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1.
Medicine (Baltimore) ; 99(40): e22334, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019409

RESUMO

This study aims to establish a diagnostic model of coronary heart disease (CHD) for diabetic foot (DF) patients.The clinical data of 489 hospitalized patients with DF were retrospectively analyzed in this case-control study. The patients were divided into the CHD group (DF with CHD, n = 212) and the control group (DF without CHD, n = 277). Univariate analysis was performed to screen for CHD-related risk factors, and multivariate logistic regression analysis was conducted to determine significant CHD risk factors. Scores were assigned according to the ratio of risk factors (OR) to establish a diagnostic model of CHD for patients with DF. The area under the ROC curve was used to test the application value of the diagnostic model.The logistic regression analysis showed that the risk factors for CHD in DF patients were age, duration of diabetes, toe-brachial index, hyperuricemia, and chronic renal insufficiency. The area under the ROC curve of the diagnostic model was 0.798 (0.759-0.837), the diagnostic point of CHD was 6 points, the diagnostic sensitivity was 69.3%, and the specificity was 76.5%.The established model has good diagnostic value and provides the basis for preliminary screening for CHD in patients with DF.


Assuntos
Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Pé Diabético/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Estudos de Casos e Controles , Feminino , Humanos , Hiperuricemia/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
2.
BMJ Open ; 10(9): e038976, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32948572

RESUMO

OBJECTIVE: Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly. SETTING: A nested case-control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020. PARTICIPANTS: Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province. OUTCOME MEASURES: Patient demographics, survival time and status, and history of comorbidities. METHOD: A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ±1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak. RESULTS: Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001). CONCLUSION: Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.


Assuntos
Doença das Coronárias/epidemiologia , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Bronquite Crônica/epidemiologia , Estudos de Casos e Controles , Infarto Cerebral/epidemiologia , China/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Falência Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal/epidemiologia , Adulto Jovem
3.
Biomed Environ Sci ; 33(8): 573-582, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32933609

RESUMO

Objective: To investigate the relationship between human cytomegalovirus (HCMV) infection and peripheral blood CD14 +CD16 + monocytes in the pathogenesis of coronary heart disease (CHD), and to elucidate the mechanism of pathogenesis in CHD by analyzing the correlation between infection, inflammation, and CHD, to provide a basis for the prevention, evaluation, and treatment of the disease. Methods: In total, 192 patients with CHD were divided into three groups: latent CHD, angina pectoris, and myocardial infarction. HCMV-IgM and -IgG antibodies were assessed using ELISA; CD14 +CD16 + monocytes were counted using a five-type automated hematology analyzer; mononuclear cells were assessed using fluorescence-activated cell sorting; and an automatic biochemical analyzer was used to measure the levels of triglyceride, cholesterol, high- and low-density lipoprotein cholesterols, lipoprotein, hs-CRp and Hcy. Results: The positive rates of HCMV-IgM and -IgG were significantly higher in the CHD groups than in the control group. HCMV infection affects lipid metabolism to promote immune and inflammatory responses. Conclusion: HCMV infection has a specific correlation with the occurrence and development of CHD. The expression of CD14 +CD16 + mononuclear cells in the CHD group was increased accordingly and correlated with acute HCMV infection. Thus, HCMV antibody as well as peripheral blood CD14 +CD16 + mononuclear cells can be used to monitor the occurrence and development of CHD.


Assuntos
Angina Pectoris/epidemiologia , Doença das Coronárias/epidemiologia , Infecções por Citomegalovirus/complicações , Citomegalovirus/fisiologia , Inflamação/epidemiologia , Infarto do Miocárdio/epidemiologia , Angina Pectoris/virologia , China/epidemiologia , Doença das Coronárias/virologia , Humanos , Incidência , Inflamação/etiologia , Contagem de Leucócitos , Monócitos/metabolismo , Infarto do Miocárdio/virologia
4.
Nutr Metab Cardiovasc Dis ; 30(10): 1706-1713, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32811737

RESUMO

BACKGROUND AND AIMS: Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio may play a role in predicting cardiovascular events. We aimed to prospectively explore the association between the TG/HDL-C ratio and atherosclerotic cardiovascular disease (ASCVD), ischemic stroke, as well as coronary heart disease (CHD) in a Chinese population. METHODS AND RESULTS: This prospective cohort study included 9368 participants from four Chinese populations in the People's Republic of China-United States of America (PRC-USA) Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology. Over a follow-up period of 20 years, 624 cases of ASCVD events including 458 ischemic stroke events and 166 CHD events were recorded. The relationship between the TG/HDL-C ratio and the endpoints was evaluated through multivariate Cox proportional hazard models adjusted for potential confounding variables, including age, sex, urban or rural residence, northern or southern China, occupational type, education, physical exercise, smoking status, drinking status, body mass index, hypertension, high low-density lipoprotein cholesterol, diabetes, and antihypertensive medication use at baseline. With the lowest TG/HDL-C tertile as the reference, the middle and highest tertiles had the hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.13 (0.91, 1.40), 1.36 (1.10, 1.67) respectively for ASCVD (p for trend = 0.0028), and 1.19 (0.93, 1.54),1.47 (1.15, 1.87) respectively for ischemic stroke (p for trend = 0.0016). However, no significant association was found for CHD events. CONCLUSION: TG/HDL-C ratio was positively associated with the risk of ASCVD and ischemic stroke events in the Chinese population.


Assuntos
Aterosclerose/epidemiologia , Isquemia Encefálica/epidemiologia , HDL-Colesterol/sangue , Doença das Coronárias/epidemiologia , Dislipidemias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Triglicerídeos/sangue , Adulto , Aterosclerose/diagnóstico , Aterosclerose/mortalidade , Biomarcadores/sangue , Isquemia Encefálica/mortalidade , China/epidemiologia , Doença das Coronárias/mortalidade , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/mortalidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo
5.
BMC Public Health ; 20(1): 1034, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600440

RESUMO

BACKGROUND: A recent community-based disease management (CBDM) pilot study reported a 20.5% prevalence of hypertension and a 0.5 and 3.6% prevalence of stroke and coronary heart disease (CHD), respectively, in an elderly population (mean age 65 years) in the Xin Jiang autonomous region of China. The CBDM was initiated in 2013 as an essential public health service; however, the potential long-term impact of CBDM on cardiovascular (CV: CHD and stroke) events is unknown. The objective of the study was to understand the long-term impact of CBDM interventions on CV risk factors using disease-model simulation based on a single-arm experimental study. METHODS: A discrete event simulation was developed to evaluate the impact of CBDM on the long-term CV risk among patients with hypertension, in China's Xin Jiang autonomous region. The model generated pairs of identical patients; one receives CBDM and one does not (control group). Their clinical courses were simulated based on time to CV events (CHD and strokes), which are estimated using published risk equations. The impact of CBDM was incorporated as improvement in systolic blood pressure (SBP) based on observations from the CBDM study. The simulation estimated the number of CV events over patients' lifetimes. RESULTS: During a 2-year follow up, the CBDM led to an average reduction of 8.73 mmHg in SBP from baseline, and a 42% reduction in smoking. The discrete event simulation showed that, in the control group, the model estimated incidence rates of 276, 1789, and 616 per 100,000 individuals for lifetime CHD, stroke, and CV-related death, respectively. The impact of CBDM on SBP translated into reductions of 8, 28, and 23% in CHD, stroke, and CV-related deaths, respectively. Taking into account CBDM's reduction of both SBP and smoking, deaths from CHD, stroke, and CV-related deaths were reduced by 12, 30, and 26%, respectively. CONCLUSIONS: The implementation of CBDM in China's Xinjiang autonomous region is expected to significantly reduce incidences of CHD, strokes, and CV-related deaths.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Serviços de Saúde Comunitária/estatística & dados numéricos , Doença das Coronárias/complicações , Hipertensão/complicações , Acidente Vascular Cerebral/complicações , Idoso , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , China/epidemiologia , Simulação por Computador , Doença das Coronárias/epidemiologia , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de Risco , Comportamento de Redução do Risco , Acidente Vascular Cerebral/epidemiologia
6.
Biosci Rep ; 40(8)2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32725148

RESUMO

The new 2019 coronavirus disease (COVID-19), according to the World Health Organization (WHO), has been characterized as a pandemic. As more is being discovered about this virus, we aim to report findings of the complete blood count (CBC) of COVID-19 patients. This would serve in providing physicians with important knowledge on the changes that can be expected from the CBC of mild and normal COVID-19 patients. A total of 208 mild and common patients were admitted at the Dongnan Hospital located in the city of Xiaogan, Hubei, China. The CBCs of these patients, following a confirmed diagnosis of COVID-19, were retrospectively analyzed and a significant P<0.05 was found after a full statistical analysis was conducted using the Statistical Package for the Social Sciences (IBM SPSS). CBC analysis revealed changes in the levels of red blood cells (RBCs), hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), and C-reactive protein (CRP). Clinicians should expect similar findings when dealing with the new COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Doença das Coronárias/diagnóstico , Infecções por Coronavirus/diagnóstico , Diabetes Mellitus/diagnóstico , Hipertensão/diagnóstico , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/diagnóstico , Adulto , Idoso , Doenças Assintomáticas , Contagem de Células Sanguíneas , Proteína C-Reativa/metabolismo , China/epidemiologia , Comorbidade , Doença das Coronárias/sangue , Doença das Coronárias/epidemiologia , Doença das Coronárias/fisiopatologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/fisiopatologia , Índices de Eritrócitos , Eritrócitos/patologia , Eritrócitos/virologia , Feminino , Hematócrito , Hemoglobinas/metabolismo , Humanos , Hipertensão/sangue , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Insuficiência Respiratória/sangue , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença
7.
PLoS One ; 15(7): e0235839, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634156

RESUMO

Given recent slowing of declines in national all-cause, heart disease, and stroke mortality, examining spatiotemporal distributions of coronary heart disease (CHD) death rates and trends can provide data critical to improving the cardiovascular health of populations. This paper documents county-level CHD death rates and trends by age group, race, and gender from 1979 through 2017. Using data from the National Vital Statistics System and a Bayesian multivariate space-time conditional autoregressive model, we estimated county-level age-standardized annual CHD death rates for 1979 through 2017 by age group (35-64 years, 65 years and older), race (white, black, other), and gender (men, women). We then estimated county-level total percent change in CHD death rates during four intervals (1979-1990, 1990-2000, 2000-2010, 2010-2017) using log-linear regression models. For all intervals, national CHD death rates declined for all groups. Prior to 2010, although most counties across age, race, and gender experienced declines, pockets of increasing CHD death rates were observed in the Mississippi Delta, Oklahoma, East Texas, and New Mexico across age groups and gender, and were more prominent among non-white populations than whites. Since 2010, across age, race, and gender, county-level declines in CHD death rates have slowed, with a marked increase in the percent of counties with increasing CHD death rates (e.g. 4.4% and 19.9% for ages 35 and older during 1979-1990 and 2010-2017, respectively). Recent increases were especially prevalent and geographically widespread among ages 35-64 years, with 40.5% of counties (95% CI: 38.4, 43.1) experiencing increases. Spatiotemporal differences in these long term, county-level results can inform responses by the public health community, medical providers, researchers, and communities to address troubling recent trends.


Assuntos
Doença das Coronárias/mortalidade , Adulto , Afro-Americanos , Fatores Etários , Idoso , Teorema de Bayes , Doença das Coronárias/epidemiologia , Doença das Coronárias/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Análise Multivariada , Fatores Sexuais , Estados Unidos/epidemiologia , Estados Unidos/etnologia
8.
Int J Antimicrob Agents ; 56(4): 106093, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32653618

RESUMO

This study was conducted to assess the spread of SARS-CoV-2 in Russia and the adaptation of the population to the virus in March to June 2020. Two groups were investigated: 1) 12 082 individuals already proven positive for SARS-CoV-2 (clinical information was studied); 2) 7864+4458 individuals with suspected respiratory infections (polymerase chain reaction [PCR] tests and clinical information were studied). In the latter, SARS-CoV-2-positive individuals comprised 5.37% in March and 11.42% in June 2020. Several viral co-infections were observed for SARS-CoV-2. Rhinoviruses accounted for the largest proportion of co-infections (7.91% of samples were SARS-CoV-2-positive); followed by respiratory syncytial virus (7.03%); adenoviruses (4.84%); metapneumoviruses (3.29%); parainfluenza viruses (2.42%); enterovirus D68 (1.10%) and other viruses (entero-, echo-, parecho-) (<1%). Average SARS-CoV-2 case fatality rate in the group of 12 537 individuals was determined to be 0.6% (in contrast to official Russian government statistics of 1.5% mortality). This rate is within the range of mortality caused by other common seasonal respiratory viruses (0.01-2.21% in Russia in 2012 to 2020). Most fatalities occurred in individuals with comorbidities, as for other respiratory viruses. The proportion of SARS-CoV-2 asymptomatic carriers was 56.68% in March and 70.67% in June 2020. This new pathogen presents a substantial risk to human beings as it was not contained at the start of its outbreak in Wuhan and spread worldwide. However, surveillance, prevention and treatment must be strictly evidence-based and not dictated by fear.


Assuntos
Betacoronavirus/patogenicidade , Doenças Cardiovasculares/epidemiologia , Doença das Coronárias/epidemiologia , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Obesidade/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Infecções Respiratórias/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Criança , Pré-Escolar , Comorbidade , Doença das Coronárias/diagnóstico , Doença das Coronárias/mortalidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/transmissão , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Medo/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/mortalidade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/transmissão , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/mortalidade , Infecções Respiratórias/transmissão , Estudos Retrospectivos , Federação Russa/epidemiologia , Índice de Gravidade de Doença , Análise de Sobrevida
9.
BMJ ; 370: m2297, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32669282

RESUMO

OBJECTIVE: To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease. DESIGN: Updated meta-analysis. DATA SOURCES: Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020. REVIEW METHODS: Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke. RESULTS: A total of 129 studies were included, involving 10 069 955 individuals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10 000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P>0.10). CONCLUSIONS: Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.


Assuntos
Doenças Cardiovasculares/mortalidade , Doença das Coronárias/mortalidade , Estado Pré-Diabético/complicações , Acidente Vascular Cerebral/mortalidade , Idoso , Aterosclerose/complicações , Aterosclerose/epidemiologia , Aterosclerose/mortalidade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/patologia , Doenças Cardiovasculares/prevenção & controle , Estudos de Casos e Controles , Ensaios Clínicos como Assunto , Doença das Coronárias/epidemiologia , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Estado Pré-Diabético/epidemiologia , Risco , Fatores de Risco , Prevenção Secundária/métodos , Acidente Vascular Cerebral/epidemiologia
10.
Chemosphere ; 260: 127399, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32668362

RESUMO

There is increasingly concern that PM2.5 constituents play a significant role in PM2.5-related cardiovascular outcomes. However, little is known about the associations between specific constituents of PM2.5 and risk for cardiovascular health. To evaluate the exposure to specific chemicals of PM2.5 from various sources and their cardiac effects, a longitudinal investigation was conducted with four repeated measurements of elderly participants' HRV and PM2.5 species in urban Beijing. Multiple chemicals in PM2.5 (metals, ions and PAHs) were characterized for PM2.5 source apportionment and personalized exposure assessment. Five sources were finally identified with specific chemicals as the indicators: oil combustion (1.1%, V & PAHs), secondary particle (11.3%, SO42- & NO3-), vehicle emission (1.2%, Pd), construction dust (28.7%, Mg & Ca), and coal combustion (57.7%, Se & As). As observed, each IQR increase in exposure to oil combustion (V), vehicle emission (Pd), and coal combustion (Se) significantly decreased rMSSD by 13.1% (95% CI: -25.3%, -1.0%), 27.4% (95% CI: -42.9%, -7.6%) and 24.7% (95% CI: -39.2%, -6.9%), respectively, while those of PM2.5 mass with decreases of rMSSD by 11.1% (95% CI: -19.6%, -1.9%) at lag 0. Elevated exposures to specific sources/constituents of PM2.5 disrupt cardiac autonomic function in elderly and have more adverse effects than PM2.5 mass. In the stratified analysis, medication and gender modify the associations of specific chemicals from variable sources with HRV. The findings of this study provide evidence on the roles of influential constituents of ambient air PM2.5 and their sources in terms of their adverse cardiovascular health effects.


Assuntos
Poluentes Atmosféricos/análise , Doença das Coronárias/epidemiologia , Exposição Ambiental/estatística & dados numéricos , Material Particulado/análise , Idoso , Pequim/epidemiologia , Carvão Mineral , Poeira/análise , Monitoramento Ambiental , Feminino , Frequência Cardíaca , Humanos , Emissões de Veículos/análise
11.
Nutr Metab Cardiovasc Dis ; 30(8): 1315-1321, 2020 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-32513579

RESUMO

BACKGROUND AND AIM: Along with the increasing evidence of the cardioprotective effects of the Mediterranean Diet (MD), the scientific interest and advocacy of dietary variety as a potentially healthy eating habit gradually faded, until its complete oblivion in the latest European cardiovascular prevention guidelines. Our study aims to investigate whether dietary variety adds to the "Mediterranean-ness" of the diet in protecting against coronary heart disease (CHD). METHODS AND RESULTS: In this case-control Italian study, data on eating habits were collected from 178 patients with CHD and 155 healthy controls, primarily males, frequency matched for age and gender, using the Food Frequency Questionnaire (FFQ) of the European Prospective Investigation into Cancer and Nutrition. Adherence to MD was estimated from FFQ by the Mediterranean Diet Score (MDS), an index developed by Trichopoulou (2003) ranging from 0 to 9, with higher scores indicating a stricter adherence. Overall dietary variety was computed from FFQ as a count of single food items consumed at least once a month. Associations between MDS or overall dietary variety and coronary status were evaluated by logistic regression models adjusted for BMI, physical activity, smoking, education, and caloric intake; the Odds Ratio (OR) for CHD for each 1.5-point increase in MDS was 0.76 [IC 95% 0.59; 0.98], whereas the OR for CHD for each 15-item increase in dietary variety was 0.62 [IC 95% 0.46; 0.84]. Remarkably, adherence to MD and overall dietary variety were independently associated with a significantly reduced chance of CHD. CONCLUSION: Dietary Mediterranean-ness and overall dietary variety exhibit additive cardioprotective effects.


Assuntos
Doença das Coronárias/prevenção & controle , Dieta Saudável , Dieta Mediterrânea , Comportamento Alimentar , Valor Nutritivo , Comportamento de Redução do Risco , Idoso , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Recomendações Nutricionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
12.
Medicine (Baltimore) ; 99(26): e20898, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590801

RESUMO

This study was performed to explore the relationship between coronary heart disease (CHD) and nonalcoholic fatty liver disease (NAFLD) in patients without hypertension and diabetes with a focus on predicting CHD.In total, 78 consecutive patients without hypertension and diabetes who were suspected of CHD underwent coronary angiography (CAG) or computed tomography CAG. They were segregated into the CHD and non-CHD group according to the CAG or computed tomography angiography results. The Gensini score was calculated based on CAG results in the CHD group. All patients underwent ultrasonographic measurement of the liver, subcutaneous fat, and visceral fat thickness.The CHD and the Gensini score were significantly correlated with V1, V2, and NAFLD. As the grade of NAFLD increases, the Gensini score was increased. After correcting for confounding factors, NAFLD (B = 2.474, P < .001, 95% confidence interval: 3.32-42.406) and cholesterol (B = 1.176, P = 0.025, 95% confidence interval: 1.155-9.101) were predictor for CHD.The CHD is associated with NAFLD in the patients without hypertension and diabetes. The high-grade NAFLD may be predicted the risk of CHD in patients without hypertension and diabetes.


Assuntos
Doença das Coronárias/complicações , Hepatopatia Gordurosa não Alcoólica/etiologia , Adulto , Idoso , China/epidemiologia , Doença das Coronárias/epidemiologia , Doença das Coronárias/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Ultrassonografia/métodos
13.
Clin Immunol ; 217: 108509, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32535188

RESUMO

BACKGROUND: National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited. METHODS: All consecutive patients aged ≥18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated. RESULTS: Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56-75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5-11) days. At hospital admission, fever (≥ 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60-99), with median PaO2/FiO2 ratio, 267 (IQR 184-314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4-16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality. CONCLUSION: In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE.


Assuntos
Doença das Coronárias/diagnóstico , Infecções por Coronavirus/diagnóstico , Diabetes Mellitus/diagnóstico , Hipertensão/diagnóstico , Falência Renal Crônica/diagnóstico , Pneumonia Viral/diagnóstico , Edema Pulmonar/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico , Fatores Etários , Idoso , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Comorbidade , Doença das Coronárias/epidemiologia , Doença das Coronárias/imunologia , Doença das Coronárias/mortalidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/mortalidade , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/imunologia , Diabetes Mellitus/mortalidade , Feminino , Hospitalização , Humanos , Hipertensão/epidemiologia , Hipertensão/imunologia , Hipertensão/mortalidade , Período de Incubação de Doenças Infecciosas , Itália/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/imunologia , Falência Renal Crônica/mortalidade , Contagem de Linfócitos , Linfócitos/imunologia , Linfócitos/patologia , Linfócitos/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/mortalidade , Edema Pulmonar/epidemiologia , Edema Pulmonar/imunologia , Edema Pulmonar/mortalidade , Fatores de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/imunologia , Síndrome Respiratória Aguda Grave/mortalidade , Índice de Gravidade de Doença , Análise de Sobrevida
14.
Am J Public Health ; 110(8): 1175-1181, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32552022

RESUMO

Coronary heart disease (CHD) mortality rates in the United States have declined by up to two thirds in recent decades. Closer examination of these trends reveals substantial inequities in the distribution of mortality benefits. It is worrying that the uneven distribution of CHD that exists from lowest to highest social class-the social gradient-has become more pronounced in the United States since 1990 and is most pronounced for women.Here we consider ways in which this trend disproportionately affects premenopausal women aged 35 to 54 years. We apply a social determinants of health framework focusing on intersecting axes of inequalities-notably gender, class, ethnicity, geographical location, access to wealth, and class-among other power relations to which young and middle-aged women are especially vulnerable, and we argue that increasing inequalities may be driving these unprecedented deteriorations. We conclude by discussing interventions and policies to target and alleviate inequality axes that have potential to promote greater equity in the distribution of CHD mortality and morbidity gains.The application of this framework in the context of women's cardiovascular health can help shed light regarding why we are seeing persistently poorer outcomes for premenopausal US women.


Assuntos
Doença das Coronárias/epidemiologia , Disparidades nos Níveis de Saúde , Pré-Menopausa/fisiologia , Saúde da Mulher , Adulto , Doença das Coronárias/mortalidade , Doença das Coronárias/terapia , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia
15.
J Infect Dis ; 222(4): 556-563, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32526012

RESUMO

Patients who died from COVID-19 often had comorbidities, such as hypertension, diabetes, and chronic obstructive lung disease. Although angiotensin-converting enzyme 2 (ACE2) is crucial for SARS-CoV-2 to bind and enter host cells, no study has systematically assessed the ACE2 expression in the lungs of patients with these diseases. Here, we analyzed over 700 lung transcriptome samples from patients with comorbidities associated with severe COVID-19 and found that ACE2 was highly expressed in these patients compared to control individuals. This finding suggests that patients with such comorbidities may have higher chances of developing severe COVID-19. Correlation and network analyses revealed many potential regulators of ACE2 in the human lung, including genes related to histone modifications, such as HAT1, HDAC2, and KDM5B. Our systems biology approach offers a possible explanation for increased COVID-19 severity in patients with certain comorbidities.


Assuntos
Infecções por Coronavirus/epidemiologia , Pulmão/enzimologia , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/epidemiologia , Estudos de Casos e Controles , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/genética , Comorbidade , Doença das Coronárias/epidemiologia , Doença das Coronárias/genética , Infecções por Coronavirus/enzimologia , Infecções por Coronavirus/genética , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/genética , Epigenômica , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/genética , Masculino , Pandemias , Peptidil Dipeptidase A/genética , Pneumonia Viral/enzimologia , Pneumonia Viral/genética , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/genética , Índice de Gravidade de Doença , Biologia de Sistemas , Transcriptoma
16.
Am J Med Sci ; 360(3): 268-278, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32563567

RESUMO

BACKGROUND: Sex and age may affect the pathogenesis of coronary heart disease, such as cardiovascular risk factors, treatment and prognosis, but this information is not well known. METHODS: This was a single-center retrospective cohort study. Patients with unstable angina pectoris between January 2013 and June 2018 were included and stratified into 4 age groups (<55, 55-64, 65-74 and ≥75 years). The cardiovascular risk factors profile, treatment and in-hospital prognosis differences by sex and age were explored. RESULTS: This study included 5,908 patients (2,198 women). The women were older than the men (mean age 67 vs. 62 years). Approximately 2 of 3 patients had ≥3 cardiovascular risk factors. Men were more likely to be smokers, and women had a higher level of total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Hypertension, diabetes and chronic kidney disease were more frequent in women ≥ 65 years old than in similarly aged men. Men and women less than 65 years of age had more frequent family history of coronary heart disease, higher body mass index, higher fasting plasma glucose, and higher lipid levels, especially for patients <55 years of age. More women tended to receive medical therapy than men (51.6% vs. 42.8%, P < 0.01). The overall incidence of in-hospital major adverse cardiovascular events was higher in men than in women (4.1% vs. 2.6%, P < 0.05), whereas there was no sex difference in the in-hospital cardiac mortality (0.2% vs. 0.2%, P > 0.05). CONCLUSIONS: Women had higher cholesterol levels, and were less likely to undergo revascularization therapy than similarly aged men, and elderly women had a higher prevalence of hypertension, diabetes, and chronic kidney disease than elderly men. In-hospital major adverse cardiovascular events were lower in women than in men; however, there was no sex difference in the in-hospital cardiac mortality.


Assuntos
Fatores Etários , Angina Instável/epidemiologia , Fatores Sexuais , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Estudos de Coortes , Doença das Coronárias/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia
17.
J Mol Cell Cardiol ; 145: 25-29, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32526224

RESUMO

As the coronavirus disease 2019 (COVID-19) epidemic worsens, this global pandemic is impacting more than 200 countries/regions and more than 4,500,000 confirmed cases worldwide. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which might attack not only the respiratory system, but also the other important organs, including the heart. It was reported that COVID-19 patients with a past history of cardiovascular diseases would have a higher mortality. Meanwhile, elevated troponin levels were frequently observed in COVID-19 cases. Besides the comprehensive treatments for COVID-19, as a cardiologist, we should also remain vigilant about the cardiac injuries, especially those with severe emergent cardiovascular symptoms.


Assuntos
Betacoronavirus , Doença das Coronárias/epidemiologia , Infecções por Coronavirus/epidemiologia , Miocardite/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Biomarcadores/sangue , Comorbidade , Doença das Coronárias/virologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Humanos , Interleucina-6/sangue , Masculino , Miocardite/tratamento farmacológico , Miocardite/imunologia , Miocardite/virologia , Peptídeo Natriurético Encefálico/sangue , Pandemias , Fragmentos de Peptídeos/sangue , Pneumonia Viral/imunologia , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Fatores de Risco , Resultado do Tratamento , Troponina I/sangue
18.
PLoS Med ; 17(5): e1003094, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32379755

RESUMO

BACKGROUND: There is emerging interest in multimorbidity in type 2 diabetes (T2D), which can be either concordant (T2D related) or discordant (unrelated), as a way of understanding the burden of disease in T2D. Current diabetes guidelines acknowledge the complex nature of multimorbidity, the management of which should be based on the patient's individual clinical needs and comorbidities. However, although associations between multimorbidity, glycated haemoglobin (HbA1c), and mortality in people with T2D have been studied to some extent, significant gaps remain, particularly regarding different patterns of multimorbidity, including concordant and discordant conditions. This study explores associations between multimorbidity (total condition counts/concordant/discordant/different combinations of conditions), baseline HbA1c, and all-cause mortality in T2D. METHODS AND FINDINGS: We studied two longitudinal cohorts of people with T2D using the UK Biobank (n = 20,569) and the Taiwan National Diabetes Care Management Program (NDCMP) (n = 59,657). The number of conditions in addition to T2D was used to quantify total multimorbidity, concordant, and discordant counts, and the effects of different combinations of conditions were also studied. Outcomes of interest were baseline HbA1c and all-cause mortality. For the UK Biobank and Taiwan NDCMP, mean (SD) ages were 60.2 (6.8) years and 60.8 (11.3) years; 7,579 (36.8%) and 31,339 (52.5%) were female; body mass index (BMI) medians (IQR) were 30.8 (27.7, 34.8) kg/m2 and 25.6 (23.5, 28.7) kg/m2; and 2,197 (10.8%) and 9,423 (15.8) were current smokers, respectively. Increasing total and discordant multimorbidity counts were associated with lower HbA1c and increased mortality in both datasets. In Taiwan NDCMP, for those with four or more additional conditions compared with T2D only, the mean difference (95% CI) in HbA1c was -0.82% (-0.88, -0.76) p < 0.001. In UK Biobank, hazard ratios (HRs) (95% CI) for all-cause mortality in people with T2D and one, two, three, and four or more additional conditions compared with those without comorbidity were 1.20 (0.91-1.56) p < 0.001, 1.75 (1.35-2.27) p < 0.001, 2.17 (1.67-2.81) p < 0.001, and 3.14 (2.43-4.03) p < 0.001, respectively. Both concordant/discordant conditions were significantly associated with mortality; however, HRs were largest for concordant conditions. Those with four or more concordant conditions had >5 times the mortality (5.83 [4.28-7.93] p <0.001). HRs for NDCMP were similar to those from UK Biobank for all multimorbidity counts. For those with two conditions in addition to T2D, cardiovascular diseases featured in 18 of the top 20 combinations most highly associated with mortality in UK Biobank and 12 of the top combinations in the Taiwan NDCMP. In UK Biobank, a combination of coronary heart disease and heart failure in addition to T2D had the largest effect size on mortality, with a HR (95% CI) of 4.37 (3.59-5.32) p < 0.001, whereas in the Taiwan NDCMP, a combination of painful conditions and alcohol problems had the largest effect size on mortality, with an HR (95% CI) of 4.02 (3.08-5.23) p < 0.001. One limitation to note is that we were unable to model for changes in multimorbidity during our study period. CONCLUSIONS: Multimorbidity patterns associated with the highest mortality differed between UK Biobank (a population predominantly comprising people of European descent) and the Taiwan NDCMP, a predominantly ethnic Chinese population. Future research should explore the mechanisms underpinning the observed relationship between increasing multimorbidity count and reduced HbA1c alongside increased mortality in people with T2D and further examine the implications of different patterns of multimorbidity across different ethnic groups. Better understanding of these issues, especially effects of condition type, will enable more effective personalisation of care.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doença das Coronárias/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/mortalidade , Grupo com Ancestrais do Continente Asiático , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade/tendências , Fatores de Risco , Taiwan , Reino Unido/epidemiologia
20.
Lancet ; 396(10244): 97-109, 2020 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-32445693

RESUMO

BACKGROUND: Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovascular disease, or death in populations drawn from the community. Given that most cardiovascular disease occurs in low-income and middle-income countries (LMICs), there is a need for comprehensive information comparing treatments and outcomes between women and men in HICs, middle-income countries, and low-income countries from community-based population studies. METHODS: In the Prospective Urban Rural Epidemiological study (PURE), individuals aged 35-70 years from urban and rural communities in 27 countries were considered for inclusion. We recorded information on participants' sociodemographic characteristics, risk factors, medication use, cardiac investigations, and interventions. 168 490 participants who enrolled in the first two of the three phases of PURE were followed up prospectively for incident cardiovascular disease and death. FINDINGS: From Jan 6, 2005 to May 6, 2019, 202 072 individuals were recruited to the study. The mean age of women included in the study was 50·8 (SD 9·9) years compared with 51·7 (10) years for men. Participants were followed up for a median of 9·5 (IQR 8·5-10·9) years. Women had a lower cardiovascular disease risk factor burden using two different risk scores (INTERHEART and Framingham). Primary prevention strategies, such as adoption of several healthy lifestyle behaviours and use of proven medicines, were more frequent in women than men. Incidence of cardiovascular disease (4·1 [95% CI 4·0-4·2] for women vs 6·4 [6·2-6·6] for men per 1000 person-years; adjusted hazard ratio [aHR] 0·75 [95% CI 0·72-0·79]) and all-cause death (4·5 [95% CI 4·4-4·7] for women vs 7·4 [7·2-7·7] for men per 1000 person-years; aHR 0·62 [95% CI 0·60-0·65]) were also lower in women. By contrast, secondary prevention treatments, cardiac investigations, and coronary revascularisation were less frequent in women than men with coronary artery disease in all groups of countries. Despite this, women had lower risk of recurrent cardiovascular disease events (20·0 [95% CI 18·2-21·7] versus 27·7 [95% CI 25·6-29·8] per 1000 person-years in men, adjusted hazard ratio 0·73 [95% CI 0·64-0·83]) and women had lower 30-day mortality after a new cardiovascular disease event compared with men (22% in women versus 28% in men; p<0·0001). Differences between women and men in treatments and outcomes were more marked in LMICs with little differences in HICs in those with or without previous cardiovascular disease. INTERPRETATION: Treatments for cardiovascular disease are more common in women than men in primary prevention, but the reverse is seen in secondary prevention. However, consistently better outcomes are observed in women than in men, both in those with and without previous cardiovascular disease. Improving cardiovascular disease prevention and treatment, especially in LMICs, should be vigorously pursued in both women and men. FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).


Assuntos
Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Países em Desenvolvimento/economia , Adulto , Idoso , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Causas de Morte/tendências , Doença das Coronárias/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Estudos Epidemiológicos , Feminino , Estilo de Vida Saudável/fisiologia , Humanos , Incidência , Renda , Masculino , Pessoa de Meia-Idade , Pobreza , Estudos Prospectivos , Fatores de Risco , População Rural , Prevenção Secundária , Fatores Socioeconômicos
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