Assuntos
Tecido Adiposo/imunologia , Aterosclerose/imunologia , Subpopulações de Linfócitos B/imunologia , Paniculite/imunologia , Tecido Adiposo/efeitos dos fármacos , Tecido Adiposo/metabolismo , Tecido Adiposo/patologia , Animais , Anti-Inflamatórios/uso terapêutico , Aterosclerose/diagnóstico , Aterosclerose/metabolismo , Aterosclerose/terapia , Autoimunidade , Subpopulações de Linfócitos B/efeitos dos fármacos , Subpopulações de Linfócitos B/metabolismo , Subpopulações de Linfócitos B/patologia , Comunicação Celular , Citocinas/imunologia , Citocinas/metabolismo , Humanos , Imunoterapia , Mediadores da Inflamação/imunologia , Mediadores da Inflamação/metabolismo , Paniculite/diagnóstico , Paniculite/metabolismo , Paniculite/terapia , Fenótipo , Transdução de Sinais
12.
Am J Ophthalmol ; 217: 121-130, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32222370

RESUMO

PURPOSE: The prediction of atherosclerosis using retinal fundus images and deep learning has not been shown possible. The purpose of this study was to develop a deep learning model which predicted atherosclerosis by using retinal fundus images and to verify its clinical implications by conducting a retrospective cohort analysis. DESIGN: Retrospective cohort study. METHODS: The database at the Health Promotion Center of Seoul National University Hospital (HPC-SNUH) was used. The deep learning model was trained using 15,408 images to predict carotid artery atherosclerosis, which was named the deep-learning funduscopic atherosclerosis score (DL-FAS). A retrospective cohort was constructed of participants 30-80 years old who had completed elective health examinations at HPC-SNUH. Using DL-FAS as the main exposure, participants were followed for the primary outcome of death due to CVD until Dec. 31, 2017. RESULTS: For predicting carotid artery atherosclerosis among subjects, the model achieved an area under receiver operating curve (AUROC) and area under the precision-recall curve (AUPRC), accuracy, sensitivity, specificity, positive and negative predictive values of 0.713, 0.569, 0.583, 0.891, 0.404, 0.465, and 0.865 respectively. The cohort consisted of 32,227 participants, 78 cardiovascular disease (CVD) deaths, and 7.6-year median follow-up visits. Those with DL-FAS greater than 0.66 had an increased risk of CVD deaths compared to those with DL-FAS <0.33 (hazard ratio: 8.33; 95% confidence interval [CI], 3.16-24.7). Risk association was significant among intermediate and high Framingham risk score (FRS) subgroups. The DL-FAS improved the concordance by 0.0266 (95% CI, 0.0043-0.0489) over the FRS-only model. The relative integrated discrimination index was 20.45% and net reclassification index was 29.5%. CONCLUSIONS: A deep learning model was developed which could predict atherosclerosis from retinal fundus images. The resulting DL-FAS was an independent predictor of CVD deaths when adjusted for FRS and added predictive value over FRS.


Assuntos
Doenças Cardiovasculares/mortalidade , Aprendizado Profundo , Oftalmoscopia/métodos , Retina/patologia , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico , Aterosclerose/mortalidade , Doenças Cardiovasculares/diagnóstico , Artérias Carótidas/diagnóstico por imagem , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Ultrassonografia/métodos
13.
Arq Bras Cardiol ; 114(2): 256-264, 2020 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32215494

RESUMO

BACKGROUND: The Instantaneous Wave-Free Ratio (iFR) is an invasive functional evaluation method that does not require vasoactive drugs to induce maximum hyperemia. OBJECTIVE: To evaluate the contribution of the iFR to the therapeutic decision-making of coronary lesions in the absence of non-invasive diagnostic methods for ischemia, or in case of discordance between these methods and coronary angiography. METHOD: We studied patients older than 18 years, of both sexes, consecutively referred for percutaneous treatment between May 2014 and March 2018. Coronary stenotic lesions were classified by visual estimation of the stenosis diameter into moderate (41-70% stenosis) or severe (71%-90%). An iFR ≤ 0.89 was considered positive for ischemia. Logistic regression was performed using the elastic net, with placement of stents as outcome variable, and age, sex, arterial hypertension, diabetes, dyslipidemia, smoking, family history, obesity and acute myocardial infarction (AMI) as independent variables. Classification trees, ROC curves, and Box Plot graphs were constructed using the R software. A p-value < 0.05 was considered statistically significant. RESULTS: Fifty-two patients with 96 stenotic lesions (56 moderate, 40 severe) were evaluated. The iFR cut-off point of 0.87 showed a sensitivity of 0.57 and 1-specificity of 0.88, demonstrating high accuracy in reclassifying the lesions. Diabetes mellitus, dyslipidemia, and presence of moderate lesions with an iFR < 0.87 were predictors of stent implantation. Stents were used in 32% of lesions in patients with stable coronary artery disease and AMI with or without ST elevation (non-culprit lesions). CONCLUSION: The iFR has an additional value to the therapeutic decision making in moderate and severe coronary stenotic lesions, by contributing to the reclassification of lesions and decreasing the need for stenting.


Assuntos
Cateterismo Cardíaco/métodos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico , Aterosclerose/fisiopatologia , Tomada de Decisão Clínica , Angiografia Coronária/métodos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Stents
14.
Angiology ; 71(6): 552-558, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32208847

RESUMO

Anti-Müllerian hormone (AMH), which is secreted by granulosa cells of late preantral and small antral follicles, is a marker of ovarian reserve. The association of ovarian reserve with subclinical atherosclerosis in women of reproductive age is currently unknown. We primary investigated whether AMH levels are associated with markers of subclinical atherosclerosis in healthy, normally menstruating women. In this cross-sectional study, vascular structure and function were assessed by measurement of carotid and femoral intima-media thickness (IMT), flow-mediated dilation, carotid-femoral pulse wave velocity and augmentation index. Lipid profile and serum AMH concentrations were also measured. Seventy premenopausal women, aged 32.7 ± 6.5 years, were included. Mean AMH levels were lower in smokers than in non-smokers and negatively associated with total cholesterol (TC) levels. An inverse association between mean AMH concentrations and femoral and carotid IMT in all segments was observed. No correlation with other markers of subclinical atherosclerosis or established cardiovascular (CV) risk factors was found. After multivariable adjustment, the association between AMH concentrations and combined carotid IMT or carotid bulb IMT remained significant. In conclusion, in healthy, normally ovulating women, AMH concentrations are negatively associated with subclinical atherosclerosis indices and TC levels, independently of established CV risk factors.


Assuntos
Hormônio Antimülleriano/sangue , Aterosclerose/sangue , Pré-Menopausa/sangue , Adulto , Doenças Assintomáticas , Aterosclerose/diagnóstico , Aterosclerose/etiologia , Biomarcadores/sangue , Colesterol/sangue , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Ovulação , Fatores de Risco , Fumar/efeitos adversos , Fumar/sangue
15.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32209701

RESUMO

BACKGROUND: Elevated non-high-density lipoprotein cholesterol (HDL-C) levels are used to identify children at increased cardiovascular risk, but the use of non-HDL-C in childhood to predict atherosclerosis is unclear. We examined whether the National Heart, Lung, and Blood Institute classification of youth non-HDL-C status predicts high common carotid artery intima-media thickness in adulthood. METHODS: We analyzed data from 4 prospective cohorts among 4582 children aged 3 to 19 years who were remeasured as adults (mean follow-up of 26 years). Non-HDL-C status in youth and adulthood was classified according to cut points of the National Heart, Lung, and Blood Institute and the National Cholesterol Education Program Adult Treatment Panel III. High carotid intima-media thickness (cIMT) in adulthood was defined as at or above the study visit-, age-, sex-, race-, and cohort-specific 90th percentile of intima-media thickness. RESULTS: In a log-binomial regression analysis adjusted with age at baseline, sex, cohort, length of follow-up, baseline BMI, and systolic blood pressure, children with dyslipidemic non-HDL-C were at increased risk of high cIMT in adulthood (relative risk [RR], 1.29; 95% confidence interval [CI], 1.07-1.55). Compared with the persistent normal group, the persistent dyslipidemia group (RR, 1.80; 95% CI, 1.37-2.37) and incident dyslipidemia (normal to dyslipidemia) groups (RR, 1.45; 95% CI, 1.07-1.96) had increased risk of high cIMT in adulthood, but the risk was attenuated for the resolution (dyslipidemia to normal) group (RR, 1.17; 95% CI, 0.97-1.41). CONCLUSIONS: Dyslipidemic non-HDL-C levels predict youth at risk for developing high cIMT in adulthood. Those who resolve their non-HDL-C dyslipidemia by adulthood have normalized risk of developing high cIMT in adulthood.


Assuntos
Aterosclerose/sangue , Artéria Carótida Primitiva/diagnóstico por imagem , Espessura Intima-Media Carotídea , Colesterol/sangue , Previsões , Medição de Risco/métodos , Adolescente , Adulto , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Austrália/epidemiologia , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Triglicerídeos/sangue , Estados Unidos/epidemiologia , Adulto Jovem
16.
Circ J ; 84(3): 524-528, 2020 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-32023564

RESUMO

BACKGROUND: Although it has been discussed which measures against atherosclerotic diseases should be started in childhood, the current situation in Japan is unclear.Methods and Results:We conducted a health management survey of all 12-year-old children in a local town for 20 years. The body mass index tended to decrease over time. Although the serum low-density lipoprotein cholesterol level did not change, the levels of serum high-density lipoprotein cholesterol and serum triglycerides significantly increased over time. CONCLUSIONS: The serum triglyceride levels in school children increased significantly, probably through lifestyle changes, and the health management system should be reviewed.


Assuntos
Aterosclerose/epidemiologia , Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Obesidade Pediátrica/epidemiologia , Fatores Etários , Aterosclerose/diagnóstico , Biomarcadores/sangue , Pressão Sanguínea , Índice de Massa Corporal , Criança , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Dislipidemias/sangue , Dislipidemias/diagnóstico , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/fisiopatologia , Japão/epidemiologia , Masculino , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Triglicerídeos/sangue
17.
BMC Cardiovasc Disord ; 20(1): 77, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32046640

RESUMO

BACKGROUND: Identification of early signs of atherosclerosis in young adults have the potential to guide early interventions to prevent later cardiovascular disease. We therefore analyzed measures of vascular structure and function and biomarkers of cardiovascular risk in a sample of young healthy adults. METHODS: Pulse-wave velocity (PWV), carotid-intima media thickness (cIMT) and augmentation index (AIX) were measured in 834 healthy non-smokers (ages 18.0-25.9). Emphasis was put on discriminating between individuals having a vascular structure and function associated with a higher or lower risk, and cluster analysis algorithms were employed to assign the subjects into groups based on these vascular measurements. In addition, a vascular status score (VSS) was calculated by summarizing the results according to quintiles of the vascular measurements. The associations between VSS and cardiovascular biomarkers were examined by regression analyses. RESULTS: The cluster analyses did not yield sufficiently distinct clustering (groups of individuals that could be categorized unequivocally as having either a vascular structure and function associated with a higher or lower CVD risk). VSS proved a better classificatory variable. The associations between VSS and biomarkers of cardiovascular risk were analyzed by univariable and multivariable regressions. Only body fat percentage and C-reactive protein (CRP) were independently associated with VSS. CONCLUSIONS: A VSS calculation, which integrates PWV, cIMT, and AIX measurements is better suited for cardiovascular risk evaluation in young adults than cluster analyses. The independent associations of VSS with body fat percentage and CRP highlight the decisive role of adiposity and systemic inflammation in early atherosclerotic progression and suggests a subordinate role of insulin and lipid metabolism in this age span.


Assuntos
Adiposidade , Aterosclerose/etiologia , Proteína C-Reativa/análise , Mediadores da Inflamação/sangue , Inflamação/complicações , Obesidade/complicações , Adolescente , Adulto , Fatores Etários , Aterosclerose/sangue , Aterosclerose/diagnóstico , Aterosclerose/fisiopatologia , Biomarcadores/sangue , Espessura Intima-Media Carotídea , Análise por Conglomerados , Feminino , Nível de Saúde , Humanos , Inflamação/sangue , Inflamação/diagnóstico , Masculino , Obesidade/diagnóstico , Obesidade/fisiopatologia , Prognóstico , Análise de Onda de Pulso , Medição de Risco , Fatores de Risco , Adulto Jovem
18.
Obes Facts ; 13(1): 29-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31968341

RESUMO

OBJECTIVE: There is a close relationship between excess adiposity and cardiovascular disease. Although body mass index (BMI) is the most used approach to estimate excess weight, other anthropometric indices have been developed to measure total body and abdominal adiposity. Here, our objective was to assess the usefulness of these anthropometric indices to detect subclinical atheromatous disease. METHODS: A cross-sectional study with 6,809 middle-aged subjects (mean age, 57 [53-63] years) with low to moderate cardiovascular risk from the ILERVAS project. Measures of total body fat (BMI, Clínica Universidad de Navarra - Body Adiposity Estimator [CUN-BAE], and Deurenberg's formula) and central adiposity (waist and neck circumferences, conicity index, waist-to-height ratio, Bonora's equation, the A body adiposity index, and body roundness index) were performed in all participants. Bilateral carotid and femoral ultrasound vascular studies allowed the identification of subjects with plaque. -Results: All measured indices were significantly higher in males with subclinical carotid or femoral plaques (p ≤ 0.021 for all). Also, a positive and significant correlation between all indices and the number of affected territories was found (p ≤ 0.013 for all). From the ROC analysis, all measurements identified patients with asymptomatic atheromatosis but none of them helped make clinical decisions. Regarding females, the results were less conclusive. CONCLUSION: Obesity indices are related to subclinical atheromatosis, especially in men, in a large cohort of middle-aged subjects. However, the indices could not detect the presence of arterial plaque, so, when used in isolation, are unlikely to be decisive.


Assuntos
Aterosclerose/diagnóstico , Aterosclerose/etiologia , Indicadores Básicos de Saúde , Obesidade/etiologia , Adiposidade/fisiologia , Idoso , Doenças Assintomáticas , Aterosclerose/epidemiologia , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Prognóstico , Fatores de Risco , Razão Cintura-Estatura
19.
Microvasc Res ; 129: 103972, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31891717

RESUMO

We investigated the effects of age on microvascular responses during reactive hyperemia and arterial stiffness in 13 young (22 ± 1 years), 12 middle-aged (42 ± 5 years), and 15 older (63 ± 2 years) women. During the vascular occlusion test (VOT), forearm tissue oxygen saturation (StO2) was measured using near-infrared spectroscopy (NIRS). During reperfusion, the area under the curve (AUC) during hyperemia in young women (1123 ± 208% s) was significantly greater than that in middle-aged (771 ± 445% s, P = 0.024) and older women (619 ± 356% s, P = 0.001) with no differences between middle-aged and older women (P = 0.265). Cardio-ankle vascular index (CAVI) as an indicator of arterial stiffness was assessed using four-limb oscillometry. CAVI significantly increased with age (8.1 ± 0.7 in the older group, 6.0 ± 0.8 in the middle-aged group, and 5.8 ± 0.4 in the young group), with significant differences between older women and women in the other groups (P < 0.001); however, no differences in CAVI between young and middle-aged women (P = 0.484) were found. When the data of all groups were pooled, the AUC or upslope was associated with CAVI or body mass index or mean arterial pressure (all P < 0.05). To conclude, the AUC derived by NIRS measures of StO2 during the reperfusion phase can be used as one of the evaluations of microvascular function, followed by the development of atherosclerosis in middle-aged and older women.


Assuntos
Envelhecimento , Aterosclerose/diagnóstico , Índice Vascular Coração-Tornozelo , Hiperemia/fisiopatologia , Microcirculação , Espectroscopia de Luz Próxima ao Infravermelho , Rigidez Vascular , Adulto , Fatores Etários , Idoso , Aterosclerose/etiologia , Aterosclerose/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores Sexuais , Adulto Jovem
20.
J Cardiovasc Pharmacol Ther ; 25(4): 307-315, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31918567

RESUMO

PURPOSE: This study aims to analyze the treatment patterns and goal attainment of low-density lipoprotein cholesterol (LDL-C) among patients with atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus (DM) in the real-world setting in Fuzhou, China. METHODS: Patients aged ≥20 years with a valid LDL-C measurement (index date) in 2016 were selected from National Healthcare Big Data in Fuzhou, China. Patients were stratified into mutually exclusive cardiovascular risk categories: ASCVD (including recent acute coronary syndrome [ACS], chronic coronary heart disease [CHD], stroke, and peripheral arterial disease [PAD]), and DM alone (without ASCVD). Lipid-modifying medication and LDL-C attainment at the index date were assessed. RESULTS: A total of 21 989 patients met the inclusion criteria, including 17 320 (78.8%) with ASCVD and 4669 (21.2%) with DM alone; 47.7% of patients received current statin therapy in the overall cohort (53.5% in ASCVD, 26.5% for DM); 20.5% ASCVD population achieved LDL-C target with the highest in patients with recent ACS (33.8%), followed by chronic CHD (21.2%), PAD (20.9%), and ischemic stroke (17.3%); 49.0% of patients with DM achieved LDL-C target. Higher LDL-C attainment was observed in high-intensity statin and a combination of statin and nonstatin groups. Atorvastatin was the most commonly used statin with the highest LDL-C attainment, followed by rosuvastatin. CONCLUSION: Compared with previous studies in China, our study found a relatively low statin use and LDL-C target attainment, but higher than similar studies in Europe. Guidelines should be well complied and more prescription of high-intensity statin or statin and nonstatin combination should be advocated.


Assuntos
Aterosclerose/tratamento farmacológico , LDL-Colesterol/sangue , Dislipidemias/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Biomarcadores/sangue , China/epidemiologia , Comorbidade , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Regulação para Baixo , Uso de Medicamentos , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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